New evaluated radioxenon decay data and its implications in nuclear explosion monitoring

Publication date: Available online 7 March 2018
Source:Journal of Environmental Radioactivity
Author(s): Monica Galan, Martin Kalinowski, Abdelhakim Gheddou, Kassoum Yamba
This work presents the last updated evaluations of the nuclear and decay data of the four radioxenon isotopes of interest for the Comprehensive Nuclear-Test-Ban Treaty (CTBT): Xe-131 m, Xe-133, Xe-133 m and Xe-135. This includes the most recent measured values on the half-lives, gamma emission probabilities (Pγ) and internal conversion coefficients (ICC). The evaluation procedure has been made within the Decay Data Evaluation Project (DDEP) framework and using the latest available versions of nuclear and atomic data evaluation software tools and compilations. The consistency of the evaluations was confirmed by the very close result between the total available energy calculated with the present evaluated data and the tabulated Q-value. The article also analyzes the implications on the variation of the activity ratio calculations from radioxenon monitoring facilities depending on the nuclear database of reference.



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Radionuclide distribution in soil and undecayed vegetative litter samples in a riparian system at the Savannah River Site, SC

Publication date: Available online 7 March 2018
Source:Journal of Environmental Radioactivity
Author(s): Chieh-Ming Wu, Olorunfemi Adetona, Luke Naeher, Brian J. Viner, Tim Jannik, Allan Hepworth, Eric Doman, Teresa Eddy
The aim of this study is to comprehensively investigate radionuclide concentrations in surface soil and un-decayed vegetative litter along four stream systems (i.e. Fourmile Branch, Lower Three Runs, Pen Branch, and Steel Creek) at the Savannah River Site (SRS), Aiken, South Carolina. Soil and litter samples from systematically spaced 12 pairs (contaminated or uncontaminated) of plots along the four streams were analyzed for 16 distinct radionuclide activities. Lower radionuclide concentrations were observed in soil and litter samples collected along Pen Branch compared to the other 3 streams. The anthropogenic radionuclide with the highest activity was ¹³⁷Cs in soil (10.6–916.9 Bq/kg) and litter (8.0–222.3 Bq/kg), while the naturally occurring radionuclides possessing the highest concentration in the samples were ⁴⁰K (33.5–153.7 Bq/kg and 23.1–56.0 Bq/kg in soil and litter respectively) and ²²⁶Ra (55.6–159.9 Bq/kg and 30.2–101.8 Bq/kg in soil and litter respectively). A significant difference (p < 0.05) of radionuclide concentrations between paired-plots across four streams was observed for ²⁴¹Am, ¹³⁷Cs, ²³⁸Pu, ²³⁹Pu, and ²²⁶Ra in both contaminated and non-contaminated samples. ¹³⁷Cs and uranium isotopes had the highest litter-to-soil correlation in contaminated (rho = 0.70) and uncontaminated plots (rho = 0.31–0.41), respectively. ⁹⁰Sr was the only radionuclide with higher radioactive concentrations in litter (12.65–37.56 Bq/kg) compared to soil (1.61–4.79 Bq/kg). The result indicates that 1) historical discharges of anthropogenic ¹³⁷Cs was the most important contributor of radiation contamination in the riparian environment at SRS, 2) ⁹⁰Sr was the only radionuclide with higher concentration in litter than in soil, and 3) no apparent pattern in deposition density in soil or litter along downstream was observed for the radionuclides measured in this study.



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Radiocesium contamination of the moss Hypnum plumaeforme caused by the Fukushima Dai-ichi Nuclear Power Plant accident

Publication date: Available online 7 March 2018
Source:Journal of Environmental Radioactivity
Author(s): Emiko Oguri, Hironori Deguchi
We investigated ¹³⁴Cs and ¹³⁷Cs activity concentrations in the common Japanese moss species Hypnum plumaeforme collected from 32 sites within ca. 100 km radius of the Fukushima Dai-ichi Nuclear Power Plant. A total of 32 samples of H. plumaeforme were collected during the field surveys from November 2013 to September 2014. The maximum radiocesium activity concentrations in H. plumaeforme were 60.9 ± 1.8 kBq kg⁻¹ for ¹³⁴Cs and 123 ± 2.3 kBq kg⁻¹ for ¹³⁷Cs. The mean value for the ¹³⁴Cs/¹³⁷Cs was 1.17 ± 0.05, and the mean Tag value was 0.09 ± 0.13. Positive correlations were obtained between total ¹³⁴Cs + ¹³⁷Cs activity concentrations in H. plumaeforme and the air dose rate with a correlation coefficient (r) of 0.55 (P = 0.001), and between ¹³⁷Cs activity concentration in H. plumaeforme and ¹³⁷Cs deposition density on soil with r of 0.55 (P = 0.001). These results suggest that the perennial moss species H. plumaeforme could be more suitable and useful as a qualitative indicator for the radiocesium pollution compared to vascular plants spreading over the lowlands including human habitation in Fukushima Prefecture.



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Challenges and complexities in remediation of uranium contaminated soils: A review

Publication date: Available online 7 March 2018
Source:Journal of Environmental Radioactivity
Author(s): Rajendran Selvakumar, Govindarajan Ramadoss, Mridula P. Menon, Karuppuli Rajendran, Palanisami Thavamani, Ravi Naidu, Mallavarapu Megharaj
Uranium contamination of soil has been a major concern with respect to its toxicity, accumulation in the food chain and persistence in the environment. Owing to these problems, remediation of uranium-contaminated soils has been investigated by various techniques. This review focuses on the challenges and complexities associated with the remediation of uranium-contaminated soil at field level. Therefore, laboratory studies have been excluded from this review. Challenges faced during remediation of uranium-contaminated soil using various techniques such as microbial/phyto/chemical/material based strategies have been discussed with suitable examples. Various factors that have a major influence on uranium decontamination process in soil such as soil type, uranium speciation, the presence of coexisting ions and organics, etc., have been highlighted. This review brings out the significance of the integrated role of various factors which determine the efficiency of the uranium decontamination process.



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The marine kd and water/sediment interaction problem

Publication date: Available online 7 March 2018
Source:Journal of Environmental Radioactivity
Author(s): R. Periáñez, I. Brovchenko, K.T. Jung, K.O. Kim, V. Maderich
The behavior of marine distribution coefficients is analyzed with the help of numerical experiments and analytical solutions of equations describing kinetic models for uptake/release of radionuclides. The difficulties in measuring true kd in a marine environment perturbed by an external radionuclide source are highlighted. Differences between suspended matter and bed sediment kd are analyzed. The performances of different kinetic models (1-step/2step; single-layer/multi-layer) are studied in model/model and model/experiment comparisons. Implications for the use of models to assess radioactive contamination after an emergency are given; as well as recommendations when kd data are compiled in order to create a useful database.



