In Screening For Celiac Disease, Deamidated Gliadin Rarely Predicts Disease When Tissue Transglutaminase Is Normal

Objective: While tissue transglutaminase (tTG) antibodies are the most established serological test for celiac disease, newer deamidated gliadin peptide (DGP) screening tests are increasingly being completed. No pediatric study has systematically assessed the incidence of celiac disease in patients with an isolated positive DGP result. We sought to determine the positive predictive value of DGP serology for biopsy-confirmed celiac disease in pediatric patients with elevated DGP and normal tTG, to help guide clinicians' decision making when screening for this common condition and avoid unnecessary invasive follow-up diagnostic testing. Methods: A multi-center retrospective review of children, from birth to age 18, with isolated DGP IgG positive serology referred to three Canadian centers was completed. The positive predictive value of an isolated elevated DGP result was calculated. Results: Forty patients with DGP positive, tTG negative serology underwent endoscopy with duodenal biopsy. Of these, only 1 patient had biopsy-confirmed celiac disease. This patient was IgA deficient. This yields a positive predictive value of 2.5% (95% CI 0.1–14.7%) for isolated DGP IgG positive serology. Conclusion: In isolation, DGP positive serology has a poor positive predictive value for celiac disease in children, especially in IgA sufficient individuals. Our findings suggest that DGP IgG testing should not be completed as part of the initial screening for celiac disease in the pediatric population as it does not effectively differentiate between individuals with and without the disease. Further research is needed to clarify to role of DGP IgG in children under the age of 2 and those with IgA deficiency. Address correspondence and reprint requests to Dr. Catharine M. Walsh, Highest Academic Degree(s): MD, MEd, PhD, FRCPC, FAAP, The Wilson Centre; and the Division of Gastroenterology, Hepatology and Nutrition, the Learning and Research Institutes, Hospital for Sick Children, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada M5G 1X8 (e-mail: catharine.walsh@sickkids.ca). Received 16 March, 2018 Accepted 3 July, 2018 Financial Disclosure: The authors have no financial relationships relevant to this article to disclose. Conflicts of Interest and Source of Funding: None to declare © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Motor Proficiency and Generalized Self-Efficacy towards Physical Activity in Children with Intestinal Failure

Objective: Survival rates of children with intestinal failure have increased, however associated co-morbidities may impact long-term motor developmental outcomes. This study evaluates motor proficiency and generalized self-efficacy towards physical activity (PA) in children age 6–12 years with intestinal failure. Methods: Observational, cross-sectional study of children followed in a multi-disciplinary intestinal rehabilitation program. Motor proficiency was assessed using the Bruininks-Oseretsky Test of Motor Proficiency-2 Short Form (BOT-2 SF) and the Scales of Independent Behavior (parent-proxy report). Children completed the Children's Self-Perceptions of Adequacy in and Predilection for Physical Activity (CSAPPA) and a PA questionnaire. Relevant demographic and medical variables were correlated with assessment results. Results: Thirty children (18 males), median age 7 years (IQR 6, 9) with gestational age 35 weeks (IQR 32, 39) and birth weight 2.13 kilograms (IQR 1.68, 2.77). Thirteen (43%) were dependent on parenteral nutrition. Fifteen (50%) scored below average on the BOT-2 SF. Lower BOT-2 SF scores were significantly associated with lower CSAPPA scores (r = 0.480, p = 0.01), with a common barrier to PA being the presence of a central line or enterostomy tube. Gestational age, height z-scores, length of hospital admissions and number of septic events were all significantly correlated with lower scores in motor proficiency. Number of septic events and total parenteral nutrition days were significant predictors of lower BOT-2 SF scores, when adjusting for birth weight. Conclusions: Multiple medical variables related to intestinal failure may impact motor proficiency and PA self-efficacy. Developmental follow-up is important to optimize motor skill development and promote PA participation. Address correspondence and reprint requests to Stephanie So, Department of Rehabilitation Services, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada (e-mail: stephanie.so@sickkids.ca). Received 24 October, 2017 Accepted 2 July, 2018 Funding Acknowledgements: OT/PT Paediatric Network, Toronto, Ontario Individual Acknowledgements: Kristen Pitzul and Karolina Urban for statistical support. Dr. John Hay for research support. University Acknowledgements: This research was completed in partial fulfillment of the requirements for an MSc.PT degree at the University of Toronto. Conflicts of interest: None of the authors have a conflict of interest to declare for this study. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Persistence of muscle-bone deficits following anti-tumour necrosis factor therapy in adolescents with crohn's disease

Objectives: To assess change in the muscle-bone unit in adolescents with Crohn's disease (CD) on anti-tumor necrosis factor (anti-TNFα). Methods: Prospective study following anti-TNFα in 19 adolescents with CD with a median age (range) of 15.1 years (11.2, 17.2). At baseline, 6 and 12 months, subjects had a biochemical assessment of insulin growth factor (IGF) axis, bone turnover and muscle-bone health by dual energy absorptiometry (DXA), peripheral quantitative computed tomography (pQCT) and dynamic isometry. Results: Significant clinical improvement in disease activity was observed by 2 weeks [p = 0.004 vs baseline] and maintained at 12 months [p = 0.038 vs baseline]. Median bone specific alkaline phosphatase SDS increased from -1.7 (-3.6, -1.0) to -1.2 (-3.6, -0.5) by 6 weeks [p = 0.01]. At baseline, DXA total body and lumbar spine bone mineral density (BMD) SDS was -0.9 (-2.3, 0.5) and -1.1 (-2.9, 0.4), respectively. At baseline, pQCT trabecular BMD SDS at 4% tibia and muscle cross sectional area SDS at 66% radius was -1.6 (-3.2, 1.1) and -2.4 (-4.3, -0.3), respectively. At baseline, maximal isometric grip force (MIGF) of the non-dominant hand adjusted for height was -1.5 (-4.5, 0.49). All these deficits in muscle-bone persisted at 6 and 12 months. Conclusion: Despite improvement in disease and osteoblast activity, bone and muscle deficits, as assessed by DXA, pQCT and grip strength in adolescents with CD did not improve following twelve months of anti-TNFα. Address correspondence and reprint requests to Dr. Sze Choong Wong, Developmental Endocrinology Research Group, Royal Hospital for Children, Office Block, Ground Floor, Zone 1, RHC & QEUH Campus, 1345 Govan Road, Glasgow G51 4TF (e-mail: jarod.wong@glasgow.ac.uk). Received 12 May, 2018 Accepted 5 July, 2018 Disclosure Statements: RKR has received speaker's fees, travel support, and participated in medical board meetings with Abbvie, Napp, Nestlé Health Science, Celltrion, Shire and Janssen. The other authors have nothing to disclose in relation to this current submission. Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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The approach and safety of esophageal dilation for treatment of strictures in children with epidermolysis bullosa

