Age-related microvascular dysfunction: novel insight from near-infrared spectroscopy

Abstract

Near-infrared spectroscopy (NIRS) has emerged as a promising tool to evaluate vascular reactivity in vivo. Whether this approach can be used to assess age-related impairments in microvascular function has not been tested. Tissue oxygen saturation (StO₂) post-occlusion recovery kinetics were measured in two distinct age groups (<35 year and >65 years) using NIRS placed over the flexor digitorum profundus. Key end-points included: (1) the desaturation rate during cuff occlusion; (2) the lowest StO₂ value obtained during ischemia (StO_2min); (3) StO₂ reperfusion rate; (4) the highest StO₂ value reached after cuff release (StO_2max); and (5) the reactive hyperemia area under the curve (AUC). First, using a conventional 5 minute cuff occlusion protocol, the elderly participants achieved a much slower rate of oxygen recovery (1.5 ± 0.2 vs. 2.5 ± 0.2%·s⁻¹), lower StO_2max (85.2 ± 2.9 vs. 92.3 ± 1.5%), and lower reactive hyperemia AUC (2651.8 ± 307.0 vs. 4940.0 ± 375.8%·s⁻¹). However, due to a lower skeletal muscle resting metabolic rate, StO_2min was also significantly attenuated in the elderly participants compared to the young controls (55.7 ± 3.5 vs. 41.0 ± 3.4%), resulting in a much lower ischemic stimulus. To account for this important group difference, we then matched the level of tissue ischemia in a subset of young healthy participants by reducing the cuff occlusion protocol to 3 minutes. Remarkably, when we controlled for tissue ischemia, we observed no differences in any of the hyperemic endpoints between the young and elderly participants. These data highlight the important role NIRS can serve in vascular biology, but also establishes the need for assessing tissue ischemia during cuff-occlusion protocols.

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Hyperglycemia induced by chronic i.p. and oral glucose loading leads to hypertension through increased Na+-retention in proximal tubule

Abstract

Feeding animals glucose, fructose, sucrose, and fat-enriched diets can lead to diet-induced hyperglycemia, severity of which largely depends on type and concentration of nutrients used and length of dietary intervention. As a strategy of dietary intervention, we adopted glucose-enriched diet, drinking water, and intraperitoneal (i.p.) glucose injection at the dose previously determined to be effective to establish a sustained hyperglycemia over a period of 2 weeks. In our current study, we used 4 groups of Sprague Dawley rats: control, glucose-treated, glucose+tempol, and glucose+captopril-treated groups. Our study demonstrated that glucose levels gradually started to increase from day 3, and reached to the highest levels (321 mg dl⁻¹) at day 12 and maintained similar levels until the end of the study on day 14 in glucose treated-group compared to control. However, tempol- and captopril-treated groups showed significantly high glucose levels in only second week. Plasma insulin level has been significantly increased in glucose-treated animals but not in tempol- and captopril-treated groups when compared to control. We also observed elevated blood pressure (BP) in glucose-treated group compared to control, which can be attributed to increased Ang II production from 46.67 pg.ml⁻¹ to 99 pg.ml⁻¹ (control vs. glucose), increased oxidative stress in cortical proximal tubule (PT), decreased urine flow, and increased expression and activity of PT-specific α₁-subunit of Na⁺-K⁺-ATPase in renal cortex, the latter is responsible for increased sodium reabsorption from epithelial cells of PT into peritubular capillaries, leading to increased blood volume and eventual blood pressure. All these events are reversed in captopril- and tempol-treated animals.

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Parental Refusal of Human Papillomavirus Vaccine: Multisite Study

The purpose of this study was to explore reasons why parents may refuse administration of the human papillomavirus vaccine to their children. The data from this multisite study will contribute to our understanding of why parents may refuse administration of the vaccine.

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Pediatric Bipolar Disorder: A Case Presentation and Discussion

Bipolar disorder is a mood disorder characterized by periods of mania, hypomania, and depression that interfere with the child's daily functioning (American Psychiatric Association, 2013; Birmaher, 2013). There are subtypes of bipolar disorder, such as bipolar I disorder, bipolar II disorder, cyclothymic disorder, and other specified bipolar and related disorders (American Psychiatric Association, 2013; Birmaher, 2013). Pediatric bipolar disorder has a more tenuous disease course compared with adult onset disorder with many associated comorbidities (Frías, Palma, & Farriols, 2015; Post et al., 2017).

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Pediatric Headache: A Case Study

Headaches are the most common neurologic issue in pediatrics, affecting up to 88% of children and adolescents, and are one of the most common reasons that children seek medical care (Langdon & DiSabella, 2017). Furthermore, headaches can significantly affect quality of life and cause children to miss school and extracurricular activities (Langdon & DiSabella, 2017). Knowing how to manage headaches and differentiate between types of headaches and understand symptoms of a potential serious underlying condition are important skills for the pediatric nurse practitioner.

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Radiological risk factors for progression of ossification of posterior longitudinal ligament following laminoplasty

Research shows the progression of OPLL following decompressive surgery for cervical myelopathy, particularly in cases presenting with continuous or mixed radiographic types. To date, no study has investigated OPLL progression within each motion segment.

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The suprachiasmatic nucleus drives day–night variations in postprandial triglyceride uptake into skeletal muscle and brown adipose tissue

New Findings

• What is the central question of this study?

  What are the factors influencing day–night variations in postprandial triglycerides?

• What is the main finding and its importance?

  Rats show low postprandial plasma triglyceride concentrations early in the active period that are attributable to a higher uptake by skeletal muscle and brown adipose tissue. We show that these day–night variations in uptake are driven by the suprachiasmatic nucleus, probably via a Rev-erbα-mediated mechanism and independent of locomotor activity. These findings highlight that the suprachiasmatic nucleus has a major role in day–night variations in plasma triglycerides and that disturbances in our biological clock might be an important risk factor contributing to development of postprandial hyperlipidaemia.

Energy metabolism follows a diurnal pattern, mainly driven by the suprachiasmatic nucleus (SCN), and disruption of circadian regulation has been linked to metabolic abnormalities. Indeed, epidemiological evidence shows that night work is a risk factor for cardiovascular disease, and postprandial hyperlipidaemia is an important contributor. Therefore, the aim of this work was to investigate the factors that drive day–night variations in postprandial triglycerides (TGs). Intact and SCN-lesioned male Wistar rats were subjected to an oral fat challenge during the beginning of the rest phase (day) or the beginning of the active phase (night). The plasma TG profile was evaluated and tissue TG uptake assayed. After the fat challenge, intact rats showed lower postprandial plasma TG concentrations early in the night when compared with the day. However, no differences were observed in the rate of intestinal TG secretion between day and night. Instead, there was a higher uptake of TG by skeletal muscle and brown adipose tissue early in the active phase (night) when compared with the rest phase (day), and these variations were abolished in rats bearing bilateral SCN lesions. Rev-erbα gene expression suggests this as a possible mediator of the mechanism linking the SCN and day–night variations in TG uptake. These findings show that the SCN has a major role in day–night variations in plasma TGs by promoting TG uptake into skeletal muscle and brown adipose tissue. Consequently, disturbance of the biological clock might be an important risk factor contributing to the development of hyperlipidaemia.

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One-day low-intensity combined arm–leg (Cruiser) ergometer exercise intervention: cardiorespiratory strain and gross mechanical efficiency in one-legged and two-legged exercise

This study aims to research whether there is a difference in cardiorespiratory variables and gross mechanical efficiency (GE) in healthy individuals during low-intensity one-legged and two-legged exercise on the combined arm–leg (Cruiser) ergometer and whether motor learning occurs. The outcome of this study will support the use of the Cruiser ergometer in future as a testing and training instrument in the rehabilitation of patients with a lower limb amputation. Twenty-eight healthy men participated in this randomized-controlled trial. One group (n=14) used one leg and both arms during the exercise and the other group (n=14) used both legs and both arms. All participants performed a 1-day low-intensity exercise protocol. This included a standardized pretest and post-test of three bouts of 4 min exercise at 40 W and an exercise intervention of seven bouts of 2×4 min exercise at 40 W. The one-legged and two-legged group differed significantly in the heart rate and GE between the pretest and post-test. At the post-test, the one-legged group showed motor learning. GE improved significantly in both groups over the duration of the three exercise bouts of the pretest, but it did not improve during the post-test. There are differences in cardiorespiratory variables and GE between one-legged and two-legged exercise on the Cruiser ergometer. When using this ergometer in the rehabilitation of patients with a lower limb amputation, it is important to consider these differences and the occurrence of motor learning.

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Research on prevalence of secondary conditions in individuals with disabilities: an overview

Individuals with disabilities may be at increased risk of a number of secondary conditions. Secondary conditions influence health status and quality of life. Many of these conditions are preventable and their consequences can be managed. Knowledge of the prevalence, course, and association with age of secondary conditions is needed for better prevention and management. The aim of present study was to review the available literature on the prevalence of secondary conditions in individuals with disability. We performed searches of electronic databases for studies published between 1980 and 2017 that provided information on the prevalence of secondary conditions in individuals with disabilities. The reference list of all relevant citations was also reviewed for further material. Nineteen papers were included. The findings indicate that (i) studies were mainly population-based descriptive studies, (ii) researchers used different questionnaires, (iii) the most common studied population are patients with spinal cord injury, and (iv) even though secondary conditions are different in different patient populations, the main secondary conditions are pain, spasticity, urinary tract infections, fatigue, depression, and sleep problems. The prevalence of each condition varies widely depending on the studied population and research methodologies across studies. There is still much information that remains to be obtained on the prevalence, definition, and conceptual organization of secondary conditions. There is also a lack of longitudinal studies on the natural course of these conditions.

