Genetic and functional analysis of the RYR1 mutation p.Thr84Met revealed a susceptibility to malignant hyperthermia

Abstract

Purpose

The aim of this study was to analyze the genetic and functional role of a novel RYR1 variant c.251 C > T (p.Thr84Met) identified in a patient with muscle weakness demonstrating MH susceptibility.

Methods

DNA testing of family members was conducted for assessment of pathogenicity of the genetic variant. For functional analysis, Ca²⁺ measurement using patient-derived myotubes and p.Thr84Met RYR1-transfected human embryonic kidney (HEK)-293 cells was performed to evaluate reactivity to RYR1 activators. The half-maximal effective concentration (EC₅₀) values of two RYR1 activators, caffeine and 4-chloro-m-cresol (4CmC), were calculated from the acquired dose–response curves. The EC₅₀ was compared between two groups: for myotubes, the control group and the patient, and for HEK-293 cells, WT and p.Thr84Met.

Results

Dose–response curves for caffeine and 4CmC were shifted to the left in both myotubes and HEK-293 cells compared to controls. The 50% effective concentration values for caffeine and 4CmC were significantly lower in both myotubes and HEK-293 cells compared to controls (P < 0.001 for all comparisons).

Conclusions

Our results of functional testing indicated RYR1 hypersensitivity to caffeine and 4CmC. We conclude that the genetic variant was associated with MH susceptibility.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2DhkrVI
via IFTTT

Molecular Screening Versus Phenotypic Susceptibility Testing of Multidrug-Resistant Mycobacterium tuberculosis Isolates for Streptomycin and Ethambutol

Microbial Drug Resistance , Vol. 0, No. 0.


from Mary Ann Liebert, Inc. publishers via xlomafota13 on Inoreader http://ift.tt/2ENVyNK
via IFTTT

Arcobacter butzleri Ciprofloxacin Resistance: Point Mutations in DNA Gyrase A and Role on Fitness Cost

Microbial Drug Resistance , Vol. 0, No. 0.


from Mary Ann Liebert, Inc. publishers via xlomafota13 on Inoreader http://ift.tt/2FL5Uis
via IFTTT

Erector spinae plane block for inguinal hernia repair in preterm infants

Summary

Neuro-axial anesthesia has been the preferred technique for inguinal hernia repair when attempting to avoid general anesthesia in neonates and preterm infants. We present a case where an erector spinae plane block was used successfully for this surgery. Hemodynamic stability, minimal anesthetic requirements, and excellent pain control were documented. This block promises to be a valuable and safe alternative for inguinal hernia repair, accompanying the path of neuroprotective anesthesia.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2DEgCqu
via IFTTT

Identification of perioperative pulmonary aspiration in children using quality assurance and hospital administrative billing data

Summary

Background

Perioperative aspiration is a rare but potentially devastating complication, occurring in 1-10 per 10 000 anesthetics based on studies of quality assurance databases. Quality assurance reporting is known to underestimate the incidence of adverse outcomes, but few large studies use supplementary data sources. This study aims to identify the incidence of and risk factors for perioperative aspiration in children using quality assurance data supplemented by administrative billing records, and to examine the utility of billing data as a supplementary data source.

Methods

Aspiration events for children receiving anesthesia at a tertiary care pediatric hospital between 2008 and 2014 were identified using (i) a perioperative quality assurance database and (ii) hospital administrative billing records with International Classification of Diseases, Ninth Revision Clinical Modification coded diagnoses of aspiration. Records were subject to review by pediatric anesthesiologists. Following identification of all aspiration events, the incidence of perioperative aspiration was calculated and risk factors were assessed.

Results

47 272 anesthetic cases were evaluated over 7 years. The quality assurance database identified 20 cases of perioperative aspiration occurring in surgical inpatients, same-day admissions, and outpatients. Using hospital administrative data (which excludes outpatients with shorter than a 24-hour stay), 9 cases of perioperative aspiration were identified of which 6 had not been found through quality assurance data. Overall, International Classification of Diseases, Ninth Revision coding demonstrated a positive predictive value of 94.5% for any aspiration event; however, positive predictive value was <4% for perioperative aspiration. A total incidence of 5.5 perioperative aspirations per 10 000 (95% CI: 3.7-8.0 per 10 000) anesthetics was found.

Conclusion

Quality assurance data offer an efficient way to measure the incidence of rare events, but may underestimate perioperative complications. International Classification of Diseases, Ninth Revision codes for aspiration used as a secondary data source were nonspecific for perioperative aspiration, but when combined with record review yielded a 30% increase in identified cases of aspiration over quality assurance data alone. The use of administrative data therefore holds potential for supplementing quality assurance studies of rare complications.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2rfPwDv
via IFTTT

The prediction probabilities for emergence from sevoflurane anesthesia in children: A comparison of the perfusion index and the bispectral index

Summary

Background

Predicting recovery of consciousness is one of the most essential functions of anesthesia depth monitors in anesthesia practice. Perfusion index and bispectral index are 2 indicators of the anesthesia depth monitoring with different working principles. The progression of the anesthesia emergence stages reflected by those monitors has not been well understood, especially in pediatric patients. The goals of this study were to compare the prediction probabilities of perfusion index and bispectral index in predicting awakening and in differentiating the different levels of arousal during emergence after sevoflurane anesthesia in children undergoing open inguinal hernia repairs.

Methods

Forty-five patients, aged 1 to 5 years, ASA Status I or II and scheduled for elective open inguinal hernia repairs under general anesthesia were enrolled. The perfusion index and bispectral index were monitored simultaneously during anesthesia recovery. The University of Michigan Sedation Scale was applied to evaluate the clinical arousal levels during emergence. The prediction probability was used to assess the performance of perfusion index and bispectral index in predicting awakening and distinguishing different levels of arousal corresponding to the University of Michigan Sedation Scale during recovery.

Results

The prediction probability of perfusion index (Pk_PI-Awakening = .81, 95% CI 0.73-0.89) in differentiating full consciousness from unconsciousness during recovery was comparable to that of bispectral index (Pk_{BIS- Awakening} = .86, 95% CI 0.79-0.92) (P = .47). The prediction probability for perfusion index (Pk_PI-UMSS = .61, 95% CI 0.55-0.73) and bispectral index (Pk_BIS-UMSS = .64, 95% CI 0.53-0.69) had similar performance in distinguishing different University of Michigan Sedation Scale levels.

Conclusion

Both the perfusion index and bispectral index performed comparably well in predicting awakening and different arousal levels when emerging from sevoflurane anesthesia in children.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2Dh9ELf
via IFTTT

Genomic Identification and Functional Characterization of Essential Genes in Caenorhabditis elegans

Using combined genetic mapping, Illumina sequencing, bioinformatics analyses, and experimental validation, we identified 60 essential genes from 104 lethal mutations in two genomic regions of C. elegans totalling approximately 14 Mb on chromosome III(mid) and chromosome V(left). Five of the 60 genes had not previously been shown to have lethal phenotypes by RNA interference depletion. By analyzing the regions around the lethal missense mutations, we identified four putative new protein functional domains. Furthermore, functional characterization of the identified essential genes shows that most are enzymes, including helicases, tRNA synthetases, and kinases in addition to ribosomal proteins. Gene Ontology analysis indicated that essential genes often encode for enzymes that conduct nucleic acid binding activities during fundamental processes, such as intracellular DNA replication, transcription, and translation. Analysis of essential gene shows that they have fewer paralogs, encode proteins that are in protein interaction hubs, and are highly expressed relative to non-essential genes. All these essential gene traits in C. elegans are consistent with those of human disease genes. Most human orthologs (90%) of the essential genes in this study are related to human diseases. Therefore, functional characterization of essential genes underlines their importance as proxies for understanding the biological functions of human disease genes.

from Genetics via xlomafota13 on Inoreader http://ift.tt/2FKmOxK
via IFTTT

Genetic Diversity, Molecular Phylogeny and Selection Evidence of Jinchuan Yak Revealed by Whole-Genome Resequencing

Jinchuan yak, a newly discovered yak breed, not only possesses a large proportion of multi-ribs but also exhibits many good characteristics, such as high meat production, milk yield and reproductive performance. However, information about their overall genetic structure, relationship with yaks in other areas, and possible origins and evolutionary processes is limited. In this study, 7,693,689 high-quality single-nucleotide polymorphisms were identified by resequencing the genome of Jinchuan yak. Principal component and population genetic structure analyses showed that Jinchuan yak was distinguished as an independent population among the domestic yak population. Linkage disequilibrium analysis showed that the decay rate of Jinchuan yak was the lowest in the domestic yak breeds, indicating that the degree of domestication and selection intensity of Jinchuan yak were higher than those of other yak breeds. Combined with archaeological data, we speculated that the origin of domestication of Jinchuan yak was about 6,000 years ago (4,000-10,000 years ago). The quantitative dynamics of population growth history in Jinchuan yak was similar to that of other breeds of domestic and wild yaks but was closer to that of the wild yak. No significant gene exchange between Jinchuan and other domestic yaks occurred. Compared with other domestic yaks, Jinchuan yak possessed 339 significantly and positively selected genes, several of which relate to physiological rhythm, histone and the excellent production characters of Jinchuan yak. Our results provide a basis for the discovery of the evolution, molecular origin, and unique traits of Jinchuan yak.

from Genetics via xlomafota13 on Inoreader http://ift.tt/2EOSzVp
via IFTTT

Upregulation of calcium channel alpha-2-delta 1 subunit in dorsal horn contributes to spinal cord injury-induced tactile allodynia

Spinal cord injury (SCI) commonly results not only in motor paralysis but also in the emergence of neuropathic pain, both of which can impair the quality of life for SCI patients. In the clinical field, it is well known that pregabalin, which binds to the voltage-gated calcium channel α2δ-1subunit has therapeutic effects on neuropathic pain after SCI. A Previous study has demonstrated that SCI increased α2δ-1 in L4–6 dorsal spinal cord of SCI rats by Western blot analysis and that the increase of α2δ-1 was correlated with tactile allodynia of the hind paw.

from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2EOflg2
via IFTTT

Relationships between vitamin D and paraspinal muscle: human data and experimental rat model analysis

Vitamin D deficiency (VDD) has been closely linked with skeletal muscle atrophy in many studies, but to date no study has focused on paraspinal muscle.

from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2FMoS8H
via IFTTT

Quiz: Are you a FirstNet expert?

Take this quiz to see how well you know FirstNet

from EMS via xlomafota13 on Inoreader http://ift.tt/2D8xVip
via IFTTT

Transjugular intrahepatic portosystemic shunt for hepatorenal syndrome: A systematic review and meta-analysis

Hepatorenal syndrome is a severe complication of advanced liver diseases with a dismal prognosis.