Objective: To analyze a large series of esophageal balloon dilations in patients with Epidermolysis Bullosa (EB) to determine procedural approach and frequency of post-endoscopic adverse events (AE). Methods: Retrospective chart review for AE occurrence and clinical outcomes in children and adolescents with EB, age 1–19, who underwent esophageal dilation for esophageal stricture(s) from January 2003- April 2016 at an academic, tertiary care, free-standing children's hospital. The primary outcome measure was occurrence of procedural AEs (defined as events occurring within 72 hours after endoscopic dilation procedure). Results: 231 fluoroscopy-guided esophageal balloon dilation procedures (209 anterograde, 20 retrograde, 2 both) were performed in 24 patients. Strictures were more common in the proximal portion of the esophagus with median stricture location 13 cm from the lips. From 2003–2012, 4.1% of dilations were retrograde. From 2013–2016, 20.2% of dilations were retrograde. AEs attributable to dilation occurred after 10.0% of procedures, and the most common AEs were vomiting, pain, and fever. No esophageal perforations, serious bleeding events, or deaths occurred secondary to dilation. The rate of post-dilation hospitalization was 6.9%. Dilation approach (anterograde versus retrograde) did not impact the likelihood of AEs. Conclusions: The characteristic esophageal lesion in EB is a single, proximal esophageal stricture. EB patients can safely undergo repeat pneumatic esophageal balloon dilations with minimal risk for severe complication. We observed a trend towards increased use of retrograde esophageal dilation. Address correspondence and reprint requests to David E. Brumbaugh, MD, Children's Hospital Colorado, 13123 E 16th Ave, B290, Aurora, CO 80045 (E-mail: David.Brumbaugh@childrenscolorado.org). Received 6 November, 2017 Accepted 23 June, 2018 Sources of Support: Dr. Feinstein is supported in part by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (1K23HD091295–01). Conflicts of Interest: None declared. Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Relationship of Initial Pancreatic Enzyme Replacement Therapy Dose with Weight Gain in Infants with Cystic Fibrosis

Objective: To test the hypothesis of a positive relationship between initial dose of pancreatic enzyme replacement therapy (PERT) in infants with cystic fibrosis (CF) and optimal weight gain over the first two years of life. Methods: Using the CF Foundation Patient Registry, we identified 502 children born in 2010 and used multivariable models to compare as our primary analysis their 2-year changes in weight-for-age z score (WAZ) and as our secondary analysis weight-for-length percentile (W/L%) by initial PERT dose. We focused on initial dose without reference to subsequent changes in treatment in order to avoid confounding by indication (severity). Results: Initial PERT dose demonstrated a linear relationship to change in WAZ and W/L% at age 2 years. An initial dose of >1500 lipase units/kg/largest meal resulted in a higher likelihood of attaining WAZ at 2 years at or above the birth WAZ (adjusted odds ratio [aOR] 1.87, 95% confidence interval [CI]: 1.22–2.86) and at the top quartile for improvement over 2 years in WAZ (aOR 1.90, 95% CI: 1.19–3.05).. There was no correlation between initial PERT dose and weight at initial PERT encounter (p = 0.35). Findings were similar for W/L% and when the cohort was restricted to infants who began PERT in the first 3 months of life. Conclusion: Infants receiving higher initial PERT dose demonstrate better weight-related outcomes, as reflected by attainment of favorable changes in WAZ and W/L%, at age 2 years. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. https://ift.tt/OBJ4xP Address correspondence and reprint requests to Michael Schechter, MD, MPH, Virginia Commonwealth University (VCU) Children's Hospital of Richmond at VCU, Department of Pediatrics Division of Pulmonary Medicine 1000 East Broad Street P.O. Box 980315 Richmond, Virginia 23298-0315 (e-mail: mschechter@vcu.edu). Received 1 October, 2017 Accepted 20 May, 2018 Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). Clinical trial registration: Not applicable Conflicts of Interest and Source of Funding M.S. Schechter has no financial relationship with AbbVie Inc and received no funding for his work on this manuscript. He receives research support from the NIH, CF Foundation, Anthera, and Novartis; and has had consulting relationships with AbbVie, Vertex, Novartis, Gilead, Genentech, and Celtaxsys. S. Michel is a consultant to AbbVie Inc. She is also a technical advisor to MVW Nutritionals, makers of cystic fibrosis-specific vitamin products. M. Kapoor and R. Khurmi are employed by AbbVie Inc., and may own stock. S. Liu was an employee of AbbVie Inc. during the analysis. Her current affiliation is Astellas Inc., Northbrook, IL. B. Woun Seo was an employee of AbbVie Inc., during the analysis. His current affiliation is Rhythm Pharmaceuticals, Boston, MA. M. Haupt was an employee of AbbVie Inc. during the analysis. His current affiliation is ARIEL Precision Medicine, Pittsburgh, PA. Funding for this study was provided by AbbVie Inc. Author Contributions: M.S. Schechter contributed to designing and performing the study, analyzing and interpreting the data, and writing and critically revising the manuscript. S. Michel contributed to designing and performing the study, analyzing and interpreting the data, and critically revising the manuscript. S. Liu contributed to designing and performing the study, analyzing and interpreting the data, and writing and critically revising the manuscript. B.W. Seo contributed to designing the study, analyzing and interpreting the data, and critically revising the manuscript. M. Kapoor contributed to designing the study, analyzing and interpreting the data, and writing the manuscript. R Khurmi contributed to designing the study, analyzing and interpreting the data, and critically revising the manuscript. M. Haupt contributed to designing the study, analyzing and interpreting the data, and writing and critically revising the manuscript. All authors approved the manuscript for submission. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Quality of Life in Patients with Progressive Familial Intrahepatic Cholestasis: No Difference between Post Liver Transplantation and Post Partial External Biliary Diversion

Objectives: In patients with progressive familial intrahepatic cholestasis (PFIC), partial external biliary diversion (PEBD), which is associated with a permanent stoma, is recommended as first-line therapy, whereas primary liver transplantation (LTx) is restricted to those with cirrhosis. Our aim was to quantify the health-related quality of life (HRQOL) in PFIC patients and to evaluate whether there is a difference in their HRQOL depending on the surgical approach. Methods: A prospective HRQOL study on a consecutive series of PFIC was conducted using Pediatric Quality of Life Inventory 4.0 child-self and parent-proxy reports. PFIC patients after PEBD who still lived with their native livers were compared to those after LTx. Both groups were compared to healthy children. Results: 32 patients (53% female) patients with a mean age of 17.7 ± 7.3 years were studied. 22 had undergone LTx at a mean age of 7.8 ± 3.8 years and 10 had undergone PEBD at at mean age of 4.1 ± 3.9 years. At the time of HRQOL assessment, the mean age was 18.9 ± 7.5 years in the LTx group and 15.3 ± 6.5 years in the PEBD group. Child-self and parent-proxy reports showed no significant difference in HRQOL between PFIC patients after LTx and those after PEBD except for marginal difference in physical functioning/health (p = 0.07). Except for a lower score in patient school functioning of patients after LTx (p = 0.01), HRQOL-results showed no difference from healthy children in any group. Conclusions: The HRQOL of PFIC patients after PEBD was similar to those after LTx. The HRQOL in both groups was also similar to that of healthy children. Thus, our data supports the current policy of PEBD as primary surgical treatment for PFIC patients without cirrhosis. Address correspondence and reprint requests to Nagoud Schukfeh, MD, Department of Pediatric Surgery, Hannover Medical School, 30625 Hannover, Germany (e-mail: schukfeh.nagoud@mh-hannover.de). Received 4 January, 2018 Accepted 9 July, 2018 Author contribution Sonja Wasman: Conception, data acquisition and analysis, drafting manuscript Eva D. Pfister: Data acquisition and analysis and drafting and revising manuscript Benno M. Ure: Conception, interpretation, drafting and revising manuscript Imeke Goldschmidt: Data interpretation, analysis, drafting manuscript Jens Dingemann: Data interpretation, analysis, drafting and revising manuscript Ulrich Baumann: Data interpretation, analysis, drafting manuscript Joachim F. Kuebler: Conception and design, interpretation, revising manuscript Nagoud Schukfeh: Conception, design, data acquisition and analysis, drafting and revising manuscript Sonja Wassman and Eva-Doreen Pfister equally contributed to this manuscript and shared first authorship. Conflicts of interest and source of funding: All authors state that they have no financial support or grant and no conflict of interest to declare. Trial identification number (Ethical committee): 3683-2017 © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Can We Estimate Quality of Life in Pediatric Inflammatory Bowel Disease Patients? An Asian Multicenter Study