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Systematic review of measurement property evidence for eight financial management instruments in populations with acquired cognitive impairment

Publication date: Available online 7 March 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Lisa Engel, Adora Chui, Dorcas E. Beaton, Robin E. Green, Deirdre R. Dawson
ObjectiveTo critically appraise the measurement property evidence (i.e., psychometric) for eight observation-based financial management assessment instruments.Data sourcesSeven databases were searched in May 2015.Study SelectionTwo reviewers used an independent decision-agreement process to select studies of measurement property evidence relevant to populations with adulthood acquired cognitive impairment, appraise the quality of the evidence, and extract data. Twenty-one articles were selected.Data extractionThis review used the COnsensus-based Standards for the selection of health Measurement Instruments review (COSMIN) guidelines and four-point tool to appraise evidence. After appraising the methodological quality, adequacy of results and volume of evidence per instrument were synthesized. Measurement property evidence with high risk of bias was excluded from the synthesis.Data synthesisVolume of measurement property evidence per instrument is low; most instruments had one to three included studies. Many included studies had poor methodological quality per measurement property evidence area examined. Six of the eight instruments reviewed had supporting construct validity/hypothesis-testing evidence of fair methodological quality. There is a dearth of acceptable quality content validity, reliability, and responsiveness evidence for all eight instruments.ConclusionsRehabilitation practitioners assess financial management functions in adults with acquired cognitive impairments. However, there is limited published evidence to support using any of the reviewed instruments. Practitioners should exercise caution when interpreting results of these instruments. This review highlights the importance of appraising the quality of measurement property evidence prior to examining the adequacy of the results and synthesizing the evidence.



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Functional Electrical Stimulation-A new therapeutic approach to enhance exercise intensity in Chronic Obstructive Pulmonary Disease patients : a randomised controlled cross-over trial.

Publication date: Available online 7 March 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Clément Medrinal, Guillaume Prieur, Yann Combret, Aurora Robledo Quesada, David Debeaumont, Tristan Bonnevie, Francis Edouard Gravier, Elise Dupuis Lozeron, Jean Quieffin, Olivier Contal, Bouchra Lamia
ObjectiveTo evaluate the effect of quadriceps Functional Electrical Stimulation (FES)-Cycling on exertional VO2 compared with Placebo FES-cycling in patients with COPD.DesignA randomised, single-blind, placebo-controlled, cross-over trialSettingPulmonary Rehabilitation DepartmentParticipants23 consecutive patients with COPD GOLD stage 2, 3 or 4 (mean FEV1 : 1.4±0.4 L (50.3% pred)) who had recently begun a respiratory rehabilitation program.InterventionTwo consecutive 30-minute sessions were carried out at a constant load with active and placebo FES-Cycling.Main outcome measuresThe primary outcome was mean VO2 during the 30-minute exercise session. The secondary outcomes were respiratory gas exchange and hemodynamic parameters averaged over the 30-minute endurance session. Lactate values, dyspnea and perceived muscle fatigue were evaluated at the end of the sessions.ResultsFES-Cycling increased the physiological response more than the placebo, with a greater VO2 achieved of 36.6 (95% CI 8.9-64.3) mL/min (p=0.01). There was also a greater increase in lactate after FES-Cycling (+1.5 (95% CI 0.05 to 2.9) mmol/L; p=0.01). FES-Cycling did not change dyspnoea or muscle fatigue compared with the placebo condition.ConclusionFES-Cycling effectively increased exercise intensity in patients with COPD. Further studies should evaluate longer-term FES-Cycling rehabilitation programs.



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Cannabis Use in Individuals with Spinal Cord Injury or Moderate to Severe Traumatic Brain Injury in Colorado

Publication date: Available online 7 March 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Lenore Hawley, Jessica M. Ketchum, Clare Morey, Kathleen Collins Pharm.D., Susan Charlifue
ObjectiveTo describe the prevalence of cannabis use in an adult sample with spinal cord injury (SCI) or traumatic brain injury (TBI) in Colorado, and to describe the self-reported reasons and side effects of cannabis use in this sample.DesignMixed methods observational study, using focus group data and telephone surveySettingCommunityParticipantsColorado adults who have sustained SCI or moderate to severe TBI and have received services through the rehabilitation hospital conducting the study.InterventionsNone; Measures: SurveyResultsFocus group participants identified issues that were then included in the survey development. Seventy percent of the 116 surveyed reported cannabis use pre-injury (67% SCI, 74% TBI) with 48% reporting use after injury (53% SCI, 45% TBI). Overall, the most common reason for use was recreational (67%), followed by reducing stress/anxiety (62.5%), and improving sleep (59%). Among the respondents with SCI, the most common reasons for use were to reduce spasticity (70%), recreation (63%), and to improve sleep (63%). Among those with TBI, reasons endorsed were recreational (72%), reducing stress/anxiety (62%), and improving sleep (55%). Smoking was the most common method of use.ConclusionsA majority of this sample report using cannabis prior to injury, and approximately half report using cannabis post-injury. Both groups report recreational use, while the group with SCI also highly endorses using cannabis to address chronic medical conditions. Clinicians should be aware of the high prevalence of cannabis use in these populations and the impact such use may have on the individual's medical management. Further research in this area is needed.



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Primate fetal hepatic responses to maternal obesity: epigenetic signalling pathways and lipid accumulation

Abstract

Maternal obesity (MO) increases offspring cardiometabolic disease risk. Altered fetal liver development in response to the challenge of MO has metabolic consequences underlying adverse offspring life-course health outcomes. Little is known about molecular pathways and potential epigenetic changes regulating primate fetal liver responses to MO. We hypothesized that MO would induce fetal baboon liver epigenetic changes resulting in dysregulation of key metabolic pathways that impact lipid metabolism. MO was induced prior to pregnancy by a high fat, high sucrose diet. Unbiased gene and microRNA (miRNA; small RNA Seq) abundance analyses were performed on fetal baboon livers at 0.9 gestation (G) and subjected to pathway analyses to identify fetal liver molecular responses to MO. Fetal baboon liver lipid and glycogen content were quantified by Computer Assisted Stereology Toolbox. In response to MO, fetal livers revealed dysregulation of TCA cycle, proteasome, oxidative phosphorylation, glycolysis and Wnt/β-catenin signalling pathways together with marked lipid accumulation supporting our hypothesis that multiple pathway dysregulation detrimentally impacts lipid management. This is the first study of MO programming of the nonhuman primate fetal liver using unbiased transcriptome analysis to detect changes in hepatic gene expression levels and identify potential miRNA epigenetic regulators of metabolic disruption.

This article is protected by copyright. All rights reserved

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Kinesin 6 Regulation in Drosophila Female Meiosis by the Non-conserved N- and C- Terminal Domains

Bipolar spindle assembly occurs in the absence of centrosomes in the oocytes of most organisms. In the absence of centrosomes in Drosophila oocytes, we have proposed that the kinesin 6 Subito, a MKLP-2 homolog, is required for establishing spindle bipolarity and chromosome biorientation by assembling a robust central spindle during prometaphase I. Although the functions of the conserved motor domains of kinesins is well studied, less is known about the contribution of the poorly conserved N- and C- terminal domains to motor function. In this study, we have investigated the contribution of these domains to kinesin 6 functions in meiosis and early embryonic development. We found that the N-terminal domain has antagonistic elements that regulate localization of the motor to microtubules. Other parts of the N- and C- terminal domains are not required for microtubule localization but are required for motor function. Some of these elements of Subito are more important for either mitosis or meiosis, as revealed by separation-of-function mutants. One of the functions for both the N- and C-terminals domains is to restrict the CPC to the central spindle in a ring around the chromosomes. We also provide evidence that CDK1 phosphorylation of Subito regulates its activity associated with homolog bi-orientation. These results suggest the N- and C-terminal domains of Subito, while not required for localization to the central spindle microtubules, have important roles regulating Subito, by interacting with other spindle proteins and promoting activities such as bipolar spindle formation and homologous chromosome bi-orientation during meiosis. Supplemental Material available at Figshare: http://ift.tt/2oWC82X

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Editorial Board w/barcode

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Table of Contents

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Can lateral decubitus cause uvular necrosis after general anesthesia?