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Botulinum toxin use in rehabilitation clinics: a survey to highlight differences and similarities

Spasticity is a complex condition and its management is multifaceted, involving physical therapies as well as interventions with botulinum toxin. There is currently no standard for best practice and also wide variation in spasticity service set-ups and the background of clinicians involved in treatment. This could potentially cause large differences in practice. The aim of this survey was to attempt to identify some of the common elements of service delivery as well as highlight any significant variations in service models. It was hoped that the results would assist healthcare professionals working with toxins to gauge or improve their own service provision in the light of any findings. A survey of 48 botulinum toxin experts was conducted at a national conference in the UK. Questions included (i) numbers of patients referred and diagnostic groups, (ii) staff composition of each clinic, (iii) methods of spasticity assessment, (iv) outcome measures and treatment goals commonly used and (v) follow-up arrangements. There were broad areas of agreement between experts such as methods of assessment of spasticity, treatment, injection guidance and follow-up arrangements. However, there were differences in diagnostic groups seen, staff composition and in outcome measurement across a wide range of clinic settings. There are considerable variations in practice between toxin experts. This survey may help practitioners identify areas of improvement in their services or explore alternative service arrangements.

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Effects of physical exercise in older adults with reduced physical capacity: meta-analysis of resistance exercise and multimodal exercise

Older adults with reduced physical capacity are at greater risk of progression to care dependency. Progressive resistance strength exercise and multimodal exercise have been studied to restore reduced physical capacity. To summarize the best evidence of the two exercise regimes, this meta-analysis study appraised randomized-controlled trials from published systematic reviews. Medline, Embase, and the Cochrane Database of Systematic Review and Cochrane Central Register of Controlled Clinical Trials were searched for relevant systematic reviews. Two reviewers independently screened the relevant systematic reviews to identify eligible trials, assessed trial methodological quality, and extracted data. RevMan 5.3 software was used to analyze data on muscle strength, physical functioning, activities of daily living, and falls. Twenty-three eligible trials were identified from 22 systematic reviews. The mean age of the trial participants was 75 years or older. Almost all multimodal exercise trials included muscle strengthening exercise and balance exercise. Progressive resistance exercise is effective in improving muscle strength of the lower extremity and static standing balance. Multimodal exercise is effective in improving muscle strength of the lower extremity, dynamic standing balance, gait speed, and chair stand. In addition, multimodal exercise is effective in reducing falls. Neither type of exercise was effective in improving activities of daily living. For older adults with reduced physical capacity, multimodal exercise appears to have a broad effect on improving muscle strength, balance, and physical functioning of the lower extremity, and reducing falls relative to progressive resistance exercise alone.

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Electrical stimulation therapy for dysphagia: a follow-up survey of USA dysphagia practitioners

The aim of this study was to compare current application, practice patterns, clinical outcomes, and professional attitudes of dysphagia practitioners regarding electrical stimulation (e-stim) therapy with similar data obtained in 2005. A web-based survey was posted on the American Speech-Language-Hearing Association Special Interest Group 13 webpage for 1 month. A total of 271 survey responses were analyzed and descriptively compared with the archived responses from the 2005 survey. Results suggested that e-stim application increased by 47% among dysphagia practitioners over the last 10 years. The frequency of weekly e-stim therapy sessions decreased while the reported total number of treatment sessions increased between the two surveys. Advancement in oral diet was the most commonly reported improvement in both surveys. Overall, reported satisfaction levels of clinicians and patients regarding e-stim therapy decreased. Still, the majority of e-stim practitioners continue to recommend this treatment modality to other dysphagia practitioners. Results from the novel items in the current survey suggested that motor level e-stim (e.g. higher amplitude) is most commonly used during dysphagia therapy with no preferred electrode placement. Furthermore, the majority of clinicians reported high levels of self-confidence regarding their ability to perform e-stim. The results of this survey highlight ongoing changes in application, practice patterns, clinical outcomes, and professional attitudes associated with e-stim therapy among dysphagia practitioners.

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Gait analysis on force treadmill in children: comparison with results from ground-based force platforms

Gait analysis (GA) typically includes surface electromyographic (sEMG) recording from several lower limb muscles, optoelectronic measurement of joint rotations, and force recordings from ground-based platforms. From the latter two variables, the muscle power acting on the lower limb joints can be estimated. Recently, gait analysis on a split-belt force treadmill (GAFT) was validated for the study of adult walking. It showed high reliability of spatiotemporal, kinematic, dynamic, and sEMG parameters, matching those obtainable with GA on the basis of ground walking. GAFT, however, still needs validation in children. Potential differences with respect to adult GAFT relate to (a) possible high signal-to-noise ratio, given the lower forces applied; (b) higher differences between treadmill and over-ground walking; and (c) limited compliance with the experimental setup. This study aims at investigating whether GAFT provides results comparable with those obtainable from ground walking in children and consistent with results from GAFT in adults. GAFT was applied to three groups of healthy children aged 5–6 years (n=6), 7–8 years (n=6), and 9–13 years (n=8) walking at the same average speed spontaneously adopted overground. The results were compared with those obtained from another study applying GA to an age-matched and speed-matched sample of 47 children, and with those obtained from GAFT in adults. The reliability (as indicated by the SD) of both spatiotemporal and dynamic parameters was higher in GAFT compared with GA. In the 5–6-, 7–8-, and 9–13-year-old groups, at average speeds of 0.83, 1.08, and 1.08 m/s, step length was shorter by 9.19, 3.57, and 2.30% compared with GA in controls at comparable speeds, respectively. For the youngest group, a lower power generation from the plantar flexors (peak power: 1.35±0.32 vs. 2.11±1.02 W/kg) and a slightly more flexed posture of the hip, knee, and ankle joints were observed during GAFT compared with GA in controls. The other gait parameters were very similar between the GAFT and the GA groups. The shortening of step length during GAFT, relative to GA at superimposable speed, was on average of all children 6.8%, in line with the 8% decrease found in adults. The profiles of sEMG and joint rotations, and all of the weight-standardized joint power parameters, matched those recorded in adults. The entire experimental session lasted about 1 h. All children complied with the experimental setting and easily completed the requested tests. In conclusion, GAFT seems to be a promising alternative to conventional GA in children.

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The value of musculoskeletal ultrasound in geriatric care and rehabilitation

The WHO reports that one of the major chronic conditions affecting the elderly worldwide is musculoskeletal disorders that are associated with long-term pain and disability. Considering the healthcare needs of the elderly (i.e. comprehensive, accessible, efficient) and the advantages of ultrasound (US) use (patient-friendly, convenient, cost-effective, and does not require exposure to radiation or magnetic fields), there seems to be a 'gap' in the actual clinical practice. In this paper, we aimed to highlight the potential value of US imaging in the management of the elderly with a wide spectrum of musculoskeletal conditions (degenerative/rheumatic joint diseases, falls/trauma, nursing care, peripheral nerve problems, sarcopenia, and interventions). In this respect, electronic databases (ISI Web of Science, PubMed, Elsevier Science Direct) and reference lists of relevant articles/reviews were screened by two blinded investigators for each topic. The main medical subject heading terms selected to capture the most relevant papers on the topics in accordance with the literature were knee/hip/hand osteoarthritis, prevalence, rotator cuff injury, lateral epicondylitis, tendinopathy, rheumatoid arthritis, Sjogren's syndrome, polymyalgia rheumatica, crystal arthropathies, gout, pseudogout, carpal tunnel syndrome, fall, fractures, hematoma, pressure ulcer, ultrasonography, interventional, sarcopenia, body composition, rehabilitation, frail elderly, and aged. The search was limited to peer-reviewed full-text English journals starting from the earliest papers to May 2017. A study population (or part of the study population) of adults older than 65 years (if possible) was included. We especially underscore the use of US by clinicians as an extension of their physical examination or as a practical guide for an immediate intervention.

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Three-dimensional head-mounted gaming task procedure maximizes effects of vestibular rehabilitation in unilateral vestibular hypofunction: a randomized controlled pilot trial

Considering the emerging advantages related to virtual reality implementation in clinical rehabilitation, the aim of the present study was to discover possible (i) improvements achievable in unilateral vestibular hypofunction patients using a self-assessed head-mounted device (HMD)-based gaming procedure when combined with a classical vestibular rehabilitation protocol (HMD group) as compared with a group undergoing only vestibular rehabilitation and (ii) HMD procedure-related side effects. Therefore, 24 vestibular rehabilitation and 23-matched HMD unilateral vestibular hypofunction individuals simultaneously underwent a 4-week rehabilitation protocol. Both otoneurological measures (vestibulo-ocular reflex gain and postural arrangement by studying both posturography parameters and spectral values of body oscillation) and performance and self-report measures (Italian Dizziness Handicap Inventory; Activities-specific Balance Confidence scale; Zung Instrument for Anxiety Disorders, Dynamic Gait Index; and Simulator Sickness Questionnaire) were analyzed by means of a between-group/within-subject analysis of variance model. A significant post-treatment between-effect was found, and the HMD group demonstrated an overall improvement in vestibulo-ocular reflex gain on the lesional side, in posturography parameters, in low-frequency spectral domain, as well as in Italian Dizziness Handicap Inventory and Activities-specific Balance Confidence scale scores. Meanwhile, Simulator Sickness Questionnaire scores demonstrated a significant reduction in symptoms related to experimental home-based gaming tasks during the HMD procedure. Our findings revealed the possible advantages of HMD implementation in vestibular rehabilitation, suggesting it as an innovative, self-assessed, low-cost, and compliant tool useful in maximizing vestibular rehabilitation outcomes.