Objectives: Inflammatory bowel disease (IBD) is a chronic lifelong condition and is related to poor quality of life (QoL). The aim of this study was to evaluate the QoL of Asian pediatric patients with IBD and to determine the clinical factors that can influence QoL. Methods: Children and adolescents aged 9 to 18 years diagnosed with IBD were enrolled from seven hospitals. The patients completed the IMPACT-III questionnaire, and clinical data were collected. The results of the questionnaire and the correlation with clinical data were analyzed. Results: A total of 208 patients (Crohn's disease: n = 166; ulcerative colitis: n = 42) were enrolled. There was no definite QoL difference according to the Paris classification. Female sex (-5.92 ± 2.97, P = 0.0347) and active disease status (-10.79 ± 3.11, P = 0.0006) were significantly associated with poor QoL. Extreme body weight z score and older age at diagnosis were also associated with worse QoL. Conclusions: Various clinical factors may affect the QoL in patients with IBD, but determining the overall QoL of patients using only these clinical factors is difficult. Therefore, regular direct measurements of QoL are necessary to better understand patients with IBD. Address correspondence and reprint requests to Hong Koh, MD, PhD, Pediatric Gastroenterology, Hepatology and Nutrition, Yonsei University College of Medicine, Severance Pediatric IBD Research Group, Severance Children's Hospital, 50-1 Yonsei-ro, Seodaemun-gu, Seoul,03722, Korea (e-mail: khong@yuhs.ac). Received 18 April, 2018 Accepted 20 July, 2018 Source of funding: This study was supported by research funds from the Korean Society of Pediatric Gastroenterology, Hepatology, and Nutrition. Conflicts of Interest: The authors declare no conflict of interests. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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A Pilot analysis of early lactobacillus rhamnosus GG for infant colic prevention

We conducted a secondary analysis of data from a trial of Lactobacillus rhamnosus GG (LGG) supplementation as a pilot study to assess whether LGG prevents infant colic. For the first 6 months of life, infants received a daily dose of 10 billion colony-forming units of LGG or a control (n = 184). We compared the likelihood of a diagnosis of colic before 4 months of age, based on parent reported symptoms or a physician diagnosis of colic. Out of the 184 infants, 18 (9.8%) had colic. There were no differences between the two groups in the percentage of infants with colic based on symptoms (control 5.4% vs. LGG 9.8%; p = 0.19); physician diagnosis (control 3.2% vs. LGG 7.6%; p = 0.26); or either symptoms or diagnosis combined (control 6.5% vs. LGG 13.0%; p = 0.13). In this pilot study, early infant LGG supplementation does not appear to prevent the later development of colic. Address correspondence and reprint requests to Michael D. Cabana, MD, MPH, 3333 California Street, Laurel Heights Bldg #245, San Francisco, CA 94118 (e-mail: michael.cabana@ucsf.edu). Received 19 October, 2017 Accepted 24 May, 2018 Contributors' Statements Michael D. Cabana, MD, MPH: Dr. Cabana conceptualized and designed the study, designed the data collection instruments, interpreted the data and analyses, drafted the initial manuscript and approved the final manuscript as submitted. Michelle McKean, RD, MPH: Ms. McKean designed the study, supervised and coordinated the overall data collection, interpreted the data and analyses, critically reviewed the manuscript and approved the final manuscript as submitted. Amy L. Beck, MD, MPH interpreted the data and analyses, critically reviewed the manuscript and approved the final manuscript as submitted. Valerie Flaherman, MD, MPH assisted with the data analysis, interpreted the data and analyses, critically reviewed the manuscript and approved the final manuscript as submitted. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. Financial Disclosure: The authors have no financial relationships relevant to this article to disclose. Funding Source: Funded by the National Institutes of Health (HL 080074) and the Clinical and Translational Science Institute (UL1 RR024131) at UCSF. Conflict of Interest: MDC has served as a paid consultant for Biogaia AB (Stockholm, Sweden). Clinical Trial Registration: ClinicalTrials.gov identifier: NCT00113659 Abbreviations: CAindicates California; CFU; Colony forming units; CI Confidence interval; CT, Connecticut; HRHazard ratio; LGGLactobacillus rhamnosus GG; SDStandard deviation; TIPSTrial of Infant Probiotic Supplementation; UCSFUniversity of California; San Francisco; USUnited States © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Total Bile Acid Concentration in duodenal fluid Is a Useful Preoperative Screening Marker to Rule Out Biliary Atresia

Objectives: Duodenal tube test (DTT) is used as a preoperative screening to rule out biliary atresia (BA). In previous reports, DTT was assessed by the color of the duodenal fluid, but there were no quantitative criteria. The aim of this study was to examine the efficacy of DTT based on the total bile acid (TBA) concentration in duodenal fluid. Methods: This is a single-center retrospective study of infants with cholestasis who underwent DTT from 2008 to 2016 at the Osaka University Hospital. The cut-off values of maximum TBA in duodenal fluid (dTBA), dTBA/serum TBA ratio (sTBA), and dTBA/serum gamma-glutamyl transpeptidase (sGGT) ratio were assessed for the accuracy in excluding BA. Results: A total of 37 infants were included in this study; 16 infants with BA and 21 infants with other causes of intrahepatic cholestasis. dTBA demonstrated sensitivity of 100% and specificity of 90.5% with the cut-off value of 16.8 μmol/L. Specificity was further improved to 95.2% with dTBA/sTBA ratio (cut-off value: 0.088) and 100% with dTBA/sGGT ratio (cut-off value: 0.076 μmol/U). DTT could be performed 0.8 ± 1.4 days after admission. Hypoglycemia was developed in 1 infant. Conclusions: DTT evaluated by dTBA, dTBA/sTBA ratio, and dTBA/sGGT ratio had high accuracy to rule out BA and could avoid unnecessary surgery in some infants. Address correspondence and reprint requests to Dr. Kazuhiko Bessho, MD, PhD, Department of Pediatrics, Graduate School of Medicine, Osaka University, 2–2-D5, Yamada-oka, Suita, Osaka 565–0871, Japan (e-mail: bessho@ped.med.osaka-u.ac.jp). Received 20 February, 2018 Accepted 9 May, 2018 Source of Funding: None declared. The authors report 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 (www.jpgn.org). © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Determining Significance in the New Era for p-Values

No abstract available

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No Sreen and Treat in Children for Helicobacter pylori Infection

No abstract available

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Paediatric Coeliac Disease: Earlier Diagnosis for Better Lifelong Health

No abstract available

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Early Life Incidence of Gastrointestinal and Respiratory Infections in Children with Gastroschisis: A Cohort Study

Objectives: Survival in infants with gastroschisis is increasing although little is known about early childhood morbidity. In the context of a hypothesised link between the gastrointestinal (GI) tract and immune function, this study explores rates of GI and respiratory infections in children with gastroschisis. Methods: We conducted a population-based retrospective cohort study using data from the Health Improvement Network (THIN), a large database of UK primary care medical records. We identified children born from 1990 to 2013, and extracted follow-up data to their fifth birthday. We calculate incidence rates (IR) of GI and respiratory tract infections, overall and stratified by age, sex, socioeconomic status and gestational age at birth, and compared these between children with and without gastroschisis by calculating adjusted incidence rate ratios (aIRR). Results: Children with gastroschisis had a 65% higher IR of GI infection compared to children without (aIRR 1.65, 95% CI 1.37-1.99, p 

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Relationship between bite size per mouthful and dental arch size in healthy subjects

Abstract

Although multiple factors influence food bite size, the relationship between food bite size per mouthful and mandible or tongue size remains poorly understood. Here, we examined the correlations between food bite size and the lower dental arch size (an indicator of tongue size) in human subjects with good oral and general health, using fish sausage and bread as test foods. Notably, bite size of both foods was significantly positively correlated with the lower dental arch size, whereas masticatory performance (measured in terms of glucose extraction from a gummy jelly) showed no dependence on bite size. Further, bite size was significantly positively correlated with the body mass index. Our findings suggest that larger bite size is associated with larger tongue size, which might be a contributory factor to obesity.

