Πέμπτη, 7 Απριλίου 2016

TRAINING SPECIFIC FUNCTIONAL, NEURAL AND HYPERTROPHIC ADAPTATIONS TO EXPLOSIVE- VS. SUSTAINED-CONTRACTION STRENGTH TRAINING

Training specificity is considered important for strength training, although the functional and underpinning physiological adaptations to different types of training, including brief explosive contractions, are poorly understood. This study compared the effects of 12-wks of explosive-contraction (ECT, n=13) vs. sustained-contraction (SCT, n=16) strength training vs. control (CON, n=14) on the functional, neural, hypertrophic, and intrinsic contractile characteristics of healthy young men. Training involved 40 isometric repetitions (x3/wk): contracting as fast and hard as possible for ~1 s (ECT); or gradually increasing to 75% of maximum voluntary torque (MVT) before holding for 3 s (SCT). Torque and EMG during maximum and explosive contractions, torque during evoked octet contractions, and total quadriceps muscle volume (QUADSVOL) were quantified pre- and post-training. MVT increased more after SCT than EST (23 vs. 17%; effect size [ES]=0.69), with similar increases in neural drive, but greater QUADSVOL changes after SCT (8.1 vs. 2.6%; ES=0.74). ECT improved explosive torque at all time points (17-34%; 0.54≤ES≤0.76) due to increased neural drive (17-28%), whereas only late-phase explosive torque (150 ms, +12%; ES=1.48) and corresponding neural drive (18%) increased after SCT. Changes in evoked torque indicated slowing of the contractile properties of the muscle-tendon unit after both training interventions. These results showed training-specific functional changes that appeared to be due to distinct neural and hypertrophic adaptations. ECT produced a wider range of functional adaptations than SCT, and given the lesser demands of ECT this type of training provides a highly efficient means of increasing function.



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The accuracy and robustness of a simple algorithm to measure vessel diameter from B-mode ultrasound images.

Measurement of changes in arterial vessel diameter can be used to assess the state of cardiovascular health, but the use of such measurements as biomarkers is contingent upon the accuracy and robustness of the measurement. This work presents a simple algorithm for measuring diameter from B-mode images derived from vascular ultrasound. The algorithm is based upon Gaussian curve fitting and a Viterbi search process. We assessed the accuracy of the algorithm by measuring the diameter of a digital reference object (DRO) and ultrasound-derived images of a carotid artery. We also assessed the robustness of the algorithm by manipulating the quality of the image. Across a broad range of signal-to-noise ratio and with varying image edge error, the algorithm measured vessel diameter within 0.7% of the creation dimensions of the DRO. This was a similar level of difference (0.8%) when an ultrasound image was used. When SNR dropped to 18 dB, measurement error increased to 1.3%. When edge position was varied by as much as 10%, measurement error was well maintained between 0.68 and 0.75%. All these errors fall well within the margin of error established by the medical physics community for quantitative ultrasound measurements. We conclude that this simple algorithm provides consistent and accurate measurement of lumen diameter from B-mode images across a broad range of image quality.



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Paramedic - Ambulance Service of Fulton County

NOW HIRING: FULL TIME/ PART TIME/ PER DIEM PARAMEDICS AND EMTS The Ambulance Service of Fulton County is looking for energetic, professional individuals with high integrity who want to give back to their community through emergency medical care. At ASFC we believe that the most important asset of every organization is its employees. We continuously invest in our staff by providing ongoing in-depth ...

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EMERGENCY MEDICAL TECHNICIAN - Ambulance Service of Fulton County

NOW HIRING: FULL TIME/ PART TIME/ PER DIEM PARAMEDICS AND EMTS The Ambulance Service of Fulton County is looking for energetic, professional individuals with high integrity who want to give back to their community through emergency medical care. At ASFC we believe that the most important asset of every organization is its employees. We continuously invest in our staff by providing ongoing in-depth ...

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Man accused of sexually assaulting patient



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Outcome of a prospective multicentre observational data-monitored study of minimally invasive fusion in the surgical treatment of degenerative lumbar disorders: 1-year follow-up study

BACKGROUND CONTEXT: To present the outcome of a prospective multicentre observational data-monitored study of minimally invasive fusion (MILIF) in the surgical treatment of degenerative lumbar disorders: 1-year follow-up study.