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Robot ZORA in rehabilitation and special education for children with severe physical disabilities: a pilot study

The aim of this study was to explore the potential of ZORA robot-based interventions in rehabilitation and special education for children with severe physical disabilities. A two-centre explorative pilot study was carried out over a 2.5-month period involving children with severe physical disabilities with a developmental age ranging from 2 to 8 years. Children participated in six sessions with the ZORA robot in individual or in group sessions. Qualitative and quantitative methods were used to collect data on aspects of feasibility, usability, barriers and facilitators for the child as well as for the therapist and to obtain an indication of the effects on playfulness and the achievement of goals. In total, 17 children and seven professionals participated in the study. The results of this study show a positive contribution of ZORA in achieving therapy and educational goals. Moreover, sessions with ZORA were indicated as playful. Three main domains were indicated to be the most promising for the application of ZORA: movement skills, communication skills and cognitive skills. Furthermore, ZORA can contribute towards eliciting motivation, concentration, taking initiative and improving attention span of the children. On the basis of the results of the study, it can be concluded that ZORA has potential in therapy and education for children with severe physical disabilities. More research is needed to gain insight into how ZORA can be applied best in rehabilitation and special education.

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Antivertiginous drug therapy does not hinder the efficacy of individualized vibrotactile neurofeedback training for vestibular rehabilitation – a randomized trial

Vestibular rehabilitation using individualized vibrotactile neurofeedback training (IVNT) can lead to significant improvement in the postural stability of patients with vestibular symptoms of different origins. However, some of these patients have complex, severe dizziness, meaning that a pharmacological pretreatment or parallel (to vestibular rehabilitation) treatment can help them perform the rehabilitation exercises. Hence, the present study investigated the influence of a pharmacological treatment on the efficacy of vibrotactile neurofeedback training in patients with chronic, noncompensated vestibulopathies. All participants performed IVNT for ∼10 min each day for 2 weeks. In addition, every second participant was selected randomly to receive oral medication (20 mg cinnarizine and 40 mg dimenhydrinate per tablet), taking three tables per day. Trunk and ankle sway and postural stability were measured. In addition, the dizziness handicap inventory was evaluated immediately before training on the last day of training and 6 months after training. After the 10-day period of IVNT, both groups showed a statistically significant improvement in all parameters tested. A follow-up analysis after 6 months showed a long-term efficacy for the IVNT, that is, the patients remained significantly improved in their postural stability. The antivertiginous therapy did not hinder the efficacy of the IVNT. The present results indicate that IVNT even in combination with an antivertiginous drug therapy is an effective treatment regime for patients with disabling vertigo of different origins.

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Effectiveness of the conductive educational approach added to conventional physiotherapy in the improvement of gait parameters of poststroke patients: randomized-controlled pilot study

Our objective was to assess the benefits of the conductive education (CE) approach added to conventional physiotherapy in gait functions of poststroke, hemiparetic patients. A randomized-controlled trial was designed in a rehabilitation clinic. Late and chronic poststroke patients with gait disturbances (n=17, median age: 55 years, range: 41–72 years) were enrolled in the study. All patients received conventional physiotherapy. However, patients of only one group took part in therapy on the basis of the CE approach. The gait parameters, semiobjective outcome measures, functional independence measure, and International Classification of Functioning, Disability and Health domains were collected. The effectiveness of the CE approach was underlined by those outcome measures that were only significant (P≤0.05) in the conductive group: functional independence measure motor subscale; maintaining body position and walking long distances; and muscle strength in some muscle groups. The results suggest that CE could have an additive effect on gait improvement of stroke patients.

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Localized muscle vibration reverses quadriceps muscle hypotrophy and improves physical function: a clinical and electrophysiological study

Quadriceps weakness has been associated with knee osteoarthritis (OA). High-frequency localized muscle vibration (LMV) has been proposed recently for quadriceps strengthening in patients with knee OA. The purpose of this study was (a) to investigate the clinical effectiveness of high-frequency LMV on quadriceps muscle in patients with knee OA and (b) to disentangle, by means of surface electromyography (sEMG), the underlying mechanism. Thirty patients, aged between 40 and 65 years, and clinically diagnosed with knee OA were included in this randomized, controlled, single-blinded pilot study. Participants were randomly assigned to two groups: a study group treated with LMV, specifically set for muscle strengthening (150 Hz), by means of a commercial device VIBRA, and a control group treated with neuromuscular electrical stimulation. Clinical outcome was measured using the Western Ontario and McMaster Universities Osteoarthritis Index, Visual Analogue Scale, knee range of motion, Timed Up and Go test, and Stair climbing test. To assess changes in muscle activation and fatigue a subgroup of 20 patients was studied with the use of sEMG during a sustained isometric contraction. The LMV group showed a significant change in Western Ontario and McMaster Universities Osteoarthritis Index score, Visual Analogue Scale score, Timed Up and Go test, Stair Climbing Test, and knee flexion. These improvements were not significant in patients treated with neuromuscular electrical stimulation. sEMG analysis suggested an increased involvement of type II muscle fibers in the group treated with LMV. In conclusion, the present study supports the effectiveness of local vibration in muscle function and clinical improvement of patients with knee OA.

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Spinal cord injury following a mild trauma in homocystinuria-related bone frailty: neurorehabilitation and education on bone health management

Homocystinuria (HCU) is a rare autosomal recessive disease characterized by the deficiency of cystathionine β-synthetase, presenting with variable clinical features including micronutrient deficiency-related osteoporosis. Early-onset osteoporosis results in increased bone fragility, which is associated with low-impact fractures. To date, no traumatic myelopathy has ever been described in patients with HCU. This case report describes a 30-year-old male patient with HCU who was not aware that he was at high risk of sustaining debilitating bone fractures. After a mild trauma, he reported a T12 compression fracture with spinal cord injury. The patient underwent a tailored rehabilitation program, on the basis of multidisciplinary approach, and was educated about the increased risk of fractures, maintaining adherence to treatment and diet, having an active lifestyle, avoiding excessive weight loss, and preventing falls or other traumatic injury. To reduce the risk of fractures – with possible catastrophic consequences – patients with HCU, and their caregivers, should be educated about prevention of fractures.

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Ischemic Preconditioning Improves Time-Trial Performance at Moderate Altitude.

PURPOSE: Endurance athletes often compete and train at altitude where exercise capacity is reduced. Investigating acclimation strategies is therefore critical. Ischemic preconditioning (IPC) can improve endurance performance at sea level through improved O2 delivery and utilization, which could also prove beneficial at altitude. However, data are scarce and there is no study at altitudes commonly visited by endurance athletes. METHODS: In a randomized, crossover study, we investigated performance and physiological responses in thirteen male endurance cyclists during four 5-km cycling time trials (TT), preceded by either IPC (3x5-minutes ischemia/5-minutes reperfusion cycles at 220 mmHg) or SHAM (20 mmHg) administered to both thighs, at simulated low (FIO2 0.180, ~1200 m) and moderate (FIO2 0.154, ~2400 m) altitudes. Time to completion, power output, cardiac output (Q), arterial O2 saturation (SpO2), quadriceps tissue saturation index (TSI) and ratings of perceived exertion (RPE) were recorded throughout the TT. Differences between IPC and SHAM were analyzed at every altitude using Cohen's effect size (ES) and compared to the smallest worthwhile change. RESULTS: At low altitude, IPC possibly improved time to complete the TT (-5.2sec, -1.1%, Cohen's ES +/- 90% confidence limits -0.22, -0.44;0.01), power output (2.7%, ES 0.21, -0.08;0.51) and Q (5.0%, ES 0.27, 0.00;0.54), but did not alter SpO2, muscle TSI and RPE. At moderate altitude, IPC likely enhanced completion time (-7.3sec, -1.5%, ES -0.38, -0.55;-0.20) and power output in the second half of the TT (4.6%, ES 0.28, -0.15;0.72), increased SpO2 (1.0%, ES 0.38, -0.05;0.81), and decreased TSI (-6.5%, ES -0.27, -0.73;0.20) and RPE (-5.4%, ES -0.27, -0.48;-0.06). CONCLUSION: IPC may provide an immediate and effective strategy to defend SpO2 and enhance high-intensity endurance performance at moderate altitude. (C) 2017 American College of Sports Medicine

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Effects of ad libitum Low Carbohydrate High-Fat Dieting in Middle-Age Male Runners.

PURPOSE: This study examined the effects of a 3-week ad libitum high fat (~70% of calories), low carbohydrate (

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Impact of Blood Flow Restriction Exercise on Muscle Fatigue Development and Recovery.

Purpose: The present study was designed to provide mechanistic insight into the time-course and etiology of muscle fatigue development and recovery during and after low-intensity exercise when it is combined with blood flow restriction (BFR). Methods: Seventeen resistance-trained males completed four sets of low-intensity isotonic resistance exercise under two experimental conditions: knee extension exercise combined with (i) BFR and (ii) without BFR (CON). Neuromuscular tests were performed before, during (immediately after each set of knee extension exercise) and 1, 2, 4, and 8 min after each experimental condition. Maximal voluntary torque (MVT), quadriceps twitch torque in response to paired electrical stimuli at 10 Hz (PS10) and 100 Hz (PS100), PS10[BULLET OPERATOR]PS100-1 ratio as an index of low-frequency fatigue and voluntary activation were measured under isometric conditions. Perceptual and EMG data were recorded during each exercise condition. Results: After the first set of exercise, BFR induced significantly greater reductions in MVT, PS100 and PS10[BULLET OPERATOR]PS100-1 ratio compared to CON. These parameters progressively declined throughout the BFR protocol but recovered substantially within 2 min post-exercise when blood flow was restored. Neither a progressive decline in the course of the exercise protocol nor a substantial recovery of these parameters occurred during and after CON. Only at exercise termination, voluntary activation differed significantly between BFR and CON with greater reductions during BFR. Conclusion: At the early stage of exercise, BFR exacerbated the development of muscle fatigue mainly due to a pronounced impairment in contractile function. Despite the high level of muscle fatigue during BFR exercise, the impact of BFR on muscle fatigue was diminished after 2 min of reperfusion, suggesting that BFR has a strong but short-lasting impact on neuromuscular function. (C) 2017 American College of Sports Medicine

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Exercise-induced Protein Arginine Methyltransferase Expression in Skeletal Muscle.