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Delineation of metals and radionuclides bioconcentration in eggs of seabream Sparus aurata and effect of environmental pCO2

Publication date: December 2018

Source: Journal of Environmental Radioactivity, Volume 192

Author(s): Thomas Lacoue-Labarthe, François Oberhänsli, Jean-Louis Teyssié, Sophie Martin

Abstract

Considered as the most vulnerable ontogenic stages to environmental stressors, the early-life stages of fish paid a peculiar attention with respect to their vulnerability to metal and radionuclides contamination. Concomitantly, the increasing anthropogenic CO₂ release in the atmosphere will cause major change of the seawater chemistry that could affect the trace elements and radionuclides bioconcentration efficiencies by marine organisms. The aim of this work was to 1) delineate the uptake behaviours of Ag, Am, Cd, Co and Zn in seabream eggs during 65 h of development and retention by newly hatched and 7 h-old larvae maintained in clean seawater, respectively, and 2) investigate the effects of elevated pCO₂ on the bioconcentration efficiencies of these elements in eggs. Besides differing in terms of maximal concentration factors values, the uptake kinetics showed element-specific patterns with Am being linearly bioconcentrated and Co and Zn showing a saturation state equilibrium. The ^110mAg and ¹⁰⁹Cd uptake kinetics shared a two-phases pattern being best described by a saturation equation during the first 24 h of development, and then an exponential loss of accumulated elements although the radiotracer concentrations in the surrounding water remained constant. At hatching time, the radioactivity of ^110mAg was the highest among radiotracers detected in the larvae. After 7 h in depuration conditions, 60% of this metal was still detected whereas ²⁴¹Am, ⁶⁰Co and ⁶⁵Zn were almost totally lost, suggesting an efficient incorporation of Ag in the embryo during the egg development. Finally, this study brought first qualitative data on the effect of pCO₂/pH on metal bioconcentration in eggs, raising the need to unravel chemical and biological processes to predict a potential shift of the toxicity of environmental contamination of fish early life stages with future ocean change.

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An Evaluation of HER2-Positive Ovarian Carcinoma Xenografts: From a Novel Therapy to a Noninvasive Monitoring Method

Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.


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An Evaluation of HER2-Positive Ovarian Carcinoma Xenografts: From a Novel Therapy to a Noninvasive Monitoring Method

Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.


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Cerebral effects of music during isometric exercise: An fMRI study

Publication date: Available online 27 July 2018

Source: International Journal of Psychophysiology

Author(s): Marcelo Bigliassi, Costas I. Karageorghis, Daniel T. Bishop, Alexander V. Nowicky, Michael J. Wright

Abstract

A block-design experiment was conducted using fMRI to examine the brain regions that activate during the execution of an isometric handgrip exercise performed at light-to-moderate-intensity in the presence of music. Nineteen healthy adults (7 women and 12 men; M_age = 24.2, SD = 4.9 years) were exposed to an experimental condition (music [MU]) and a no-music control condition (CO) in a randomized order within a single session. Each condition lasted for 10 min and participants were required to execute 30 exercise trials (i.e., 1 trial = 10 s exercise + 10 s rest). Attention allocation, exertional responses, and affective changes were assessed immediately after each condition. The BOLD response was compared between conditions to identify the combined effects of music and exercise on neural activity. The findings indicate that music reallocated attention toward task-unrelated thoughts (d = 0.52) and upregulated affective arousal (d = 0.72) to a greater degree when compared to a no-music condition. The activity of the left inferior frontal gyrus (lIFG) also increased when participants executed the motor task in the presence of music (F = 24.65), and a significant negative correlation was identified between lIFG activity and perceived exertion for MU (limb discomfort: r = −0.54; overall exertion: r = −0.62). The authors hypothesize that the lIFG activates in response to motor tasks that are executed in the presence of environmental sensory stimuli. Activation of this region might also moderate processing of interoceptive signals – a neurophysiological mechanism responsible for reducing exercise consciousness and ameliorating fatigue-related symptoms.

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The Role of Nrf2 in the Response to Normal Tissue Radiation Injury

Radiation Research, Volume 190, Issue 2, Page 99-106, August 2018.


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Erratum

Radiation Research, Volume 190, Issue 2, Page 216-216, August 2018.


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Anatomical basis for simultaneous block of greater and third occipital nerves, with an ultrasound-guided technique

Abstract

Purpose

In some headache disorders, for which the greater occipital nerve block is partly effective, the third occipital nerve is also suggested to be involved. We aimed to establish a simple technique for simultaneously blocking the greater and third occipital nerves.

Methods

We performed a detailed examination of dorsal neck anatomy in 33 formalin-fixed cadavers, and deduced two candidate target points for blocking both the greater and third occipital nerves. These target points were tested on three Thiel-fixed cadavers. We performed ultrasound-guided dye injections into these points, examined the results by dissection, and selected the most suitable injection point. Finally, this target point was tested in three healthy volunteers. We injected 4 ml of local anesthetic and 1 ml of radiopaque material at the selected point, guided with a standard ultrasound system. Then, the pattern of local anesthetic distribution was imaged with computed tomography.

Results

We deduced that the most suitable injection point was the medial head of the semispinalis capitis muscle at the C1 level of the cervical vertebra. Both nerves entered this muscle, in close proximity, with little individual variation. In healthy volunteers, an anesthetic injected was confined to the muscle and induced anesthesia in the skin areas innervated by both nerves.

Conclusions

The medial head of the semispinalis capitis muscle is a suitable landmark for blocking the greater and third occipital nerves simultaneously, by which occipital nerve involvement in various headache disorders may be rapidly examined and treated.

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The history and progress of local anesthesia: multiple approaches to elongate the action

Abstract

Analgesia and temporary inhibition of motor activity without interfering with central nervous function have been the essential merits of local anesthesia. Local anesthetics originated from cocaine have played a major role in local analgesia. However, the relatively short duration of action of local anesthetics has been a concern in intra- and post-operative analgesia. From the early age of modern local anesthesia, physicians and medical scientists had been struggling to control the active duration of local anesthetics. Such approach includes: development of long-acting local anesthetics, with physical tourniquet techniques, co-administration of other medicines such as vaso-constrictive agents or analgesics, development of mechanical devices to continuously or intermittently administer local anesthetics, and utilization of pharmaceutical drug delivery systems. In this review, the historical sequence of studies that have been performed in an effort to elongate the action of local anesthetics is presented, referring to epoch-making medical and scientific studies.

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The Effect of Mass Evacuation on Infant Feeding: The Case of the 2016 Fort McMurray Wildfire

Abstract

Objectives We examine the ways in which the 2016 Fort McMurray wildfire evacuation affected infant feeding. Our primary objective is to understand the decisions and perceptions of primary caregivers of children age 0–36 months who evacuated from Fort McMurray, Canada. Methods We used a mixed methods approach to assess the overall impact that the evacuation had on infant feeding. Specific outcome variables for the quantitative research are: decision-making, access to support and resources, and changes in routine. Participants were recruited using a purposive sampling technique through infant feeding in emergency support groups on social media in which members were primarily evacuees from the Fort McMurray wildfire. Loglinear results include a model of feeding methods before and after the wildfire evacuation. Results Content analyses results from qualitative data support findings from the loglinear model. Specifically, the findings suggest that the evacuation was associated with a reduction in breastfeeding and an increase in use of infant formula The open-ended data revealed that caregivers experienced stress during and after the evacuation due to moving from place to place, food insecurity associated with artificial feeding, warding off unhealthy food for older children, and managing family reunification. In addition, respondents reported that breastfeeding was a source of comfort for infants and contributed to a sense of empowerment. Conclusions for Practice This study sets forth important groundwork for understanding decision-making, stress, logistics, and social factors that influence infant feeding in a large-scale evacuation event. Emergency management, health workers, and nutrition experts can provide support to families in disasters to mitigate some of the adverse impacts the evacuation may have on infant feeding.

