Παρασκευή 11 Μαΐου 2018

Changes in Health Insurance Coverage and Barriers to Health Care Access Among Individuals with Serious Psychological Distress Following the Affordable Care Act

Abstract

The Affordable Care Act (ACA) aims to expand health insurance coverage and minimize financial barriers to receiving health care services for individuals. However, little is known about how the ACA has impacted individuals with mental health conditions. This study finds that the implementation of the ACA is associated with an increase in rate of health insurance coverage among nonelderly adults with serious psychological distress (SPD) and a reduction in delaying and forgoing necessary care. The ACA also reduced the odds of an individual with SPD not being able to afford mental health care. Mental health care access among racial and ethnic minority populations and people with low income has improved during 2014–2016, but gaps remain.



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Paramedic - University of Colorado Hospital

Paramedic responds to calls for emergency medical services and provides patient care as directed and/or determined necessary. Contact [Marci.Miller@uchealth.org](mailto:Marci.Miller@uchealth.org) regarding upcoming interview events and Paramedic opportunities. **Requirements** - High School diploma or GED. - National Certification as defined by the unit certification list. - Current State Licensure ...

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The domino SWI2/SNF2 Gene Product Represses Cell Death in Drosophila melanogaster

The Drosophila domino locus encodes DNA-dependent ATPases of the SWI2/SNF2 class. This class of chromatin remodeler is associated with an array of cellular activities encompassing transcription, replication, repair and recombination. Moreover, domino was observed initially to maintain a repressive chromatin state via genetic interaction studies with homeotic genes. Although domino mutations were also characterized with a cell death phenotype, its association with a death pathway has not been investigated. Here we have used targeted RNA interference to depress domino function in the wing. Resultant wing damage phenotypes were found to be enhanced through overexpression of pro-apoptotic loci, and suppressed through loss of function of these loci. Loss of wing margin and blade tissue was correlated with activation of the effector Caspase Dcp-1, a marker for apoptosis. The affected wing regions also exhibited lower levels of the DIAP1 protein, an inhibitor of apoptosis. The lower level of DIAP1 protein was not correlated with an effect on the activity of a DIAP1 gene transgenic reporter (thread-LacZ), suggesting that loss of DIAP1 occurred post transcriptionally. In some cases excessive cell proliferation within the targeted tissue, measured through BrdU incorporation, was also observed. Finally, we used a transgenic reporter construct to monitor the chromatin state upstream of the proapoptotic reaper locus. In genotypes exhibiting targeted domino loss and wing phenotypes, we observed increased reporter activity only in the affected areas. These data support the conclusion that domino normally functions to maintain pro-apoptotic genes in a repressed state.



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NMR metabolomic study of blood plasma in ischemic and ischemically preconditioned rats: an increased level of ketone bodies and decreased content of glycolytic products 24 h after global cerebral ischemia

Abstract

Cardiac arrest is one of the leading causes of death among adults in older age. Understanding mechanisms how organism responds to ischemia at global level is essential for the prevention and ischemic patient's treatment. In this study, we used a global cerebral ischemia induced by four-vessel occlusion as an established animal model for ischemic stroke to investigate metabolic changes after 24 h reperfusion, when transitions occur due to the onset of delayed neuronal death. We also focused on the endogenous phenomenon known as ischemic tolerance by the pre-ischemic treatment. The experiments were carried out on blood plasma samples as easily available and metabolically reflecting the overall changes in injured organism. Our results imply that disturbed glycolysis pathway, as a consequence of ischemic injury, leads to the increased level of ketone bodies (acetone, acetoacetate and β-hydroxybutyrate) along with increased utilization of triacylglycerols in plasma of ischemic and ischemically preconditioned rats. Complementary to, a decreased level of glycolytic intermediates (lactate, pyruvate, acetate) with increased level of glucose was found in ischemic and preconditioned animals. The protective effect of ischemic preconditioning on metabolome recovery was demonstrated by significantly increased level of creatine compared to ischemic, non-preconditioned rats. We also document that acetoacetate, pyruvate, lactate, and leucine have the best discriminatory power between ischemic and control plasma. Conclusively, our results provide evidence that NMR spectra analysis can identify specific group of metabolites present in plasma with the capability for discrimination between individual groups of animals. In addition, an excellent feasibility for the statistical discrimination among ischemic, preconditioned, and control rats can be applied regardless of native or deproteinated plasma and also regardless of noesy or cpmg NMR acquisition.



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Motor innervation pattern of labral muscles of Locusta migratoria

Abstract

The current study investigates the motor innervation pattern of labral muscles in the adult locust and tries to interpret the results in the light of the hypothesis that the labrum phylogenetically developed by the fusion of paired appendages associated with the intercalary segment. Using Neurobiotin™ as a retrograde neuronal tracer, specific motor nerves or individual labral muscles were stained. Results show that the labral muscles receive innervation from tritocerebrum and suboesophageal ganglion. The axons of many motor neurons use three different pathways to cross the midline in the periphery to innervate ipsi- and contralateral muscles. Intracellular recordings from fibers of individual muscles and simultaneous recordings from motor neurons imply that the labral muscles lack inhibitory innervation. The location of motor neurons in both tritocerebrum and suboesophageal ganglion supports the notion that the labrum is innervated by the so-called intercalary segment. That many of the efferent axons cross the midline in the periphery might be explained by the hypothesis that the labrum derives from a fusion of appendages.