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2mIAnWL
via IFTTT

Radiotherapy of rectal cancer in elderly patients: real-world data assessment in a decade

There is paucity of data on the efficacy and toxicity of radiotherapy in rectal cancer (RC) elderly patients. The objective was to identify management strategies and resulting outcomes in RC patients ≥70 years undergoing radiotherapy.

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2rhm008
via IFTTT

A rare cause of occult gastrointestinal bleeding

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2mPCEQ7
via IFTTT

Phase III randomized trial comparing 5-fluorouracil and oxaliplatin with or without docetaxel in first-line advanced gastric cancer chemotherapy (GASTFOX study)

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2rhlCPe
via IFTTT

Mountain rescues to get high-tech boost with new fire department drones

Delivering a bottle of water or a cell phone to an injured and stranded hiker are among the possibilities with the department's two new DJI Matrice Drones

from EMS via xlomafota13 on Inoreader http://ift.tt/2EMd2tQ
via IFTTT

Cyclic AMP-dependent plasticity underlies rapid changes in odor coding associated with reward learning [Genetics]

Learning and memory rely on dopamine and downstream cAMP-dependent plasticity across diverse organisms. Despite the central role of cAMP signaling, it is not known how cAMP-dependent plasticity drives coherent changes in neuronal physiology that encode the memory trace, or engram. In Drosophila, the mushroom body (MB) is critically involved in...

from Genetics via xlomafota13 on Inoreader http://ift.tt/2B5Unqy
via IFTTT

Expression of an active G{alpha}s mutant in skeletal stem cells is sufficient and necessary for fibrous dysplasia initiation and maintenance [Genetics]

Fibrous dysplasia (FD) is a disease caused by postzygotic activating mutations of GNAS (R201C and R201H) that encode the α-subunit of the Gs stimulatory protein. FD is characterized by the development of areas of abnormal fibroosseous tissue in the bones, resulting in skeletal deformities, fractures, and pain. Despite the well-defined...

from Genetics via xlomafota13 on Inoreader http://ift.tt/2DfSQ79
via IFTTT

Induced GnasR201H expression from the endogenous Gnas locus causes fibrous dysplasia by up-regulating Wnt/{beta}-catenin signaling [Genetics]

Fibrous dysplasia (FD; Online Mendelian Inheritance in Man no. 174800) is a crippling skeletal disease caused by activating mutations of the GNAS gene, which encodes the stimulatory G protein Gαs. FD can lead to severe adverse conditions such as bone deformity, fracture, and severe pain, leading to functional impairment and...

from Genetics via xlomafota13 on Inoreader http://ift.tt/2DfzdMC
via IFTTT

Antagonistic regulation of trafficking to Caenorhabditis elegans sensory cilia by a Retinal Degeneration 3 homolog and retromer [Genetics]

Sensory neurons often possess cilia with elaborate membrane structures that are adapted to the sensory modality of the host cell. Mechanisms that target sensory transduction proteins to these specialized membrane domains remain poorly understood. Here, we show that a homolog of the human retinal dystrophy gene Retinal Degeneration 3 (RD3)...

from Genetics via xlomafota13 on Inoreader http://ift.tt/2DhsOAJ
via IFTTT

A word of caution: never use tacks for mesh fixation to the diaphragm!

Abstract

Background

The mesh fixation technique used in repair of hiatal hernias and subxiphoid ventral and incisional hernias must meet strenuous requirements. In the literature, there are reports of life-threatening complications with cardiac tamponade and a high mortality rate on using tacks. The continuing practice of tack deployment for mesh fixation to the diaphragm and esophageal hiatus should be critically reviewed.

Methods

In a systematic search of the available literature in May 2017, 23 cases of severe penetrating cardiac complications were identified. The authors became aware of two other cases in which they acted as medical experts. Furthermore, the instructions for use issued by the manufacturers of the tacks were reviewed with regard to their deployment in the diaphragm.

Results

Twenty-three of 25 cases (92%) with severe cardiac injuries and subsequent cardiac tamponade were triggered by the use of tacks in the diaphragm. In six cases (24%), these related to ventral and incisional hernias with extension to the subxiphoid area, and in 19 cases (76%) to mesh-augmented hiatoplasty. Twelve of 25 (48%) patients died as a result of pericardial and/or heart muscle injury with cardiac tamponade despite heart surgery intervention. In the tack manufacturers' instructions for use, their deployment in the diaphragm, in particular in the vicinity of the heart, is contraindicated. Likewise, the existing guidelines urgently advise against the use of tacks in the diaphragm, recommending instead alternative fixation techniques.

Conclusions

Tacks should not be used for mesh fixation in the diaphragm above the costal arch.

from Endoscopy via xlomafota13 on Inoreader http://ift.tt/2DhH24i
via IFTTT

Changes in plasma albumin levels in early detection of infectious complications after laparoscopic colorectal cancer surgery with ERAS protocol

Abstract

Background

Combination of laparoscopic approach with ERAS protocol in colorectal surgery allows for an early discharge. However there is a risk that some of the discharged patients are developing, asymptomatic at the time, infectious complications. This may lead to a delay in diagnostics and proper treatment introduction. We aimed to assess the usefulness of preoperative plasma albumin concentration and their changes as indicators of infectious complications in patients undergoing colorectal cancer surgery.

Methods

Prospective analysis included 105 consecutive patients who underwent laparoscopic colorectal cancer resection between August 2014 and September 2016. In all cases standardised 16-item perioperative care ERAS protocol was used (mean compliance > 85%). Patients with IBD, distant metastases, undergoing emergency or multivisceral resection were excluded. Blood samples were collected preoperatively and on POD 1, 2, 3. Plasma albumin concentration was measured. Patients were divided into two groups depending on the presence of infectious complications. We analysed the differences in the levels of albumin and the dynamics of changes.

Results

Group 1—82 not complicated patients, Group 2—23 patients with at least one infectious complication. Preoperatively, there were no significant differences in the levels of serum albumin between those groups (Group 1—38.7 ± 4.9 g/l; Group 2—37.7 ± 5.0 g/l). In postoperative period, decrease was observed in both (POD 1: Group 1—36.5 ± 4.2 g/l, Group 2—34.7 ± 4.2 g/l, p = 0.07; POD 2: Group 1—36.2 ± 4.1 g/l, Group 2—32.6 ± 5.6 g/l, p = 0.01; POD 3: Group 1—36.0 ± 4.4 g/l, Group 2—30.9 ± 3.5 g/l, p = 0.01). The decrease was significantly greater in Group 2 on POD 2 and 3.

Conclusions

We showed that a regular measurement of albumin in the early postoperative days may be beneficial in the detection of postoperative infectious complications. Although changes in albumins are observed early after surgery, this parameter is relatively unspecific.

from Endoscopy via xlomafota13 on Inoreader http://ift.tt/2B6jfym
via IFTTT

Adenoma detection rate metrics in colorectal cancer surveillance colonoscopy

Abstract

Background

A target goal for screening adenoma detection rate (S-ADR) of ≥ 25% has been set to define high-quality colonoscopy performance. However, there is no current accepted target goal for ADR in colorectal cancer (CRC) surveillance. This makes quality assessment challenging when physicians perform cancer surveillance colonoscopy but minimal screening procedures.

Methods

In this cohort study, consecutive colonoscopies performed at either Rush University Medical Center or Rush Oak Park Hospital by a gastroenterologist or colorectal surgeon in average risk screening population and CRC surveillance population were reviewed retrospectively from 2006 to 2012 and prospectively from 2013 to 2016. ADR in first surveillance colonoscopy following surgical resection of CRC (CRC-ADR) was reported in high-quality detectors (HQD) or low-quality detectors (LQD) based on achievement of 25% ADR in consecutive screening colonoscopy in average risk patients. Pearson's correlation was used to describe the association between individual S-ADR and CRC-ADR for colonoscopists.

Results

There was a very strong positive correlation (r = 0.88, p = 0.002) between ADR in average risk screening and first time CRC surveillance. For HQD as defined by S-ADR ≥ 25% (n = 10 colonoscopists), the CRC-ADR was 37.7% (78/207, SD 8%) which was very similar to their respective S-ADR of 33.4% (816/2440, p = 0.22). For LQD (n = 5 colonoscopists), the CRC-ADR was 20.2% (40/198) which was similar to their respective S-ADR of 20.1% (119/591, p = 0.99). The CRC-ADR was significantly higher for HQD than for LQD (37.7 vs. 20.2%, p < 0.0001).

Conclusions

The major finding of this study is a defined CRC-ADR for HQD based on the ability to achieve S-ADR ≥ 25%. S-ADR strongly correlates with CRC-ADR. CRC-ADR is quite similar to the colonoscopists' respective S-ADR for both HQD and LQD. For colonoscopists who perform limited screening colonoscopies but do perform CRC surveillance colonoscopies, ADR metrics similar to S-ADR to assess quality in colonoscopy could be considered.

from Endoscopy via xlomafota13 on Inoreader http://ift.tt/2DhnCN7
via IFTTT

Randomized controlled study of intraincisional infiltration versus intraperitoneal instillation of standardized dose of ropivacaine 0.2% in post-laparoscopic cholecystectomy pain: Do we really need high doses of local anesthetics—time to rethink!

Abstract

Background

Earlier studies done to compare the efficacy of use of local anesthetics at intraperitoneal location versus intraincisional use had utilized equal amount of drugs at the two locations, usually 10–20 ml. Using this large amount of drug in the small space of intraincisional location as compared to similar amount of drug in large intraperitoneal space created an inadvertent bias in favor of patients receiving the drug intraincisionally so these patients naturally experienced less pain.

Aims and objectives

To conduct a randomized, triple-blind, placebo-controlled study by standardizing dose of local anesthetic, to compare the effectiveness of intraperitoneal against intraincisional use of ropivacaine 0.2% for post-laparoscopic cholecystectomy pain relief.

Materials and methods

294 patients underwent elective 4-port laparoscopic cholecystectomy. Patients were triple blindly randomized. All patients received ~ 23 ml of solution, of which 20 ml was given intraperitoneally (1 ml/cm; 16 ml along right hemi-dome and 4 ml in gall bladder fossa) and ~ 3 ml intraincisionally (1 ml/cm of length of incision). Solution was either normal saline or drug (0.2% ropivacaine) depending on the group [controls (n = 86), intraperitoneal group (n = 100), and intraincisional group (n = 108)]. 5 different pain scales were used for assessment of overall pain. Pain scores were assessed at 5 points of time.

Results

Patients in intraincisional group showed significantly less overall pain and rescue analgesia requirement (p < 0.05). Intraincisional group showed significantly less overall pain (p < 0.05) as compared to intraperitoneal group; however, use of rescue analgesia was comparable in the two groups (p > 0.05); and shoulder pain was significantly less in intraperitoneal group (p < 0.05).