Uvular necrosis or ulceration is a rare cause of post-operative sore throat after endotracheal intubation (40%) or Laryngeal Mask Airway (7–12%) insertion. Till date, only 17 cases of uvular necrosis have been reported. According to literature, overzealous suctioning, upper GI endoscopy, bronchoscopy via nasal approach, long-term intubation and trans-esophageal echocardiography can cause uvular necrosis (2, 3). Patients present with post-operative severe pain and swollen, elongated, erythematous uvula with odynophagia and dysphagia which require urgent attention and treatment.

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Diagnostic accuracy of radiology (CT, X-ray, US) for predicting difficult intubation in adults: A meta-analysis

The aim of this study was to evaluate the overall accuracy of radiological measurements in prediction of difficult airway and compare the diagnostic value between the radiological measurements and the modified Mallampati score through a meta-analysis of published studies.

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Epidural management for obstetric patient with Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) undergoing emergent cesarean section

Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a rare, autosomal dominant disorder that results from mutations of the NOTCH 3 gene on chromosome 19. The resultant dysfunctional NOTCH 3 protein leads to impaired cerebrovascular autoregulation. CADASIL is characterized by recurrent subcortical ischemic infarcts that can lead to migraine, with or without aura; cognitive problems; seizures; psychiatric symptoms; dementia; walking difficulties; and urinary incontinence [1].

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Flexible gastroendoscope as a rescue device for an anaesthetist

Managing the airway of a patient with temporo-mandibular joint (TMJ) ankylosis is very challenging. Securing the airway by awake fiberoptic bronchoscopy is considered as a gold standard [1]. Easy and ubiquitous availability of the gastroendoscopes in the endoscopy room makes them a good alternative to fiberoptic bronchoscope. So we present a unique case of TMJ ankylosis posted for upper gastrointestinal endoscopy, wherein anaesthesia was given to the patient while the flexible gastroendoscope was also used as a rescue device for emergency airway management.

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Anesthesia management of a newborn with Pena-Shokeir Syndrome

Perinatal diagnosis of Pena-Shokeir Syndrome (PSS) characterized by multiple joint contractures, intrauterine growth retardation, craniofacial deformities, multiple ankyloses, camptodactilia, short umbilical cord, polyhydramnios, and pulmonary hypoplasia is possible up to 14th week of pregnancy with abnormal position of fetal organs, abnormal fetal movements or fetal akinesia and those anomalies which may lead to mortality are considered to provide reasonable criteria for decision of termination of pregnancy [1].

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Efficacy of ultrasound imaging for differential diagnosis of cervical swelling after brachial plexus block for shoulder arthroscopy

Various complications associated with peripheral brachial plexus nerve block have been reported, such as pneumothorax, hemodynamic collapse, and hematoma leading to airway obstruction [1]. Here, we report the successful use of ultrasound imaging in the differential diagnosis of cervical swelling after brachial plexus block for shoulder arthroscopy.

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Obstructive sleep apnea as a risk factor associated with difficult airway management - A narrative review

The association between obstructive sleep apnea (OSA) and difficult airway had been studied in various clinical trials but the relationship between the two conditions has not been clearly established. The objective of this narrative review is to determine if OSA is a risk factor associated with difficult airway.

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Supraglottic airway for upper gastrointestinal endoscopy in children: A review of 10years' experience

Children undergoing diagnostic EGD require deep sedation or general anesthesia [1] [2]. The anesthesiologist may choose to protect the airway with an endotracheal tube, or use sedation using a variety or combinations of sedatives and analgesics, while relying on the patient's native airway, and without airway protection [2] [3]. There can, in these instances, however, be serious cardiorespiratory complications; specifically, apnea, hypoventilation and oxygen desaturation; and hypercarbia from periods of apnea during deep sedation go unmeasured.

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Serratus plane block in thoracoscopic sympathectomy surgery

Video-assisted thoracic surgery (VATS), a minimally invasive procedure, has allowed less impairment of pulmonary function compared with thoracotomy. Besides that, there have been reports of significant acute and chronic pain following it [1].

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Laparoscope surgical Instrument usage to manage an extremely difficult airway

Airway management is an integral part of anaesthesia practice. Technical difficulty to intubate the patient may pose some critical challenges. We encountered one such case, a smiling girl of 6years posted for 2nd stage palatal fistula repair. Her tongue was attached to the palate (Fig. 1) four weeks back. After explaining the procedure, informed consent and permission to publication was obtained from the parent (mother), patient was prepared for anaesthesia. Surgeon requested for nasal intubation in view of better exposure.

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Ultrasound guided distal adductor canal block provides effective postoperative analgesia in lower leg surgery

In order to provide adequate postoperative analgesia in patients undergoing lower extremity surgeries, blockage of both lumbar and sacral plexus originating nerves are required as part of multimodal analgesia regimens. Block of the sciatic nerve from the popliteal region is a frequently used regional anesthesia/analgesia technique in lower leg surgery. Additionally, saphenous nerve block at the adductor canal level or femoral nerve block may also be included. Runge et al. reported that local anesthetic injected at the distal of the adductor canal around the femoral artery spread both proximally to the saphenous nerve and distally to the popliteal area, around the sciatic nerve in a cadaver model [1].

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Is CPAP treatment not effective after supratentorial craniotomy? Author's reply

We thank the authors for their comments [1] on our study "Efficacy of continuous positive airway pressure and incentive spirometry on respiratory functions during the postoperative period following supratentorial craniotomy: A prospective randomized controlled study" [2], which was published in your journal.

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Intraoperative clevidipine use to manage an acute hypertensive episode in a patient with a simultaneous kidney-pancreatic transplant

Arterial hypertension represents one of the most common diagnoses pathology in general population and usually is associated with a high appearance of complications and an increase in the mortality and morbidity during the perioperative period [1]. Refractory hypertension episodes following a simultaneous kidney-pancreatic transplant (SKPT) are not described by the current literature, and usually are associated with a multifactorial pathogenesis (immunosuppressive drugs use, chronic allograft dysfunction, genetic susceptibility or vascular complications) [2].

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The correlation of the depth of anesthesia and postoperative cognitive impairment: A meta-analysis based on randomized controlled trials

To comprehensively evaluate the associations between the depth of anesthesia and postoperative delirium (POD) or postoperative cognitive dysfunction (POCD).

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Ultrasound guided low thoracic erector spinae plane block for management of acute herpes zoster

Interfascial plane blocks have become very popular in recent years. A novel interfascial plane block, erector spinae plane (ESP) block can target the dorsal and ventral rami of the thoracic spinal nerves but its effect in neuropathic pain is unclear [1]. If acute pain management for herpes zoster is not done aggressively, it can turn into chronic pain. However; ESP block is first described as inject local anesthetics around the erector spinae muscle at the level of T5 spinous process for thoracic region, if the block is performed at lower levels it could be effective for abdominal and lumbar region [2].

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Anesthetic and pharmacologic considerations in perioperative care of obese children

Anesthetic management of obese pediatric patients is challenging. With increasing prevalence of childhood obesity, more severely obese children with comorbidities present for surgery every day. The purpose of this review is to provide an up-to-date comprehensive narrative review on the impact of pathophysiological changes imposed by pediatric obesity on the perioperative management of obese children, especially drug dosing. This knowledge is necessary to provide safe delivery of anesthesia for severely obese children.

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Anesthetic management of an adult patient with Cor Triatriatum Sinistrum: Utility of transesophageal echocardiography

Cor Triatriatum Sinistrum (CTS) is an uncommon congenital cardiac defect, reported in 0.1% to 0.4% of patients with congenital heart disease, and which results from the division of the left atrium into two chambers by a perforated fibromuscular septum [1]. CTS is commonly diagnosed in childhood, though cases with incomplete or fenestrated membranes may remain asymptomatic throughout adulthood.