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Why extragastric deep-type buried bumper syndrome should (not) be a contraindication for endoscopic treatment?



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Rare Complication of Permanent Indwelling Transmural Plastic Stent



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Why extragastric deep-type buried bumper syndrome should (not) be a contraindication for endoscopic treatment?



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Rare Complication of Permanent Indwelling Transmural Plastic Stent



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Electrophysiological correlates of timbre imagery and perception

Publication date: Available online 11 May 2018
Source:International Journal of Psychophysiology
Author(s): Przemysław Tużnik, Paweł Augustynowicz, Piotr Francuz
The primary objective of the present study was to verify whether the differences in imagined timbre are reflected by the event-related potentials (ERPs). It was verified the hypotheses that imagining of sounds, varying in spectral characteristics of timbre, influence the amplitude of the late positive component (LPC), associated with auditory imagery-related processes. It was also verified whether the manipulation of the perceived timbre corresponds to the amplitude fluctuations of the auditory evoked potentials (AEPs) N1 and P2. Also, it was expected that the amplitudes of the LPC, N1 and P2 components depend on musical expertise.Musicians and non-musicians took part in two experiments, each of which involved timbre manipulation in term of one parameter of the sound spectrum – spectral centroid or spectral irregularity. Each experiment consisted of auditory perception task followed by auditory imagery training and auditory imagery task.The present study showed that differences in perceived timbre associated with spectral centroid and spectral irregularity are reflected by fluctuations in the amplitude of the N1 and P2 potentials. Perceived differences in spectral centroid are sufficiently distinctive that generation of auditory images of sounds differing in this property induces changes in the amplitude of the late positive component (LPC), recorded during auditory imagery. This means that the LPC is sensitive to changes in the timbre of the imagined sound. Musicians are more accurate in performing auditory imagery task related to timbre than non-musicians. However, musical expertise does not affect the amplitude of the N1, P2 and LPC potentials.



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North Dakota selects ESO to create statewide data repository for EMS agencies

System enables collaborative data input and sharing to drive performance improvement, injury prevention and better outcomes for North Dakota communities AUSTIN — ESO, the leading data and software company serving emergency medical services (EMS), fire departments and hospitals, today announced it is partnering with North Dakota to create a data repository to collect and analyze EMS patient care ...

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American Academy of Physical Medicine and Rehabilitation Position Statement on Opioid Prescribing



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Both High and Low Maternal Thyroid Function Are Associated with Child Autistic Spectrum Disorders, While Only Hypothyroxinemia Is Associated with Child ADHD

Clinical Thyroidology, Volume 30, Issue 5, Page 220-222, May 2018.


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More Dynamic Diagnostic Criteria Are Needed to Define Noninvasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP)

Clinical Thyroidology, Volume 30, Issue 5, Page 200-202, May 2018.


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Noninvasive Follicular Thyroid Neoplasms With Papillary-like Nuclear Features (NIFTP) Show Molecular and Clinical Similarity to Follicular Adenomas

Clinical Thyroidology, Volume 30, Issue 5, Page 203-205, May 2018.


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TSH Stimulation Increases DOTATATE Scanning Sensitivity but Decreases Its Sensitivity for Follicular-Cell–Derived Thyroid Cancer Metastases

Clinical Thyroidology, Volume 30, Issue 5, Page 226-229, May 2018.


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Using the American College of Radiology Thyroid Imaging Reporting and Data System Will Decrease the Number of Thyroid Nodule Biopsies While Improving Diagnostic Accuracy

Clinical Thyroidology, Volume 30, Issue 5, Page 206-209, May 2018.


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Neonatal TSH <0.90 mIU/L Increases the Risk for Hyperthyroidism in Infants of Mothers with Graves’ Disease

Clinical Thyroidology, Volume 30, Issue 5, Page 217-219, May 2018.


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Minimal Extrathyroidal Extension Carries a Modest Increase for Recurrence but Not Mortality in Differentiated Thyroid Cancer

Clinical Thyroidology, Volume 30, Issue 5, Page 210-212, May 2018.


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Radioactive Iodine Ablation Decreases Serum Anti-Müllerian Hormone Concentrations (as a Marker of Ovarian Reserve) in Women with Thyroid Cancer

Clinical Thyroidology, Volume 30, Issue 5, Page 223-225, May 2018.


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Management of Thyroid Nodules in Post-Septuagenarians Needs to Consider Coexistent Serious Diseases

Clinical Thyroidology, Volume 30, Issue 5, Page 213-216, May 2018.


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Does the Level of Certain Thyroidal mRNAs Change with Age?

Clinical Thyroidology, Volume 30, Issue 5, Page 230-233, May 2018.


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Long-Term, Low-Frequency Cluster of a German-Imipenemase-1-Producing Enterobacter hormaechei ssp. steigerwaltii ST89 in a Tertiary Care Hospital in Germany

Microbial Drug Resistance, Ahead of Print.


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Dissemination of VanA-Type Enterococcus faecium Isolates in Hungary

Microbial Drug Resistance, Ahead of Print.


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Salmonella Species' Persistence and Their High Level of Antimicrobial Resistance in Flooded Man-Made Rivers in China

Microbial Drug Resistance, Ahead of Print.