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DFW airport emergency room takes off with innovative communication platform

The world's first fully-equipped airport emergency room opened recently at the Dallas Fort Worth International Airport. Using state-of-the-art communication platform, Pulsara, the ED will be able to quickly exchange patient information, estimated time of arrival, and other data with local EMS to get critical patients treated sooner. These medical care facility projects at DFW are the...

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A robot-based gait training therapy for pediatric population with cerebral palsy: goal setting, proposal and preliminary clinical implementation

The use of robotic trainers has increased with the aim of improving gait function in patients with limitations. Nevertheless, there is an absence of studies that deeply describe detailed guidelines of how to c...

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Evaluation of ecological half-life of dose rate based on airborne radiation monitoring following the Fukushima Dai-ichi nuclear power plant accident

Publication date: December 2018

Source: Journal of Environmental Radioactivity, Volume 192

Author(s): Yukihisa Sanada, Yoshimi Urabe, Miyuki Sasaki, Kotaro Ochi, Tatsuo Torii

Abstract

Airborne radiation monitoring was conducted in order to evaluate the influence of radionuclides emitted by the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident throughout Japan. Carrying out airborne radiation monitoring using manned and unmanned helicopters, the we have developed and established an analysis method concurrently with the development of this monitoring method. In particular, because the background radiation level differs greatly between East and West regions of Japan, we have developed a discrimination method for natural radionuclide and cosmic rays using the gamma energy spectra. The reliability of the airborne radiation monitoring data was validated through comparison with large amounts of ground measurement data. The ecological half-lives of short and long components for decline of the ambient dose equivalent (air dose rate) were 0.61 years and 57 years, respectively, based on the results of air dose rate of airborne radiation monitoring using manned helicopter. These results indicate the importance of airborne monitoring to evaluate and predict the radiation exposure of residents.

Graphical abstract

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Fire dept. intern saves man’s life with newly-learned skills

Kaylee Mosley jumped into action to save a man who had driven into a wall by performing CPR, which she had just been certified in four days earlier

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A Study on the In-Situ Melt Pool Size Estimation Method for Directed-Energy Additive Manufacturing Based on Modal Parameters

3D Printing and Additive Manufacturing, Ahead of Print.


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Pinnacle EMS Quick Take: Why public safety leaders must have zero-tolerance for sexual misconduct

Police sergeant challenges and educates EMS leaders to do more to reduce the risk and occurrence of sexual harassment for all employees

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Pinnacle EMS Quick Take: Active shooter incident lessons learned for leaders

NFPA 3000 is a framework for preparing EMS agencies, fire departments, other responders and communities for active shooter incident response and recovery

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High-throughput determination of RNA structures

High-throughput determination of RNA structures

High-throughput determination of RNA structures, Published online: 27 July 2018; doi:10.1038/s41576-018-0034-x

High-throughput sequencing technology is enabling the structures of RNA to be determined on an unprecedented scale, providing insights into the relationship between the structures adopted by RNAs and the functions they perform in the cell.

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How to predict the future

How to predict the future

How to predict the future, Published online: 27 July 2018; doi:10.1038/s41576-018-0041-y

Two studies use targeted sequencing to identify features of clonal haematopoiesis that may predict the risk of developing acute myeloid leukaemia years before diagnosis.

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The International Public Safety Association announces open registration for its Fall 2018 Mass Casualty Incidents Symposium in Washington D.C.

GOODYEAR, Ariz. — The International Public Safety Association opened registration for its Fall 2018 Mass Casualty Incidents Symposium in Washington D.C. This timely and important event is a significant cross-disciplinary training opportunity for all public safety officials, from senior level executives to the first responders who arrive on-scene. The event will be held November 14 and 15,...

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Linking toxin-antitoxin systems with phenotypes: A Staphylococcus aureus viewpoint

Publication date: Available online 27 July 2018

Source: Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms

Author(s): Roberto Sierra, Patrick Viollier, Adriana Renzoni

Abstract

Toxin-antitoxin systems (TAS) are genetic modules controlling different aspects of bacterial physiology. They operate with versatility in an incredibly wide range of mechanisms. New TA modules with unexpected functions are continuously emerging from genome sequencing projects. Their discovery and functional studies have shed light on different characteristics of bacterial metabolism that are now applied to understanding clinically relevant questions and even proposed to as antimicrobial treatment. Our main source of knowledge of TA systems derives from Gram-negative bacterial studies, but studies in Gram-positives are becoming more prevalent and provide new insights to TA functional mechanisms. In this review, we present an overview of the present knowledge of TA systems in the clinical pathogen Staphylococcus aureus, their implications in bacterial physiology and discuss relevant aspects that are driving TAS research. "This article is part of a Special Issue entitled: Dynamic gene expression, edited by Prof. Patrick Viollier".

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High-throughput determination of RNA structures

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How to predict the future

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Accuracy of identifying the cricothyroid membrane in children using palpation

Abstract

Accurate identification of the cricothyroid membrane (CTM) has paramount importance in the event of a 'cannot intubate, cannot oxygenate' scenario. We sought to determine the ability of anesthesiologists to correctly identify the CTM in obese and non-obese children. Anesthesiologists were asked to mark the entry point of the cricothyroidotomy device with an ultraviolet invisible pen on obese and non-obese (BMI < 95th percentile for age and sex) children aged 7–12 years. A correct estimation was defined as a mark made between the upper and lower borders of the CTM and within the 3-mm midline. Twenty anesthesiologists palpated 30 obese and 50 non-obese children. The CTM was accurately identified with digital palpation in a total 55% of children, and there were no differences inaccurate identification rates of the CTM between obese and non-obese children [57 vs. 54%, respectively; median difference 3%; 95% confidence interval (− 20 to 25%); p = 0.82]. Accuracy was not correlated with any demographic or morphometric features of the children. Percutaneous identification of the CTM in children aged 7–12 years was poor and not significantly different for obese and non-obese children. Pre-procedural ultrasonography may help to identify the landmarks for cricothyroidotomy.

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Opioids, gliosis and central immunomodulation

Abstract

Neuropathic pain is a common health problem that affects millions of people worldwide. Despite being studied extensively, the cellular and molecular events underlying the central immunomodulation and the pathophysiology of neuropathic pain is still controversial. The idea that 'glial cells are merely housekeepers' is incorrect and with respect to initiation and maintenance of neuropathic pain, microglia and astrocytes have important roles to play. Glial cells differentially express opioid receptors and are thought to be functionally modulated by the activation of these receptors. In this review, we discuss evidence for glia-opioid modulation of pain by focusing on the pattern of astrocyte and microglial activation throughout the progress of nerve injury/neuropathic pain. Activation of astrocytes and microglia is a key step in central immunomodulation in terms of releasing pro-inflammatory markers and propagation of a 'central immune response'. Inhibition of astrocytes before and after induction of neuropathic pain has been found to prevent and reverse neuropathic pain, respectively. Moreover, microglial inhibitors have been found to prevent (but not to reverse) neuropathic pain. As they are expressed by glia, opioid receptors are expected to have a role to play in neuropathic pain.