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In vivo remodelling of an organic bone mineral spinal fusion

BACKGROUND CONTEXT: Issues such as donor site morbidity make bone graft substitutes an attractive option for cervical fusions. Such material will eventually re-model into trabecular bone as fusion progresses.

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Man accused of sexually assaulting patient



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Evolution of Plant Phenotypes, from Genomes to Traits



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Utilizing Gene Tree Variation to Identify Candidate Effector Genes in Zymoseptoria tritici

Zymoseptoria tritici is a host-specific, necrotrophic pathogen of wheat. Infection by Z. tritici is characterized by its extended latent period, which typically lasts 2 wks, and is followed by extensive host cell death, and rapid proliferation of fungal biomass. This work characterizes the level of genomic variation in 13 isolates, for which we have measured virulence on 11 wheat cultivars with differential resistance genes. Between the reference isolate, IPO323, and the 13 Australian isolates we identified over 800,000 single nucleotide polymorphisms, of which ~10% had an effect on the coding regions of the genome. Furthermore, we identified over 1700 probable presence/absence polymorphisms in genes across the Australian isolates using de novo assembly. Finally, we developed a gene tree sorting method that quickly identifies groups of isolates within a single gene alignment whose sequence haplotypes correspond with virulence scores on a single wheat cultivar. Using this method, we have identified < 100 candidate effector genes whose gene sequence correlates with virulence toward a wheat cultivar carrying a major resistance gene.



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Accuracy of Genomic Prediction in Switchgrass (Panicum virgatum L.) Improved by Accounting for Linkage Disequilibrium

Switchgrass is a relatively high-yielding and environmentally sustainable biomass crop, but further genetic gains in biomass yield must be achieved to make it an economically viable bioenergy feedstock. Genomic selection (GS) is an attractive technology to generate rapid genetic gains in switchgrass, and meet the goals of a substantial displacement of petroleum use with biofuels in the near future. In this study, we empirically assessed prediction procedures for genomic selection in two different populations, consisting of 137 and 110 half-sib families of switchgrass, tested in two locations in the United States for three agronomic traits: dry matter yield, plant height, and heading date. Marker data were produced for the families' parents by exome capture sequencing, generating up to 141,030 polymorphic markers with available genomic-location and annotation information. We evaluated prediction procedures that varied not only by learning schemes and prediction models, but also by the way the data were preprocessed to account for redundancy in marker information. More complex genomic prediction procedures were generally not significantly more accurate than the simplest procedure, likely due to limited population sizes. Nevertheless, a highly significant gain in prediction accuracy was achieved by transforming the marker data through a marker correlation matrix. Our results suggest that marker-data transformations and, more generally, the account of linkage disequilibrium among markers, offer valuable opportunities for improving prediction procedures in GS. Some of the achieved prediction accuracies should motivate implementation of GS in switchgrass breeding programs.



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Identification of Polymorphisms Associated with Drought Adaptation QTL in Brassica napus by Resequencing

Brassica napus is a globally important oilseed for which little is known about the genetics of drought adaptation. We previously mapped twelve quantitative trait loci (QTL) underlying drought-related traits in a biparental mapping population created from a cross between winter and spring B. napus cultivars. Here we resequence the genomes of the mapping population parents to identify genetic diversity across the genome and within QTL regions. We sequenced each parental cultivar on the Illumina HiSeq platform to a minimum depth of 23 x and performed a reference based assembly in order to describe the molecular variation differentiating them at the scale of the genome, QTL and gene. Genome-wide patterns of variation were characterized by an overall higher single nucleotide polymorphism (SNP) density in the A genome and a higher ratio of nonsynonymous to synonymous substitutions in the C genome. Nonsynonymous substitutions were used to categorize gene ontology terms differentiating the parent genomes along with a list of putative functional variants contained within each QTL. Marker assays were developed for several of the discovered polymorphisms within a pleiotropic QTL on chromosome A10. QTL analysis with the new, denser map showed the most associated marker to be that developed from an insertion/deletion polymorphism located in the candidate gene Bna.FLC.A10, and it was the only candidate within the QTL interval with observed polymorphism. Together, these results provide a glimpse of genome-wide variation differentiating annual and biennial B. napus ecotypes as well as a better understanding of the genetic basis of root and drought phenotypes.



