Genome Evolution in Three Species of Cactophilic Drosophila

We report genomes of two species of cactophilic Drosophila, Drosophila arizonae and Drosophila navojoa. These two are the closest relatives of Drosophila mojavensis, forming the mojavensis cluster. Drosophila mojavensis and D. arizonae diverged from D. navojoa approximately 5.8 Mya, while the split between D. arizonae and D. mojavensis is more recent, at 1.5 Mya. Together the three genomes provide opportunities to examine genomic changes associated with speciation and host shifts in this ecologically defined group of flies. The three species also are separated by fixed inversion differences in three of their six chromosomes. While the levels of nucleotide divergence in the colinear chromosomes are significantly lower than in the inverted chromosomes, consistent with a role of the inversions in preventing gene flow in the past, the patterns differ among the inverted chromosomes when the locations of nucleotides inside or outside of the inversions are considered. For Muller element E, there is greater divergence external to the inversion breakpoints. For Muller A, the divergence is slightly higher inside the inversions, while for Muller B, the breakpoints and hence the difference in substitutions in relation to the inversions could not be determined. The differences among the inverted chromosomes, especially once the breakpoints are clearly established, could aid in dating the origins of the inversions.

from Genetics via xlomafota13 on Inoreader http://ift.tt/2b4p97Y
via IFTTT

Cross-Validation Without Doing Cross-Validation in Genome-Enabled Prediction

Cross-validation of methods is an essential component of genome-enabled prediction of complex traits. We develop formulae for computing the predictions that would be obtained when one or several cases are removed in the training process, to become members of testing sets, but by running the model using all observations only once. Prediction methods to which the developments apply include least squares, best linear unbiased prediction (BLUP) of markers or genomic BLUP, reproducing kernels Hilbert spaces regression with single or multiple kernel matrices, and any member of a suite of linear regression methods known as "Bayesian alphabet". The approach used for Bayesian models is based in importance sampling of posterior draws. Proof of concept is provided by applying the formulae to a wheat data set representing 599 inbred lines genotyped for 1279 markers, and the target trait was grain yield. The data set was used to evaluate predictive mean-squared error, impact of alternative layouts on maximum likelihood estimates of regularization parameters, model complexity and residual degrees of freedom stemming from various strengths of regularization, as well as two forms of importance sampling. Our results will facilitate carrying out extensive cross-validation without model re-training for most machines employed in genome-assisted prediction of quantitative traits.

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

Interallelic Transcriptional Enhancement as an In Vivo Measure of Transvection in Drosophila melanogaster

Transvection – pairing-dependent interallelic regulation resulting from enhancer action in trans – occurs throughout the Drosophila melanogaster genome, likely as a result of the extensive somatic homolog pairing seen in Dipteran species. Recent studies of transvection in Drosophila have demonstrated important qualitative differences between enhancer action in cis versus in trans, as well as a modest synergistic effect of cis- and trans-acting enhancers on total tissue transcript levels at a given locus. In the present study, we identify a system in which cis- and trans-acting GAL4-UAS enhancer synergism has an unexpectedly large quantitative influence on gene expression, boosting total tissue transcript levels at least four-fold relative to those seen in the absence of transvection. We exploit this strong quantitative effect by using publically available UAS-shRNA constructs from the TRiP library to assay candidate genes for transvection activity in vivo. The results of the present study, which demonstrate that in trans activation by simple UAS enhancers can have large quantitative effects on gene expression in Drosophila, have important new implications for experimental design utilizing the GAL4-UAS system.

from Genetics via xlomafota13 on Inoreader http://ift.tt/2b4pNlC
via IFTTT

Genome-Wide Analysis of Polyadenylation Events in Schmidtea mediterranea

In eukaryotes, 3' untranslated regions (UTRs) play important roles in regulating post-transcriptional gene expression. The 3'UTR is defined by regulated cleavage/polyadenylation of the pre-mRNA. The advent of next-gen sequencing technology has now enabled us to identify these events on a genome-wide scale. In this study, we used poly(A)-position profiling by sequencing (3P-Seq) to capture all poly(A) sites across the genome of the freshwater planarian, Schmidtea mediterranea, an ideal model system for exploring the process of regeneration and stem cell function. We identified the 3'UTRs for ~14,000 transcripts and thus improved the existing gene annotations. We found 97 transcripts, which are polyadenylated within an internal exon, resulting in the shrinking of the ORF and loss of a predicted protein domain. Around 40% of the transcripts in planaria were alternatively polyadenylated (ApA), resulting either in an altered 3'UTR or a change in coding sequence. We identified specific ApA transcript isoforms that were subjected to miRNA mediated gene regulation using degradome sequencing. In this study, we also confirmed tissue-specific expression pattern for alternate polyadenylated transcripts. The insights from this study highlights the potential role of ApA in regulating the gene expression essential for planarian regeneration.

from Genetics via xlomafota13 on Inoreader http://ift.tt/2ajN7Pm
via IFTTT

Responses of Non-Eye Movement Central Vestibular Neurons to Sinusoidal Yaw Rotation in Compensated Macaques after Unilateral Semicircular Canal Plugging