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Ultrasound guided erector spinae block for postoperative analgesia in pediatric nephrectomy surgeries

Erector spinae block (ESB) is a newly identified regional anesthesia technique, which became popular between the clinicians for its ease and relatively safer administration [1]. There were quite many cases reporting its use for many different indications in adults. By far its use in pediatric cases was just defined for thoracic surgery [2,3]. We would like to share our experience about the use of ESB for postoperative analgesia in two pediatric cases undergoing nephrectomy for Wilms tumor. Written informed consent of all patients' parents was provided for using data of the children in this report.

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Huge Bursitis associated with Scapular Osteochondroma Presenting as a Giant Mass of the Chest Wall: A Case Presentation

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Editorial Board

Publication date: March 2018
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms, Volume 1861, Issue 3





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Scientific Session of the 16th World Congress of Endoscopic Surgery, jointly hosted by Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) & Canadian Association of General Surgeons (CAGS), Seattle, Washington, USA, 11–14 April 2018

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Optimal time of resuming anticoagulant after endoscopic sphincterotomy in patients at risk for thromboembolism: a retrospective cohort study

Abstract

Background

One major adverse event of endoscopic sphincterotomy (EST) is bleeding, which could be more common and severe in patients receiving anticoagulant therapy. However, the cessation of anticoagulants for long periods could lead to thromboembolic events. We aimed to evaluate the optimal timing of resumption of anticoagulants after EST in patients at risk for thromboembolism.

Materials and methods

From January 2010 through October 2017, a retrospective cohort at risk for thromboembolism who had taken warfarin and bridging therapy with heparin around EST from three tertiary hospitals in South Korea was investigated. The primary outcome was to compare the incidence of post-EST delayed bleeding according to the resumption time of anticoagulant. The secondary outcome was to investigate any thromboembolic adverse events related to interruption of the anticoagulant.

Results

A total of 96 patients (46 males and 50 females; median age 75 years [range, 24–91 years]) were enrolled. Overall, the patient numbers of very early (< 24 h), early (24–48 h), and late resumption (> 48 h) of anticoagulant after EST were 56, 23, and 17, respectively. The baseline characteristics were similar between groups except resumption time of anticoagulant. There was no significant difference in the rate of post-EST delayed bleeding (5% in very early group vs. 9% in early group vs. 0 in late group, p = 0.47). The rate of thromboembolic adverse events was significantly higher in the late resumption of anticoagulant group (0 vs. 0 vs. 24%, p < 0.001).

Conclusion

There was no significant difference in the incidence of post-EST delayed bleeding according to the resuming time of anticoagulant. Since long cessation of anticoagulant could increase the risk of thrombotic adverse events, the early resumption of anticoagulant seems to be preferred.

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Scientific Session of the 16th World Congress of Endoscopic Surgery, jointly hosted by Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) & Canadian Association of General Surgeons (CAGS), Seattle, Washington, USA, 11–14 April 2018

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Computer-assisted 3D bowel length measurement for quantitative laparoscopy

Abstract

Background

This study aimed at developing and evaluating a tool for computer-assisted 3D bowel length measurement (BMS) to improve objective measurement in minimally invasive surgery. Standardization and quality of surgery as well as its documentation are currently limited by lack of objective intraoperative measurements. To solve this problem, we developed BMS as a clinical application of Quantitative Laparoscopy (QL).

Methods

BMS processes images from a conventional 3D laparoscope. Computer vision algorithms are used to measure the distance between laparoscopic instruments along a 3D reconstruction of the bowel surface. Preclinical evaluation was performed in phantom, ex vivo porcine, and in vivo porcine models. A bowel length of 70 cm was measured with BMS and compared to a manually obtained ground truth. Afterwards 70 cm of bowel (ground truth) was measured and compared to BMS.

Results

Ground truth was 66.1 ± 2.7 cm (relative error + 5.8%) in phantom, 65.8 ± 2.5 cm (relative error + 6.4%) in ex vivo, and 67.5 ± 6.6 cm (relative error + 3.7%) in in vivo porcine evaluation when 70 cm was measured with BMS. Using 70 cm of bowel, BMS measured 75.0 ± 2.9 cm (relative error + 7.2%) in phantom and 74.4 ± 2.8 cm (relative error + 6.3%) in ex vivo porcine evaluation. After thorough preclinical evaluation, BMS was successfully used in a patient undergoing laparoscopic Roux-en-Y gastric bypass for morbid obesity.

Conclusions

QL using BMS was shown to be feasible and was successfully translated from studies on phantom, ex vivo, and in vivo porcine bowel to a clinical feasibility study.

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Scientific Session of the 16th World Congress of Endoscopic Surgery, jointly hosted by Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) & Canadian Association of General Surgeons (CAGS), Seattle, Washington, USA, 11–14 April 2018: Video Loop Videos

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Clinicopathological features and endoscopic findings of HER2-positive gastric cancer

Abstract

Background

Human epidermal growth factor receptor 2 (HER2) expression in gastric cancer is highly heterogeneous. Therefore, it is important to take endoscopic samples from appropriate tumor sites.

Methods

Between January 2008 and April 2015, patients with gastric or gastroesophageal junction cancer with histologically confirmed adenocarcinoma were included. Surgical samples or endoscopic biopsy samples were examined for HER2 using immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH). Tissues were considered to be HER2 positive when either assessment revealed either an IHC score of 3+ or an IHC score of 2+ accompanied by a positive FISH result. Endoscopic findings were retrieved in all cases where available, and we examined the portion from which a biopsy was obtained.

Results

Out of the 612 patients included in the study, 104 (17%) were HER2 positive. The proportion of HER2-positive gastric tumors with differentiated (vs. undifferentiated) histology was significantly higher (29 vs. 6%, respectively; p < 0.001). The HER2-positive rate of papillary adenocarcinomas (vs. tubular) was particularly high (62%, 8/13; p = 0.023). The proportion of HER2-positive gastric tumors of Borrmann classification 0 or 1 was significantly higher than that of tumors of classified as 2, 3, or 4 (45 vs. 16%, respectively; p < 0.001). The HER2-positive rates per biopsy specimen from the superficial spreading portion, ulcer mound, ulcer bed, and mass portion were 100, 91, 45, and 100%, respectively.

Conclusions

HER2-positive gastric cancer tends to be associated with a differentiated histology, particularly papillary adenocarcinoma, and a Borrmann classification of 0 or 1 tumors. Based on these endoscopic findings, it is important to recognize the superficial spreading portion and the mass portion of gastric malignancies.

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Evaluation of a novel electrosurgical sealing mode in an ex vivo and in vivo porcine model

Abstract

Background

Bipolar vessel sealing has been successfully introduced in a variety of procedures like prostatectomy, hysterectomy, and nephrectomy. In this study, we evaluated a new sealing mode—the thermoSEAL^® mode (TSM)—operated with the VIO3 generator in an ex vivo and in vivo animal study and compared the results with the commercially available BiClamp mode (BCM), operated with the VIO300D generator. Two different instruments were used in combination with both modes, BiCision^® and BiClamp^® 201T (Erbe Elektromedizin GmbH).

Methods

In the ex vivo experiment, the sealing of renal arteries was evaluated using both instruments and modes. For the in vivo study, different types of arteries and veins were sealed using both modes and instruments in a side-by-side comparison for acute complications in a total of four animals.