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Whole-exome sequencing identifies rare genetic variations in German families with pulmonary sarcoidosis

Abstract

Genome-wide and candidate gene studies for pulmonary sarcoidosis have highlighted several candidate variants among different populations. However, the genetic basis of functional rare variants in sarcoidosis still needs to be explored. To identify functional rare variants in sarcoidosis, we sequenced exomes of 22 sarcoidosis cases from six families. Variants were prioritized using linkage and high-penetrance approaches, and filtered to identify novel and rare variants. Functional networking and pathway analysis of identified variants was performed using gene ontology based gene–phenotype, gene–gene, and protein–protein interactions. The linkage (n = 1007–7640) and high-penetrance (n = 11,432) prioritized variants were filtered to select variants with (a) reported allele frequency < 5% in databases (1.2–3.4%) or (b) novel (0.7–2.3%). Further selection based on functional properties and validation revealed a panel of 40 functional rare variants (33 from linkage region, 6 highly penetrant and 1 shared by both approaches). Functional network analysis implicated these gene variants in immune responses, such as regulation of pro-inflammatory cytokines including production of IFN-γ and anti-inflammatory cytokine IL-10, leukocyte proliferation, bacterial defence, and vesicle-mediated transport. The KEGG pathway analysis indicated inflammatory bowel disease as most relevant. This study highlights the subsets of functional rare gene variants involved in pulmonary sarcoidosis, such as, regulations of calcium ions, G-protein-coupled receptor, and immune system including retinoic acid binding. The implicated mechanisms in etiopathogenesis of familial sarcoidosis thus include Wnt signalling, inflammation mediated by chemokine and cytokine signalling and cadherin signalling pathways.

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Patellar Tendon Reflex And Vastus Medialis Hoffmann Reflex Are Down Regulated And Correlated In Women With Patellofemoral Pain

Publication date: Available online 27 July 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Marcella Ferraz Pazzinatto, Danilo de Oliveira Silva, Amanda Schenatto Ferreira, Marina Cabral Waiteman, Evangelos Pappas, Fernando Henrique Magalhães, Fábio Mícolis de Azevedo

ABSTRACT

Objective

(s): The aim of this study was threefold: (i) To compare the amplitude of patellar tendon reflex (T-reflex) between women with patellofemoral pain (PFP) and pain-free controls; (ii) To compare the amplitude of vastus medialis Hoffmann reflex (VM H-reflex) between women with PFP and pain-free controls; (iii) To investigate the association between the amplitude of patellar T-reflex and VM H-reflex in women with PFP and pain-free controls.

Design

Cross-sectional observational study.

Setting

Laboratory of biomechanics and motor control.

Participants

Thirty women with PFP and thirty pain-free women aged 18 to 35 years.

Main Outcome Measure(s)

Peak-to-peak amplitudes of maximal VM H-reflex (elicited via electrical stimulation on the femoral nerve) and patellar T-reflex (elicited via mechanical percussion on the patellar tendon) were estimated.

Results

Women with PFP had significant lower amplitude of patellar T-reflex (mean difference = 0.086; 95% CI = 0.020 to 0.151; p = 0.010; moderate effect) and VM H-reflex (mean difference = 0.150; 95% CI = 0.073 to 0.227; p < 0.001; large effect) compared to pain-free controls. The VM H-reflex was strongly correlated with patellar T-reflex in both PFP group (r = 0.66; p < 0.001) and control group (r = 0.72; p < 0.001).

Conclusion

(s): As the T-reflex is easier to perform than H-reflex assessments in a clinical setting, it represents a feasible option to assess the impaired excitability of the stretch reflex pathway associated with PFP.

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Editorial Board w/barcode

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Table of Contents

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Factors associated with length of stay and 30-day revisits in pediatric acute pancreatitis

Journal of Pediatric Gastroenterology and Nutrition

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Barriers and facilitators to a good bowel preparation for colonoscopy in children: a qualitative study

Journal of Pediatric Gastroenterology and Nutrition

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Mortality due to cirrhosis and liver cancer in the United States, 1999-2016: Observational study

BMJ

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Early treatment response predicts outcome in paediatric ulcerative colitis: Gastroenterology: Inflammatory bowel disease

Journal of Pediatric Gastroenterology and Nutrition

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Sarcopenia contributes to the progression of nonalcoholic fatty liver disease- related fibrosis: a meta-analysis

Digestive Diseases

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Diagnostic point-of-care ultrasound: applications in obstetric anaesthetic management.

Diagnostic point-of-care ultrasound: applications in obstetric anaesthetic management.

Anaesthesia. 2018 Jul 26;:

Authors: Zieleskiewicz L, Bouvet L, Einav S, Duclos G, Leone M

Abstract
Complications during pregnancy are not frequent, but may occur abruptly. Point-of-care ultrasound is a non-invasive, non-ionising diagnostic tool that is available at the bed-side when complications occur. This review covers the use of ultrasound in various clinical situations. Gastric ultrasound can identify stomach contents that put the woman at risk for pulmonary aspiration. In the future, this tool will probably be used routinely before induction of anaesthesia to determine the presence of stomach contents above a particular risk threshold. Difficult tracheal intubation, and the potential for 'can't intubate, can't oxygenate', is more frequent in pregnant women. Point-of-care ultrasound of the airway allows accurate identification of the cricothyroid membrane, permitting rapid and safer establishment of front-of-neck airway access. Combined cardiac and lung ultrasound can determine the potential risk:benefit of fluid administration in the pregnant patient. Such prediction is of critical importance, given the tendency of pregnant women to develop pulmonary oedema. Combined echocardiography and lung ultrasound can be combined with ultrasound of the leg veins to differentiate between the various causes of acute respiratory failure, and guide treatment in this situation. Finally, as shown in the general population, multi-organ point-of-care ultrasound allows early diagnosis of the main causes of circulatory failure and cardiac arrest at the bed-side. As the importance of point-of-care ultrasound in critical patients is increasingly recognised, it is emerging as an important tool in the therapeutic armoury of obstetric anaesthetists.

PMID: 30047997 [PubMed - as supplied by publisher]

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Long-term links between physical activity and sleep quality

Purpose Findings from cross-sectional research indicate that the relationship between sleep quality and physical activity is mixed. For research that does indicate a significant association, the interpretation of the finding most often is that physical activity leads to better sleep, or less frequently, that better sleep leads to more involvement in physical activity (see sleep deprivation studies). Cross-sectional studies, however, are not able to assess the direction of these effects, and experimental studies have tested only one direction of the effects. Longitudinal studies, with their focus on temporal order, are needed to specifically examine the link between sleep and physical activity as well as the direction of effects. The current study had three goals: to examine 1) the longitudinal relationship between sleep and physical activity, 2) the direction of effects, and 3) whether emotion regulation mediates the relationship between sleep and physical activity. Methods Participants included a sample of 827 (Mage at baseline = 19.04 years, SD = .92 years, 73.88% female) students at a university in Southwestern Ontario, who took part in a larger longitudinal survey that started in their first year of university. Participants were surveyed annually for 3 years (2011, 2012, 2013; retention: 83.9%). Measures assessed sleep quality, physical activity, emotion regulation, and involvement in sports clubs. Results A cross-lagged auto-regressive path analysis revealed that sleep quality indirectly predicted increased high, moderate and low intensity physical activity over time through its positive effect on emotion regulation. Moderate levels of physical activity indirectly predicted sleep quality over time through emotion regulation. Conclusions Overall, there appears to be support for a bidirectional relationship between sleep and physical activity over time (at least for moderate physical activity) but only indirectly through emotion regulation. Corresponding author information: Thalia Semplonius, Department of Psychology, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON L2S 3A1. Phone: 1 (905) 688-5550 ex. 4137. Email: ts11jy@brocku.ca Submitted for publication March 2018. Accepted for publication June 2018. © 2018 American College of Sports Medicine

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Sex Differences in Training Loads during British Army Basic Training