Purpose: This study aimed to determine protein arginine methyltransferase 1 (PRMT1), -4 (also known as coactivator-associated arginine methyltransferase 1; CARM1), and -5 expression and function during acute, exercise-induced skeletal muscle remodelling in vivo. Methods: C57BL/6 mice were assigned to one of three experimental groups: sedentary, acute bout of exercise, or acute exercise followed by 3 hours of recovery. The mice in the exercise groups performed a single bout of treadmill running at 15 m/min for 90 minutes. Hindlimb muscles were collected and quantitative real-time polymerase chain reaction and Western blotting were employed to examine exercise-induced gene expression. Results: PRMT gene expression and global enzyme activity were muscle-specific, generally being higher (P

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Maximal Exercise Alters the Inflammatory Phenotype and Response of Mononuclear Cells.

Purpose: Monocytes express the CD14 receptor that facilitates lipopolysaccharide (LPS) ligation to toll-like receptor 4 (TLR4) to elicit production of interleukin (IL)-6, IL-10, and tumor necrosis factor alpha (TNF-[alpha]). However, pro-inflammatory conditions, such as strenuous exercise, increase the percentage of monocytes expressing CD16, a receptor that enhances LPS stimulated TNF-[alpha] production. Therefore, we examined whether maximal treadmill exercise would alter the inflammatory phenotype of classical (CD14+/CD16-) and pro-inflammatory monocytes (intermediate [CD14++/CD16+] and non-classical [CD14+/CD16++]), evidenced by changes in TLR4, CD14, and CD16 receptor expression, and their inflammatory response to ex vivo LPS stimulation. Methods: Human mononuclear cells from 25 male participants (age: 24.2 +/- 4.0 yr.) were isolated prior to and following exercise to assess TLR4, CD14, and CD16 expression by flow cytometry and ex vivo production of LPS-stimulated inflammatory cytokines (IL-6, IL-10, and TNF-[alpha]). Results: Exercise reduced the percentage of classical monocytes and increased the percentage of intermediate and non-classical monocytes. In addition, TLR4 expression decreased on classical and intermediate monocytes, but not the non-classical monocyte subset. Furthermore, while CD14 expression decreased on all monocyte subsets, CD16 expression increased on intermediate monocytes only. In parallel with these phenotypic changes, the inflammatory milieu shifted towards a pro-inflammatory response following LPS stimulation (decreased IL-6 and IL-10 and increased IL-6 to IL-10 ratio and TNF-[alpha] production). Conclusion: These findings demonstrate that acute maximal exercise elicits a pro-inflammatory phenotype of isolated monocytes exposed to LPS and highlight potential mechanisms that will help elucidate the role of acute and chronic exercise on the innate immune response of circulating monocytes. (C) 2017 American College of Sports Medicine

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Effect of Early- and Adult-Life Socioeconomic Circumstances on Physical Inactivity.

Purpose: To investigate the associations between early- and adult-life socioeconomic circumstances and physical inactivity (level and evolution) in ageing using large-scale longitudinal data. Methods: This study used the Survey of Health Ageing and Retirement in Europe (SHARE), a 10-year population-based cohort study with repeated measurements in 5 waves, every 2 years between 2004 and 2013. Self-reported physical inactivity (waves 1, 2, 4, and 5), household income (waves 1, 2, 4, and 5), educational attainment (wave of the first measurement occasion), and early-life SEC (wave 3) were collected in 22,846 individuals aged 50 to 95 years. Results: Risk of physical inactivity was increased for women with the most disadvantaged early-life socioeconomic circumstances (odds ratio [OR] = 1.49, 95% confidence interval [CI] = 1.20 to 1.86). With ageing, the risk of physical inactivity increased for both sexes and was strongest for those with the most disadvantaged early-life socioeconomic circumstances (OR = 1.04, CI = 1.02 to 1.06 for women; OR = 1.02, CI = 1.00 to 1.05 for men), with the former effect being more robust than the latter one. The association between early-life socioeconomic circumstances and physical inactivity was mediated by adult-life socioeconomic circumstances, with education being the strongest mediator. Conclusions: Early-life socioeconomic circumstances predicted high levels of physical inactivity at older ages, but this effect was mediated by socioeconomic indicators in adult life. This finding has implications for public health policies, which should continue to promote education to reduce physical inactivity in people at older ages and to ensure optimal healthy ageing trajectories, especially among women with disadvantaged early-life socioeconomic circumstances. (C) 2017 American College of Sports Medicine

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Ask the Authors

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Event-related neuronal responses to acoustic novelty in single-sided deaf cochlear implant users: Initial findings

Cochlear implants (CIs) restore hearing to deaf and severely hard of hearing individuals. They bypass a non-functional inner ear by direct electrical stimulation of auditory nerves (Zeng et al., 2011). Compared to normal acoustic hearing CI-transmitted sounds are degraded (Drennan and Rubinstein, 2008). This makes speech understanding difficult, particularly in background noise (Baskent et al., 2016; Wilson and Dorman, 2008). Speech intelligibility with the CI is typically assessed via word or sentences tests in quiet or noise (Hahlbrock, 1953; Haumann et al., 2010; Hey et al., 2014, 2016; Hochmair-Desoyer et al., 1997; Zeng and Fay, 2013).

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Optimal use of EEG montages to identify inferior temporal epileptiform activity

The 10/20 EEG electrode position system recommended by Herbert Jasper at the 2nd International EEG Congress has remarkably stood the test of time (Klem et al., 1999). Image localization and studies of closely spaced electrode systems have generally confirmed that 10/20 electrode positions are located similarly, within 1 cm of major anatomic landmarks in individuals despite their varying head sizes and shapes (Homan et al., 1987). Silverman and other recognized, however, that interictal and ictal epileptiform discharges often originate in basal and anterior temporal regions that are poorly sampled by standard 10/20 leads and recommended T1/T2 electrodes for recording anterior inferior sources (Silverman, 1960).

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Electromagnetic Source Imaging Using Simultaneous Scalp EEG and Intracranial EEG: An Emerging Tool for Interacting with Pathological Brain Networks

Functional brain imaging aims at studying the function and dysfunction of the brain by monitoring its functional dynamics over time. Such modalities include, for instance, functional magnetic resonance imaging (fMRI) (Bandettini et al., 1992; Kwong et al., 1992; Ogawa et al., 1992), positron emission tomography (PET) (Ter-Pogossian et al., 1975), electroencephalography (EEG) (He et al., 1987; Michel and He, 2011; Niedermeyer and da Silva, 2005), and magnetoencephalography (MEG) (Cohen, 1972; Hämäläinen et al., 1993).

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Race/ethnicity difference in the pharmacogenetics of bilirubin-related atazanavir discontinuation.

Background: Atazanavir causes plasma indirect bilirubin to increase. We evaluated associations between Gilbert's polymorphism and bilirubin-related atazanavir discontinuation stratified by race/ethnicity. Patients and methods: Patients had initiated atazanavir/ritonavir-containing regimens at an HIV primary care clinic in the southeastern USA, and had at least 12 months of follow-up data. Metabolizer group was defined by UGT1A1 rs887829 C->T. Genome-wide genotype data were used to adjust for genetic ancestry in combined population analyses. Results: Among 321 evaluable patients, 15 (4.6%) had bilirubin-related atazanavir discontinuation within 12 months. Homozygosity for rs887829 T/T was present in 28.1% of Black, 21.4% of Hispanic, and 8.6% of White patients. Among all patients the hazard ratio (HR) for bilirubin-related discontinuation with T/T versus C/C genotype was 7.3 [95% confidence interval (CI): 1.7-31.5; P=0.007]. Among 152 White patients the HR was 14.4 (95% CI: 2.6-78.7; P=0.002), but among 153 Black patients the HR was 0.8 (95% CI: 0.05-12.7; P=0.87). Conclusion: Among patients who initiated atazanavir/ritonavir-containing regimens, UGT1A1 slow metabolizer genotype rs887829 T/T was associated with increased bilirubin-related discontinuation of atazanavir in White but not in Black patients, this despite T/T genotype being more frequent in Black patients. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Emergency Medical Technician - San Jose, CA - Falck Northern California

Falck Northern California is seeking professional EMTs with excellent customer service skills to be a part of our Santa Clara County EMS operations. Job Qualifications (EMT/Medic) * California State EMT/Medic Card * Valid California Driver's License * Ambulance Driver Certification * Valid Medical Examiner Card * Current BLS CPR Certification * A clean DMV Printout * At least 18 years of age Preferred ...

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Emergency Medical Technician - Basic (San Carlos, CA) - Falck Northern California

Falck Northern California is seeking professional EMTs with excellent customer service skills to be a part of our San Mateo County EMS operations. Job Qualifications (EMT/Medic) California State EMT/Medic Card Valid California Driver's License Ambulance Driver Certification Valid Medical Examiner Card Current BLS CPR Certification A clean DMV Printout At least 18 years of age Preferred Applicants will ...