Conclusion

The intraincisional use of injection ropivacaine at its minimum concentration of 0.2% in minimal doses of 1 ml/cm at the end of procedure provides significantly more post-operative analgesia as compared to intraperitoneal group and controls. However, for controlling shoulder pain, the use of intraperitoneal ropivacaine is desirable.

from Endoscopy via xlomafota13 on Inoreader http://ift.tt/2B6buso
via IFTTT

Comparison between submucosal tunneling endoscopic resection and video-assisted thoracoscopic enucleation for esophageal submucosal tumors originating from the muscularis propria layer: a randomized controlled trial

Abstract

Background and aims

Surgical resection is considered the first treatment option for submucosal tumors (SMTs) originating from the muscularis propria layer while submucosal tunneling endoscopic resection (STER) is proved to be a safe and effective method for treating SMTs. This study aimed to compare video-assisted thoracoscopic enucleation (VATE) with STER for treating esophageal SMTs.

Methods

Sixty-six patients with small esophageal SMTs were prospectively randomized from July 2014 to December 2015. After exclusion of 8 patients, 58 subjects scheduled for STER or VATE were enrolled. Clinicopathological, endoscopic, and adverse events (AEs) data were collected and analyzed between STER and VATE.

Results

Forty-six males and 12 females with a mean age of 46.1 ± 9.4 years were randomized to the STER (n = 30) and VATE (n = 28) groups, respectively. Demographics and lesion features were similar between the two groups. Median procedure time was shorter in the STER group than the VATE group (44.5 vs. 106.5 min, P < 0.001); cost was lower in the STER group (4499.46 vs. 6137.32 USD, P = 0.010). Median decrease in hemoglobin levels post-procedure was − 1.6 g/L in the STER group and 14.7 g/L after VATE (P = 0.001). Lower postoperative pain scores were found in the STER group compared with the VATE group (2 vs. 4, P < 0.001). No recurrent or residual tumors were found in either group. En bloc resection rates, complete resection rates, hospital times, and post-procedure AEs were similar between two groups. The en bloc resection rates for SMTs < 20.0 mm were 100% in both groups while STER achieved only 71.4% en bloc resection rate for SMTs ≥ 20.0 mm.

Conclusion

STER and VATE are comparably effective for esophageal SMTs; however, STER is superior to VATE with shorter operation time and decreased cost, and seems safer than VATE. STER is recommended for SMTs < 20.0 mm while VATE is recommended for SMTs with a transverse diameter > 35.0 mm.

Clinical trail registration statement: This study is registered at http://ift.tt/2B7wI9b. The registration identification number is ChiCTR-TRC-14004759. The registration date is April 30, 2014.

from Endoscopy via xlomafota13 on Inoreader http://ift.tt/2Di74Vl
via IFTTT

Laparoscopic surgery in colon cancer patients treated with chronic anti-thrombotic therapy

Abstract

Background

Anti-thrombotic medications are commonly used for the treatment and prevention of cardiovascular diseases. Laparoscopic resection of colon cancer has generally been accepted with favorable outcomes being reported in randomized control trials. However, the safety and efficacy of laparoscopic surgery for colon cancer patients receiving chronic anti-thrombotic therapy (AT) remain unclear.

Methods

We identified 951 patients who underwent elective resection for colon cancer between 2009 and 2016 from our database. Patients were classified according to the surgical approach and chronic AT. Clinicopathological factors and surgical outcomes were analyzed between patient groups. Patients' backgrounds were matched using propensity scores in laparoscopic surgery.

Results

Anti-thrombotic drugs were chronically used in 135 patients. Among 714 patients who underwent laparoscopy-assisted surgery, 96 received AT. The laparoscopic approach was superior to open surgery in terms of bleeding, surgical site infections, and hospital stay in patients receiving AT. In laparoscopy-assisted surgery, the AT group patients were older and showed lower hemoglobin and albumin levels than those not receiving AT (non-AT group), and were predominantly male. After propensity score matching, estimated blood loss and operative times were similar between the two groups (93 matched patients). The frequencies of postoperative bleeding (2.2%) and thrombotic complications (0%) in the AT group did not significantly differ from those in the non-AT group (1.1 and 0%, respectively). Moreover, AT did not affect survivals.

Conclusion

Laparoscopic approach appears to be safer and beneficial for colonic cancer patients receiving long-term AT. Bleeding and thrombotic events associated with laparoscopic surgery were not significantly affected by AT.

from Endoscopy via xlomafota13 on Inoreader http://ift.tt/2DfUUMK
via IFTTT

Single-port laparoscopic surgery in uncomplicated acute appendicitis: a randomized controlled trial

Abstract

Background

Single-port laparoscopic surgery (SPLS) is an alternative, minimally invasive surgical approach for managing appendicitis. The aim of this randomized trial was to evaluate the safety and efficacy of SPLS in uncomplicated appendicitis.

Methods

Between December 2009 and November 2010, 194 patients with radiologically diagnosed acute appendicitis were randomly allocated to undergo either SPLS or multiport laparoscopic surgery (MPLS). Patients with intraoperative findings of perforated appendicitis were excluded from the analysis. The primary endpoint was perioperative morbidity. All data were analyzed according to the intention-to-treat principle.

Results

Fourteen cases were excluded from the analysis. Of the remaining 180 patients, 90 were assigned to the SPLS group, and 90 to the MPLS group. Baseline characteristics were well balanced between the groups. In the SPLS group, the rate of conversion to MPLS was 11.1%. The operation time was 14.5 min longer for SPLS than for MPLS (p < 0.01), but there was no between-group difference in the rate of intraoperative complications (SPLS, 4.4%; MPLS, 0%; p = 0.12) or postoperative complications (SPLS, 4.4%; MPLS, 2.2%; p = 0.68). Compared to the MPLS group, the SPLS group had higher cumulative dose of analgesics (tramadol; 73.9 vs. 51.7 mg, p = 0.04), longer postoperative time to first passage of flatus (27.7 vs. 20.1 h, p < 0.01), longer postoperative hospitalization (2.5 vs. 2.1 days, p < 0.05), and higher total cost (1826.9 vs. 1662.4 USD, p < 0.01).

Conclusions

This randomized trial indicates that, compared to MPLS, SPLS does not increase the rate of perioperative or postoperative complications in uncomplicated appendicitis, but may have disadvantages such as increased operation time, later postoperative functional recovery, longer hospital stay, and higher costs, although the difference is minimal (ClinicalTrials.gov Identifier: NCT01007318).

from Endoscopy via xlomafota13 on Inoreader http://ift.tt/2B71ezU
via IFTTT

Hiatal hernia recurrence following magnetic sphincter augmentation and posterior cruroplasty: intermediate-term outcomes

Abstract

Background

We have previously reported short-term outcomes after hiatal hernia repair (HHR) at the time of magnetic sphincter augmentation (MSA) for gastroesophageal reflux disease (GERD). Here we report intermediate-term outcomes and hernia recurrence rate after concomitant MSA and HHR.

Methods

This is a retrospective cohort study of patients who underwent repair of a hiatal hernia 3 cm or larger at the time of MSA implantation between May 2009 and December 2015. The primary endpoint was hiatal hernia recurrence identified by routine postoperative videoesophagography or endoscopy. Recurrence was defined by a 2 cm or greater upward displacement of the stomach through the diaphragmatic esophageal hiatus. Secondary endpoints included cessation of proton-pump inhibitor (PPI), persistent dysphagia requiring intervention, and GERD health-related quality-of-life (HRQL) scores 1 year from surgery.

Results

During the study period, 47 of 53 (89%) patients underwent concomitant MSA with HHR and complied with surveillance. Hiatal hernias ranged from 3 to 7 cm (mean 4 ± 1). Mean clinical follow-up time was 19 months (range 1–39). GERD-HRQL score decreased from 20.3 to 3.1 (p < .001), 89% of patients remained off PPIs, and 97% of patients reported improvement or resolution of symptoms. Two recurrent hiatal hernias were identified on surveillance imaging for a recurrence rate of 4.3% at a mean 18 (± 10) months after initial operation. Persistent dysphagia occurred in 13% (6/47) over the first year, which resolved after a single balloon dilation in 67% (4/6). Two patients elected for device removal due to dilation-refractory dysphagia and persistent reflux symptoms.

Conclusion

Concomitant magnetic sphincter augmentation and hiatal hernia repair in patients with gastroesophageal reflux disease and a moderate-sized hiatal hernia demonstrates durable subjective reflux control and an acceptable hiatal hernia recurrence rate at 1- to 2-year follow-up.

from Endoscopy via xlomafota13 on Inoreader http://ift.tt/2DfDzDw
via IFTTT

A novel and safe approach: middle cranial approach for laparoscopic right hemicolon cancer surgery with complete mesocolic excision

Abstract

Background

Mastering right hemicolectomy techniques using laparoscopy in colorectal cancer surgery is very difficult. Although the long-term prognosis of laparoscopic right hemicolectomy (LRH) and complete mesocolic excision is unquestionable, different surgeons have their own opinions on routes of conducting LRH.

Objectives

LRH surgery is very complex due to the upper abdominal anatomical structure and vascular variation. Therefore, it has been considered the most difficult of all colorectal cancer surgeries. Our innovative middle cranial approach (MCA) was developed to avoid unnecessary injuries and minimize the operative time, thereby reducing the patient's hospital stay and improving their short-term prognosis.

Methods

We compared 90 colon cancer patients who underwent the MCA between January 2016 and January 2017 with 82 patients who underwent the conventional central approach conducted by the same group of physicians (with Dr Cui as the surgeon) from 2011 to 2015. A short-term statistical analysis was performed.

Results

A total of 90 patients were included: 43 men and 47 women. Twenty-three patients underwent abdominal surgery (including stomach, rectum, and sigmoid colon surgery; appendectomy; and uterine attachment surgery). The median age of these patients was 62.6 (28–85) years; the median BMI was 22.9 (14.7–33.3) kg/m²; the mean bleeding volume was 53.9 (10–100) ml; the mean tumour diameter was 5.7 (0.8–9) cm, and the average number of lymph nodes detected was 19.2 (7–49).

Conclusions

Our study showed that radical resection of right-sided colon cancer using the MCA was safe and feasible for the treatment of colorectal cancer patients.

from Endoscopy via xlomafota13 on Inoreader http://ift.tt/2B6QWQt
via IFTTT

Laparoscopic liver resection for colorectal liver metastasis patients allows patients to start adjuvant chemotherapy without delay: a propensity score analysis

Abstract

Background

Although adjuvant chemotherapy (AC) is widely used after liver resection (LR) for colorectal liver metastasis (CRLM), surgical invasiveness may lead to delay in starting AC, which is preferably started within 8 weeks postoperative. We investigated whether laparoscopic liver resection (LLR) for CRLM facilitates AC start without delay.