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High Throughput Analyses of Budding Yeast ARSs Reveal New DNA Elements Capable of Conferring Centromere-Independent Plasmid Propagation

The ability of plasmids to propagate in Saccharomyces cerevisiae has been instrumental in defining eukaryotic chromosomal control elements. Stable propagation demands both plasmid replication, which requires a chromosomal replication origin (i.e., an ARS), and plasmid distribution to dividing cells, which requires either a chromosomal centromere for segregation or a plasmid-partitioning element. While our knowledge of yeast ARSs and centromeres is relatively advanced, we know less about chromosomal regions that can function as plasmid partitioning elements. The Rap1 protein-binding site (RAP1) present in transcriptional silencers and telomeres of budding yeast is a known plasmid-partitioning element that functions to anchor a plasmid to the inner nuclear membrane (INM), which in turn facilitates plasmid distribution to daughter cells. This Rap1-dependent INM-anchoring also has an important chromosomal role in higher-order chromosomal structures that enhance transcriptional silencing and telomere stability. Thus, plasmid partitioning can reflect fundamental features of chromosome structure and biology, yet a systematic screen for plasmid partitioning elements has not been reported. Here, we couple deep sequencing with competitive growth experiments of a plasmid library containing thousands of short ARS fragments to identify new plasmid partitioning elements. Competitive growth experiments were performed with libraries that differed only in terms of the presence or absence of a centromere. Comparisons of the behavior of ARS fragments in the two experiments allowed us to identify sequences that were likely to drive plasmid partitioning. In addition to the silencer RAP1 site, we identified 74 new putative plasmid-partitioning motifs predicted to act as binding sites for DNA binding proteins enriched for roles in negative regulation of gene expression and G2/M-phase associated biology. These data expand our knowledge of chromosomal elements that may function in plasmid partitioning and suggest underlying biological roles shared by such elements.



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Genome-Wide Analysis of Transposon and Retroviral Insertions Reveals Preferential Integrations in Regions of DNA Flexibility

DNA transposons and retroviruses are important transgenic tools for genome engineering. An important consideration affecting the choice of transgenic vector is their insertion site preferences. Previous large-scale analyses of Ds transposon integration sites in plants were done on the basis of reporter gene expression or germ-line transmission, making it difficult to discern vertebrate integration preferences. Here, we compare over 1300 Ds transposon integration sites in zebrafish with Tol2 transposon and retroviral integration sites. Genome-wide analysis shows that Ds integration sites in the presence or absence of marker selection are remarkably similar and distributed throughout the genome. No strict motif was found, but a preference for structural features in the target DNA associated with DNA flexibility (Twist, Tilt, Rise, Roll, Shift, and Slide) was observed. Remarkably, this feature is also found in transposon and retroviral integrations in maize and mouse cells. Our findings show that structural features influence the integration of heterologous DNA in genomes, and have implications for targeted genome engineering.



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A Genetic Map for the Only Self-Fertilizing Vertebrate

The mangrove killifish Kryptolebias marmoratus, and its close relative Kryptolebias hermaphroditus, are the only vertebrate species known to reproduce by self-fertilization due to functional ovotestis development. To improve our understanding of their genomes, we constructed a genetic map. First, a single F1 fish was made by artificial fertilization between K. marmoratus and K. hermaphroditus strains. F2 progeny were then obtained by self-fertilization of the F1 fish. We used RAD-seq to query genomic DNAs from the two parental strains, the F1 individual and 49 F2 progeny. Results identified 9904 polymorphic RAD-tags (DNA markers) that mapped to 24 linkage groups, corresponding to the haploid chromosome number of these species. The total length of the map was 1248 cM, indicating that about one recombination occurred for each of the 24 homologous chromosome pairs in each meiosis. Markers were not evenly distributed along the chromosomes: in all chromosomes, many markers (> 8% of the total markers for each chromosome) mapped to chromosome tips. Centromeres suppress recombination, and this uneven distribution is probably due to the species' acrocentric chromosomes. Mapped marker sequences were compared to genomic sequences of medaka and platyfish, the next most closely related species with sequenced genomes that are anchored to genetic maps. Results showed that each mangrove killifish chromosome corresponds to a single chromosome of both platyfish and medaka, suggesting strong conservation of chromosomes over 100 million years of evolution. Our genetic map provides a framework for the K. marmoratus/K. hermaphroditus genome sequence and an important resource for understanding the biology of hermaphroditism.