Purpose To compare training loads between men and women during 14-weeks of British Army standard entry basic training. Methods Thirty-one male (mean ± SD, age 21 ± 4 years, height 1.78 ± 0.08 m, mass 77.1 ± 10.5 kg) and 28 female (age 22 ± 4 years, height 1.65 ± 0.05 m, mass 63.9 ± 8.9 kg) British Army recruits had external (distance) and internal (heart rate [HR], training impulse [TRIMP], ratings of perceived exertion [RPE]) training loads measured during weeks 1, 2, 6, 12 and 13 of basic training. Total energy expenditure (TEE) was measured during weeks 1−2 and 12−13. Results Daily distance was higher for men than women (13,508 ± 666 vs 11,866 ± 491 m, respectively, P

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A Dual-Accelerometer System for Classifying Physical Activity in Children and Adults

Introduction Accurately monitoring 24-hour movement behaviours is a vital step for progressing the time-use epidemiology field. Past accelerometer-based measurement protocols are either hindered by lack of wear time compliance, or the inability to accurately discern activities and postures. Recent work has indicated that skin-attached dual-accelerometers exhibit excellent 24-hour uninterrupted wear time compliance. This study extends this work by validating this system for classifying various physical activities and sedentary behaviours in children and adults. Methods Seventy-five participants (42 children) were equipped with two Axivity AX3 accelerometers; one attached to their thigh, and one to their lower back. Ten activity trials (e.g., sitting, standing, lying, walking, running) were performed while under direct observation in a lab setting. Various time- and frequency-domain features were computed from raw accelerometer data, which were then used to train a random forest machine learning classifier. Model performance was evaluated using leave-one-out cross-validation. The efficacy of the dual-sensor protocol (relative to single sensors) was evaluated by repeating the modelling process with each sensor individually. Results Machine learning models were able to differentiate between six distinct activity classes with exceptionally high accuracy in both adults (99.1%) and children (97.3%). When a single thigh or back accelerometer was used, there was a pronounced drop in accuracy for non-ambulatory activities (up to a 26.4% decline). When examining the features used for model training, those that took the orientation of both sensors into account concurrently were more important predictors. Conclusion When previous wear time compliance results are taken together with our findings, it represents a promising step forward for monitoring and understanding 24-hour time-use behaviours. The next step will be to examine the generalisability of these findings in a free-living setting. Corresponding author: Dr Tom Stewart, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand. Phone: +64 9 921 9999 ext 7855. E-mail: tom.stewart@aut.ac.nz No external funding was received for this study. Participant incentives were covered using internal department funds. The results of this study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute endorsement by ACSM. © 2018 American College of Sports Medicine

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Numerical Reconstruction of Traumatic Brain Injury in Skiing and Snowboarding

PURPOSE Proper evaluation of ski helmet designs and safety standards should rely on head impact conditions involved in skiing and snowboarding head injuries. In order to study these impacts, main crash scenarios involving head injuries are numerically replicated. METHODS Multibody models of skiers and snowboarders were developed to investigate 5 common crash scenarios involved in traumatic brain injury: forward and sideways skiing falls, snowboarding backward falls, collisions between users and collisions with obstacles. For each scenario, the influence of crash conditions on head impact (location, speed, linear and rotational accelerations) and risk of injury are evaluated. Crash conditions were initial velocity, user height, position and approach angle, slope steepness, obstacles and snow stiffness. RESULTS 1149 crashes were simulated and three significant levels of impact conditions were discriminated over the investigated crash scenarios: 1) the smallest normal-to-slope impact velocities [6 km/h; 22 km/h] and peak linear accelerations [42 G; 75 G] were obtained during forward and sideways skiing falls; 2) Snowboarding backward falls and collisions between users were associated with high normal-to-surface impact velocities [26 km/h; 32 km/h] and head accelerations [80 G; 149 G] above one published threshold for mild traumatic brain injury but below the pass/fail criteria of helmet standard tests; 3) Collisions with obstacles were associated with high normal-to-surface impact velocities [19 km/h; 35 km/h] and the highest head accelerations [626 G; 1885 G]. CONCLUSION Current impact conditions of helmet standard evaluations consistently replicate collisions with obstacles, but need to be revised to better reflect other significant crash scenarios leading to traumatic brain injury. Corresponding author: Nicolas Bailly, Laboratoire de recherche en imagerie et orthopédie, Centre de recherche de l'HSCM, 5400, boul. Gouin Ouest, local K-4075, Montréal, (Québec) H4J 1C5, CANADA. Tél. : +1 514 567 8296. Mail: nicolas1.bailly@gmail.com Authors declare that the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The present study does not constitute endorsement by ACSM. Dr. Bailly and Mr. Donnadieu report personal fees (employment) from Salomon SAS during the conduct of the study. In addition, Dr. Bailly, Mr. Donnadieu, Dr. Masson and Dr. Arnoux have a patent on helmets pending. Submitted for publication March 2018. Accepted for publication June 2018. © 2018 American College of Sports Medicine

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Associations of Sedentary Time with Energy Expenditure and Anthropometric Measures

Purpose To investigate associations between accelerometer-determined sedentary time (ST) in prolonged (≥30 minutes) and non-prolonged (

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Association of Sickle Cell Trait and Hemoglobin S Percentage with Physical Fitness

Purpose This study aimed to determine the association between sickle cell trait (SCT) as a binary variable and hemoglobin S percentage as a stratified categorical variable with aerobic and anaerobic fitness. Methods This retrospective cohort study included all recruits who entered U.S. Air Force basic training between January 2009 and December 2014. Fitness parameters among recruits with and without SCT were compared using a standardized fitness assessment of a 1.5-mile timed run, 1 minute of push-ups, and 1 minute of sit-ups. Performance was further compared by stratifying those with SCT by their hemoglobin S percentage (20-29.99%; 30-39.99%; and ≥40%). Results Of all recruits (N=210,461) who entered training during the surveillance period, 2,161 (1.0%) had SCT. After adjusting for age, sex, race, body mass index, and ambient temperature while conducting the fitness assessment, recruits with SCT were slower on their initial run than their peers without SCT by a mean (standard error) of 9.4 (2.6) seconds (p

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Influence of Vitamin D Supplementation by Sunlight or Oral D3 on Exercise Performance

Purpose To determine the relationship between vitamin D status and exercise performance in a large, prospective cohort study of young men and women across seasons (Study-1). Then, in a randomized, placebo-controlled trial, to investigate the effects on exercise performance of achieving vitamin D sufficiency (serum 25(OH)D ≥ 50 nmol·L-1) by a unique comparison of safe, simulated-sunlight and oral vitamin D3 supplementation in wintertime (Study-2). Methods In Study-1, we determined 25(OH)D relationship with exercise performance in 967 military recruits. In Study-2, 137 men received either placebo, simulated-sunlight (1.3x standard erythemal dose in T-shirt and shorts, three-times-per-week for 4-weeks and then once-per-week for 8-weeks) or oral vitamin D3 (1,000 IU[BULLET OPERATOR]day-1 for 4-weeks and then 400 IU[BULLET OPERATOR]day-1 for 8-weeks). We measured serum 25(OH)D by LC-MS/MS and endurance, strength and power by 1.5-mile run, maximum-dynamic-lift and vertical jump, respectively. Results In Study-1, only 9% of men and 36% of women were vitamin D sufficient during wintertime. After controlling for body composition, smoking and season, 25(OH)D was positively associated with endurance performance (P ≤ 0.01, [INCREMENT]R2 = 0.03–0.06, small f2 effect sizes): 1.5-mile run time was ~half-a-second faster for every 1 nmol·L-1 increase in 25(OH)D. No significant effects on strength or power emerged (P > 0.05). In Study-2, safe simulated-sunlight and oral vitamin D3 supplementation were similarly effective in achieving vitamin D sufficiency in almost all (97%); however, this did not improve exercise performance (P > 0.05). Conclusion Vitamin D status was associated with endurance performance but not strength or power in a prospective cohort study. Achieving vitamin D sufficiency via safe, simulated summer sunlight or oral vitamin D3 supplementation did not improve exercise performance in a randomized-controlled trial. Corresponding Author: Prof. Neil P. Walsh FACSM, College of Health and Behavioural Sciences, Bangor University, Bangor, LL57 2PZ, UK. Email: n.walsh@bangor.ac.uk. Telephone: + 44 1248 383480 This work was funded by the Ministry of Defence (Army), UK. Conflict of interest: None declared. The results of Study 1 and Study 2 are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation; and, they do not constitute endorsement by ACSM. Submitted for publication April 2018. Accepted for publication July 2018. © 2018 American College of Sports Medicine