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Emergency Medical Technician - Basic (San Carlos, CA) - Falck Northern California

Falck Northern California is seeking professional EMTs with excellent customer service skills to be a part of our San Mateo County EMS operations. Job Qualifications (EMT/Medic) * California State EMT/Medic Card * Valid California Driver's License * Ambulance Driver Certification * Valid Medical Examiner Card * Current BLS CPR Certification * A clean DMV Printout * At least 18 years of age Preferred ...

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Visionaries define top 7 current health care challenges

Health care spending, the silver tsunami, technology and epidemiology issues require innovative solutions

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Stimulus, response and excitability – What is new?

Publication date: Available online 7 November 2017
Source:Clinical Neurophysiology
Author(s): David Burke, Matthew C. Kiernan




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Abnormal Cortical Neural Synchrony During Working Memory in Schizophrenia

Publication date: Available online 6 November 2017
Source:Clinical Neurophysiology
Author(s): Seung Suk Kang, Angus W. MacDonald, Matthew V. Chafee, Chang-Hwan Im, Edward M. Bernat, Nicholas D. Davenport, Scott R. Sponheim
ObjectiveTo better understand the origins of working memory (WM) impairment in schizophrenia we investigated cortical oscillatory activity in people with schizophrenia (PSZ) while they performed a WM task requiring encoding, maintenance, and retrieval/manipulation processes of spatial information.MethodsWe examined time-frequency synchronous energy of cortical source signals that were derived from magnetoencephalography (MEG) localized to cortical regions using WM-related hemodynamic responses and individualized structural head-models.ResultsCompared to thirteen healthy controls (HC), twelve PSZ showed performance deficits regardless of WM-load or duration. During encoding, PSZ had early theta and delta event-related synchrony (ERS) deficits in prefrontal and visual cortices which worsened with greater memory load and predicted WM performance. During prolonged maintenance of material, PSZ showed deficient beta event-related desynchrony (ERD) in dorsolateral prefrontal, posterior parietal, and visual cortices. In retrieval, PSZ showed reduced delta/theta ERS in the anterior prefrontal and ventral visual cortices and diminished gamma ERS in the premotor and posterior parietal cortices.ConclusionsAlthough beta/gamma cortical neural oscillatory deficits for maintenance/retrieval are evident during WM, the abnormal prefrontal theta-frequency ERS for encoding is most predictive of poor WM in schizophrenia.SignificanceTime-frequency-spatial analysis identified process- and frequency-specific neural synchrony abnormalities underlying WM deficits in schizophrenia.



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Alk and Ltk ligands are essential for iridophore development in zebrafish mediated by the receptor tyrosine kinase Ltk [Genetics]

Anaplastic lymphoma kinase (Alk) and leucocyte tyrosine kinase (Ltk) were identified as "orphan" receptor tyrosine kinases (RTKs) with oncogenic potential. Recently ALKAL1 and ALKAL2 (also named "augmentor-β" and "augmentor-α" or "FAM150A" and "FAM150B," respectively) were discovered as physiological ligands of Alk and Ltk. Here, we employ zebrafish as a model...

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Induction of H3K9me3 and DNA methylation by tethered heterochromatin factors in Neurospora crassa [Genetics]

Functionally different chromatin domains display distinct chemical marks. Constitutive heterochromatin is commonly associated with trimethylation of lysine 9 on histone H3 (H3K9me3), hypoacetylated histones, and DNA methylation, but the contributions of and interplay among these features are not fully understood. To dissect the establishment of heterochromatin, we investigated the relationships...

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Variants in CIB2 cause DFNB48 and not USH1J

The genetic, mutational and phenotypic spectrum of deafness-causing genes shows great diversity and pleiotropy. The best examples are the group of genes, which when mutated can either cause non-syndromic hearing loss (NSHL) or the most common dual sensory impairment, Usher Syndrome (USH). Variants in the CIB2 gene have been previously reported to cause of hearing loss at the DFNB48 locus and deaf-blindness at the USH1J locus. In this study, we characterize the phenotypic spectrum in a multiethnic cohort with autosomal recessive non-syndromic hearing loss (ARNSHL) due to variants in the CIB2 gene. Of the 6 families we ascertained, 3 segregated novel loss-of-function variants, 2 families segregated missense variants (one novel) and 1 family segregated a previously reported pathogenic variant in trans with a frameshift variant. This report is the first to show that biallelic loss of function variants in CIB2 cause ARNSHL and not USH. In the era of precision medicine, providing the correct diagnosis (NSHL vs USH) is essential for patient care as it impacts potential intervention and prevention options for patients. Here we provide evidence disqualifying CIB2 as an USH-causing gene.

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E26 Transformation-Specific Transcription Factor ETS2 as an Oncogene Promotes the Progression of Hypopharyngeal Cancer

Cancer Biotherapy & Radiopharmaceuticals , Vol. 0, No. 0.


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Emergency Medical Services Manager - City of Orange

The Orange City Fire Department is seeking an Emergency Services Manager to join our team. The ideal candidate will possess a strong background in the planning, coordination, implementation, and evaluation of paramedic and other Emergency Medical Services activities. If you are a motivated, self-starter wishing to advance your career, this position will provide you the platform to showcase your interpersonal ...

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E26 Transformation-Specific Transcription Factor ETS2 as an Oncogene Promotes the Progression of Hypopharyngeal Cancer

Cancer Biotherapy & Radiopharmaceuticals , Vol. 0, No. 0.


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European guidelines on perioperative venous thromboembolism prophylaxis: Neurosurgery

No abstract available

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European guidelines on perioperative venous thromboembolism prophylaxis: Surgery during pregnancy and the immediate postpartum period

No abstract available

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European Guidelines on perioperative venous thromboembolism prophylaxis: Executive summary

No abstract available

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European guidelines on perioperative venous thromboembolism prophylaxis: Day surgery and fast-track surgery

No abstract available

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European guidelines on perioperative venous thromboembolism prophylaxis: Intensive care

No abstract available

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European guidelines on perioperative venous thromboembolism prophylaxis: Surgery in the obese patient

No abstract available

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European guidelines on perioperative venous thromboembolism prophylaxis: Cardiovascular and thoracic surgery

No abstract available

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European guidelines on perioperative venous thromboembolism prophylaxis: Chronic treatments with antiplatelet agents

No abstract available

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European guidelines on perioperative venous thromboembolism prophylaxis: Aspirin

No abstract available

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European guidelines on perioperative venous thromboembolism prophylaxis: Patients with preexisting coagulation disorders and after severe perioperative bleeding

No abstract available

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European guidelines on perioperative venous thromboembolism prophylaxis: Mechanical prophylaxis

No abstract available

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European guidelines on perioperative venous thromboembolism prophylaxis: Inferior vena cava filters

No abstract available

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European guidelines on perioperative venous thromboembolism prophylaxis

No abstract available

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AT&T’s 'Flying COW' reconnects Puerto Rico after Hurricane Maria

The Flying Cell on Wings is an LTE cell site placed on a drone to connect first responders and residents while the network is restored

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A processing schema for children in the auditory equiprobable Go/NoGo task: ERP components and behaviour

Publication date: Available online 6 November 2017
Source:International Journal of Psychophysiology
Author(s): Robert J. Barry, Frances M. De Blasio, Jack S. Fogarty
A sequential processing model for adults in the auditory equiprobable Go/NoGo task has been developed in recent years. This used temporal principal components analysis (PCA) to decompose Go/NoGo event related potential (ERP) data into components that mark stages of perceptual and cognitive processing. The model has been found useful in frameworking several studies in young and older adults, and in children. Recently, it has been demonstrated that the common PCA approach of decomposing Go and NoGo ERP data together results in misallocation of variance between the conditions, distorting the timing, topography, and amplitudes of the resultant components in each condition. The present study thus reanalyses data from a child study, conducting separate PCAs on the data from each condition. Multiple regression was then used to seek links with behavioural measures from the task. In addition to confirming the previous NoGo N2b/inhibitory processing link, novel NoGo Negative Slow Wave/error evaluation and Go N1-1/RT variability links were obtained. Based on these outcomes, the recommended separate application of PCAs to Go and NoGo data was confirmed. The present data were used to develop a child-specific sequential processing schema for this paradigm, suggesting earlier separation of the Go and NoGo processing chains, and the need to include an additional inhibition and evaluation stage. The child schema should be useful in future studies involving this and other two-choice reaction tasks.

Graphical abstract

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Validation of an automated bilateral feet cold pressor test

Publication date: Available online 7 November 2017
Source:International Journal of Psychophysiology
Author(s): Petra Bachmann, Xinwei Zhang, Mauro F. Larra, Dagmar Rebeck, Karsten Schönbein, Klaus P. Koch, Hartmut Schächinger
The Cold Pressor Test (CPT) is often used in psychobiological research. However, the classical CPT version (unilateral hand immersion into ice-water) involves some disadvantages: hands may be needed for further applications, attentional drift towards the affected sensory hemi-field and/or physiological activation of the contralateral hemisphere may produce a laterality bias. Furthermore, instruction-induced motor activity may bias physiologic reactivity. To avoid these problems, a fully automated bilateral feet CPT was developed and tested for validity and feasibility. The test procedure is based on computerized control of water influx and efflux. This allows for maximal standardization and precise timing. Furthermore, water is kept in permanent flow to prohibit formation of stable temperature layers in skin proximity. Laterality bias, instructions effects and motor responses (e.g. lifting feet out of a water basin) are avoided.In a counterbalanced within-subject design, 28 healthy male students were exposed to the CPT and to a warm water control (CNT) condition twice, one week apart. Cardiovascular parameters, salivary cortisol and subjective ratings (stress, arousal and pain) were assessed before, during, and after interventions.The CPT profoundly affected physiology as well as subjective ratings. Expectation effects (immediately before testing) were small. Furthermore, post-CPT (presumably compensatory/counter-regulatory) effects on heart rate and stroke volume were found.In conclusion, the automated bilateral feet CPT is a valid and feasible stress test modification. Hemodynamic, subjective and endocrine stress responses are substantial, suggesting that this test version represents an advanced and suitable tool in human stress research.