Methods

Between November 2014 and December 2016, 117 consecutive CRLM patients underwent LR followed by AC. LLR and OLR were performed in 30 and 87 patients, respectively. After propensity score matching on clinical characteristics, oncologic features, and type of resection, the time interval between liver resection and AC start was compared between LLR (n = 22) and OLR (n = 44) groups.

Results

After propensity score matching, major LR was performed in 8/22 (36%) and 15/44 (34%) cases of LLR and OLR groups, respectively (P = 1.0). Clinical-pathological characteristic and intraoperative findings were comparable between two groups. There was no significant difference in postoperative complications between the two groups. The time interval between liver resection and AC start was significantly shorter in LLR than in OLR group (43 ± 10 versus 55 ± 18 days, P = 0.012). While 15/44 (34%) patients started AC after 8 weeks postoperative in OLR group, all patients in LLR group started AC within 8 weeks.

Conclusions

LLR for CRLM is associated with quicker return to AC when compared to OLR. The delivery of AC without delay allows CRLM patients to optimize the oncologic treatment sequence.

from Endoscopy via xlomafota13 on Inoreader http://ift.tt/2DhqvNW
via IFTTT

A software-based tool for video motion tracking in the surgical skills assessment landscape

Abstract

Background

The use of motion tracking has been proved to provide an objective assessment in surgical skills training. Current systems, however, require the use of additional equipment or specialised laparoscopic instruments and cameras to extract the data. The aim of this study was to determine the possibility of using a software-based solution to extract the data.

Methods

6 expert and 23 novice participants performed a basic laparoscopic cholecystectomy procedure in the operating room. The recorded videos were analysed using Kinovea 0.8.15 and the following parameters calculated the path length, average instrument movement and number of sudden or extreme movements.

Results

The analysed data showed that experts had significantly shorter path length (median 127 cm vs. 187 cm, p = 0.01), smaller average movements (median 0.40 cm vs. 0.32 cm, p = 0.002) and fewer sudden movements (median 14.00 vs. 21.61, p = 0.001) than their novice counterparts.

Conclusion

The use of software-based video motion tracking of laparoscopic cholecystectomy is a simple and viable method enabling objective assessment of surgical performance. It provides clear discrimination between expert and novice performance.

from Endoscopy via xlomafota13 on Inoreader http://ift.tt/2B835Vo
via IFTTT

Endoscopic perforations: what are the indications for surgery?

Abstract

Background

Despite their low occurrence, endoscopic perforations (EPs) are concerning. Some predictive factors have been identified, and EP management is debated, whether non-surgical (medical and/or endoscopic) or surgical. The objective was to elaborate a predictive score for surgical management of EP.

Methods

All the patients addressed for upper and lower EP, except oesophageal EP, were retrospectively included (2004–2015). Demographic data, endoscopic features (indication, location, type), clinical, biological and radiological presentations of EP were reviewed. Management of EP and outcomes were recorded. A predictive score was constructed by multiple linear regression and a cut-off value for surgical management was identified. Additional subgroup analysis was performed according to the location of EP (upper and lower).

Results

Among 41150 endoscopic procedures, 44 patients (22 males, median age = 65 years [22–87]) presenting with EP were included (0.09%). Lower gastrointestinal (GI) endoscopy was mostly performed (66%). EP diagnosis was immediate in 73% of the cases (n = 32). Non-surgical management was efficient in 2/3 cases treated medically alone, and 18/20 cases treated by endoscopy. Surgical management was always successful (n = 24/24). In case of peritonitis, surgery was systematically required, whereas easily required in case of delayed diagnostic of EP. The EP score was based on the presence of previous abdominal surgery, lower GI endoscopy and diagnostic endoscopy. A cut-off EP score of 22.8% for surgery was chosen; it was associated with a specificity and sensitivity of 40 and 100%, respectively. When subgroups were analysed according to EP location, the EP score was still based on the presence of previous abdominal surgery and diagnostic endoscopy. The cut-off was 6.3 and 73.3% for upper (specificity: 73%, sensitivity: 100%) and lower (89 and 45%) locations, respectively.

Conclusion

The predictive EP score may avoid inappropriate surgical management, as well as delayed surgery after non-surgical management failure. Forthcoming study should prospectively validate this score.

from Endoscopy via xlomafota13 on Inoreader http://ift.tt/2DhqlWQ
via IFTTT

Single-incision laparoscopic hepaticojejunostomy for children with perforated choledochal cysts

Abstract

Background

Conventionally, perforated choledochal cyst (CDC) is a contraindication of laparoscopic treatment. The current study is to evaluate efficacy of single-incision laparoscopic hepaticojejunostomy (SILH) in children with perforated CDCs.

Methods

One hundred and thirty-three children with perforated CDCs who underwent SILHs in our hospital between August 2011 and August 2017 were reviewed.

Results

Fifteen (11.3%) patients were converted to open procedures due to severe adhesions and oozing. The mean age at SILH was 2.09 years (range 2 days–12.37 years). The average operative time was 3.23 h (range 2–5 h). The mean postoperative hospital stay was 6.25 days (range 4–16 days). The mean time to full diet resumption was 2.18 days (range 2–6 days). The mean duration of drainage was 3.71 days (range 3–10 days). The median follow-up period was 24 months. Postoperative liver function tests and serum amylase levels returned to normal within 1 year. Three (2.5%) patients required blood transfusions because of extensive oozing from intramural micro-vessels of CDCs. Two (1.7%) patients encountered duodenal injuries because of severe adhesions. The duodenum was repaired with double-layer 5–0 PDS running sutures. One (0.8%) patient with giant CDC had abdominal fluids because of extensive dissection of intrapancreatic segment of CDC. He recovered after 10 days of drainage. None of patients had bile leak, anastomotic stenosis, cholangitis, intrahepatic reflux, pancreatic leak, pancreatic calculi formation, pancreatitis, Roux-loop obstruction, or adhesive intestinal obstruction.

Conclusions

Single-incision laparoscopic hepaticojejunostomy is safe and effective for selected patients with perforated CDCs in experienced hands.

from Endoscopy via xlomafota13 on Inoreader http://ift.tt/2B5CHLR
via IFTTT

Comparison of mesh fixation devices for laparoscopic ventral hernia repair: an experimental study on human anatomic specimens

Abstract

Background

As there is a lack of clarity in terms of the tensile strength of mesh fixation for laparoscopic ventral hernia repair (LVHR), our aim was to investigate the immediate tensile strength of currently available mesh fixation devices on human anatomic specimens.

Methods

Sixteen recently deceased body donators (mean body mass index of 24.4 kg/m²) were used to test the immediate tensile strength (Newton) of 11 different LVHR mesh fixation devices.

Results

Each of the 11 different laparoscopic fixation devices was tested 44 times. Non-articulating tackers provided higher fixation resistance to tensile stress in comparison to articulating tackers (5.1-mm ReliaTack™: 16.9 ± 8.7 N vs. 12.2 ± 5.6 N, p = 0.013; 7-mm ReliaTack™: 19.8 ± 9.4 N vs. 15.0 ± 7.0 N, p = 0.007). Absorbable tacks with a greater length, i.e. ≥6 mm (7-mm ReliaTack™, 6-mm SorbaFix™ and 7.2-mm SecureStrap™) had significantly higher fixation tensile strength than tacks with a shorter length, i.e. < 6 mm (5.1-mm ReliaTack™ and 5.1-mm AbsorbaTack™) (p < 0.001). Furthermore, transfascial sutures (PDS 2-0 sutures 26.3 ± 5.6 N) provided superior fixation tensile strength than 5.1-mm AbsorbaTack™ (13.6 ± 7.3 N) and cyanoacrylate glues such as LiquiBand FIX8™ (3.5 ± 2.4 N) (p < 0.001, respectively). There was a significant deterioration in fixation capacity in obese body donators with a body mass index > 30 kg/m² (13.8 ± 8.0 vs. 17.9 ± 9.7 N, p = 0.044).

Conclusions

Although articulating laparoscopic tackers improve accessibility and facilitate the utilization of tacks within the fixation weak spot adjacent to the trocar placement, an articulating shaft that is not ergonomic to use may limit mechanisms of force transmission. For mesh fixation in LVHR, transfascial sutures and tacks with a longer length provide better immediate fixation tensile strength results.

from Endoscopy via xlomafota13 on Inoreader http://ift.tt/2DhqcTi
via IFTTT

Expanding indications of robotic thyroidectomy

Abstract

Background

Robotic thyroidectomy has many advantages with comparable oncologic safety over conventional open surgery in low-risk differentiated thyroid cancer cases. However, there have been few reports on the outcomes of patients who have been treated with robotic thyroidectomy for more advanced thyroid cancer. The aim of this study was to investigate the validity of expanding indications of robotic thyroidectomy for more advanced thyroid cancer.

Methods

The data of 80 patients with thyroid cancer who underwent robotic total thyroidectomy between January 2013 and December 2014 performed by a single surgeon at Chung-Ang University Hospital were retrospectively reviewed. Among them, 40 patients who had cancer larger than 2 cm or suspicious capsular invasion, or central lymph node (LN) metastasis in preoperative pathologic and radiologic examinations were categorized into the more advanced thyroid cancer group and the remaining patients into the early thyroid cancer group. We compared surgical safety and surgical completeness parameters between the two groups.

Results

The patients in more advanced thyroid cancer group had larger tumors, more extrathyroidal extension, and higher T stages. Surgical safety parameters, such as hypoparathyroidism, vocal cord palsy, and other complications did not differ significantly between the two groups. Surgical completeness parameters, such as the mean number of retrieved LNs, median values of the stimulated thyroglobulin levels, and the proportion of patients with stimulated thyroglobulin levels less than 1 ng/mL, also did not differ significantly.

Conclusions

The outcomes of the patients with more advanced thyroid cancer who were treated with robotic thyroidectomy were comparable to those of the early cancer group patients. Well-designed investigations that are conducted at multiple centers are needed to affirm the validity of expanding indications of robotic thyroidectomy.

from Endoscopy via xlomafota13 on Inoreader http://ift.tt/2B7wGhz
via IFTTT

Does advancement in stapling technology with triple-row and enhanced staple configurations confer additional safety? A matched comparison of 340 stapled ileocolic anastomoses

Abstract

Background

Over the past few decades, studies have focused on the safety of stapled anastomosis, especially when compared to that of the handsewn technique. However, studies on the improvement of stapling technology are limited. This study aimed to investigate whether linear triple-row staples (tri-staples) had any advantage over double-row staples.

Methods

This is a retrospective review of all cases of functional end-to-end anastomoses with linear staplers performed at two centers between 2005 and 2015. Data were retrieved from a prospectively maintained database. Cases of anastomoses performed with double-row (DS) and triple-row (TS) staples were matched according to propensity scores. The rates of anastomotic leakage, bleeding, reoperation, and 30-day mortality were compared.