Results

Mean burst pressure was in all cases significantly above 360 mmHg (p < 0.001). Sealing time during the ex vivo setting was significantly shorter for TSM compared to BCM: BiCision^® (3.7 ± 0.4 vs. 7.1 ± 0.3 s; p < 0.0001); BiClamp^® 201T (3.9 ± 0.3 vs. 5.1 ± 1.1 s; p < 0.0015). Lateral thermal damage was more pronounced for BCM: BiCision^® (TSM 1.4 ± 0.3 mm vs. BCM 1.9 ± 0.2 mm; p < 0.0001); BiClamp^® 201T (TSM 1.9 ± 0.6 mm vs. BCM 3.1 ± 0.6 mm; p < 0.0001). The sealing time during the in vivo study was significantly shorter for TSM in combination with BiCision^® for arteries [TSM 3.0 ± 0.7 s vs. BCM 6.5 ± 1.3 s, (p < 0.0001) and veins 3.2 ± 1.1 vs. 5.8 ± 1.8 s, (p < 0.0001)]. No significant differences were seen for the two modes used with BiClamp^® 201T [artery: TSM 3.3 ± 0.7 s vs. BCM 3.4 ± 0.9 s, (p = 0.891)]. High sealing rates for arteries (100%) and veins (>90%) were noted for both instruments and modes.

Conclusions

While both modes used with two different instruments reveal high safety characterized by a high burst pressure, low thermal damage (ex vivo) zones, and high sealing rates (in vivo), the thermoSEAL^® mode convinces by its fast sealing speed probably helping to reduce operation time.

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Endoscopic gastrojejunostomy revision is more effective than medical management alone to address weight regain after RYGB

Abstract

Background

Weight regain after bariatric roux-en-y gastric bypass affects up to 30% of individuals. Revisional surgery is risky, and is typically avoided in favor of dietary and psychological management. Endoscopic gastrojejunostomy revision is a low-morbidity, outpatient procedure that may be more effective than medical management alone for regain after gastric bypass.

Methods

Two patient cohorts were retrospectively assembled. Both groups had gastric bypass, regained weight, and were cleared for revision by their surgeon, dietician, and psychologist. The revision group underwent the procedure, and the no-revision group did not, typically due to insurance issues. Weights from pre-bypass to 2 years post-revision, obesity-related comorbidities, and intraoperative factors were collected and analyzed.

Results

There were 41 patients included in the revision group and 14 in the no-revision group. Up to the time of revision procedure, body mass index, and % excess weight loss between groups were similar. After revision, the groups diverged over a 2-year period, with improvement seen in the revision group and worsening in the no-revision group. The revision group showed overall improvement in comorbidities compared to the no-revision group. Analysis of intraoperative factors suggests that gastric pouch restriction in addition to stoma diameter reduction may promote weight loss.

Conclusions

In this retrospective study, endoscopic revision provided significantly greater weight loss compared to medical management alone. Results show that revision can help resolve obesity-related comorbidities. Analysis of intraoperative factors suggests that pouch reduction at time of stoma revision may improve weight loss.

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Erratum to: First human use of hybrid synthetic/biologic mesh in ventral hernia repair: a multicenter trial

Some values in the pages 1, 3, and 5 of the original article are corrected and also an updated Table 5 is displayed.

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No meditation-related changes in the auditory N1 during first-time meditation

Publication date: Available online 6 March 2018
Source:International Journal of Psychophysiology
Author(s): L.J. Barnes, G.M. McArthur, B.A. Biedermann, P. de Lissa, V. Polito, N.A. Badcock
Recent studies link meditation expertise with enhanced low-level attention, measured through auditory event-related potentials (ERPs). In this study, we tested the reliability and validity of a recent finding that the N1 ERP in first-time meditators is smaller during meditation than non-meditation – an effect not present in long-term meditators. In the first experiment, we replicated the finding in first-time meditators. In two subsequent experiments, we discovered that this finding was not due to stimulus-related instructions, but was explained by an effect of the order of conditions. Extended exposure to the same tones has been linked with N1 decrement in other studies, and may explain N1 decrement across our two conditions. We give examples of existing meditation and ERP studies that may include similar condition order effects. The role of condition order among first-time meditators in this study indicates the importance of counterbalancing meditation and non-mediation conditions in meditation studies that use event-related potentials.



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The effects of two different doses of ultraviolet-A light exposure on nitric oxide metabolites and cardiorespiratory outcomes

Abstract

Purpose

The present study investigated different doses of ultraviolet-A (UV-A) light on plasma nitric oxide metabolites and cardiorespiratory variables.

Methods

Ten healthy male participants completed three experimental conditions, 7 days apart. Participants were exposed to no light (CON); 10 J cm² (15 min) of UV-A light (UVA10) and 20 J cm² (30 min) of UV-A light (UVA20) in a randomized order. Plasma nitrite [NO₂⁻] and nitrate [NO₃⁻] concentrations, blood pressure (BP), and heart rate (HR) were recorded before, immediately after exposure and 30 min post-exposure. Whole body oxygen utilization ( \(}{\rm O}_{2}\) ), resting metabolic rate (RMR) and skin temperature were recorded continuously.

Results

None of the measured parameters changed significantly during CON (all P > 0.05). \(}{\rm O}_{2}\) and RMR were significantly reduced immediately after UVA10 (P < 0.05) despite no change in plasma [NO₂⁻] (P > 0.05). Immediately after exposure to UVA20, plasma [NO₂⁻] was higher (P = 0.014) and \(}{\rm O}_{2}\) and RMR tended to be lower compared to baseline (P = 0.06). There were no differences in [NO₂⁻] or \(}{\rm O}_{2}\) at the 30 min time point in any condition. UV-A exposure did not alter systolic BP, diastolic BP or MAP (all P > 0.05). UV-A light did not alter plasma [NO₃⁻] at any time point (all P > 0.05).

Conclusions

This study demonstrates that a UV-A dose of 20 J cm² is necessary to increase plasma [NO₂⁻] although a smaller dose is capable of reducing \(}{\rm O}_{2}\) and RMR at rest. Exposure to UV-A did not significantly reduce BP in this cohort of healthy adults. These data suggest that exposure to sunlight has a meaningful acute impact on metabolic function.

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Low pH stress responsive transcriptome of seedling roots in wheat ( Triticum aestivum L.)

Abstract

Soil acidification is one of major problems limiting crop growth and especially becoming increasingly serious in China owing to excessive use of nitrogen fertilizer. Only the STOP1 of Arabidopsis was identified clearly sensitive to proton rhizotoxicity and the molecular mechanism for proton toxicity tolerance of plants is still poorly understood. The main objective of this study was to investigate the transcriptomic change in plants under the low pH stress. The low pH as a single factor was employed to induce the response of the wheat seedling roots. Wheat cDNA microarray was used to identify differentially expressed genes (DEGs). A total of 1057 DEGs were identified, of which 761 genes were up-regulated and 296 were down-regulated. The greater percentage of up-regulated genes involved in developmental processes, immune system processes, multi-organism processes, positive regulation of biological processes and metabolic processes of the biological processes. The more proportion of down-regulation genes belong to the molecular function category including transporter activity, antioxidant activity and molecular transducer activity and to the extracellular region of the cellular components category. Moreover, most genes among 41 genes involved in ion binding, 17 WAKY transcription factor genes and 17 genes related to transport activity were up-regulated. KEGG analysis showed that the jasmonate signal transduction and flavonoid biosynthesis might play important roles in response to the low pH stress in wheat seedling roots. Based on the data, it is can be deduced that WRKY transcription factors might play a critical role in the transcriptional regulation, and the alkalifying of the rhizosphere might be the earliest response process to low pH stress in wheat seedling roots. These results provide a basis to reveal the molecular mechanism of proton toxicity tolerance in plants.