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Drak Is Required for Actomyosin Organization During Drosophila Cellularization

The generation of force by actomyosin contraction is critical for a variety of cellular and developmental processes. Nonmuscle myosin II is the motor that drives actomyosin contraction, and its activity is largely regulated by phosphorylation of the myosin regulatory light chain. During the formation of the Drosophila cellular blastoderm, actomyosin contraction drives constriction of microfilament rings, modified cytokinesis rings. Here, we find that Drak is necessary for most of the phosphorylation of the myosin regulatory light chain during cellularization. We show that Drak is required for organization of myosin II within the microfilament rings. Proper actomyosin contraction of the microfilament rings during cellularization also requires Drak activity. Constitutive activation of myosin regulatory light chain bypasses the requirement for Drak, suggesting that actomyosin organization and contraction are mediated through Drak's regulation of myosin activity. Drak is also involved in the maintenance of furrow canal structure and lateral plasma membrane integrity during cellularization. Together, our observations suggest that Drak is the primary regulator of actomyosin dynamics during cellularization.



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Man accused of sexually assaulting patient



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Mapping of Variable DNA Methylation Across Multiple Cell Types Defines a Dynamic Regulatory Landscape of the Human Genome

DNA methylation is an important epigenetic modification involved in many biological processes and diseases. Many studies have mapped DNA methylation changes associated with embryogenesis, cell differentiation, and cancer at a genome-wide scale. Our understanding of genome-wide DNA methylation changes in a developmental or disease-related context has been steadily growing. However, the investigation of which CpGs are variably methylated in different normal cell or tissue types is still limited. Here, we present an in-depth analysis of 54 single-CpG-resolution DNA methylomes of normal human cell types by integrating high-throughput sequencing-based methylation data. We found that the ratio of methylated to unmethylated CpGs is relatively constant regardless of cell type. However, which CpGs made up the unmethylated complement was cell-type specific. We categorized the 26,000,000 human autosomal CpGs based on their methylation levels across multiple cell types to identify variably methylated CpGs and found that 22.6% exhibited variable DNA methylation. These variably methylated CpGs formed 660,000 variably methylated regions (VMRs), encompassing 11% of the genome. By integrating a multitude of genomic data, we found that VMRs enrich for histone modifications indicative of enhancers, suggesting their role as regulatory elements marking cell type specificity. VMRs enriched for transcription factor binding sites in a tissue-dependent manner. Importantly, they enriched for GWAS variants, suggesting that VMRs could potentially be implicated in disease and complex traits. Taken together, our results highlight the link between CpG methylation variation, genetic variation, and disease risk for many human cell types.



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Carcinoid Tumor Complicating Crohn's Disease in a Female Adolescent: A Letter to the Editor.

No abstract available

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Accuracy of Prediction Formulae for the Assessment of Resting Energy Expenditure in Hospitalized Children.

Background and aim: The resting energy expenditure (REE) of ill children is commonly estimated from prediction formulae developed in healthy children. The aim of the present study was to evaluate the accuracy of commonly employed REE prediction formulae vs. indirect calorimetry (IC) in hospitalized children. Methods: We performed a cross-sectional study of 236 infants, children and adolescents consecutively admitted to the Intermediate Care, Nephrology, Intensive Care, Emergency, and Cystic Fibrosis Units of the De Marchi Pediatric Hospital (Milan, Italy) between September 2013 and March 2015. REE was measured by IC and estimated using the WHO, Harris-Benedict, Schofield and Oxford formulae. Results: The mean (standard deviation) difference between the estimated and measured REE was: - 1 (234) kcal/day for the WHO formula; 82 (286) kcal/day for the Harris-Benedict formula; 2 (215) kcal/day for the Schofield-weight formula;-2 (214) kcal/day for the Schofield-weight and height formula and; - 5 (221) kcal/day for the Oxford formula. Even though the WHO, Schofield and Oxford formulae gave accurate estimates of REE at the population level (small mean bias), all the formulae were not accurate enough to be employed at the individual level (large SD of bias). Conclusions: The WHO, Harris-Benedict, Schofield and Oxford formulae should not be used to estimate REE in hospitalized children. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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More than Just the Delivery.