After vestibular labyrinth injury, behavioral measures of vestibular performance recover to variable degrees (vestibular compensation). Central neuronal responses after unilateral labyrinthectomy (UL), which eliminates both afferent resting activity and sensitivity to movement, have been well studied. However, unilateral semicircular canal plugging (UCP), which attenuates angular velocity detection while leaving afferent resting activity intact, has not been extensively studied. The current study reports response properties of yaw sensitive non-eye movement rhesus macaque vestibular neurons after compensation from UCP. The responses at a series of frequencies (0.1 to 2 Hz) and peak velocities (15 to 210°/s) were compared between neurons recorded before and at least 6 weeks after UCP. The gain (sp/s/°/s) of central type I neurons (responding to ipsilateral yaw rotation) on the side of UCP was reduced relative to normal controls at 0.5 Hz, ±60°/s (0.48±0.30(SD) normal, 0.32±0.15 ipsilesion; 0.44±0.2 contralesion). Type II neurons (responding to contralateral yaw rotation) after UCP have reduced gain (0.40±0.27 normal, 0.35±0.25 ipsilateral; 0.25±0.18 contralateral). The difference between responses after UCP and after UL is primarily the distribution of type I and type II neurons in the vestibular nuclei (type I neurons comprise 66% in VN normally; 51% ipsilesion UCP; 59% contralesion UCP; 38% ipsilesion UL; 65% contralesion UL), and the magnitude of the responses of type II neurons ipsilateral to the lesion. These differences suggest that the need to compensate for unilateral loss of resting vestibular nerve activity after UL necessitates a different strategy for recovery of dynamic vestibular responses compared to after UCP.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2b4jgro
via IFTTT

High fidelity optical excitation of cortico-cortical projections at physiological frequencies

Optogenetic activation of axons is a powerful approach for determining the synaptic properties and impact of long-range projections both in vivo and in vitro. However, due to the difficulty of measuring activity in axons, our knowledge of the reliability of optogenetic axonal stimulation has relied on data from somatic recordings. Yet, there are many reasons why activation of axons may not be comparable to cell bodies. Thus, we developed an approach to more directly assess the fidelity of optogenetic activation of axonal projections. We expressed opsins (ChR2, Chronos, or oChIEF) in the mouse primary visual cortex (V1) and recorded extracellular, pharmacologically-isolated presynaptic action potentials in response to axonal activation in the higher visual areas. Repetitive stimulation of axons with ChR2 resulted in a 70% reduction in the fiber volley amplitude and a 60% increase in the latency at all frequencies tested (10 - 40 Hz). Thus, ChR2 cannot reliably recruit axons during repetitive stimulation, even at frequencies that are reliable for somatic stimulation, likely due to pronounced channel inactivation at the high light powers required to evoke action potentials. By comparison, oChIEF and Chronos evoked photocurrents that inactivated minimally, and could produce reliable axon stimulation at frequencies up to 60 Hz. Our approach provides a more direct and accurate evaluation of the efficacy of new optogenetic tools, and has identified Chronos and oChIEF as viable tools to interrogate the synaptic and circuit function of long-range projections.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2ajHEIa
via IFTTT

Losing touch: age-related changes in plantar skin sensitivity, lower-limb cutaneous reflex strength, and postural stability in older adults.

Age-related changes in the density, morphology, and physiology of plantar cutaneous receptors negatively impact the quality and quantity of balance-relevant information arising from the foot soles. Plantar perceptual sensitivity declines with age, and may predict postural instability; however, alteration in lower-limb cutaneous reflex strength may also explain greater instability in older adults, and has yet to be investigated. We replicated the age-related decline in sensitivity by assessing monofilament and vibrotactile (30 & 250 Hz) detection thresholds near the first metatarsal head bilaterally in healthy young and older adults. We additionally applied continuous 30 and 250 Hz vibration to drive mechanically evoked reflex responses in the Tibialis Anterior muscle, measured via surface electromyography. To investigate potential relationships between plantar sensitivity, cutaneous reflex strength, and postural stability, we performed posturography during quiet standing without vision. Anteroposterior and mediolateral postural stability decreased with age, and increases in postural sway amplitude and frequency were significantly correlated with increases in plantar detection thresholds. With 30 Hz vibration, cutaneous reflexes were observed in 95% of young adults, but only 53% of older adults, and reflex gain, coherence, and cumulant density at 30 Hz were lower in older adults. Reflexes were not observed with 250 Hz vibration, suggesting this high frequency cutaneous input is filtered-out by motoneurons innervating Tibialis Anterior. Our findings have important implications for assessing the risk of balance impairment older adults.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2auUJfd
via IFTTT

Natural Compounds as Inhibitors of Tyrosyl-tRNA Synthetase

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


from Mary Ann Liebert, Inc. publishers via xlomafota13 on Inoreader http://ift.tt/2aVIJ78
via IFTTT

Spatial spread of local field potential is band-pass in the primary visual cortex