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Casein kinase 2 inhibition impairs spontaneous and oxytocin-induced contractions in late pregnant mouse uterus

New Findings

• What is the central question of this study?

  Does the inhibition of protein kinase CK2 alter the uterine contractility?

• What is the main finding and its importance?

  Inhibition of protein kinase CK2 impaired the spontaneous and oxytocin-induced contractility in late pregnant mouse uterus. This finding suggests that CK2 is a novel pathway mediating oxytocin-induced contractility in the uterus. And thus opens up the possibility for this class of drugs to be developed as new class of tocolytics

Abstract

Protein kinase CK2 (casein kinase 2) is a ubiquitously expressed serine or threonine kinase known to phosphorylate a bulk of substrates. The aim of this study was to assess the effect of casein kinase-2 inhibition on spontaneous and oxytocin-induced uterine contractions in 19-day pregnant mice. The CK2 inhibitor, CX-4945 elicited a concentration-dependent relaxation in late pregnant mouse uterus. CX-4945 and another selective CK2 inhibitor, apigenin also inhibited the oxytocin-induced contractile response in late pregnant uterine tissue. Apigenin blunted the PGF2α response as well, but CX-4945 did not. CK2 was located in the lipid raft fractions of the cell membrane, and disruption of lipid rafts was found to reverse its effect. The results of the current study suggest that casein kinase 2 located in lipid rafts of the cell membrane, is an active regulator of spontaneous as well as oxytocin-induced uterine contractions in the late pregnant mouse.

This article is protected by copyright. All rights reserved

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Recovery of facial expressions using functional electrical stimulation after full-face transplantation

We assessed the recovery of 2 face transplantation patients with measures of complexity during neuromuscular rehabilitation. Cognitive rehabilitation methods and functional electrical stimulation were used to ...

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No association of leg strength asymmetry with walking ability, fatigability, and fatigue in multiple sclerosis

This cross-sectional study aims to determine whether leg strength asymmetries are associated with walking ability, objective measures of fatigability, or subjective perceptions of fatigue. Maximal knee extensor strength was assessed in 19 patients with multiple sclerosis (PwMS), and a symmetry index was calculated. Walking ability was determined through the total distance covered during a 6-min walk test (6MWT) and fatigability by calculating the change in distance covered between minutes 6 and 1. Perceptions of fatigue were assessed using the Fatigue Severity Scale and by obtaining ratings of perceived exertion during the first and final minute of the 6MWT. PwMS covered less distance (P=0.01) and perceived greater exertion (P

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Efficacy of stabilization splint treatment on the oral-health related quality of life – a randomized controlled one-year follow-up trial

Summary

The aim of this randomized controlled trial was to assess the efficacy of stabilization splint treatment on the oral health-related quality of life (OHRQoL) during a one-year follow-up. Originally, the sample consisted of 80 patients (18 men, 62 women) with temporomandibular disorders (TMD) who had been referred to the Oral and Maxillofacial Department, Oulu University Hospital, Finland, for treatment. Patients were randomly designated into splint (n = 39) and control group (n = 41). Patients in the splint group were treated with a stabilization splint. Additionally, patients in both groups received counseling and instructions on masticatory muscle exercises. The patients filled in the Oral Health Impact Profile-14 (OHIP-14) questionnaire before treatment and at 3 months, 6 months and 1 year. At total, 67 patients (35 in the splint group vs. 32 in the control group) completed the questionnaire at baseline. The outcome variables were OHIP prevalence, OHIP severity and OHIP extent. Linear mixed-effect regression model was used to analyze factors associated with change in OHIP severity during the one-year follow-up, taking into account treatment time, age, gender, and group status. OHIP prevalence, severity and extent decreased in both groups during the follow-up. According to linear mixed-effect regression, decrease in OHIP severity did not associate significantly with group status. Compared to masticatory muscle exercises and counseling alone, stabilization splint treatment was not more beneficial on self-perceived OHRQoL among TMD patients over a one-year follow up.

This article is protected by copyright. All rights reserved.

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Cardiac Arrest in the Operating Room: Part 2—Special Situations in the Perioperative Period Erratum

No abstract available

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Utilizing Patient E-learning in an Intervention Study on Preoperative Smoking Cessation

BACKGROUND: Patients who smoke put themselves at increased risk for serious surgical complications, yet it is not currently routine practice to educate patients about the risk of complications due to smoking. Computer-based smoking cessation programs are increasingly being utilized in the general population and may overcome some of the barriers such as lack of time, knowledge, and training to provide interventions. Our objective was to develop and implement a patient e-learning program designed for surgical patients as part of a multifaceted program aimed at assisting them to quit smoking and to determine the factors cross-sectionally and longitudinally associated with abstinence. METHODS: In this prospective multicenter study, smokers undergoing elective noncardiac surgery participated in a preoperative smoking cessation program consisting of a patient e-learning program, brief advice, educational pamphlet, tobacco quitline referral, letter to the primary care physician, and pharmacotherapy. The patient e-learning program described (1) the benefits of quitting smoking before surgery; (2) how to quit smoking; and (3) how to cope while quitting. The 7-day point prevalence (PP) abstinence on the day of surgery and at 1, 3 and 6 six months after surgery was separately assessed, and factors most associated with abstinence were identified using multivariable logistic regression analysis. Generalized estimating equation methods were used to estimate effect of the factors associated with abstinence longitudinally. The reach of the program was assessed with the number of smokers who participated in the program versus the number of patients who were referred to the program. RESULTS: A total of 459 patients (68.9% of eligible patients) participated. The 7-day PP abstinence at day of surgery, 1 month, 3 months, and 6 months was 22%, 29%, 25%, and 22%, respectively. The variables predicting abstinence at 6 months were use of pharmacotherapy (odds ratio [OR], 7.32; 95% confidence interval [CI], 3.71–14.44; P

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Retraction Notice

No abstract available

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Lack of Translatable Proinflammatory Cytokines in Cerebrospinal Fluid in Rats With Increased Hyperalgesia With or Without Fentanyl Treatment

No abstract available

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In Response

No abstract available

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In Response

No abstract available

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Complications of Regional Anesthesia, 3rd ed

No abstract available

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Perioperative Cardiac Arrest: Focus on Malignant Hyperthermia (MH) Erratum

No abstract available

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Monitoring the Nervous System for Anesthesiologists and Other Health Care Professionals, 2nd ed

No abstract available

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Usefulness of Basophil Activation Tests for Diagnosis of Sugammadex-Induced Anaphylaxis

BACKGROUND: Sugammadex is used to reverse the effects of neuromuscular blocking agents in many cases of general anesthesia. However, there are several reports of anaphylaxis after its use. Skin testing is the gold standard for detecting the causative agent of anaphylaxis. However, due to the lack of validated protocols for skin testing with sugammadex, the diagnostic accuracy might be inadequate. Recently, the basophil activation test (BAT) has been established as a tool to detect the causative agent of anaphylaxis with high sensitivity and specificity. However, few studies have investigated the utility of the BAT for sugammadex-induced anaphylaxis. METHODS: Eight patients who presented with immediate hypersensitivity to sugammadex during general anesthesia were included in this study. We conducted skin tests to confirm the diagnosis of sugammadex-induced anaphylaxis. Twenty-one sugammadex-naive individuals who had a negative skin test for allergy to this drug were enrolled as controls. Basophils were selected on a CD3−/CRTH2+ gate and labeled with CD63 and CD203c. RESULTS: The ratios of activated basophils in the patients were much higher than those in controls: the median values of areas under the curves in the patients and controls for CD203c were 1,265,985 (95% confidence interval [CI], 77,580–5,040,270) and 116,325 (95% CI, −268,605 to 232,690), respectively (Mann-Whitney U test, P