Results

Functional end-to-end ileocolic anastomoses were performed in 563 consecutive patients during the study period. Double- and triple-row stapling devices were used in 389 and 174 anastomoses, respectively. With propensity score matching, 170 cases were chosen from each group. Both groups showed comparable baseline characteristics. The anastomotic leakage, anastomotic bleeding, and intra-abdominal collection rates were 2.4 and 0% (p = 0.123), 1.2 and 0% (p = 0.499), and 3.5 and 1.2% (p = 0.283) for DS and TS, respectively. The reoperation and 30-day mortality rates were 5.9 and 1.8% (p = 0.048) and 0.6 and 1.2% (p = 1.000) for DS and TS, respectively. The median lengths of stay were 5 and 6 days (p = 0.072) for DS and TS, respectively.

Conclusion

Anastomoses with triple-row staples tended to have a lower morbidity rate, but a significant advantage over double-row staples was not demonstrated in this study.

from Endoscopy via xlomafota13 on Inoreader http://ift.tt/2Dhq0n2
via IFTTT

Ureteral stents increase risk of postoperative acute kidney injury following colorectal surgery

Abstract

Background

Ureteral stents are commonly placed before colorectal resection to assist in identification of ureters and prevent injury. Acute kidney injury (AKI) is a common cause of morbidity and increased cost following colorectal surgery. Although previously associated with reflex anuria, prophylactic stents have not been found to increase AKI. We sought to determine the impact of ureteral stents on the incidence of AKI following colorectal surgery.

Methods

All patients undergoing colon or rectal resection at a single institution between 2005 and 2015 were reviewed using American College of Surgeons National Surgical Quality Improvement Program dataset. AKI was defined as a rise in serum creatinine to ≥ 1.5 times the preoperative value. Univariate and multivariate regression analyses were performed to identify independent predictors of AKI.

Results

2910 patients underwent colorectal resection. Prophylactic ureteral stents were placed in 129 patients (4.6%). Postoperative AKI occurred in 335 (11.5%) patients during their hospitalization. The stent group demonstrated increased AKI incidence (32.6% vs. 10.5%; p < 0.0001) with bilateral having a higher rate than unilateral stents. Hospital costs were higher in the stent group ($23,629 vs. $16,091; p < 0.0001), and patients with bilateral stents had the highest costs. Multivariable logistic regression identified predictors of AKI after colorectal surgery including age, procedure duration, and ureteral stent placement.

Conclusions

Prophylactic ureteral stents independently increased AKI risk when placed prior to colorectal surgery. These data demonstrate increased morbidity and hospital costs related to usage of stents in colorectal surgery, indicating that placement should be limited to patients with highest potential benefit.

from Endoscopy via xlomafota13 on Inoreader http://ift.tt/2B7Egsp
via IFTTT

Trends and surgical outcomes of laparoscopic versus open pyloromyotomy

Abstract

Background

Hypertrophic pyloric stenosis (HPS) is one of the most common pediatric illnesses necessitating surgical intervention. Controversy remains over the optimal surgical approach between laparoscopic pyloromyotomy (LP) and open pyloromyotomy (OP). LP has gained acceptance for management of HPS in an era of expanding minimal access surgical approaches to pediatric conditions. Several studies suggest advantages of LP over OP; however, selection bias and small sample sizes remain a concern. This study compares the outcomes of LP versus OP using propensity score methods.

Methods

The 2013–2015 ACS NSQIP Pediatric PUF was queried for all infants undergoing pyloromyotomy. The trend in the proportion of infants undergoing LP was described and perioperative outcomes between the OP and LP cohorts were compared using propensity score weighted regression models.

Results

4847 infants were identified to have undergone surgical pyloromyotomy. The proportion of LP performed increased significantly from 59% in 2013 to 65.5% in 2015 (p < 0.001). LP was associated with lower overall complications (1.4% vs 2.9%) (OR_adj 0.52, 95% CI 0.34–0.80), surgical site-related complications (1.1% vs 2.1%) (OR_adj 0.52, 95% CI 0.32–0.84), and post-operative length of stay (1.5 days vs 1.9 days) (OR_adj 0.89, 95% CI 0.81–0.98) without significant differences in related re-operation (0.9% vs 0.9%) (OR_adj 1.01, 95% CI 0.52–1.93) or readmissions (1.4% vs 2.1%) (OR_adj 0.73, 95% CI 0.46–1.17).

Conclusions

Our study demonstrates that LP is increasingly utilized for management of hypertrophic pyloric stenosis and is associated with shorter length of stay, and lower odds of surgical site-specific and overall complications without differences in related re-operations. This study supports LP as a safe and effective method for management of HPS.

from Endoscopy via xlomafota13 on Inoreader http://ift.tt/2DiKNa0
via IFTTT

A preclinical animal study of a novel, simple, and secure duct and vessel occluder for laparoscopic surgery

Abstract

Background

Secure occlusion of large blood vessels and ductal structures is critical to all surgeries and remains a challenge in many minimally invasive procedures. This study compares in vivo use of the Amsel Occluder (AO) for secure laparoscopic blood vessel and duct closure, with one of the many commercially available hemoclips (Ligaclip®), in the porcine model.

Methods

Laparoscopic closure of vessels and ducts was performed on 12 swine to compare the ease of use, safety and efficacy of the AO with a hemoclip, as well as the tissue response at > 30 days (10 swine). All vessels and ducts were occluded and then transected between the occluding clips. Any bleeding or leakage was noted. In the chronic study, confirmation of satisfactory vessel occlusion post nephrectomy was determined by laparotomy as well as by contrast angiography and venography. The tissue response and healing was evaluated by a histopathological study for the effects of any biological incompatibilities.

Results

In the acute laparoscopic study, a total of 24 occlusions between 2 and 10 mm were performed with the AO (n = 19) and hemoclip (n = 5). In the chronic study, 5 nephrectomies (AO n = 3, hemoclip N = 2) and 5 cholecystectomies (AO n = 3, hemoclip n = 2) were performed with survival ranging from 42 to 72 days. One pig who sustained a splenic injury at trocar insertion and suffered a delayed ruptured spleen with massive hemorrhage on postoperative day 22. Unlike occlusion with the AO, multiple hemoclips were used for each vessel occlusion. Histopathological examination showed no difference in the tissue response and healing of the AO and hemoclip.

Conclusions

The Amsel Vessel occluder delivered laparoscopically provides an occlusion similar to a hand-sewn transfixion suture, is simple to use, and creates an occlusion which is not only more secure, but also as safe with respect to the health of the surrounding tissues, as that of the widely used hemoclip (Ligaclip®).

from Endoscopy via xlomafota13 on Inoreader http://ift.tt/2B4X3F7
via IFTTT

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Abstract

Background

The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations.

Methods

Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves.

Results

After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p < 0.001), with the proportions of operations lasting > 90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score.

Conclusion

The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care.

from Endoscopy via xlomafota13 on Inoreader http://ift.tt/2Dgqb1Z
via IFTTT

Physical Inactivity from Youth to Adulthood and Risk of Impaired Glucose Metabolism

ABSTRACTIntroductionPhysical activity (PA) is important in the prevention and treatment of impaired glucose metabolism. However, association of physical inactivity during the transition between childhood and adulthood with glucose metabolism is unknown. Therefore, we studied the association of persistent physical inactivity since childhood with glucose metabolism in adulthood.MethodsData were drawn from the ongoing, Cardiovascular Risk in Young Finns Study with repeated follow-ups between 1980-2011 (baseline age 3-18 years, n=3596). Impaired glucose metabolism was defined as having impaired fasting glucose (6.1-6.9mmol/l) or type 2 diabetes in adulthood. Leisure-time PA habits were repeatedly collected with a standardized questionnaire and expressed as a PA index (PAI). Using PAI, four groups were formed (n=2000): 1) persistently low PA, 2) decreasingly active, 3) increasingly active and 4)persistently active subjects. Poisson regression model was used to examine the association between PA groups and impaired glucose metabolism.ResultsThe proportion of the sample with impaired glucose metabolism was 16.1% in individuals with persistently low PA, 14.5% in decreasingly active, 6.8% in increasingly active and 11.1% in persistently active. Compared to individuals with persistently low PA, age and sex adjusted risk for impaired glucose metabolism was lower in those who increased PA (RR=0.47 CI=0.29–0.76) and in those who were persistently active (RR=0.70 CI=0.51–0.97), but similar in those who decreased PA (RR=0.93 CI=0.66–1.36).ConclusionPersistently physically inactive lifestyle from youth to adulthood is associated with increased risk of impaired glucose metabolism in adulthood. Importantly, a moderate increase in PA lowered the risk. The results highlight the importance of avoiding physically inactive lifestyle at all stages of life. Introduction Physical activity (PA) is important in the prevention and treatment of impaired glucose metabolism. However, association of physical inactivity during the transition between childhood and adulthood with glucose metabolism is unknown. Therefore, we studied the association of persistent physical inactivity since childhood with glucose metabolism in adulthood. Methods Data were drawn from the ongoing, Cardiovascular Risk in Young Finns Study with repeated follow-ups between 1980-2011 (baseline age 3-18 years, n=3596). Impaired glucose metabolism was defined as having impaired fasting glucose (6.1-6.9mmol/l) or type 2 diabetes in adulthood. Leisure-time PA habits were repeatedly collected with a standardized questionnaire and expressed as a PA index (PAI). Using PAI, four groups were formed (n=2000): 1) persistently low PA, 2) decreasingly active, 3) increasingly active and 4)persistently active subjects. Poisson regression model was used to examine the association between PA groups and impaired glucose metabolism. Results The proportion of the sample with impaired glucose metabolism was 16.1% in individuals with persistently low PA, 14.5% in decreasingly active, 6.8% in increasingly active and 11.1% in persistently active. Compared to individuals with persistently low PA, age and sex adjusted risk for impaired glucose metabolism was lower in those who increased PA (RR=0.47 CI=0.29–0.76) and in those who were persistently active (RR=0.70 CI=0.51–0.97), but similar in those who decreased PA (RR=0.93 CI=0.66–1.36). Conclusion Persistently physically inactive lifestyle from youth to adulthood is associated with increased risk of impaired glucose metabolism in adulthood. Importantly, a moderate increase in PA lowered the risk. The results highlight the importance of avoiding physically inactive lifestyle at all stages of life. Corresponding author: Petri Kallio, MD, Paavo Nurmi Centre & Department of Health and Physical Activity, University of Turku, Turku, Finland, Kiinamyllynkatu 10, 20520 Turku, Finland. petri.kallio@utu.fi. Tel +358(50)5391907 The Cardiovascular Risk in Young Finns Study was financially supported by the Suomen Akatemia (Academy of Finland) (grants 286284 [to T.L.]; 134309 [Eye]; 126925, 121584, 124282, and 129378 [Salve]; 117787 [Gendi]; 41071 [Skidi]; 275595 [to K.P.]); Social Insurance Institution of Finland; Kuopio, Tampere, and Turku University Hospital Medical Funds (grant X51001 to T.L.); Juho Vainio Foundation; Paavo Nurmi Foundation; Finnish Foundation of Cardiovascular Research; Finnish Cultural Foundation; Sigrid Juselius Foundation; Tampere Tuberculosis Foundation; Emil Aaltonen Foundation; and Yrjö Jahnsson Foundation. This work was also partly funded by the National Heart Foundation of Australia Future Leader Fellowship (grant 100849 to C.G.M.) and the National Health and Medical Research Council Project (grant APP1098369). The authors made every attempt to present the results of the study clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The authors also acknowledge that the present study does not constitute endorsement by the American College of Sports Medicine. The authors declare that they have no competing interests. There are no conflict of interests to disclose for any of the authors. Accepted for Publication: 18 December 2017 © 2018 American College of Sports Medicine

from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2D6P9wv
via IFTTT

In Response

No abstract available

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2EMdHeC
via IFTTT

Valveless Trocar Systems and Respiratory Mechanics: Need for Revaluation

No abstract available

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2FK2FrM
via IFTTT

Ultrasound in Anesthesia, Critical Care, and Pain Management: A Critic’s Review

No abstract available

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2EKEWGo
via IFTTT

Continuous Pulse Oximetry Does Not Measure Blood Pressure

No abstract available

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2FEXMQB
via IFTTT

Evaluation of Almitrine Infusion During Veno-Venous Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome in Adults