No abstract available

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Ascites in Children: a Single Center Experience of 27 years.

Objectives: The aim of our study was to describe the changing prevalence, demographic features, etiologies, and treatment of ascites in children hospitalized over a 27 year period at the Johns Hopkins Hospital. Methods: We retrospectively reviewed discharges from 1983-2010 to select patients whose records included a diagnosis of ascites. We assessed the etiologies and degrees of ascites (ascites grade 1 detectable only by radiologic tests; ascites grade 2&3 recognized by moderate and marked abdominal distension by physical examinations). Results: We classified 518 children into 9 etiology groups: 105 had intrahepatic disease (IH), hepatic vein outflow obstruction (HVOO) (45), congestive heart disease (CH) (33), nephrotic syndrome (NS) (36), pancreatitis (26), inflammatory & infectious diseases (77), malignancy (49), idiopathic (71), and miscellaneous (76). IH and CH were predominant in younger age group (0-5 years) vs HVOO, pancreatitis and malignancy in the older age group (13-21 years) (p

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Effect of Oral Lipid Matrix Supplement on Fat Absorption in Cystic Fibrosis: A Randomized Placebo-Controlled Trial.

Pancreatic enzyme therapy does not normalize dietary fat absorption in patients with cystic fibrosis (CF) and pancreatic insufficiency (PI). Efficacy of LYM-X-SORBTM (LXS), an easily absorbable lipid matrix that enhances fat absorption was evaluated in a 12-month randomized, double-blinded, placebo-controlled trial with plasma fatty acids (FA), and coefficient of fat absorption (CFA) outcomes. 110 subjects (age 10.4 +/- 3.0 y) were randomized. Total FA increased with LXS at 3 and 12 months (+1.58; +1.14 mmol/L) and not with placebo (P = 0.046). With LXS, linoleic acid (LA) increased at 3 and 12 months (+298; +175 nmol/mL, P

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Baseline Wall Thickness is Lower in Mucosa Healed Segments 1 Year After Infliximab in Pediatric Crohn's Disease Patients.

Objectives: We aimed to quantitatively investigate the therapeutic response to combined immunosuppression treatment by magnetic resonance enterography (MRE) in active luminal Crohn's disease in the pediatric population. Methods: Pediatric patients with moderate-to-severe luminal Crohn's disease who received scheduled infliximab and azathioprine were included in this preliminary study. Ileocolonoscopy and MRE were performed at baseline and at 1 year, and Simple Endoscopic Score for Crohn's Disease (SES-CD) and Magnetic Resonance Index of Activity (MaRIA) scores were calculated. The correlation between SES-CD and MaRIA scores were investigated with analysis per-person and per-segment. Results: A total 167 segments from 17 patients were evaluated by both ileocolonoscopy and MRE. SES-CD and MaRIA scores showed significant correlations on both per-person analysis ([rho] = 0.699, P

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Coagulation Gene Expression Profiling in Infants with Necrotizing Enterocolitis.

Objectives: Coagulopathy and mesenteric thrombosis are common in premature neonates with necrotizing enterocolitis (NEC). This pilot study aimed to investigate the hypothesis that there are changes in the gene expression related to the coagulation and anticoagulation systems in NEC. Methods: Consecutive neonates (n = 11) with NEC (Bell's stages 2-3) were recruited. Two comparison groups, matched for birth weight and corrected gestational age, were selected based on: the absence of inflammation and coagulopathy (healthy control, n = 10); or the presence of a confirmed blood infection (sepsis control, n = 12). A pathway specific quantitative PCR array was used to determine the expression of 94 genes involved in human blood coagulation and anticoagulation cascade. Results: Twelve genes of the coagulation and anticoagulation systems were significantly altered in the NEC patients compared to healthy controls. In particular, ELANE, CD63, PROS1, HGF, F12 were significantly up-regulated (mean fold changes +2.74, p

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Epidural insertion height for ureteric reimplant surgery; does location matter?

Summary

Background

Surgical correction of vesicoureteric reflux through ureteric reimplantation is a common, highly successful treatment. Postoperative pain can be severe and may relate to somatic wound pain from the lower abdominal incision or from visceral bladder spasm pain.