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Richieri-Costa-Pereira syndrome: expanding its phenotypic and genotypic spectrum

Richieri-Costa-Pereira syndrome is a rare autosomal recessive acrofacial dysostosis that has been mainly described in Brazilian individuals. The cardinal features include Robin sequence, cleft mandible, laryngeal anomalies and limb defects. A biallelic expansion of a complex repeated motif in the 5' untranslated region of EIF4A3 has been shown to cause this syndrome, commonly with 15 or 16 repeats. The only patient with mild clinical findings harbored a 14-repeat expansion in one allele and a point mutation in the other allele. This proband is described here in more details, as well as is his affected sister, and five new individuals with Richieri-Costa-Pereira syndrome, including a patient from England, of African ancestry. This study has expanded the phenotype in this syndrome by the observation of microcephaly, better characterization of skeletal abnormalities, less severe phenotype with only mild facial dysmorphisms and limb anomalies, as well as the absence of cleft mandible, which is a hallmark of the syndrome. Although the most frequent mutation in this study was the recurrent 16-repeat expansion in EIF4A3, there was an overrepresentation of the 14-repeat expansion, with mild phenotypic expression, thus suggesting that the number of these motifs could play a role in phenotypic delineation.

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Efficient generation of pink-fruited tomatoes using CRISPR/Cas9 system

Publication date: Available online 6 November 2017
Source:Journal of Genetics and Genomics
Author(s): Lei Deng, Hang Wang, Chuanlong Sun, Qian Li, Hongling Jiang, Minmin Du, Chang-Bao Li, Chuanyou Li




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Tests of the sorption and olfactory "fovea" hypotheses in the mouse

The spatial distribution of receptors within sensory epithelia (e.g., retina and skin) is often markedly nonuniform to gain efficiency in information capture and neural processing. By contrast, odors, unlike visual and tactile stimuli, have no obvious spatial dimension. What need then could there be for either nearest-neighbor relationships or nonuniform distributions of receptor cells in the olfactory epithelium (OE)? Adrian (Adrian ED. J Physiol 100: 459–473, 1942; Adrian ED. Br Med Bull 6: 330–332, 1950) provided the only widely debated answer to this question when he posited that the physical properties of odors, such as volatility and water solubility, determine a spatial pattern of stimulation across the OE that could aid odor discrimination. Unfortunately, despite its longevity, few critical tests of the "sorption hypothesis" exist. Here we test the predictions of this hypothesis by mapping mouse OE responses using the electroolfactogram (EOG) and comparing these response "maps" to computational fluid dynamics (CFD) simulations of airflow and odorant sorption patterns in the nasal cavity. CFD simulations were performed for airflow rates corresponding to quiet breathing and sniffing. Consistent with predictions of the sorption hypothesis, water-soluble odorants tended to evoke larger EOG responses in the central portion of the OE than the peripheral portion. However, sorption simulation patterns along individual nasal turbinates for particular odorants did not correlate with their EOG response gradients. Indeed, the most consistent finding was a rostral-greater to caudal-lesser response gradient for all the odorants tested that is unexplained by sorption patterns. The viability of the sorption and related olfactory "fovea" hypotheses are discussed in light of these findings.

NEW & NOTEWORTHY Two classical ideas concerning olfaction's receptor-surface two-dimensional organization—the sorption and olfactory fovea hypotheses—were found wanting in this study that afforded unprecedented comparisons between electrophysiological recordings in the mouse olfactory epithelium and computational fluid dynamic simulations of nasal airflow. Alternatively, it is proposed that the olfactory receptor layouts in macrosmatic mammals may be an evolutionary contingent state devoid of the functional significance found in other sensory epithelia like the cochlea and retina.

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Spinal BDNF-induced phrenic motor facilitation requires PKC{theta} activity

Spinal brain-derived neurotrophic factor (BDNF) is necessary and sufficient for certain forms of long-lasting phrenic motor facilitation (pMF). BDNF elicits pMF by binding to its high-affinity receptor, tropomyosin receptor kinase B (TrkB), on phrenic motor neurons, potentially activating multiple downstream signaling cascades. Canonical BDNF/TrkB signaling includes the 1) Ras/RAF/MEK/ERK MAP kinase, 2) phosphatidylinositol 3-kinase (PI3K)/Akt, and 3) PLC/PKC pathways. Here we demonstrate that spinal BDNF-induced pMF requires PLC/PKC in normal rats but not MEK/ERK or PI3K/Akt signaling. Cervical intrathecal injections of MEK/ERK (U0126) or PI3K/Akt (PI-828; 100 μM, 12 μl) inhibitor had no effect on BDNF-induced pMF (90 min after BDNF; U0126 + BDNF: 59 ± 14%, PI-828 + BDNF: 59 ± 8%, inhibitor vehicle + BDNF: 56 ± 7%; all P ≥ 0.05). In contrast, PKC inhibition with theta inhibitory peptide (TIP; 0.86 mM, 12 μl) prevented BDNF-induced pMF (90 min after BDNF; TIP + BDNF: –2 ± 2%; P ≤ 0.05 vs. other groups). Thus BDNF-induced pMF requires downstream PLC/PKC signaling, contrary to initial expectations.

NEW AND NOTEWORTHY We demonstrate that BDNF-induced pMF requires downstream signaling via PKC but not MEK/ERK or PI3K/Akt signaling. These data are essential to understand the sequence of the cellular cascade leading to BDNF-dependent phrenic motor plasticity.

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Hyperalgesia and sensitization of dorsal horn neurons following activation of NK-1 receptors in the rostral ventromedial medulla

Neurons in the rostral ventromedial medulla (RVM) project to the spinal cord and are involved in descending modulation of pain. Several studies have shown that activation of neurokinin-1 (NK-1) receptors in the RVM produces hyperalgesia, although the underlying mechanisms are not clear. In parallel studies, we compared behavioral measures of hyperalgesia to electrophysiological responses of nociceptive dorsal horn neurons produced by activation of NK-1 receptors in the RVM. Injection of the selective NK-1 receptor agonist Sar9,Met(O₂)¹¹-substance P (SSP) into the RVM produced dose-dependent mechanical and heat hyperalgesia that was blocked by coadministration of the selective NK-1 receptor antagonist L-733,060. In electrophysiological studies, responses evoked by mechanical and heat stimuli were obtained from identified high-threshold (HT) and wide dynamic range (WDR) neurons. Injection of SSP into the RVM enhanced responses of WDR neurons, including identified neurons that project to the parabrachial area, to mechanical and heat stimuli. Since intraplantar injection of capsaicin produces robust hyperalgesia and sensitization of nociceptive spinal neurons, we examined whether this sensitization was dependent on NK-1 receptors in the RVM. Pretreatment with L-733,060 into the RVM blocked the sensitization of dorsal horn neurons produced by capsaicin. c-Fos labeling was used to determine the spatial distribution of dorsal horn neurons that were sensitized by NK-1 receptor activation in the RVM. Consistent with our electrophysiological results, administration of SSP into the RVM increased pinch-evoked c-Fos expression in the dorsal horn. It is suggested that targeting this descending pathway may be effective in reducing persistent pain.

NEW & NOTEWORTHY It is known that activation of neurokinin-1 (NK-1) receptors in the rostral ventromedial medulla (RVM), a main output area for descending modulation of pain, produces hyperalgesia. Here we show that activation of NK-1 receptors produces hyperalgesia by sensitizing nociceptive dorsal horn neurons. Targeting this pathway at its origin or in the spinal cord may be an effective approach for pain management.

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Method to remove photoreceptors from whole mount retina in vitro

Patch clamp recordings of neurons in the inner nuclear layer of the retina are difficult to conduct in a whole mount retina preparation because surrounding neurons block the path of the patch pipette. Vertical slice preparations or dissociated retinal cells provide access to bipolar cells at the cost of severing the lateral connection between neurons. We have developed a technique to remove photoreceptors from the rodent retina that exposes inner nuclear layer neurons, allowing access for patch clamp recording. Repeated application to and removal of filter paper from the photoreceptor side of an isolated retina effectively and efficiently removes photoreceptor cells and, in degenerate retina, hypertrophied Müller cell end feet. Live-dead assays applied to neurons remaining after photoreceptor removal demonstrated mostly viable cells. Patch clamp recordings from bipolar cells reveal responses similar to those recorded in traditional slice and dissociated cell preparations. An advantage of the photoreceptor peel technique is that it exposes inner retinal neurons in a whole mount retina preparation for investigation of signal processing. A disadvantage is that photoreceptor removal alters input to remaining retinal neurons. The technique may be useful for investigations of extracellular electrical stimulation, photoreceptor DNA analysis, and nonpharmacological removal of light input.

NEW & NOTEWORTHY This study reports a method for removing photoreceptors from rodent whole mount retina while preserving the architecture of the inner retina. The method enables easier access to the inner retina for studies of neural processing, such as by patch clamp recording.