This single-center case series investigated the effect of almitrine infusion on PaO2/fraction of inspired oxygen (FIO2) in 25 patients on veno-venous extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. A positive trial was defined as an increase of PaO2/FIO2 ratio ≥20%. Thirty-two trials were performed. Twenty (62.5%, 95% confidence interval, 37.5%–75%) trials in 18 patients were positive, with a median PaO2/FIO2 ratio increase of 35% (25%–43%). A focal acute respiratory distress syndrome and inhaled nitric oxide therapy were more frequent in patients with a positive response to almitrine. We observed no complications of almitrine use. Accepted for publication November 28, 2017. Funding: None. The authors declare no conflicts of interest. The study was approved by the Ethics Review Board of the French Language Society of Critical Care Medicine (CE SRLF17-05). The Ethics Committee approved the study and waived the requirement for informed consent from the patients or patient's kin given the observational and retrospective nature of the study. Reprints will not be available from the authors. Address correspondence to Pierre Esnault, MD, Service de Réanimation, Hôpital d'Instruction des Armées Sainte Anne, Blvd Sainte Anne, 83000 Toulon France. Address e-mail to pierre.esnault@gmail.com. © 2018 International Anesthesia Research Society

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2EMdkRg
via IFTTT

Effects of Electrical Transcutaneous Vagus Nerve Stimulation on the Perceived Intensity of Repetitive Painful Heat Stimuli: A Blinded Placebo- and Sham-Controlled Randomized Crossover Investigation

BACKGROUND: Transcutaneous vagus nerve stimulation (TVNS) is a promising treatment for acute and chronic pain. However, experimental studies yielded controversial results. We examined if TVNS reduces the perceived intensity of repetitive painful heat stimulation and temporal summation of pain (TSP) in healthy volunteers in comparison with placebo and sham stimulation, as well as no intervention. METHODS: In 4 sessions, 90 heat pulse stimuli at individual pain tolerance temperature were applied to the ventral forearm of 49 healthy volunteers (25 women) using a Contact Heat Evoked Potential Stimulator thermode (Medoc, Ramat Yishai, Israel). Pain intensity was assessed with verbal ratings on a numeric pain scale (0–100) at every tenth heat pulse. After the first session in which pain intensities without intervention were evaluated, participants completed 3 sessions in a single-blinded randomized crossover manner: (1) sham stimulation applied at the earlobes, (2) placebo stimulation (inactive device), or (3) TVNS applied at the cymbas conchae. Primary data were analyzed using analysis of variance for repeated measures and t test for paired samples. RESULTS: Pain intensity decreased during all interventions as compared to no intervention (ηp2 = 0.22, P

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2FIj7sl
via IFTTT

In Response

No abstract available

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2EMd7O3
via IFTTT

Comparing Methods for Cardiac Output: Intraoperatively Doppler-Derived Cardiac Output Measured With 3-Dimensional Echocardiography Is Not Interchangeable With Cardiac Output by Pulmonary Catheter Thermodilution

BACKGROUND: Estimation of cardiac output (CO) is essential in the treatment of circulatory unstable patients. CO measured by pulmonary artery catheter thermodilution is considered the gold standard but carries a small risk of severe complications. Stroke volume and CO can be measured by transesophageal echocardiography (TEE), which is widely used during cardiac surgery. We hypothesized that Doppler-derived CO by 3-dimensional (3D) TEE would agree well with CO measured with pulmonary artery catheter thermodilution as a reference method based on accurate measurements of the cross-sectional area of the left ventricular outflow tract. METHODS: The primary aim was a systematic comparison of CO with Doppler-derived 3D TEE and CO by thermodilution in a broad population of patients undergoing cardiac surgery. A subanalysis was performed comparing cross-sectional area by TEE with cardiac computed tomography (CT) angiography. Sixty-two patients, scheduled for elective heart surgery, were included; 1 was subsequently excluded for logistic reasons. Inclusion criteria were coronary artery bypass surgery (N = 42) and aortic valve replacement (N = 19). Exclusion criteria were chronic atrial fibrillation, left ventricular ejection fraction below 0.40 and intracardiac shunts. Nineteen randomly selected patients had a cardiac CT the day before surgery. All images were stored for blinded post hoc analyses, and Bland-Altman plots were used to assess agreement between measurement methods, defined as the bias (mean difference between methods), limits of agreement (equal to bias ± 2 standard deviations of the bias), and percentage error (limits of agreement divided by the mean of the 2 methods). Precision was determined for the individual methods (equal to 2 standard deviations of the bias between replicate measurements) to determine the acceptable limits of agreement. RESULTS: We found a good precision for Doppler-derived CO measured by 3D TEE, but although the bias for Doppler-derived CO by 3D compared to thermodilution was only 0.3 L/min (confidence interval, 0.04–0.58), there were wide limits of agreement (−1.8 to 2.5 L/min) with a percentage error of 55%. Measurements of cross-sectional area by 3D TEE had low bias of −0.27 cm2 (confidence interval, −0.45 to −0.08) and a percentage error of 18% compared to cardiac CT angiography. CONCLUSIONS: Despite low bias, the wide limits of agreement of Doppler-derived CO by 3D TEE compared to CO by thermodilution will limit clinical application and can therefore not be considered interchangeable with CO obtained by thermodilution. The lack of agreement is not explained by lack of agreement of the 3D technique. Accepted for publication December 7, 2017. Funding: Supported by the Department of Cardiothoracic Anaesthesiology and the Research Committee at the Heart Centre. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Karin Graeser, MD, Department of Cardiothoracic Anaesthesiology 4141, The Heart Centre, Rigshospitalet, Blegdamsvej 9, 2200 Copenhagen, Denmark. Address e-mail to Karin.graeser.01@regionh.dk. © 2018 International Anesthesia Research Society

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2EMd199
via IFTTT

'9-1-1' TV series is off base on first responders

I just watched the first episode of the new FOX TV series "9-1-1." And honestly, I'm not sure what to say. I had looked forward to this series. It seemed promising, with good actors and some interesting plot twists indicated in the previews. The cast is diverse and credible. But then came the first episode. Was it all bad" No. There were some affecting and entertaining moments. But ...

from EMS via xlomafota13 on Inoreader http://ift.tt/2ENv0MH
via IFTTT

Kinetic Compensations due to Chronic Ankle Instability during Landing and Jumping

ABSTRACTIntroductionSkeletal muscles absorb and transfer kinetic energy during landing and jumping, which are common requirements of various forms of physical activity. Chronic ankle instability (CAI) is associated with impaired neuromuscular control and dynamic stability of the lower extremity. Little is known regarding an intralimb, lower-extremity joint coordination of kinetics during landing and jumping for CAI patients. We investigated the effect of CAI on lower-extremity joint stiffness and kinetic and energetic patterns across the ground contact phase of landing and jumping.MethodsOne hundred CAI patients and 100 matched able-bodied controls performed five trials of a landing and jumping task (a maximal vertical forward jump, landing on a force plate with the test leg only, and immediate lateral jump toward the contralateral side). Functional analyses of variance and independent t-tests were used to evaluate between-group differences for lower-extremity net internal joint moment, power, and stiffness throughout the entire ground contact phase of landing and jumping.ResultsRelative to the control group, the CAI group revealed (i) reduced plantarflexion and knee extension and increased hip extension moments; (ii) reduced ankle and knee eccentric and concentric power, and increased hip eccentric and concentric power, and (iii) reduced ankle and knee joint stiffness and increased hip joint stiffness during the task.ConclusionsCAI patients seemed to use a hip-dominant strategy by increasing the hip extension moment, stiffness, and eccentric and concentric power during landing and jumping. This apparent compensation may be due to decreased capabilities to produce sufficient joint moment, stiffness, and power at the ankle and knee. These differences might have injury risk and performance implications. Introduction Skeletal muscles absorb and transfer kinetic energy during landing and jumping, which are common requirements of various forms of physical activity. Chronic ankle instability (CAI) is associated with impaired neuromuscular control and dynamic stability of the lower extremity. Little is known regarding an intralimb, lower-extremity joint coordination of kinetics during landing and jumping for CAI patients. We investigated the effect of CAI on lower-extremity joint stiffness and kinetic and energetic patterns across the ground contact phase of landing and jumping. Methods One hundred CAI patients and 100 matched able-bodied controls performed five trials of a landing and jumping task (a maximal vertical forward jump, landing on a force plate with the test leg only, and immediate lateral jump toward the contralateral side). Functional analyses of variance and independent t-tests were used to evaluate between-group differences for lower-extremity net internal joint moment, power, and stiffness throughout the entire ground contact phase of landing and jumping. Results Relative to the control group, the CAI group revealed (i) reduced plantarflexion and knee extension and increased hip extension moments; (ii) reduced ankle and knee eccentric and concentric power, and increased hip eccentric and concentric power, and (iii) reduced ankle and knee joint stiffness and increased hip joint stiffness during the task. Conclusions CAI patients seemed to use a hip-dominant strategy by increasing the hip extension moment, stiffness, and eccentric and concentric power during landing and jumping. This apparent compensation may be due to decreased capabilities to produce sufficient joint moment, stiffness, and power at the ankle and knee. These differences might have injury risk and performance implications.