Aim

To conduct a prospective quality improvement audit to compare four perioperative analgesic techniques.

Methods

Observational data were collected on 217 patients following open ureteroneocystostomy over 5 days. The patients were split into four groups: (i) 'morphine' infusion; (ii) 'caudal'—single-shot caudal; (iii) 'epidural'—epidural catheter inserted at T10-L2 given a bolus, followed by an infusion of 0.125% bupivacaine with fentanyl 2 μg·ml−1; (iv) 'caudal catheter'—caudal placed epidural catheter was treated similar to the epidural catheter. Data regarding postoperative analgesic interventions were recorded. Intravesical pethidine was used for bladder spasm pain and i.v. morphine for wound pain.

Results

Over the study period, the caudal catheter technique (mean interventions/patient = 1.8 ± 2.6) and the single-shot caudal (6.1 ± 4) needed significantly less bladder spasm interventions than morphine (9.2 ± 4) and epidural (8.0 ± 4.4) patients. For wound pain, the caudal catheter (8.8 ± 3.3) and epidural groups (11.4 ± 3.2) needed significantly less interventions than morphine (16.1 ± 3) and caudal (15.3 ± 3.3) patients. Overall, caudal catheter patients on average required about half the number of pain interventions and were associated with less high nursing workload.

Conclusions

Despite some limitations in data collection and study design, the caudal catheter technique was superior at reducing pain interventions, particularly bladder spasm interventions. Overall epidural analgesia was not superior to a single-shot caudal followed by opioid infusion. The issue of bladder spasm may be similar to the phenomenon of sacral sparing in obstetric epidural anesthesia. Thus, regional techniques, such as caudal epidural, targeting a better balance between sacral and lumber nerves are required.

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Pharmacokinetics of levobupivacaine following infant spinal anesthesia

Summary

Background

Infant spinal anesthesia with levobupivacaine has been promoted as a technique to reduce both the risk of postoperative apnea and exposure to volatile anesthesia. There is, however, no pharmacokinetic data to support the currently recommended doses.

Aims

Our aim was to determine whether infant levobupivacaine spinal anesthesia is associated with plasma concentrations consistent with a low risk of local anesthetic systemic toxicity.

Methods

This was an open-label pharmacokinetic safety and tolerability study of levobupivacaine spinal anesthesia in infants <55 weeks Post Menstrual Age undergoing lower abdominal surgery. Infants received a spinal anesthetic with levobupivacaine 1 mg·kg−1 in the left lateral position.

Results

Spinal anesthesia was successful in 25 (86.2%) of 29 infants (postmenstrual age 36–52 weeks; weight 2.2–4.7 kg). The median (IQR) total venous levobupivacaine plasma concentrations was 0.33 (0.25–0.42) μg·ml−1 and unbound venous levobupivacaine was 19.5 (14.5–38) ng·ml−1. Median protein binding was 93.5 (91.4–96%). Alpha-1 acid glycoprotein concentrations were 0.25 (0.17–0.37) g·l−1 and albumin concentrations were 29 (24–32) g·l−1.

Conclusion

Total plasma concentrations and unbound (free) concentration of levobupivacaine were consistently lower than concentrations reported in cases of pediatric local anesthetic toxicity. In a small number of infants requiring a repeat spinal of 1 mg·kg−1 was also associated with acceptable total and free concentrations. We conclude that levobupivacaine at 1 mg·kg−1 is associated with no systemic side effects in infants receiving awake spinal anesthesia.

Thumbnail image of graphical abstract

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Outcomes following implementation of a pediatric procedural sedation guide for referral to general anesthesia for magnetic resonance imaging studies

Summary

Background/Aims

Guidelines for referral of children to general anesthesia (GA) to complete MRI studies are lacking. We devised a pediatric procedural sedation guide to determine whether a pediatric procedural sedation guide would decrease serious adverse events and decrease failed sedations requiring rescheduling with GA.

Methods

We constructed a consensus-based sedation guide by combining a retrospective review of reasons for referral of children to GA (n = 221) with published risk factors associated with the inability to complete the MRI study with sedation. An interrupted time series analysis of 11 530 local sedation records from the Pediatric Sedation Research Consortium between July 2008 and March 2013, adjusted for case-mix differences in the pre- and postsedation guide cohorts, evaluated whether a sedation guide resulted in decreased severe adverse events (SAE) and failed sedation rates.