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Clustering Analysis of Antibiograms and Antibiogram Types of Streptococcus agalactiae Strains from Tilapia in China

Microbial Drug Resistance, Ahead of Print.


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Turning Up the Heat: An Evaluation of the Evidence for Heating to Promote Exercise Recovery, Muscle Rehabilitation and Adaptation

Abstract

Historically, heat has been used in various clinical and sports rehabilitation settings to treat soft tissue injuries. More recently, interest has emerged in using heat to pre-condition muscle against injury. The aim of this narrative review was to collate information on different types of heat therapy, explain the physiological rationale for heat therapy, and to summarise and evaluate the effects of heat therapy before, during and after muscle injury, immobilisation and strength training. Studies on skeletal muscle cells demonstrate that heat attenuates cellular damage and protein degradation (following in vitro challenges/insults to the cells). Heat also increases the expression of heat shock proteins (HSPs) and upregulates the expression of genes involved in muscle growth and differentiation. In rats, applying heat before and after muscle injury or immobilisation typically reduces cellular damage and muscle atrophy, and promotes more rapid muscle growth/regeneration. In humans, some research has demonstrated benefits of microwave diathermy (and, to a lesser extent, hot water immersion) before exercise for restricting muscle soreness and restoring muscle function after exercise. By contrast, the benefits of applying heat to muscle after exercise are more variable. Animal studies reveal that applying heat during limb immobilisation attenuates muscle atrophy and oxidative stress. Heating muscle may also enhance the benefits of strength training for improving muscle mass in humans. Further research is needed to identify the most effective forms of heat therapy and to investigate the benefits of heat therapy for restricting muscle wasting in the elderly and those individuals recovering from serious injury or illness.



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Comment on: “Talent Identification in Sport: A Systematic Review”



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Perceptual Modification of the Built Environment to Influence Behavior Associated with Physical Activity: Quasi-Experimental Field Studies of a Stair Banister Illusion

Abstract

Background

Re-engineering the built environment to influence behaviors associated with physical activity potentially provides an opportunity to promote healthier lifestyles at a population level. Here we present evidence from two quasi-experimental field studies in which we tested a novel, yet deceptively simple, intervention designed to alter perception of, and walking behavior associated with, stairs in an urban area.

Objectives

Our objectives were to examine whether adjusting a stair banister has an influence on perceptions of stair steepness or on walking behavior when approaching the stairs.

Methods

In study 1, we asked participants (n = 143) to visually estimate the steepness of a set of stairs viewed from the top, when the stair banister was adjusted so that it converged with or diverged from the stairs (± 1.91°) or remained neutral (± 0°). In study 2, the walking behavior of participants (n = 36) was filmed as they approached the stairs to descend, unaware of whether the banister converged, diverged, or was neutral.

Results

In study 1, participants estimated the stairs to be steeper if the banister diverged from, rather than converged with, the stairs. The effect was greater when participants were unaware of the adjustment. In study 2, walking speed was significantly slower when the banister diverged from, rather than converged with, the stairs.

Conclusions

These findings encourage us to speculate about the potential to economically re-engineer features of the built environment to provide opportunities for action (affordances) that invite physical activity behavior or even promote safer navigation of the environment.



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Analysis of Lower Extremity Proprioception for Anterior Cruciate Ligament Injury Prevention: Current Opinion

Abstract

Lower extremity musculoskeletal injuries—such as ACL injury—are common, and the majority of those injuries occur without external player contact. In order to prevent non-contact musculoskeletal injuries, athletes must rely on accurate sensory information (such as visual, vestibular, and somatosensory) and stabilize joints during athletic tasks. Previously, proprioception tests (the senses of joint position, movement, tension or force) have been examined using static tests. Due to the role of proprioception in achievement of joint stability, it is essential to explore the development of dynamic proprioception tests. In this current opinion, the basic background on proprioception is covered, and the research gaps and future directions are discussed.



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The Effect of Chronic Exercise Training on Leptin: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Background

Leptin is a hormone associated with satiety, lipid oxidation, energy expenditure, and energy homeostasis. To date, the current body of research examining the effect of chronic exercise training on leptin has yielded inconsistent results.

Objective

The purpose of this meta-analysis was to provide a quantitative estimate of the magnitude of change in leptin levels following participation in exercise interventions lasting ≥ 2 weeks.

Methods

All studies included were peer-reviewed and published in English. To be included, studies randomized human participants to an exercise training group or non-exercise comparison group for an exercise training intervention. Leptin levels were measured at baseline, during, and/or after completion of the exercise training program. Random-effects models were used to aggregate a mean effect size (ES) and 95% confidence intervals (CIs), and identify potential moderators.

Results

Seventy-two randomized controlled trials met the inclusion criteria and resulted in 107 effects (n = 3826). The mean ES of 0.24 (95% CI 0.16–0.32, p < 0.0001) indicated a decrease in leptin following an exercise training program. A decrease in %Fat (β = − 0.07, p < 0.01) was associated with a decrease in leptin after accounting for the type of control group (β = − 0.38, p < 0.0001) used in each study.

Conclusion

These results suggest that engaging in chronic exercise training (≥ 2 weeks) is associated with a decrease in leptin levels for individuals regardless of age and sex. However, a greater decrease in leptin occurred with a decreased percentage of body fat.