from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2D9Vese
via IFTTT

Heavy-Load Lifting: Acute Response in Breast Cancer Survivors at Risk for Lymphedema

ABSTRACTPurposeDespite a paucity of evidence, prevention guidelines typically advise avoidance of heavy lifting in an effort to protect against breast cancer–related lymphedema. This study compared acute responses in arm swelling and related symptoms after low- and heavy-load resistance exercise among women at risk for lymphedema while receiving adjuvant taxane-based chemotherapy.MethodsThis is a randomized, crossover equivalence trial. Women receiving adjuvant taxane-based chemotherapy for breast cancer who had undergone axillary lymph node dissection (n = 21) participated in low-load (60%–65% 1-repetition maximum, two sets of 15–20 repetitions) and heavy-load (85%–90% 1-repetition maximum, three sets of 5–8 repetitions) upper-extremity resistance exercise separated by a 1-wk wash-out period. Swelling was determined by bioimpedance spectroscopy and dual-energy x-ray absorptiometry, with breast cancer–related lymphedema symptoms (heaviness, swelling, pain, tightness) reported using a numeric rating scale (0–10). Order of low- versus heavy-load was randomized. All outcomes were assessed before, immediately after, and 24 and 72 h after exercise. Generalized estimating equations were used to evaluate changes over time between groups, with equivalence between resistance exercise loads determined using the principle of confidence interval inclusion.ResultsThe acute response to resistance exercise was equivalent for all outcomes at all time points irrespective of loads lifted, with the exception of extracellular fluid at 72 h after exercise with less swelling after heavy loads (estimated mean difference, −1.00; 95% confidence interval, −3.17 to 1.17).ConclusionsLow- and heavy-load resistance exercise elicited similar acute responses in arm swelling and breast cancer–related lymphedema symptoms in women at risk for lymphedema receiving adjuvant taxane-based chemotherapy. These represent important preliminary findings, which can be used to inform future prospective evaluation of the long-term effects of repeated exposure to heavy-load resistance exercise. Purpose Despite a paucity of evidence, prevention guidelines typically advise avoidance of heavy lifting in an effort to protect against breast cancer–related lymphedema. This study compared acute responses in arm swelling and related symptoms after low- and heavy-load resistance exercise among women at risk for lymphedema while receiving adjuvant taxane-based chemotherapy. Methods This is a randomized, crossover equivalence trial. Women receiving adjuvant taxane-based chemotherapy for breast cancer who had undergone axillary lymph node dissection (n = 21) participated in low-load (60%–65% 1-repetition maximum, two sets of 15–20 repetitions) and heavy-load (85%–90% 1-repetition maximum, three sets of 5–8 repetitions) upper-extremity resistance exercise separated by a 1-wk wash-out period. Swelling was determined by bioimpedance spectroscopy and dual-energy x-ray absorptiometry, with breast cancer–related lymphedema symptoms (heaviness, swelling, pain, tightness) reported using a numeric rating scale (0–10). Order of low- versus heavy-load was randomized. All outcomes were assessed before, immediately after, and 24 and 72 h after exercise. Generalized estimating equations were used to evaluate changes over time between groups, with equivalence between resistance exercise loads determined using the principle of confidence interval inclusion. Results The acute response to resistance exercise was equivalent for all outcomes at all time points irrespective of loads lifted, with the exception of extracellular fluid at 72 h after exercise with less swelling after heavy loads (estimated mean difference, −1.00; 95% confidence interval, −3.17 to 1.17). Conclusions Low- and heavy-load resistance exercise elicited similar acute responses in arm swelling and breast cancer–related lymphedema symptoms in women at risk for lymphedema receiving adjuvant taxane-based chemotherapy. These represent important preliminary findings, which can be used to inform future prospective evaluation of the long-term effects of repeated exposure to heavy-load resistance exercise.

from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2DaFwgl
via IFTTT

An Innovative Ergometer to Measure Neuromuscular Fatigue Immediately after Cycling

ABSTRACTPurposeWhen assessing neuromuscular fatigue (NMF) from dynamic exercise using large muscle mass (e.g., cycling), most studies have delayed measurement for 1 to 3 min after task failure. This study aimed to determine the reliability of an innovative cycling ergometer permitting the start of fatigue measurement within 1 s after cycling.MethodsTwelve subjects participated in two experimental sessions. Knee-extensor NMF was assessed by electrical nerve and transcranial magnetic stimulation with both a traditional chair setup (PRE- and POST-Chair, 2 min postexercise) and the new cycling ergometer (PRE, every 3 min during incremental exercise and POST-Bike, at task failure).ResultsThe reduction in maximal voluntary contraction force POST-Bike (63% ± 12% PRE; P 0.05). Vastus lateralis and rectus femoris M-wave and motor-evoked potential areas showed fair to excellent reliability (ICC, 0.45–0.88). The reduction in maximal voluntary contraction and Db100 was greater on the cycling ergometer than the isometric chair.ConclusionsThe innovative cycling ergometer is a reliable tool to assess NMF during and immediately postexercise. This will allow fatigue etiology during dynamic exercise with large muscle mass to be revisited in various populations and environmental conditions. Purpose When assessing neuromuscular fatigue (NMF) from dynamic exercise using large muscle mass (e.g., cycling), most studies have delayed measurement for 1 to 3 min after task failure. This study aimed to determine the reliability of an innovative cycling ergometer permitting the start of fatigue measurement within 1 s after cycling. Methods Twelve subjects participated in two experimental sessions. Knee-extensor NMF was assessed by electrical nerve and transcranial magnetic stimulation with both a traditional chair setup (PRE- and POST-Chair, 2 min postexercise) and the new cycling ergometer (PRE, every 3 min during incremental exercise and POST-Bike, at task failure). Results The reduction in maximal voluntary contraction force POST-Bike (63% ± 12% PRE; P 0.05). Vastus lateralis and rectus femoris M-wave and motor-evoked potential areas showed fair to excellent reliability (ICC, 0.45–0.88). The reduction in maximal voluntary contraction and Db100 was greater on the cycling ergometer than the isometric chair. Conclusions The innovative cycling ergometer is a reliable tool to assess NMF during and immediately postexercise. This will allow fatigue etiology during dynamic exercise with large muscle mass to be revisited in various populations and environmental conditions.

from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2DczWdC
via IFTTT

Absence of Fitness Improvement Is Associated with Outcomes in Heart Failure Patients

ABSTRACTPurposeThis study aimed to examine the clinical effect of cardiorespiratory fitness (CRF) and improvements in CRF after cardiac rehabilitation (CR) in heart failure (HF) patients for their risk for all-cause mortality and unplanned hospitalization and to investigate possible factors associated with the absence of improvement in CRF after rehabilitation.MethodsWe included 155 HF patients receiving CR between October 2009 and January 2015. Patients performed an incremental bicycle test to assess CRF through peak oxygen uptake (V˙O2-peak) before and after CR-based supervised exercise training. Patients were classified as responders or nonresponders on the basis of pre-to-post CR changes in V˙O2-peak (≥6% and

from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2DamZRx
via IFTTT

The Effect of Acute Taurine Ingestion on Human Maximal Voluntary Muscle Contraction

ABSTRACTPurposeThis study aimed to examine the effect of taurine ingestion on maximal voluntary muscle torque and power in trained male athletes with different caffeine habits.MethodsFourteen male athletes 21.8 ± 2.5 yr old were separated into caffeine and noncaffeine consumers to control for the effect of caffeine withdrawal on muscle function. On separate occasions, participants performed four isokinetic or three maximal isometric knee extensions with and without taurine (40 mg·kg−1 body mass) after a double-blind, counterbalanced design. Muscle contractile performances were compared between the first sets as well as between the sets where these variables scored best.ResultsIn response to isokinetic contraction, taurine treatment in the noncaffeine consumers resulted in a significant fall in first (−16.1%; P = 0.013) and best peak torque (−5.0%; P = 0.016) as well as in first (−17.7%; P = 0.015) and best power output (−8.0%; P = 0.008). In the caffeine consumers deprived of caffeine, taurine intake improved best power (5.2%; P = 0.045). With respect to the isometric variables, there was a significant decrease in the first (−5.1%; P = 0.002) and best peak torque (−4.3%; P = 0.032) in the noncaffeine group, but no effect in the group of caffeine consumers deprived of caffeine. Taurine ingestion increased blood taurine levels but had no effect on plasma amino acid levels.ConclusionsTaurine ingestion is detrimental to maximal voluntary muscle power and both maximal isokinetic and isometric peak torque in noncaffeine consumers, whereas taurine ingestion in caffeine-deprived caffeine consumers improves maximal voluntary muscle power but has no effect on other aspects of contractile performance. Purpose This study aimed to examine the effect of taurine ingestion on maximal voluntary muscle torque and power in trained male athletes with different caffeine habits. Methods Fourteen male athletes 21.8 ± 2.5 yr old were separated into caffeine and noncaffeine consumers to control for the effect of caffeine withdrawal on muscle function. On separate occasions, participants performed four isokinetic or three maximal isometric knee extensions with and without taurine (40 mg·kg−1 body mass) after a double-blind, counterbalanced design. Muscle contractile performances were compared between the first sets as well as between the sets where these variables scored best. Results In response to isokinetic contraction, taurine treatment in the noncaffeine consumers resulted in a significant fall in first (−16.1%; P = 0.013) and best peak torque (−5.0%; P = 0.016) as well as in first (−17.7%; P = 0.015) and best power output (−8.0%; P = 0.008). In the caffeine consumers deprived of caffeine, taurine intake improved best power (5.2%; P = 0.045). With respect to the isometric variables, there was a significant decrease in the first (−5.1%; P = 0.002) and best peak torque (−4.3%; P = 0.032) in the noncaffeine group, but no effect in the group of caffeine consumers deprived of caffeine. Taurine ingestion increased blood taurine levels but had no effect on plasma amino acid levels. Conclusions Taurine ingestion is detrimental to maximal voluntary muscle power and both maximal isokinetic and isometric peak torque in noncaffeine consumers, whereas taurine ingestion in caffeine-deprived caffeine consumers improves maximal voluntary muscle power but has no effect on other aspects of contractile performance.