Results

A significant increase in referrals to GA following implementation of a sedation guide occurred (P < 0.001), and fewer children with an ASA-PS class ≥III were sedated using procedural sedation (P < 0.001). There was no decrease in SAE (P = 0.874) or in SAE plus airway obstruction with concurrent hypoxia (P = 0.435). There was no change in the percentage of failed sedations (P = 0.169).

Conclusions

More studies are needed to determine the impact of a sedation guide on pediatric procedural sedation services.

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A pilot study of dexmedetomidine sedation and caudal anesthesia for inguinal hernia repair in infants

Summary

Background

Recent concerns regarding possible long-term effects of early anesthesia exposure on neurodevelopment in children have provided an impetus to explore alternative anesthetic techniques using potentially neuroprotective agents. Dexmedetomidine has not been implicated in anesthesia-induced neurotoxicity and has been shown to be neuroprotective in preclinical studies. We describe a case series of 50 neonates and infants who received dexmedetomidine sedation with caudal anesthesia instead of general endotracheal anesthesia for inguinal hernia surgery.

Methods

We conducted a retrospective chart review on all neonates and infants who underwent inguinal hernia surgery with dexemetomidine sedation and caudal anesthesia in our institution. We started exploring this technique since October 2011 and established a protocol of administering dexmedetomidine 2 mcg·kg−1 over 10 min, followed by 1 mcg·kg−1 over the next 10 min. This led to satisfactory conditions for caudal placement in 20 min, with minimal need for airway intervention during surgery.

Results

The median gestational age of the infants was 31.4 (28.7, 36.0) weeks and median postconceptual age was 39.7 weeks (IQR 37.8, 45.7) at time of surgery. Of patients, 86% had surgery successfully completed under this technique alone. Seven patients required sevoflurane or nitrous oxide due to failed caudal block (n = 1) or difficult or prolonged surgery (n = 6). After establishing the sedation protocol and excluding patients with large or complicated hernias, the success rate was 96%. Transient intra-operative apnea or hypoventilation occurred in five patients and postoperative apnea in two patients. All respiratory events were easily reversed and no patient developed significant bradycardia or required intubation.

Conclusions

Dexmedetomidine sedation with caudal anesthesia is a feasible alternative to spinal or general anesthesia in selected infants undergoing uncomplicated hernia surgery. It avoids the need for endotracheal intubation and may be potentially beneficial in avoiding the unknown effects of general anesthesia on neurodevelopment.

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Breastfeeding jaundice: how big is the problem?

2016-04-06T23-56-56Z
Source: International Journal of Contemporary Pediatrics
Rose Xavier, Manoj V. C., Vinod J. Cherian.
Background: Breastfeeding jaundice is jaundice requiring phototherapy where dehydration (weight loss more than 10% of the birth weight) was the only cause. Weight loss more than 10% is seen in 7% of term neonates. Objective of the study is to determine the prevalence and impact of inadequate breastfeeding on jaundice among neonates (>35 weeks) requiring phototherapy. Methods: The data for this study was taken from an observational study carried out in the neonatal unit of a tertiary care hospital for determining the incidence of jaundice without a known etiology. 200 eligible neonates were analyzed along the lines of peak bilirubin, onset of clinically significant jaundice and duration of phototherapy. Data was analyzed for the prevalence and impact of inadequate breastfeeding (leading to >10% weight loss) on jaundice. Results: Eighty seven (43.5%) subjects had no cause for jaundice and were classified as physiological jaundice. The remaining 113 babies were classified as non-physiological jaundice. 39 (19.5%) of the 113 babies had only dehydration as the cause and was called breastfeeding jaundice. 21 (10.5%) of the remaining 74 babies had dehydration contributing to the cause of non-physiological jaundice. Thus 50% of babies with non-physiological jaundice had dehydration contributing to the jaundice. The breastfeeding jaundice group had a lower peak bilirubin (p=0.02) and a later onset of jaundice requiring phototherapy (p=0.04) as compared to the rest of the pathological group. Conclusions: Inadequate breast feeding contributes to 50% of non-physiological jaundice. Aggressive lactation support, with daily weight monitoring can reduce the requirement of phototherapy by 30%.