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Perioperative Management May Improve Long-Term Survival in Patients After Lung Cancer Surgery: A Retrospective Cohort Study

BACKGROUND: Surgical resection is the main treatment for patients with non–small–cell lung cancer (NSCLC), but patients' long-term outcome is still challenging. The purpose of this study was to identify predictors of long-term survival in patients after lung cancer surgery. METHODS: Patients who underwent surgery for NSCLC from January 1, 2006, to December 31, 2009, were enrolled into this retrospective cohort study. The primary outcome was the survival length after surgery. Predictors of long-term survival were screened with the multivariable Cox proportional hazard model. RESULTS: Postoperative follow-up was completed in 588 patients with a median follow-up duration of 5.2 years (interquartile range, 2.0–6.8). Two hundred ninety-one patients (49.5%) survived at the end of follow-up with median survival duration of 64.3 months (interquartile range, 28.5–81.6). The overall survival rates were 90.8%, 70.0%, and 57.1% at the end of the first, third, and fifth year after surgery, respectively. Limited resection (hazard ratio [HR], 1.46; 95% confidence interval [CI], 1.08–1.98; P = .013) and large tumor size (HR, 1.29; 95% CI, 1.17–1.42; P

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Variability in Case Durations for Common Surgical Procedures

BACKGROUND: Under the Merit-based Incentive Payment System, physician payment will be adjusted using a composite performance score that has 4 components, one of which is resource use. The objective of this exploratory study is to quantify the facility-level variation in surgical case duration for common surgeries to examine the feasibility of using surgical case duration as a performance metric. METHODS: We used data from the National Anesthesia Clinical Outcomes Registry on 404,987 adult patients undergoing one of 6 general surgical or orthopedic procedures: laparoscopic appendectomy, laparoscopic cholecystectomy, laparoscopic cholecystectomy with intraoperative cholangiogram, knee arthroscopy, laminectomy, and total hip replacement. We constructed separate mixed-effects multivariable time-to-event models (survival analysis) for each of the 6 procedures to model surgical case duration. RESULTS: We identified performance outliers, based on surgical case duration, using 2013 data and then quantified the gap between high- and low-performance outliers using 2014 data. After adjusting for patient risk, patients undergoing surgery at high-performance facilities were between 54% and 79% more likely to exit the operating room (OR) per unit time compared to average-performing facilities, depending on the procedure. For example, patients undergoing a laparoscopic appendectomy at high-performance facilities were 68% more likely to exit the OR per unit time (hazard ratio, 1.68; 95% CI, 1.40–2.02; P

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Letter to the Editor Regarding Tsujikawa and Lipid Emulsion

No abstract available

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The Association Between Timing of Routine Preoperative Blood Testing and a Composite of 30-Day Postoperative Morbidity and Mortality

BACKGROUND: Laboratory testing is a common component of preanesthesia evaluation and is designed to identify medical abnormalities that might otherwise remain undetected. While blood testing might optimally be performed shortly before surgery, it is often done earlier for practical reasons. We tested the hypothesis that longer periods between preoperative laboratory testing and surgery are associated with increased odds of having a composite of 30-day morbidity and mortality. METHODS: We obtained preoperative data from 2,320,920 patients in the American College of Surgeons National Surgical Quality Improvement Program who were treated between 2005 and 2012. Our analysis was restricted to relatively healthy patients with American Society of Anesthesiology physical status I–II who had elective surgery and normal blood test results (n = 235,010). The primary relationship of interest was the odds of 30-day morbidity and mortality as a function of delay between preoperative testing and surgery. A multivariable logistic regression model was used for the 10 pairwise comparisons among the 5 laboratory timing groups (laboratory blood tests within 1 week of surgery; 1–2 weeks; 2–4 weeks; 1–2 months; and 2–3 months) on 30-day morbidity, adjusting for any imbalanced baseline covariables and type of surgery. RESULTS: A total of 4082 patients (1.74%) had at least one of the component morbidities or died within 30-days after surgery. The observed incidence (unadjusted) was 1.7% when the most recent laboratory blood tests measured within 1 week of surgery, 1.7% when it was within 1–2 weeks, 1.8% when it was within 2–4 weeks, 1.7% when it was between 1 and 2 months, and 2.0% for patients with most recent laboratory blood tests measured 2–3 months before surgery. None of the values within 2 months differed significantly: estimated odds ratios for patients within blood tested within 1 week were 1.00 (99.5% confidence interval, 0.89–1.12) as compared to 1–2 weeks, 0.88 (0.77–1.00) for 2–4 weeks, and 0.95 (0.79–1.14) for 1–2 months, respectively. The estimated odds ratio comparing 1–2 weeks to each of 2–4 weeks and 1–2 months were 0.88 (0.76–1.03) and 0.95 (0.78–1.16), respectively. Blood testing 2–3 months before surgery was associated with increased odds of outcome compared to patients whose most recent test was within 1 week (P = .002) and 1–2 weeks of the date of surgery. CONCLUSIONS: In American Society of Anesthesiologists physical status I and II patients, risk of 30-day morbidity and mortality was not different with blood testing up to 2 months before surgery, suggesting that it is unnecessary to retest patients shortly before surgery. Accepted for publication January 5, 2018. Funding: Departmental. 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). The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program are the source of the data used here; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. Reprints will not be available from the authors. Address correspondence to Kurt Ruetzler, MD, Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Ave, P-77, Cleveland, OH 44195. Address e-mail to ruetzlk@ccf.org. © 2018 International Anesthesia Research Society

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Immigrant Generational Status and Developmental Problems among Prematurely Born Children

Abstract

Immigrants in the U.S. often have comparatively favorable health outcomes despite relative socioeconomic disadvantage- a phenomenon termed the Immigrant Paradox. This study examined the relationship between family immigrant status and developmental problems among children born preterm. The 2011–2012 National Survey of Children's Health data collected through a telephone based survey based on parental report of prematurity and other comorbidities were analyzed using multivariate logistic regression analysis to examine seven developmental outcomes. Preterm 1st/2nd generation children had fewer developmental problems than preterm 3rd generation children. Controlling for socioeconomic status and other covariates, 1st/2nd generation children had significantly lower odds of developmental delay, cerebral palsy, epilepsy, and hearing problems. Consistent with the Immigrant Paradox, prematurely born children of immigrants had comparable or better developmental outcomes than preterm children of US born parents despite socioeconomic disadvantage. Further research to explicate mechanisms responsible for the protective health effects observed is warranted.

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A Universal Health Care System? Unmet Need for Medical Care Among Regular and Irregular Immigrants in Italy

Abstract

Italy has a universal health care system that covers, in principle, the whole resident population, irrespective of citizenship and legal status. This study calculates the prevalence of unmet need for medical care among Italian citizens, regular and irregular immigrants and estimates logistic regression models to assess whether differences by citizenship and legal status hold true once adjusting for potential confounders. The analysis is based on two Surveys on Income and Living Conditions of Italian households and households with foreigners. Controlling for various factors, the odds of experiencing unmet need for medical care are 27% higher for regular immigrants than for Italian citizens and 59% higher for irregular immigrants. The gaps by citizenship and legal status are even more striking among those with chronic illnesses. These results reveal the high vulnerability of immigrants in Italy and the need to develop more effective policies to achieve health care access for all residents.