from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2D8XK1M
via IFTTT

Challenges with Percent Predicted Maximal V˙O2 in Patients with Heart Failure

ABSTRACTPurposeThis study aimed to describe the influence of different equations to predict maximal oxygen uptake (MV˙O2) on the percent predicted MV˙O2 (ppMV˙O2) and the resultant categorization of patients with heart failure with reduced ejection fraction into high or low risk.MethodsIn this retrospective cohort study, ppMV˙O2 was calculated using six different equations to predict MV˙O2 among 1168 patients with heart failure with reduced ejection fraction (33% women). Repeated-measures ANOVA was used to compare within-subject differences in mean ppMV˙O2 between the prediction equations. Cochrane's Q test was used to compare the within-subject difference in the proportion of patients with ppMV˙O2 of

from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2D8VWWE
via IFTTT

Calculated versus Measured MVV—Surrogate Marker of Ventilatory CPET—Erratum

No abstract available

from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2DCrfKz
via IFTTT

Quadriceps Function and Knee Joint Ultrasonography after ACL Reconstruction

ABSTRACTPurposeIndividuals with anterior cruciate ligament reconstruction (ACLR) are at greater risk for knee osteoarthritis, partially because of chronic quadriceps dysfunction. Articular cartilage is commonly assessed using magnetic resonance imaging and radiography, but these methods are expensive and lack portability. Ultrasound imaging may provide a cost-effective and portable alternative for imaging the femoral cartilage. The purpose of this study was to compare ultrasonography of the femoral cartilage between the injured and uninjured limbs of individuals with unilateral ACLR, and to examine the association between quadriceps function and ultrasonographic measures of femoral cartilage.MethodsBilateral femoral cartilage thickness and quadriceps function were assessed in 44 individuals with unilateral ACLR. Quadriceps function was assessed using peak isometric strength, and early (RTD100) and late (RTD200) rate of torque development.ResultsCartilage thickness at the medial femoral condyle (P

from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2DCfhR0
via IFTTT

Exercise-induced Bronchoconstriction with Firefighting Contained Breathing Apparatus

ABSTRACTPurposeProtective self-contained breathing apparatus (SCBA) used for firefighting delivers decompressed (cold) dehumidified air that may enhance the severity of exercise-induced bronchoconstriction (EIB) in those susceptible. We investigated the effect of SCBA during exercise on airway caliber in people with asthma and healthy controls.MethodsTwo exercise challenges (EC) designed to elicit EIB were performed on separate days within 1 wk. The initial challenge was breathing room air (ECRA) with workload titrated to elicit >60% estimated maximum voluntary ventilation. The exercise intensity was repeated for the second challenge using SCBA (ECSCBA). Forced expiratory volume in 1 s (FEV1) was measured before and up to 20 min after exercise. Bronchial hyperresponsivenss (BHR) to the hyperosmolar mannitol test was measured in the subjects with asthma.ResultsTwenty subjects with current asthma (mean [SD]: age 27 [6] yr) and 10 healthy controls (31 [5] yr, P = 0.1) were studied. The percent fall in FEV1 after ECSCBA was greater in the mannitol-positive asthma subjects (14.4% [15.1%]) compared with mannitol-negative asthmatic subjects (1.6% [1.7%]; P = 0.02) and controls (2.3% [2.3%]; P = 0.04). The FEV1 response was not different between ECRA and ECSCBA (0.49% [5.57%]; P = 0.6). No BHR to mannitol (n = 7) was highly sensitive for identifying a negative response to ECSCBA (negative predictive value 100%).ConclusionsThe SCBA does not increase the propensity or severity for EIB in subjects with BHR. Those subjects with asthma but no BHR to inhaled mannitol did not exhibit EIB. The BHR to a hyperosmolar stimulus maybe considered a useful screening tool for potential recruits with a history of asthma. Purpose Protective self-contained breathing apparatus (SCBA) used for firefighting delivers decompressed (cold) dehumidified air that may enhance the severity of exercise-induced bronchoconstriction (EIB) in those susceptible. We investigated the effect of SCBA during exercise on airway caliber in people with asthma and healthy controls. Methods Two exercise challenges (EC) designed to elicit EIB were performed on separate days within 1 wk. The initial challenge was breathing room air (ECRA) with workload titrated to elicit >60% estimated maximum voluntary ventilation. The exercise intensity was repeated for the second challenge using SCBA (ECSCBA). Forced expiratory volume in 1 s (FEV1) was measured before and up to 20 min after exercise. Bronchial hyperresponsivenss (BHR) to the hyperosmolar mannitol test was measured in the subjects with asthma. Results Twenty subjects with current asthma (mean [SD]: age 27 [6] yr) and 10 healthy controls (31 [5] yr, P = 0.1) were studied. The percent fall in FEV1 after ECSCBA was greater in the mannitol-positive asthma subjects (14.4% [15.1%]) compared with mannitol-negative asthmatic subjects (1.6% [1.7%]; P = 0.02) and controls (2.3% [2.3%]; P = 0.04). The FEV1 response was not different between ECRA and ECSCBA (0.49% [5.57%]; P = 0.6). No BHR to mannitol (n = 7) was highly sensitive for identifying a negative response to ECSCBA (negative predictive value 100%). Conclusions The SCBA does not increase the propensity or severity for EIB in subjects with BHR. Those subjects with asthma but no BHR to inhaled mannitol did not exhibit EIB. The BHR to a hyperosmolar stimulus maybe considered a useful screening tool for potential recruits with a history of asthma.

from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2DBcKGJ
via IFTTT

Neural Correlates to the Increase in Maximal Force after Dexamethasone Administration

ABSTRACTPurposeThis study investigated the effects of short-term glucocorticoid administration on voluntary activation and intracortical inhibitory and facilitatory circuits.MethodsSeventeen healthy men participated in a pseudorandomized double-blind study to receive either dexamethasone (8 mg·d−1, n = 9 subjects) or placebo (n = 8 subjects) for 7 d. The ankle dorsiflexion torque, corresponding EMG of the tibialis anterior, and voluntary activation assessed by the interpolated twitch method using transcranial magnetic stimulation (TMS) were measured during a maximal voluntary contraction (MVC). Short-latency intracortical inhibition (SICI) and intracortical facilitation (ICF) were assessed at rest and during submaximal contraction (50% MVC torque) by paired-pulse TMS with the conditioning stimulus set at 0.8× of motor threshold and delivered 2 ms (SICI) and 13 ms (ICF) before the test stimulus (1.2× motor threshold).ResultsThe MVC torque (+14%), tibialis anterior EMG (+31%), and voluntary activation (+3%) increased after glucocorticoid treatment (P

from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2DBcFmp
via IFTTT

Genetic Variants and Hamstring Injury in Soccer: An Association and Validation Study

ABSTRACTPurposeThis study aimed to investigate the association of candidate single nucleotide polymorphisms (SNP) with noncontact hamstring muscle injuries in elite soccer players and to create and validate a model to assess the risk of hamstring injury.MethodsA total of 107 elite male outfield players were prospectively followed for six seasons. Players were genotyped for 37 SNP previously investigated in relation to musculoskeletal injuries. The association of SNP, previous injury, age, level of play, position, and anthropometric data with 129 hamstring injuries (413 observations) was investigated in the discovery phase (2010–2015), and a multivariable Cox frailty model was created using forward selection. The model's discriminative ability was tested in the validation phase (2015–2016, 31 injuries, 98 observations) using Harrell's C index.ResultsFive SNP were found to be significantly associated with hamstring injury in a multivariable model: matrix metalloproteinase 3 rs679620 (A vs G, hazard ratio [HR] = 2.06, 95% confidence interval [CI] = 1.51–2.81), tenascin C rs2104772 (A vs T, HR = 1.65, 95% CI = 1.17–2.32), interleukin 6 rs1800795 (GG vs GC + CC, HR = 1.68, 95% CI = 1.11–2.53), nitric oxide synthase 3 rs1799983 (G vs T, HR = 1.35, 95% CI = 1.01–1.79), and hypoxia-inducible factor-1α rs11549465 (CC vs CT, HR = 2.08, 95% CI = 1.00–4.29). Age also entered the model (≥24 vs

from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2DCMNGI
via IFTTT

Effect of Losartan on the Acute Response of Human Elderly Skeletal Muscle to Exercise

ABSTRACTPurposeTo investigate the effect of blocking the angiotensin II Type I receptor (AT1R) upon the response to acute heavy-resistance exercise in elderly human skeletal muscle. The hypothesis was that AT1R blocking would result in a superior myogenic response accompanied by down-regulation of transforming growth factor-beta and up-regulation of insulin-like growth factor-1 signaling.MethodsTwenty-eight healthy elderly men (+64 yr) were randomized into two groups, consuming either AT1R blocker (losartan, 100 mg·d−1) or placebo for 18 d before exercise. Participants performed one bout of heavy-unilateral-resistance exercise. Six muscle biopsies were obtained from the vastus lateralis muscles of each subject: two before exercise and four after exercise (4.5 h and 1, 4, and 7 d). Blood pressure and blood samples were collected at the same time points. Biopsies were sectioned for immunohistochemistry to determine the number of satellite cells associated with Type I and Type II fibers. Gene expression levels of Notch, connective tissue, and myogenic signaling pathways were determined by real-time reverse transcription polymerase chain reaction.ResultsChanges over time were detected for circulating creatine kinase, the number of satellite cells per Type I fiber, and most of the gene targets, with no specific effect of losartan on these. However, when compared with placebo, losartan intake resulted in a greater suppression of myostatin messenger RNA.ConclusionsIn general, there does not seem to be any effect of AT1R blocking on satellite cell number or myogenic pathways in elderly men in the days after one bout of heavy-resistance exercise. However, the greater suppression of myostatin may prove to be beneficial over a long-term intervention designed to induce hypertrophy. Purpose To investigate the effect of blocking the angiotensin II Type I receptor (AT1R) upon the response to acute heavy-resistance exercise in elderly human skeletal muscle. The hypothesis was that AT1R blocking would result in a superior myogenic response accompanied by down-regulation of transforming growth factor-beta and up-regulation of insulin-like growth factor-1 signaling. Methods Twenty-eight healthy elderly men (+64 yr) were randomized into two groups, consuming either AT1R blocker (losartan, 100 mg·d−1) or placebo for 18 d before exercise. Participants performed one bout of heavy-unilateral-resistance exercise. Six muscle biopsies were obtained from the vastus lateralis muscles of each subject: two before exercise and four after exercise (4.5 h and 1, 4, and 7 d). Blood pressure and blood samples were collected at the same time points. Biopsies were sectioned for immunohistochemistry to determine the number of satellite cells associated with Type I and Type II fibers. Gene expression levels of Notch, connective tissue, and myogenic signaling pathways were determined by real-time reverse transcription polymerase chain reaction. Results Changes over time were detected for circulating creatine kinase, the number of satellite cells per Type I fiber, and most of the gene targets, with no specific effect of losartan on these. However, when compared with placebo, losartan intake resulted in a greater suppression of myostatin messenger RNA. Conclusions In general, there does not seem to be any effect of AT1R blocking on satellite cell number or myogenic pathways in elderly men in the days after one bout of heavy-resistance exercise. However, the greater suppression of myostatin may prove to be beneficial over a long-term intervention designed to induce hypertrophy.

from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2DEFMFE
via IFTTT

Athletic Footwear and Orthoses in Sports Medicine, 2nd Edition

No abstract available

from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2D92YL6
via IFTTT