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Implementation of closed-loop-assisted intra-operative goal-directed fluid therapy during major abdominal surgery: A case–control study with propensity matching

BACKGROUND Goal-directed fluid therapy (GDFT) has been associated with improved patient outcomes. However, implementation of GDFT protocols remains low despite growing published evidence and the recommendations of multiple regulatory bodies in Europe. We developed a closed-loop-assisted GDFT management system linked to a pulse contour monitor to assist anaesthesiologists in applying GDFT. OBJECTIVE To assess the impact of our closed-loop system in patients undergoing major abdominal surgery in an academic hospital without a GDFT programme. DESIGN A case–control study with propensity matching. SETTING Operating rooms, Erasme Hospital, Brussels. PATIENTS All patients who underwent elective open major abdominal surgery between January 2013 and December 2016. INTERVENTION Implementation of our closed-loop-assisted GDFT in April 2015. METHODS A total of 104 patients managed with closed-loop-assisted GDFT were paired with a historical cohort of 104 consecutive non-GDFT patients. The historical control group consisted of patients treated before the implementation of the closed-loop-system, and who did not receive GDFT. In the closed-loop group, the system delivered a baseline crystalloid infusion of 3 ml kg−1 h−1 and additional 100 ml fluid boluses of either a crystalloid or colloid for haemodynamic optimisation. MAIN OUTCOME MEASURES The primary outcome was intra-operative net fluid balance. Secondary outcomes were composite major postoperative complications, composite minor postoperative complications and hospital length of stay (LOS). RESULTS Baseline characteristics were similar in both groups. Patients in the closed-loop group had a lower net intra-operative fluid balance compared with the historical group (median interquartile range [IQR] 2.9 [1.6 to 4.4] vs. 6.2 [4.0 to 8.3] ml kg−1 h−1; P 

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Peri-operative copeptin concentrations and their association with myocardial injury after vascular surgery: A prospective observational cohort study

BACKGROUND Copeptin levels in conjunction with cardiac troponin may be used to rule out early myocardial infarction in patients presenting with chest pain. Raised pre-operative copeptin has been shown to be associated with postoperative cardiac events. However, very little is known about the peri-operative time course of copeptin or the feasibility of very early postoperative copeptin measurement to diagnose or rule-out myocardial injury. OBJECTIVES In this preparatory analysis for a larger trial, we sought to examine the time course of peri-operative copeptin and identify the time at which concentrations returned to pre-operative levels. Second, in an explorative analysis, we sought to examine the association of copeptin in general and at various time points with myocardial injury occurring within the first 48 h. DESIGN Preparatory analysis of a prospective, observational cohort study. SETTING Single university centre from February to July 2016. PATIENTS A total of 30 consecutive adults undergoing vascular surgery. INTERVENTION Serial peri-operative copeptin measurements. MAIN OUTCOME MEASURE We measured copeptin concentrations before and immediately after surgery (0 h), then at 2, 4, 6 and 8 h after surgery and on the first and second postoperative day. Postoperative concentrations were compared with pre-operative levels with a Wilcoxon signed-rank test. Second, we explored an association between postoperative copeptin concentrations and myocardial injury by the second postoperative day. Myocardial injury was defined as a 5 ng l−1 increase between pre-operative and postoperative high-sensitivity cardiac troponin T with an absolute peak of at least 20 ng l−1. RESULTS Immediate postoperative copeptin concentrations (median [interquartile range]) increased nearly eight-fold from pre-operative values (8.5 [3.6 to 13.8] to 64.75 pmol l−1 [29.6 to 258.7]; P 

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A Prospective Observational Study of Technical Difficulty With GlideScope-Guided Tracheal Intubation in Children

BACKGROUND: The GlideScope Cobalt is one of the most commonly used videolaryngoscopes in pediatric anesthesia. Although visualization of the airway may be superior to direct laryngoscopy, users need to learn a new indirect way to insert the tracheal tube. Learning this indirect approach requires focused practice and instruction. Identifying the specific points during tube placement, during which clinicians struggle, would help with targeted education. We conducted this prospective observational study to determine the incidence and location of technical difficulties using the GlideScope, the success rates of various corrective maneuvers used, and the impact of technical difficulty on success rate. METHODS: We conducted this observational study at our quaternary pediatric hospital between February 2014 and August 2014. We observed 200 GlideScope-guided intubations and documented key intubation–related outcomes. Inclusion criteria for patients were

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Rates of Perioperative Respiratory Adverse Events Among Caucasian and African American Children Undergoing General Anesthesia

BACKGROUND: Perioperative respiratory adverse events (PRAEs) account for the major cause of morbidity and mortality in children undergoing general anesthesia. In our institutional clinical practice, we suspected that African American children experienced untoward respiratory events more frequently than other racial groups. Identification of high-risk groups can guide decision making in the perioperative period, and aggressive optimization of specific care can enhance safety and improve outcomes. METHODS: Data came from a retrospective chart review for records from August 2013 to December 2013. The primary aim was to compare the incidence of PRAEs among racial groups of young children at a single institution. We also analyzed factors that are potentially associated with a higher risk of PRAEs. There were 1148 records that met the inclusion criteria. Racial identities, PRAEs, and risk factors were identified. Logistic regression analysis was performed to evaluate differences in PRAEs among racial groups controlling for confounding variables. RESULTS: Of all 1148 patients, 62 (5.4%) had a PRAE. African American children had significantly higher incidences of PRAE (26/231, 11.4%) compared to Caucasian (27/777, 3.5%; P