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Erratum to: Sex Differences and Predictors of Changes in Body Weight and Noncommunicable Diseases in a Random, Newly-Arrived Group of Refugees Followed for Two Years

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Prevalence and Correlates of Psychological Distress and Psychiatric Disorders in Asylum Seekers and Refugees Resettled in an Italian Catchment Area

Abstract

In recent years there has been a progressive rise in the number of asylum seekers and refugees displaced from their country of origin, with significant social, economic, humanitarian and public health implications. The aim of this study is to describe the frequency and correlates of psychological distress and psychiatric disorders in asylum seekers and refugees resettled in an Italian catchment area. In the catchment area of Verona, all male asylum seekers and refugees aged 18 or above included in the Italian protection system for asylum seekers and refugees during a period of 1 year were screened for psychological distress and psychiatric disorders using validated questionnaires. During the study period, 109 asylum seekers or refugees were recruited. The frequency of traumatic events experienced was very high. More than one-third of the participants (36%) showed clinically relevant psychological distress, and one-fourth (25%), met the criteria for a psychiatric diagnosis, mainly PTSD and depressive disorders. In multivariate analyses, time after departure, length of stay in the host country and number of traumatic events were independent factors associated with psychological distress and psychiatric disorders. In an unselected sample of male asylum seekers and refugees, after around 1 year of resettlement in an Italian catchment area, the frequency of psychological distress and psychiatric disorders was substantial and clinically relevant. Health care systems should include a mental health component to recognise and effectively treat mental health conditions.

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Parent Perceptions of Child Weight Status in Mexican-Origin Immigrant Families: An Investigation of Acculturation, Stress, and Coping Factors

Abstract

Parents often underestimate their child's weight status, particularly when the child is overweight or obese. This study examined acculturation, stress, coping, and involuntary responses to stress and their relation to estimation of child's weight status among Mexican-origin immigrant families. Eighty-six families provided data on child's height and weight, caregiver's perception of their child's weight status, and caregiver's responses to acculturation, stress, and coping scales. Parents underestimated their child's weight status, particularly when the child was overweight or obese. Although acculturation and stress were not associated with accuracy, parents' responses to stress were linked to parent perceptions. Parents who reported more frequent use of involuntary engagement (e.g., rumination, physiological arousal) were more accurate. Future research, as well as healthcare providers, should consider how parents manage and respond to stress in order to fully understand the factors that explain weight perceptions among Mexican-origin immigrant parents.

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Diabetes in Immigrant Tibetan Muslims in Kashmir, North India

Abstract

Tibetan Muslims have migrated from Lhasa (3000 m altitude) to Srinagar, India (altitude 1500 m) about 55 years back. We set out to study the prevalence of diabetes and prediabetes among this immigrant population. All consenting adults aged ≥18 years were questioned about a previous history of diabetes or any other medical history. Anthropometric data were recorded. Fasting blood glucose was measured in duplicate by Accu-check glucometer and HbA1C levels were measured. Of the 281 participants, 26 (9.25%) had diabetes whereas 46 (16.4%) had pre-diabetes; 24 reporting doctor-diagnosed diabetes. Participants with diabetes/pre-diabetes were more likely to be obese, smokers and hypertensive. Multiple logistic regression analysis revealed age to be significantly associated with a higher prevalence of diabetes. One in four adults ≥18 years among Tibetan Muslims have diabetes or prediabetes. Migration to lower altitude could have contributed to this high prevalence.

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Syndemic Conditions Reinforcing Disparities in HIV and Other STIs in an Urban Sample of Behaviorally Bisexual Latino Men

Abstract

Syndemics research has made great contributions to understanding sexual risk among Latino men who have sex with men. However, such work often combines data for behaviorally bisexual men with data for men with exclusively same-sex partners. Using cross-sectional data from 148 behaviorally bisexual Latino men, this study explored the impact of syndemic factors—polydrug use, childhood sexual abuse, and depression—on sexual risk behaviors and STI incidence. Approximately one-third of participants reported polydrug use, 22% reported childhood sexual abuse, and 26% screened for clinically significant depressive symptoms. An increase in syndemic factors was associated with increased odds of lifetime STI incidence and condomless receptive anal intercourse with men; however, the model did not predict condomless insertive anal intercourse with men or condomless vaginal intercourse. More efforts are needed to explore the varying mechanisms, including but not restricted to the combined impact of syndemic conditions, that influence sexual risk in this population.

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Seroprevalence of Histoplasmosis in Somali, Burmese, and Hmong Refugees Residing in Thailand and Kenya

Abstract

Histoplasmosis is known to be endemic to the Midwestern United States, but cases have been reported throughout much of the world. Somali, Hmong, and Burmese (ethnically Karen) persons make up some of the largest refugee populations coming the United States in recent years. Yet, information about risk of Histoplasma capsulatum infection amongst these populations is limited. This study used the CDC Migrant Serum Bank to test ~100 samples from each of Somali, Burmese, and Hmong U.S.-bound refugees. Samples were tested by enzyme immunoassay for Histoplasma capsulatum IgG. Overall 1% (2/299) of refugee serum samples were positive for H. capsulatum IgG. One of 99 samples obtained from Hmong refugees was positive, and the other positive sample came from among 100 Burmese refugee samples. H capsulatum IgG positivity was detected at low levels in Hmong and Burmese refugees. No IgG positivity was detected among 100 Somali refugees.

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Psychosocial Indicators in North African Immigrant Women in Italy

Abstract

The present research evaluated the psychosocial health and quality of life of North African (NA) immigrant women living in Italy. A survey of 205 NA-born and Italian-born women was carried out. Psychosocial, sociodemographic and migration data were collected. Anthropometric indices were computed by direct measurements of height, weight, waist and hip circumferences. Multivariate analysis showed that the main explanatory variable for all dimensions of psychosocial status was the migrant status. Other explanatory variables were educational level and number of children for psychological discomfort, and weight status for well-being, quality of life and stress. Anthropometric indices were explanatory variables for quality of life. In conclusion, this study provides further evidence of higher psychological stress and discomfort and lower well-being and quality of life in immigrant women. Public social support is necessary to control, maintain and improve the mental health outcomes of immigrant communities in the host country.

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NMDA receptor-gated visual responses in hippocampal CA1 neurons

Abstract

Hippocampal processing of environmental information is critical for hippocampus-dependent brain functions that result from experience-induced hippocampal plasticity, such as memory acquisition and storage. Hippocampal responses to sensory stimulation have been extensively investigated, particularly with respect to spike activity. However, the synaptic mechanism for hippocampal processing of sensory stimulation has been much less understood. Here, we performed in vivo whole-cell recording on hippocampal CA1 pyramidal cells (PCs) from adult rodents to examine CA1 responses to a flash of visual stimulation. We first found in recordings obtained at resting potentials that ∼30% of CA1 PCs exhibited significant excitatory/inhibitory membrane-potential (MP) or membrane-current (MC) responses to the flash stimulus. Remarkably, in other (∼70%) CA1 PCs, although no responses could be detected at resting potentials, clear excitatory MP or MC responses to the same flash stimulus were observed at depolarizing potentials, and these responses were further found to depend on NMDA receptors. Our findings demonstrate the presence of NMDA receptor-mediated gating of visual responses in hippocampal CA1 neurons, a synaptic mechanism for hippocampal processing of sensory information that may play important roles in hippocampus-dependent functions such as learning and memory.

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