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Epigenetic activation of PERP transcription by MKL1 contributes to ROS-induced apoptosis in skeletal muscle cells

Publication date: Available online 27 July 2018

Source: Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms

Author(s): Zilong Li, Baoyu Chen, Wenhui Dong, Wenping Xu, Mingzi Song, Mingming Fang, Junli Guo, Yong Xu

Abstract

Excessive reactive oxygen species (ROS) causes irreparable damages to cells and commit cells to programmed cell death or apoptosis. A panel of well-documented pro-apoptotic genes, including p53 apoptosis effector related to PMP-22 (PERP), is up-regulated and collectively mediate ROS induced apoptosis. The epigenetic mechanism whereby ROS stimulates PERP transcription, however, lacks in-depth characterization. Here we report that the transcriptional modulator megakaryocytic leukemia 1 (MKL1) is activated by H₂O₂ treatment in skeletal muscle cells (C2C12). Small interfering RNA (siRNA) mediated silencing or small-molecule compound (CCG-1423) mediated inhibition of MKL1 attenuated H₂O₂ induced apoptosis of C2C12 cells. Over-expression of MKL1 potentiated trans-activation of PERP whereas MKL1 ablation/inhibition abrogated the induction of PERP by H₂O₂ in C2C12 cells. Mechanistically, MKL1 interacted with and was recruited to the PERP promoter by the transcription factor E2F1. Once bound to the PERP promoter, MKL1 engaged the histone demethylase KDM3A to modulate the chromatin structure surrounding the PERP promoter thereby leading to PERP trans-activation. Depletion of either E2F1 or KDM3A blocked the induction of PERP by H₂O₂. In conclusion, our data illustrate a novel epigenetic pathway that links PERP transcription to ROS-induced apoptosis in skeletal muscle cells.

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Incidence of peri-operative paediatric cardiac arrest: Influence of a specialised paediatric anaesthesia team

BACKGROUND Peri-operative critical events are still a major problem in paediatric anaesthesia care. Access to more experienced healthcare teams might reduce the adverse event rate and improve outcomes. OBJECTIVE The current study analysed incidences of peri-operative paediatric cardiac arrest before and after implementation of a specialised paediatric anaesthesia team and training programme. DESIGN Retrospective cohort study with before-and-after analysis. SETTING Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany. PATIENTS A total of 36 243 paediatric anaesthetics (0 to 18 years) were administered between 2008 and 2016. INTERVENTION Implementation of a specialised paediatric anaesthesia team and training programme occurred in 2014 This included hands-on supervised training in all fields of paediatric anaesthesia, double staffing for critical paediatric cases and a 24/7 emergency team. A logistic regression analysis with risk factors (age, ASA physical status, emergency) was used to evaluate the impact of implementation of the specialised paediatric anaesthesia team. MAIN OUTCOME MEASURES Incidences of peri-operative paediatric cardiac arrest and anaesthesia-attributable cardiac arrest before and after the intervention. RESULTS Twelve of 25 paediatric cardiac arrests were classified as anaesthesia-attributable. The incidence of overall peri-operative paediatric cardiac arrest was 8.1/10 000 (95% CI 5.2 to 12.7) in the period 2008 to 2013 and decreased to 4.6/10 000 (95% CI 2.1 to 10.2) in 2014 to 2016. Likewise, the incidence of anaesthesia-attributable cardiac arrest was lower after 2013 [1.6/10 000 (95% CI 0.3 to 5.7) vs. 4.3/10 000 (95% CI 2.3 to 7.9)]. Using logistic regression, children anaesthetised after 2013 had nearly a 70% lower probability of anaesthesia-attributable cardiac arrest (odds ratio 0.306, 95% CI 0.067 to 1.397; P = 0.1263). For anaesthesia-attributable cardiac arrest, young age was the most contributory risk factor, whereas in overall paediatric cardiac arrest, ASA physical statuses 3 to 5 played a more important role. CONCLUSION In this study on incidences of peri-operative paediatric cardiac arrest from a European tertiary care university hospital, implementation of a specialised paediatric anaesthesia team and training programme was associated with lower incidences of peri-operative paediatric cardiac arrest and a reduced probability of anaesthesia-attributable cardiac arrest. Correspondence to Dr Andreas Hohn, MHBA, DESA, EDIC, Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany Tel: +49 221 478 82058; fax: +49 221 478 85574; e-mail: andreas.hohn@uk-koeln.de 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/2ylyqmW). © 2018 European Society of Anaesthesiology

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Phylogenetic relationships of living and fossil African papionins: Combined evidence from morphology and molecules

Publication date: Available online 26 July 2018

Source: Journal of Human Evolution

Author(s): Kelsey D. Pugh, Christopher C. Gilbert

Abstract

African papionins are a highly successful subtribe of Old World monkeys with an extensive fossil record. On the basis of both molecular and morphological data, crown African papionins are divided into two clades: Cercocebus/Mandrillus and Papio/Lophocebus/Rungwecebus/Theropithecus (P/L/R/T), though phylogenetic relationships in the latter clade, among both fossil and extant taxa, remain difficult to resolve. While previous phylogenetic studies have focused on either molecular or morphological data, here African papionin molecular and morphological data were combined using both supermatrix and molecular backbone approaches. Theropithecus is supported as the sister taxon to Papio/Lophocebus/Rungwecebus, and while supermatrix analyses using Bayesian methods are largely unresolved, analyses using parsimony are broadly similar to earlier studies. Thus, the position of Rungwecebus relative to Papio and Lophocebus remains equivocal, possibly due to complex patterns of reticulation. Parapapio is likely a paraphyletic grouping of primitive African papionins or possibly a collection of stem P/L/R/T taxa, and a similar phylogenetic position is also hypothesized for Pliopapio. ?Papio izodi is either a stem or crown P/L/R/T taxon, but does not group with other Papio taxa. Dinopithecus and Gorgopithecus are also stem or crown P/L/R/T taxa, but their phylogenetic positions remain unstable. Finally, T. baringensis is likely the most basal Theropithecus taxon, with T. gelada and T. oswaldi sister taxa to the exclusion of T. brumpti. By integrating large amounts of molecular and morphological data, combined with the application of updated parsimony and Bayesian methods, this study represents the most comprehensive analysis of African papionin phylogenetic history to date.

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Oblique human symphyseal angle is associated with an evolutionary rate-shift early in the hominin clade

Publication date: Available online 26 July 2018

Source: Journal of Human Evolution

Author(s): James D. Pampush, Jill E. Scott, Chris A. Robinson, Lucas K. Delezene

Abstract

The rate of change in primate mandibular symphyseal angles was modeled with particular aim of locating a rate-shift within the hominin clade. Prior work noted that the human symphyseal angle must have experienced a rapid rate of change in order to assume the modern human form, suggestive of the non-random work of natural selection. This study indicates that the rate of symphyseal evolution rose dramatically between Australopithecus anamensis and Australopithecus afarensis and continued throughout the diversification of the hominin clade. Noting the timing of this event, we speculate as to what ecological factors could have been at play in driving this rearrangement of the anterior mandible, contributing to the eventual appearance of the human chin.

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