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Burnout, Fatigue, Exhaustion: An Interdisciplinary Perspective on a Modern Affliction

No abstract available

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Feasibility of Fully Automated Hypnosis, Analgesia, and Fluid Management Using 2 Independent Closed-Loop Systems During Major Vascular Surgery: A Pilot Study

Automated titration of intravenous anesthesia and analgesia using processed electroencephalography monitoring is no longer a novel concept. Closed-loop control of fluid administration to provide goal-directed fluid therapy has also been increasingly described. However, simultaneously combining 2 independent closed-loop systems together in patients undergoing major vascular surgery has not been previously detailed. The aim of this pilot study was to evaluate the clinical performance of fully automated hypnosis, analgesia, and fluid management using 2 independent closed-loop controllers in patients undergoing major vascular surgery before implementation within a larger study evaluating true patient outcomes. Accepted for publication March 30, 2018. Funding: Departmental. Conflicts of Interest: See Disclosures at the end of the article. 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 (https://ift.tt/KegmMq). A. Joosten and V. Jame contributed equally and share first authorship. Institutional review board: This study was approved by our Institutional Review Board (IRB) of Erasme Hospital (808 Route de Lennik, 1070 Bruxelles, Belgium). E-mail: helene.francois@erasme.ulb.ac.be. Reprints will not be available from the authors. Address correspondence to Alexandre Joosten, MD, Hopital ERASME, 808, Rt de Lennik, 1070 Brussels, Belgium. Address e-mail to Alexandre.Joosten@erasme.ulb.ac.be; joosten-alexandre@hotmail.com. © 2018 International Anesthesia Research Society

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Manual of Neuroanesthesia: The Essentials

No abstract available

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Propensity Score Methods: Theory and Practice for Anesthesia Research

Observational data are often readily available or less costly to obtain than conducting a randomized controlled trial. With observational data, investigators may statistically evaluate the relationship between a treatment or therapy and outcomes. However, inherent in observational data is the potential for confounding arising from the nonrandom assignment of treatment. In this statistical grand rounds, we describe the use of propensity score methods (ie, using the probability of receiving treatment given covariates) to reduce bias due to measured confounders in anesthesia and perioperative medicine research. We provide a description of the theory and background appropriate for the anesthesia researcher and describe statistical assumptions that should be assessed in the course of a research study using the propensity score. We further describe 2 propensity score methods for evaluating the association of treatment or therapy with outcomes, propensity score matching and inverse probability of treatment weighting, and compare to covariate-adjusted regression analysis. We distinguish several estimators of treatment effect available with propensity score methods, including the average treatment effect, the average treatment effect for the treated, and average treatment effect for the controls or untreated, and compare to the conditional treatment effect in covariate-adjusted regression. We highlight the relative advantages of the various methods and estimators, describe analysis assumptions and how to critically evaluate them, and demonstrate methods in an analysis of thoracic epidural analgesia and new-onset atrial arrhythmias after pulmonary resection. Accepted for publication February 16, 2018. Funding: None. 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 (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Edward J. Mascha, PhD, Departments of Quantitative Health Sciences and Outcomes Research, Cleveland Clinic, 9500 Euclid Ave, P77-007, Cleveland, OH 44195. Address e-mail to maschae@ccf.org. © 2018 International Anesthesia Research Society

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Trainability of Cricoid Pressure Force Application: A Simulation-Based Study

BACKGROUND: Aspiration of gastric contents is a leading cause of airway management–related mortality during anesthesia practice. Cricoid pressure (CP) is widely used during rapid sequence induction to prevent aspiration. National guidelines for CP suggest a target force of 10 N before and 30 N after loss of consciousness. However, few studies have rigorously assessed whether clinicians can be trained to consistently achieve these levels of force. We hypothesized that clinicians can be trained effectively to deliver 10–30 N during application of CP. METHODS: Clinicians (attending anesthesiologist, anesthesiology residents, certified registered nurse anesthetists, or operating room nurses) applied CP on a Vernier force plate simulator with measurements taken at 4 time points over 60 seconds, 2 measurements before and 2 measurements after loss of consciousness. A successful cycle required all 4 time points to be within the target range (10 ± 5 and 30 ± 5 N, respectively). After baseline assessment (n = 100 clinicians), a subset of 40 participants volunteered for education on recommended force targets, underwent self-regulated practice, and then performed 30 1-minute cycles of high-frequency simulation analyzed by cumulative sum analysis to assess their change in performance. RESULTS: At baseline, 5 cycles (1.3% [confidence interval {CI}, 0.3%–2.50%]) out of 400 were successful. Performance improved after education and self-regulated practice (16% successful cycles [CI, 7.8%–25%]), and performance during the last 4 of 30 cycles was 45% (CI, 33%–58%). The odds of success increased over time (odds ratio, 1.1; P

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Should Total Intravenous Anesthesia Be Used to Prevent the Occupational Waste Anesthetic Gas Exposure of Pregnant Women in Operating Rooms?