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Variance in exposed perturbations impairs retention of visuomotor adaptation

Sensorimotor control requires an accurate estimate of the state of the body. The brain optimizes state estimation by combining sensory signals with predictions of the sensory consequences of motor commands using a forward model. Given that both sensory signals and predictions are uncertain (i.e., noisy), the brain optimally weights the relative reliance on each source of information during adaptation. In support, it is known that uncertainty in the sensory predictions influences the rate and generalization of visuomotor adaptation. We investigated whether uncertainty in the sensory predictions affects the retention of a new visuomotor relationship. This was done by exposing three separate groups to a visuomotor rotation whose mean was common at 15° counterclockwise but whose variance around the mean differed (i.e., SD of 0°, 3.2°, or 4.5°). Retention was assessed by measuring the persistence of the adapted behavior in a no-vision phase. Results revealed that mean reach direction late in adaptation was similar across groups, suggesting it depended mainly on the mean of exposed rotations and was robust to differences in variance. However, retention differed across groups, with higher levels of variance being associated with a more rapid reversion toward nonadapted behavior. A control experiment ruled out the possibility that differences in retention were accounted for by differences in success rates. Exposure to variable rotations may have increased the uncertainty in sensory predictions, making the adapted forward model more labile and susceptible to change or decay.

NEW & NOTEWORTHY The brain predicts the sensory consequences of motor commands through a forward model. These predictions are subject to uncertainty. We use visuomotor adaptation and modulate uncertainty in the sensory predictions by manipulating the variance in exposed rotations. Results reveal that variance does not influence the final extent of adaptation but selectively impairs the retention of motor memories. These results suggest that a more uncertain forward model is more susceptible to change or decay.

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Association between sensorimotor impairments and functional brain changes in patients with low back pain: a critical review

Abstract Low back pain (LBP) coincides with sensorimotor impairments, e.g., reduced lumbosacral tactile and proprioceptive acuity and postural control deficits. Recent functional magnetic resonance imaging (fMRI) studies suggest that sensorimotor impairments in LBP may be associated with brain changes. However, no consensus exists regarding the relationship between functional brain changes and sensorimotor behavior in LBP. Therefore, this review critically discusses the available fMRI studies on brain activation related to non-nociceptive somatosensory stimulation and motor performance in individuals with LBP. Four electronic databases were searched, yielding nine relevant studies. Patients with LBP showed reduced sensorimotor-related brain activation and a reorganized lumbar spine representation in higher-order (multi)sensory processing and motor regions, including primary and secondary somatosensory cortices, supplementary motor area and superior temporal gyrus. These results may support behavioral findings of sensorimotor impairments in LBP. Additionally, patients with LBP displayed widespread increased sensorimotor-evoked brain activation in regions often associated with abnormal pain processing. Over-activation in these regions could indicate an over-responsiveness to sensory inputs that signal potential harm to the spine, thereby inducing over-generalized protective responses. Hence, functional brain changes could contribute to the development and recurrence of LBP. However, future studies investigating the causality between sensorimotor-related brain function and LBP are imperative. Correspondence: Nina Goossens, Mailing address: KU Leuven – University of Leuven, Department of Rehabilitation Sciences – Musculoskeletal Rehabilitation Research Group, Tervuursevest 101, box 1501, B-3001 Leuven, Belgium, Phone number: +32 16 37 90 40, Fax number: +32 16 32 91 97, Email address: Nina.Goossens@kuleuven.be Author Disclosures: Competing Interests: All authors (NG, SR, LJ, KC, SB) declare no conflicts of interest. Funding or grants or equipment provided for the project from any source: This study was funded by the Agency for Innovation by Science and Technology (Agentschap voor Innovatie door Wetenschap en Technologie IWT) (PhD Grant for Strategic Basic Research Nina Goossens, grant number ZKC9172-00-W01) and by the Research Foundation Flanders (Fonds Wetenschappelijk Onderzoek FWO) (Postdoctoral Fellowship Lotte Janssens, grant number 12M9815N). Financial benefits to the authors: All authors declare to have no financial benefit from this manuscript. Details on any previous presentation of the research, manuscript, or abstract in any form: This manuscript or abstract has not been presented anywhere in any form. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Tenn. county hopes direct 911 alerts trim response times

The Automated Secure Alarm Protocol allows alarm companies to send alarm-reporting calls electronically to 911 operators

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A simple method to control the distal tip of nasotracheal tube using the surgical suture.

Related Articles

A simple method to control the distal tip of nasotracheal tube using the surgical suture.

J Clin Anesth. 2017 05;38:27-28

Authors: Yang GZ, Xue FS, Sun C, Liu GP

PMID: 28372670 [PubMed - indexed for MEDLINE]

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An Evidence-Based Framework for Strengthening Exercises to Prevent Hamstring Injury

Abstract

Strength training is a valuable component of hamstring strain injury prevention programmes; however, in recent years a significant body of work has emerged to suggest that the acute responses and chronic adaptations to training with different exercises are heterogeneous. Unfortunately, these research findings do not appear to have uniformly influenced clinical guidelines for exercise selection in hamstring injury prevention or rehabilitation programmes. The purpose of this review was to provide the practitioner with an evidence-base from which to prescribe strengthening exercises to mitigate the risk of hamstring injury. Several studies have established that eccentric knee flexor conditioning reduces the risk of hamstring strain injury when compliance is adequate. The benefits of this type of training are likely to be at least partly mediated by increases in biceps femoris long head fascicle length and improvements in eccentric knee flexor strength. Therefore, selecting exercises with a proven benefit on these variables should form the basis of effective injury prevention protocols. In addition, a growing body of work suggests that the patterns of hamstring muscle activation diverge significantly between different exercises. Typically, relatively higher levels of biceps femoris long head and semimembranosus activity have been observed during hip extension-oriented movements, whereas preferential semitendinosus and biceps femoris short head activation have been reported during knee flexion-oriented movements. These findings may have implications for targeting specific muscles in injury prevention programmes. An evidence-based approach to strength training for the prevention of hamstring strain injury should consider the impact of exercise selection on muscle activation, and the effect of training interventions on hamstring muscle architecture, morphology and function. Most importantly, practitioners should consider the effect of a strength training programme on known or proposed risk factors for hamstring injury.

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Safety of first-line triple therapy with a potassium-competitive acid blocker for Helicobacter pylori eradication in children

Abstract

Background

Helicobacter pylori infection is a risk factor for gastric cancer, and it has been reported that eradication of H. pylori is effective for preventing such cancer. Recently, H. pylori eradication has been performed in children as first-line therapy against gastric cancer. Here, we report use of triple therapy with a potassium-competitive acid blocker (P-CAB) for H. pylori eradication in children.

Methods

H. pylori infection testing and eradication therapy began in fiscal year 2015 in junior high school students located in Yurihonjo city and Nikaho city, Akita prefecture, Japan. Urine-based immunochromatography, stool antigen enzyme-linked immunosorbent assay tests, and serum antibody tests were performed as the initial screening examination. Those who tested positive on one of the three examinations then underwent a urea breath test (¹³C-UBT). Those who tested positive on ¹³C-UBT and expressed the desire to undergo H. pylori eradication then received eradication therapy comprising 20 mg P-CAB, 750 mg amoxicillin, and 200 mg clarithromycin twice a day for 7 days. At least 8 weeks after treatment, eradication success was evaluated using ¹³C-UBT.

Results

A total of 118 students received eradication therapy. Eradication rates were 81.3% (95% confidence interval: 74.3–88.4, 96/118) in ITT analysis and 85.7% (95% confidence interval: 79.1–92.9 96/112) in PP analysis. Adverse effects associated with eradication therapy were observed in 25 of 118 subjects (21.1%), seven of whom required hospital treatment (rash in five, vomiting in two). All seven subjects either discontinued therapy or were administered anti-allergy drugs, which resulted in swift alleviation of symptoms.

Conclusions

First-line triple therapy with a P-CAB for H. pylori eradication in children was found to be safe.

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Kinematics of the anthropoid os centrale and the functional consequences of scaphoid-centrale fusion in African apes and hominins

Publication date: January 2018
Source:Journal of Human Evolution, Volume 114
Author(s): Caley M. Orr
In most primates, the os centrale is interposed between the scaphoid, trapezoid, trapezium, and head of the capitate, thus constituting a component of the wrist's midcarpal complex. Scaphoid-centrale fusion is among the clearest morphological synapomorphies of African apes and hominins. Although it might facilitate knuckle-walking by increasing the rigidity and stability of the radial side of the wrist, the exact functional significance of scaphoid-centrale fusion is unclear. If fusion acts to produce a more rigid radial wrist that stabilizes the hand and limits shearing stresses, then in taxa with a free centrale, it should anchor ligaments that check extension and radial deviation, but exhibit motion independent of the scaphoid. Moreover, because the centrale sits between the scaphoid and capitate (a major stabilizing articulation), scaphoid-centrale mobility should correlate with scaphocapitate mobility in extension and radial deviation. To test these hypotheses, the centrale's ligamentous binding was investigated via dissection in Pongo and Papio, and the kinematics of the centrale were quantified in a cadaveric sample of anthropoids (Pongo sp., Ateles geoffroyi, Colobus guereza, Macaca mulatta, and Papio anubis) using a computed-tomography-based method to track wrist-bone motion. Results indicate that the centrale rotates freely relative to the scaphoid in all taxa. However, centrale mobility is only correlated with scaphocapitate mobility during extension in Pongo—possibly due to differences in overall wrist configuration between apes and monkeys. If an extant ape-like wrist characterized early ancestors of African apes and hominins, then scaphoid-centrale fusion would have increased midcarpal rigidity in extension relative to the primitive condition. Although biomechanically consistent with a knuckle-walking hominin ancestor, this assumes that the trait evolved specifically for that biological role, which must be squared with contradictory interpretations of extant and fossil hominoid morphology. Regardless of its original adaptive significance, scaphoid-centrale fusion likely presented a constraint on early hominin midcarpal mobility.