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Clinical profile of children with autism spectrum disorder in tertiary care centre

2016-04-06T23-56-56Z
Source: International Journal of Contemporary Pediatrics
Alpana Kondekar, Surekha Joshi, Himani Shah, Alka Subramanyam.
Background: Autism spectrum disorders (ASDs) present with major impairments social relationships, abnormal language development and rigid patterns of behaviour. There is variable clinical presentation of each subgroup of autism spectrum. This study aim at describing and analyzing the clinical and developmental profile of children with autism. Methods: This cross-section observational study was conducted at the neurodevelopmental clinic at a tertiary care hospital in Mumbai, India over a period of two years. Consecutive 112 children (


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The Effect of Early Goal-Directed Therapy on Outcome in Adult Severe Sepsis and Septic Shock Patients: A Meta-Analysis of Randomized Clinical Trials.

BACKGROUND: Whether early goal-directed therapy (EGDT) improves outcome in severe sepsis and septic shock remains unclear. We performed a meta-analysis of existing clinical trials to examine whether EGDT improved outcome in the resuscitation of adult sepsis patients compared with control care. METHODS: We searched for eligible studies using MEDLINE, Elsevier, Cochrane Central Register of Controlled Trials, and Web of Science databases. Studies were eligible if they compared the effects of EGDT versus control care on mortality in adult patients with severe sepsis and septic shock. Two reviewers extracted data independently. Data including mortality, sample size of the patients with severe sepsis and septic shock, and resuscitation end points were extracted. Data were analyzed using methods recommended by the Cochrane Collaboration Review Manager 4.2 software. Random errors were evaluated by trial sequential analysis (TSA). RESULTS: Nine studies compared EGDT with control care, and 5202 severe sepsis and septic shock patients were included. A nonsignificant trend toward reduction in the longest all-cause mortality was observed in the EGDT group compared with control care (relative risk, 0.89; 99% confidence interval, 0.74-1.07; P = 0.10). However, EGDT significantly reduced intensive care unit mortality in severe sepsis and septic shock patients (relative risk, 0.72; 99% confidence interval, 0.57-0.90; P = 0.0002). TSA indicated lack of firm evidence for a beneficial effect. CONCLUSIONS: In this meta-analysis, a nonsignificant trend toward reduction in the longest all-cause mortality in patients resuscitated with EGDT was noted. However, EGDT significantly reduced intensive care unit mortality in severe sepsis and septic shock patients. TSA indicated a lack of firm evidence for the results. More powered, randomized controlled trials are needed to determine the effects. 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. (C) 2016 International Anesthesia Research Society

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The Current Landscape of US Pediatric Anesthesiologists: Demographic Characteristics and Geographic Distribution.

BACKGROUND: There is no comprehensive database of pediatric anesthesiologists, their demographic characteristics, or geographic location in the United States. METHODS: We endeavored to create a comprehensive database of pediatric anesthesiologists by merging individuals identified as US pediatric anesthesiologists by the American Board of Anesthesiology, National Provider Identifier registry, Healthgrades.com database, and the Society for Pediatric Anesthesia membership list as of November 5, 2015. Professorial rank was accessed via the Association of American Medical Colleges and other online sources. Descriptive statistics characterized pediatric anesthesiologists' demographics. Pediatric anesthesiologists' locations at the city and state level were geocoded and mapped with the use of ArcGIS Desktop 10.1 mapping software (Redlands, CA). RESULTS: We identified 4048 pediatric anesthesiologists in the United States, which is approximately 8.8% of the physician anesthesiology workforce (n = 46,000). The median age of pediatric anesthesiologists was 49 years (interquartile range, 40-57 years), and the majority (56.4%) were men. Approximately two-thirds of identified pediatric anesthesiologists were subspecialty board certified in pediatric anesthesiology, and 33% of pediatric anesthesiologists had an identified academic affiliation. There is substantial heterogeneity in the geographic distribution of pediatric anesthesiologists by state and US Census Division with urban clustering. CONCLUSIONS: This description of pediatric anesthesiologists' demographic characteristics and geographic distribution fills an important gap in our understanding of pediatric anesthesia systems of care. (C) 2016 International Anesthesia Research Society

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