No abstract available

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Impact of 2 Distinct Levels of Mean Arterial Pressure on Near-Infrared Spectroscopy During Cardiac Surgery: Secondary Outcome From a Randomized Clinical Trial

BACKGROUND: Near-infrared spectroscopy (NIRS) is used worldwide to monitor regional cerebral oxygenation (rScO2) during cardiopulmonary bypass (CPB). Intervention protocols meant to mitigate cerebral desaturation advocate to increase mean arterial pressure (MAP) when cerebral desaturation occurs. However, the isolated effect of MAP on rScO2 is uncertain. The aim of the present study was in a randomized, blinded design to elucidate the effect of 2 distinct levels of MAP on rScO2 values during CPB. We hypothesized that a higher MAP would be reflected in higher rScO2 values, lower frequency of patients with desaturation, and a less pronounced cerebral desaturation load. METHODS: This is a substudy of the Perfusion Pressure Cerebral Infarct trial, in which we investigated the impact of MAP levels during CPB on ischemic brain injury after cardiac surgery. Deviation in rScO2 was a predefined outcome in the Perfusion Pressure Cerebral Infarct trial. Patients were randomized to low MAP (LMAP; 40–50 mm Hg) or high MAP (HMAP; 70–80 mm Hg) during CPB. CPB pump flow was fixed at 2.4 L/min/m2, and MAP levels were targeted using norepinephrine. Intraoperatively, NIRS monitoring was performed in a blinded fashion, with sensors placed on the left and right side of the patient's forehead. NIRS recordings were extracted for offline analysis as the mean value of left and right signal during prespecified periods. Mean rScO2 during CPB was defined as the primary outcome in the present study. RESULTS: The average MAP level during CPB was 67 mm Hg ± SD 5.0 in the HMAP group (n = 88) and 45 mm Hg ± SD 4.4 in the LMAP group (n = 88). Mean rScO2 was significantly lower in the HMAP group during CPB (mean difference, 3.5; 95% confidence interval, 0.9–6.1; P = .010). There was no difference in rScO2 values at specified time points during the intraoperative period between the 2 groups. Significantly more patients experienced desaturation below 10% and 20% relative to rScO2 baseline in the HMAP group (P = .013 and P = .009, respectively), and the cerebral desaturation load below 10% relative to rScO2 baseline was more pronounced in the HMAP group (P = .042). CONCLUSIONS: In a randomized blinded study, we observed that a higher MAP induced by vasopressors, with a fixed CPB pump flow, leads to lower mean rScO2 and more frequent and pronounced cerebral desaturation during CPB. The mechanism behind these observations is not clear. We cannot exclude extracranial contamination of the NIRS signal as a possible explanation. However, we cannot recommend increasing MAP by vasoconstrictors during cerebral desaturation because this is not supported by the findings of the present study. Accepted for publication March 27, 2018. Funding: None. The authors declare no conflicts of interest. Clinicaltrial.gov identifier for main study (Perfusion Pressure Cerebral Infarct trial): NCT02185885. Reprints will not be available from the authors. Address correspondence to Frederik Holmgaard, BMSc, Department of Cardiothoracic Anesthesiology, Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9 – DK-2100, Copenhagen, Denmark. Address e-mail to frederik.holmgaard@regionh.dk. © 2018 International Anesthesia Research Society

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Proximal Versus Distal Continuous Adductor Canal Blocks: Does Varying Perineural Catheter Location Influence Analgesia? A Randomized, Subject-Masked, Controlled Clinical Trial

BACKGROUND: A continuous adductor canal block provides analgesia after surgical procedures of the knee. Recent neuroanatomic descriptions of the thigh and knee led us to speculate that local anesthetic deposited in the distal thigh close to the adductor hiatus would provide superior analgesia compared to a more proximal catheter location. We therefore tested the hypothesis that during a continuous adductor canal nerve block, postoperative analgesia would be improved by placing the perineural catheter tip 2–3 cm cephalad to where the femoral artery descends posteriorly to the adductor hiatus (distal location) compared to a more proximal location at the midpoint between the anterior superior iliac spine and the superior border of the patella (proximal location). METHODS: Preoperatively, subjects undergoing total knee arthroplasty received an ultrasound-guided perineural catheter inserted either in the proximal or distal location within the adductor canal in a randomized, subject-masked fashion. Subjects received a single injection of lidocaine 2% via the catheter preoperatively, followed by an infusion of ropivacaine 0.2% (8 mL/h basal, 4 mL bolus, 30 minutes lockout) for the study duration. After joint closure, the surgeon infiltrated the entire joint using 30 mL of ropivacaine (0.5%), ketorolac (30 mg), epinephrine (5 μg/mL), and tranexamic acid (2 g). The primary end point was the median level of pain as measured on a numeric rating scale (NRS) during the time period of 8:00 AM to 12:00 PM the day after surgery. RESULTS: For the primary end point, the NRS of subjects with a catheter inserted at the proximal location (n = 24) was a median (10th, 25th–75th, 90th quartiles) of 0.5 (0.0, 0.0–3.2, 5.0) vs 3.0 (0.0, 2.0–5.4, 7.8) for subjects with a catheter inserted in the distal location (n = 26; P = .011). Median and maximum NRSs were lower in the proximal group at all other time points, but these differences did not reach statistical significance. There were no clinically relevant or statistically significant differences between the treatment groups for any other secondary end point, including opioid consumption and ambulation distance. CONCLUSIONS: For continuous adductor canal blocks accompanied by intraoperative periarticular local anesthetic infiltration, analgesia the day after knee arthroplasty is improved with a catheter inserted at the level of the midpoint between the anterior superior iliac spine and the superior border of the patella compared with a more distal insertion closer to the adductor hiatus. Accepted for publication March 27, 2018. Funding: This work was supported by the Department of Anesthesiology, University of California San Diego (San Diego, CA). The authors declare no conflicts of interest. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the funding entity. Institutional review board: University California San Diego Human Research Protections Program at (858) 657–5100, 9500 Gilman Dr, La Jolla, CA 92093-0052. E-mail: tnelson@ucsd.edu. This report describes human research and a prospective randomized clinical trial. The authors state that the report includes every item in the Consolidated Standards of Reporting Trials (CONSORT) checklist for a prospective randomized clinical trial. This study was conducted with written informed consent from the study subjects. The study was registered before patient enrollment. This was not an observational clinical study. Registry URL: clinicaltrials.gov NCT02523235. Reprints will not be available from the authors. Address correspondence to Brian M. Ilfeld, MD, MS , Department of Anesthesiology, University California San Diego, 9500 Gilman Dr, La Jolla, CA 92093-0898. Address e-mail to bilfeld@ucsd.edu. © 2018 International Anesthesia Research Society