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Characteristics of Liver Disease in 100 Individuals With Joubert Syndrome Prospectively Evaluated At A Single Center.

Background & Aims: Joubert Syndrome (JS) is a rare, inherited, ciliopathy defined by cerebellar and brainstem malformations and is variably associated with liver, kidney, and ocular dysfunction. This study characterizes the hepatic findings in JS and identifies factors associated with probable portal hypertension. Methods: 100 individuals with JS were prospectively evaluated at the National Institutes of Health Clinical Center. Laboratory tests, imaging, and DNA sequencing were performed. Patients were stratified based on the spleen length/patient height (SL/H) ratio as a marker of splenomegaly, used as a surrogate for probable portal hypertension. Results: Forty-three patients (43%) had liver involvement based on elevated liver enzymes and/or liver hyperechogenicity and/or splenomegaly. None of the patients had macroscopic liver cysts or bile duct dilatation. Based on the SL/H ratio, 13 patients were stratified into a probable portal hypertension group. We observed significant elevations in Alkaline Phosphatase (269 vs. 169 U/L, P =

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Feed-related Splanchnic Oxygenation in Preterm Infants with Abnormal Antenatal Doppler Developing Gut Complications.

Preterm infants with antenatal absent or reversed end diastolic flow (AREDF) in umbilical arteries are at major risk for gastrointestinal (GI) complications, such as necrotizing enterocolitis, intestinal perforation and feeding intolerance. Near-infrared spectroscopy (NIRS) provides continuous monitoring of splanchnic oxygenation (SrSO2) and might represent a useful tool to predict GI outcomes in this high-risk population. This observational, pilot study assessed feed-related SrSO2 patterns at enteral feeding introduction and full enteral feeding (FEF) achievement in twenty AREDF infants with gestational age

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Diagnosis and Management of Paediatric Autoimmune Liver Disease: ESPGHAN Hepatology Committee Position Statement.

Paediatric autoimmune liver disease is characterised by inflammatory liver histology, circulating autoantibodies and increased levels of IgG, in the absence of a known etiology. Three conditions have a likely autoimmune pathogenesis: autoimmune hepatitis (AIH), autoimmune sclerosing cholangitis (ASC), and de novo AIH after liver transplantation. Two types of paediatric AIH are recognized according to seropositivity for smooth muscle and/or antinuclear antibody (SMA/ANA, AIH-1) or liver kidney microsomal type 1 and/or anti-liver cytosol type 1 antibodies (anti-LKM-1/anti-LC-1; AIH-2). Pertinent issues addressing the diagnosis, treatment and long term follow up were formulated by a core group of ESPGHAN members. They have commissioned the first authors with execution of this project. Initially, they have performed a systematic literature search on MEDLINE, ResearchGate and Mendeley databases over the last 30 years and produced a document focusing on prospective and retrospective studies in children. The ESPGHAN core group and ESPGHAN Hepatology Committee members voted on each recommendation, using a formal voting technique. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Randomized Controlled Clinical Trial on Value of Domperidone in Functional Abdominal Pain in Children.

Objectives: The aim of the study was to evaluate the therapeutic effect of domperidone on children with abdominal pain predominant functional gastrointestinal disorders (AP-FGIDs). Methods: One hundred children (aged 5-12 years) fulfilling Rome III criteria for AP-FGIDs were randomized into 8 weeks of domperidone or placebo treatment. Primary outcomes defined were cure and patient-reported general improvement. Secondary outcomes were reduction in the severity of abdominal pain and increase in gastric motility. Patients were followed up for 6 months. Results: Eighty-nine (42 in placebo group, 47 in domperidone group) completed the trial at 8 weeks. Seventy-nine completed the 6-month follow-up. When primary outcomes were assessed at 8 weeks, 37 (74%) in the domperidone group and 25 (50%) in the placebo group showed patient-reported general improvement (P = 0.013), whereas no significant difference was observed in cure (22 [44%] vs 14 [28%] P = 0.09). At 6-month follow-up 30 (60%) in the domperidone group and 19 (38%) in the placebo group reported cure (P = 0.028), whereas 44 (88%) in the domperidone group and 33 (66%) in the placebo group showed patient-reported general improvement (P = 0.009). When assessing secondary outcomes at 8 weeks, the domperidone group reported significant reduction in the severity of abdominal pain (54.1% vs 24.7%, P = 0.008) and an increase in the antral motility index (27.5% vs 7.2%, P = 0.029). None of the patients reported intervention-related adverse effects. Conclusions: Domperidone may be a safe and effective therapeutic modality to achieve a lasting remission of symptoms in children with AP-FGIDs. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Fecal Amino Acid Analysis Can Discriminate De Novo Treatment-Naive Pediatric Inflammatory Bowel Disease From Controls.

Objectives: Endoscopy remains mandatory in the diagnostic work-up of inflammatory bowel disease (IBD), but is a costly and invasive procedure. Identification of novel, non-invasive, diagnostic biomarkers remains a priority. The aim of this study was to explore the potential of fecal amino acid composition as diagnostic biomarker for pediatric IBD. Methods: In this case-control study, treatment-naive, de novo pediatric IBD patients from two tertiary centers were included. Endoscopic severity of ulcerative colitis (UC) and Crohn's disease (CD) was based on global physician assessment scores, substantiated by levels of fecal calprotectin and C-reactive protein at study inclusion. Patients were instructed to collect a fecal sample prior to bowel cleansing. Healthy controls were recruited from primary schools in the same region. Dedicated amino acid analysis was performed on all samples. Results: Significant differences between 30 IBD patients (15 UC, 15 CD) and 15 age and sex matched healthy controls (HC) were found in six amino acids (histidine, tryptophan, phenylalanine, leucine, tyrosine and valine; all AUC > 0.75 and p

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Serum 25 Hydroxy Vitamin D Levels in Very Low Birth Weight Infants Receiving Oral Vitamin D Supplementation.

Background: Vitamin D supplementation in preterm infants has been recommended by American Academy of Pediatrics (AAP) however its efficacy and safety has not been well studied. Objective: To study 25 hydroxy vitamin D (25OHD) levels as a marker of vitamin D status of very low birth weight infants while on vitamin D supplementation during NICU hospitalization. Methods: Retrospective study of preterm infants with birth weight 100 ng/ml. Results: 301 infants were enrolled, 186 very low birth weight VLBW (1000 -1499 g) infants and 115 extremely low birth weight ELBW (

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Assessment of Liver Disease Progression in cystic Fibrosis Using Transient Elastography.

Objectives: Cystic fibrosis related liver disease (CFLD) can develop silently in early life and approximately 10% of children with cystic fibrosis (CF) become cirrhotic before adulthood. Clinical, biological and ultrasound criteria used to define CFLD often reveal liver involvement at an advanced stage. The aim of this retrospective study was to assess the progression of liver stiffness measurement (LSM) in pediatric CF patients. Methods: The change of LSM, expressed as kPa/year and %/year, was measured using transient elastography (TE, Fibroscan(R)) in 82 CF children (median age: 6.8 years, IQR: 5.8). Mean time interval between the two LSM was 3.5 years. Results: Median initial liver stiffness was 3.7 kPa (IQR: 1.3)., and then progressed by 0.23 kPa/year, i.e. 6%/year. The 7 patients who developed CFLD had a higher initial level of alanine aminotransferase (50 [IQR:15] vs 30 [IQR:18], p = 0.0001) and presented a more rapid progression of LSM (0.94 vs 0.23 kPa/year, p = 0.02). Conclusions: This study shows that the slope of worsening of liver stiffness is greater in patients who will develop CFLD, suggesting that annual TE may be useful to detect risk of severe liver disease at an earlier stage. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Clear-Liquid Versus Low-Fibre Diet in Bowel Cleansing for Colonoscopy in Children: A Randomized Trial.

Objectives: In light of a paucity of data on the role of diet in colonoscopy preparation in paediatric population, the present study was designed to compare the effectiveness of clear-liquid and low-fibre diets for breakfast and lunch on the day preceding colonoscopy in children. Methods: This prospective, randomized trial was conducted at the Department of Paediatric Gastroenterology and Nutrition in Warsaw, Poland. Eligible patients, referred for colonoscopies, were 6 to 18 years old. Patients were randomly divided into two groups: the first received a clear-liquid diet and the second a low-fibre diet on the day before colonoscopy. In the afternoon, all participants were asked to drink polyethylene glycol with electrolytes at a dose of 66 ml per kg to a maximum of 4 l. The effectiveness of bowel cleansing was measured using the Boston Bowel Preparation Scale (BBPS). The preparation tolerance was assessed by parents and children using a VAS scale. Side effects were reported. Results: In total, 184 patients were enrolled. Of those, 96 received the clear-liquid diet and 88 - the low-fibre diet. The mean age of both groups was 15 years. There were no differences between the two study groups in age, weight and sex, as well as in total BBPS score (BBPS>=5 96.6% versus 95.1%, p = 0.5). The frequency of adverse effects was similar in both groups; nausea was the most common (p = 0.8). Conclusions: Clear-liquid and low-fibre diets administered to children the day before colonoscopy demonstrated similar bowel cleansing effectiveness. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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