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Patient-Controlled Versus Clinician-Controlled Sedation With Propofol: Systematic Review and Meta-analysis With Trial Sequential Analyses

BACKGROUND: Sedation with propofol is frequently used to facilitate diagnostic and therapeutic procedures. Propofol can be administrated by the patient (patient-controlled sedation [PCS]) or by a clinician (clinician-controlled sedation [CCS]). We aimed to compare these 2 techniques. METHODS: PubMed, Embase, CENTRAL, and trial registries were searched up to October 2017 for randomized controlled trials comparing PCS with CCS with propofol. The primary end points were the risks of presenting at least 1 episode of oxygen desaturation, arterial hypotension, and bradycardia, and the risk of requiring a rescue intervention (pharmacologic therapies or physical maneuvers) for sedation-related adverse events. Secondary end points were the dose of propofol administrated, operator and patient satisfaction, and the risk of oversedation. A random-effects model and an α level of .02 to adjust for multiple analyses were used throughout. Trial sequential analyses were performed for primary outcomes. Quality of evidence was assessed according to the Grades of Recommendation, Assessment, Development, and Evaluation system. RESULTS: Thirteen trials (1103 patients; median age, 47 years; American Society of Anesthesiologists physical status I–III) describing various diagnostic and therapeutic procedures with propofol sedation were included. PCS had no impact on the risk of oxygen desaturation (11 trials, 31/448 patients [6.9%] with PCS versus 46/481 [9.6%] with CCS; risk ratio, 0.74 [98% confidence interval, 0.35–1.56]) but decreased the risk of requiring a rescue intervention for adverse events (11 trials, 29/449 patients [6.5%] with PCS versus 74/482 [15.4%] with CCS; risk ratio, 0.45 [98% confidence interval, 0.25–0.81]). For both outcomes, Trial sequential analyses suggested that further trials were unlikely to change the results, although the quality of evidence was graded very low for all primary outcomes. For the risk of arterial hypotension and bradycardia, the required sample size for a definitive conclusion had not been reached. Analysis of secondary outcomes suggested that PCS decreased the risk of oversedation and had no impact on propofol dose administrated, or on operator or patient satisfaction. CONCLUSIONS: PCS with propofol, compared with CCS with propofol, had no impact on the risk of oxygen desaturation, but significantly decreased the risk of rescue interventions for sedation-related adverse events. Further high-quality trials are required to assess the risks and benefits of PCS. Accepted for publication February 16, 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 (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Lukas Kreienbühl, MD, Department of Anesthesiology, Intensive Care and Pain Medicine, Helios Klinikum Bad Saarow, Pieskower Straße 33, 15526 Bad Saarow, Germany. Address e-mail to lukas.kreienbuehl@helios-gesundheit.de. © 2018 International Anesthesia Research Society

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Does Cross-Sectional Area Really Count?

No abstract available

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Inhibiting EZH2 rescued bupivacaine-induced neuronal apoptosis in spinal cord dorsal root ganglia in mice

Abstract

Purpose

In the present work, we intended to explore the function of enhancer of zeste homolog 2 (EZH2) in modulated anesthetic reagent bupivacaine-induced neuronal apoptosis in spinal cord dorsal root ganglia (DRG).

Methods

Murine DRG explant was treated with 5 mM bupivacaine in vitro to induce neuronal apoptosis, which was examined by a TUNEL assay. Protein and mRNA expressions of EZH2 in bupivacaine-treated DRG were examined by western blot and qRT-PCR assays. EZH2 was downregulated by siRNA in bupivacaine-treated DRG. Its functional role in protecting bupivacaine-induced neuronal apoptosis was examined. In addition, apoptotic protein caspase-9 and EZH2-associated signaling pathway, and tropomyosin receptor kinase C (TrkC) were further investigated, by western blot assay, in EZH2-downregulated and bupivacaine-injured DRG.

Results

In vitro treatment of bupivacaine-induced DRG neuronal apoptosis, and upregulated EZH2 at both protein and mRNA levels. SiRNA transfection successfully downregulated EZH2, as confirmed by western blot and qRT-PCR assays. Examination of TUNEL assay showed that EZH2 downregulation rescued bupivacaine-induced DRG neuronal apoptosis. Moreover, in bupivacaine-injured DRG, EZH2 downregulation reduced caspase-9, whereas upregulated TrkC and phosphorylated-TrkC (p-TrkC).

Conclusion

EZH2 is upregulated, whereas inhibiting EZH2 exerted rescuing effect in anesthetics (bupivacaine)-induced spinal cord DRG. The possible downstream target of EZH2 inhibition may interact with caspase and TrkC signaling pathways.



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Correction to: A zebrafish model of foxe3 deficiency demonstrates lens and eye defects with dysregulation of key genes involved in cataract formation in humans

The authors noticed that Fig. 5A and B aspect ratios appeared sub-optimal in the online published version. This has now been changed.



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Evidence-Based Physiatry: Learning to Choose Wisely

No abstract available

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Orotracheal intubation in a patient with difficult airway by using fiberoptic nasotracheal intubation: A case report.

Related Articles

Orotracheal intubation in a patient with difficult airway by using fiberoptic nasotracheal intubation: A case report.

J Dent Anesth Pain Med. 2018 Apr;18(2):125-128

Authors: Yun HJ, So E, Karm MH, Kim HJ, Seo KS

Abstract
In cases of a difficult intubation where numerous intubation methods, including laryngoscopy, have failed, yet oral intubation is still necessary, the method of tube exchange after fiberoptic nasal intubation may be attempted. Fiberoptic nasal intubation allows intubation to be performed relatively easily when the laryngeal view grade is poor. We report a case in which our attempt at oral intubation for total maxillectomy with laryngoscopy and fiberoptic oral intubation had failed due to an unexpected difficult airway; subsequently, we successfully completed the surgery by performing fiberoptic nasal intubation to secure the airway, followed by using a tube exchanger to exchange to an oral endotracheal tube.

PMID: 29744389 [PubMed]



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Effect of Bougie-Guided Nasal Intubations upon Bleeding: A Randomised Controlled Trial.

Related Articles

Effect of Bougie-Guided Nasal Intubations upon Bleeding: A Randomised Controlled Trial.

Turk J Anaesthesiol Reanim. 2018 Apr;46(2):96-99

Authors: Vadhanan P, Tripaty DK

Abstract
Objective: Bleeding due to inadvertent trauma is a troublesome complication of nasal intubations. A lot of methods have been suggested to minimise this problem. A flexible bougie can be passed atraumatically via the nasal route to the trachea and an appropriate-sized endotracheal tube can be railroaded over it to avoid this problem. The primary objective of the study was to compare the severity of bleeding with bougie-guided and conventional nasotracheal intubations on a subjective scale. The time taken for successful intubations and the number of attempts required were also noted.
Methods: This randomised controlled study was performed in 40 adult patients requiring nasotracheal intubations for various elective surgeries over a 3-month period in a teaching hospital. The patients after satisfying the inclusion criteria were randomised into two groups of 20 each: Bougie-guided (Group B) and Not Bougie-guided (Group NB). Group B patients were intubated by railroading the endotracheal tube over a flexible bougie, and Group NB patients were intubated conventionally without the bougie. The degree of bleeding was noted on a subjective scale as nil, mild, moderate or severe. The time taken for intubation in seconds and the number of attempts taken were noted. The degree of bleeding was compared using Mann-Whitney U test, and the time taken for intubation was compared using the Student's t test after assessing normalcy. An alpha error of 5% was used, and p values less than 0.05% were considered significant.
Results: All patients randomised completed the study. The degree of bleeding was lesser in the Bougie-guided group than in the conventional group (p=0.02), and the time taken for intubation was longer in the bougie-guided group (p<0.01).
Conclusion: Using a bougie routinely for nasal intubations might minimise trauma during nasal intubations but increase the time taken for intubation marginally. The success rates for intubations may also be better.

PMID: 29744243 [PubMed]



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The impact of tumor differentiation on the prognosis of HBV-associated solitary hepatocellular carcinoma following hepatectomy: A propensity score matching analysis

Digestive Diseases and Sciences

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Prevalence and severity of nonalcoholic fatty liver disease by transient elastography: Genetic and metabolic risk factors in a general population

Liver International

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Risk factors for early postoperative complications and length of hospital stay in ileocecal resection and right hemicolectomy for Crohn's disease: A single-center experience

International Journal of Colorectal Disease

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Circulating microRNA-22-3p predicts the malignant progression of precancerous gastric lesions from intestinal metaplasia to early adenocarcinoma

Digestive Diseases and Sciences

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Shorter hepatitis B immunoglobulin administration is not associated to hepatitis B virus recurrence when receiving combined prophylaxis after liver transplantation

Liver International

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Treating obstructive sleep apnea and chronic intermittent hypoxia improves the severity of nonalcoholic fatty liver disease in children

The Journal of Pediatrics

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Risk factors for postoperative ileus following elective laparoscopic right colectomy: A retrospective multicentric study

International Journal of Colorectal Disease

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