Local Field Potential (LFP) is a valuable tool in understanding brain function and in brain-machine-interfacing applications. However, there is no consensus on the spatial extent of cortex that contributes to the LFP (its "spatial spread"), with different studies reporting values between a few hundred micrometers and several millimeters. Further, the dependency of the spatial spread on frequency, which could reflect properties of the network architecture and extracellular medium, is not well studied, with theory and models predicting either "all-pass" (frequency independent) or "low-pass" behavior. Surprisingly, we found the LFP spread to be "band-pass" in primate primary visual cortex, with greatest spread in the high-gamma range (60-150 Hz). This was accompanied by an increase in phase coherency across neighboring sites in the same frequency range, consistent with the findings of a recent model that reconciles previous studies by suggesting that spatial spread depends on neuronal correlations.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2aS3uDy
via IFTTT

Postsynaptic nicotinic acetylcholine receptors facilitate excitation of developing CA1 pyramidal neurons

The hippocampus plays a key role in learning and memory. The normal development and mature function of hippocampal networks supporting these cognitive functions depends on afferent cholinergic neurotransmission mediated by nicotinic acetylcholine receptors. While it is well-established that nicotinic receptors are present on GABAergic interneurons and on glutamatergic presynaptic terminals within the hippocampus, the ability of these receptors to mediate postsynaptic signaling in pyramidal neurons is not well understood. Here, we use whole-cell electrophysiology to show that heteromeric nicotinic receptors mediate direct inward currents, depolarization from rest and enhanced excitability in hippocampus CA1 pyramidal neurons of male mice. Measurements made throughout postnatal development provide a thorough developmental profile for these heteromeric nicotinic responses, which are greatest during the first two weeks of postnatal life and decrease to low adult levels shortly thereafter. Pharmacological experiments find that responses are blocked by a competitive antagonist of α4β2* nicotinic receptors and augmented by a positive allosteric modulator of α5 subunit-containing receptors, which is consistent with expression studies suggesting the presence of α4β2 and α4β2α5 nicotinic receptors within the developing CA1 pyramidal cell layer. These findings demonstrate that functional heteromeric nicotinic receptors are present on CA1 pyramidal neurons during a period of major hippocampal development, placing these receptors in a prime position to play an important role in the establishment of hippocampal cognitive networks.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2b4je2K
via IFTTT

Cerebellar tDCS Dissociates the Timing of Perceptual Decisions from Perceptual Change in Speech

Neuroimaging studies suggest that the cerebellum might play a role in both speech perception and speech perceptual learning. However, it remains unclear what this role is: does the cerebellum directly contribute to the perceptual decision? Or does it contribute to the timing of perceptual decisions? To test this, we applied transcranial direct current stimulation (tDCS) to the right cerebellum during a speech perception task. Participants experienced a series of speech perceptual tests designed to measure and then manipulate their perception of a phonetic contrast. One group received cerebellar tDCS during speech perceptual learning and a different group received "sham" tDCS during the same task. Both groups showed similar learning-related changes in speech perception that transferred to a different phonetic contrast. For both trained and untrained speech perceptual decisions, cerebellar tDCS significantly increased the time it took participants to indicate their decisions with a keyboard press. The results suggest that cerebellar tDCS disrupted the timing of perceptual decisions, while leaving the eventual decision unaltered. In support of this conclusion, we use the drift diffusion model to decompose the data into processes that determine the outcome of perceptual decision-making and those that do not. The modeling suggests that cerebellar tDCS disrupted processes unrelated to decision-making. Taken together, the empirical data and modeling demonstrate that right cerebellar tDCS dissociates the timing of perceptual decisions from perceptual change. The results provide initial evidence in healthy humans that the cerebellum critically contributes to speech timing in the perceptual domain.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2ajHuAB
via IFTTT

Motor outcomes of feedback delays and implicit/explicit strategy use: experimental considerations and clinical implications

In the following, we reviewed Brudner and colleagues, "Delayed feedback during sensorimotor learning selectively disrupts adaptation, but not strategy use" (J. Neurophysiol, 2016). This paper evaluates the impact of temporal constraints on learning strategies with varying sources of feedback, including error-based and outcome-based feedback. We briefly discuss the contributions of their findings along with relevant future directions. A discussion of the clinical implications of this research is also provided.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2b4jsXI
via IFTTT

Sour taste increases swallowing and prolongs hemodymamic responses in the cortical swallowing network

Sour stimuli have been shown to upregulate swallowing in patients and in healthy volunteers. However, such changes may be dependent on taste-induced increases in salivary flow. Other mechanisms include genetic taster status (Bartoshuk et al., 2004) and differences between sour and other tastes. We investigated the effects of taste on swallowing frequency and cortical activation in the swallowing network and whether taster status affected responses. 3ml boluses of sour, sour with slow infusion, sweet, water, and water with infusion were compared on swallowing frequency and hemodynamic responses. The sour conditions increased swallowing frequency, whereas sweet and water did not. Changes in cortical oxygenated hemoglobin (hemodynamic responses) measured by functional near-infrared spectroscopy were averaged over 30 trials for each condition per participant in the right and left motor cortex, S1 and supplementary motor area for 30 s following bolus onset. Motion artifact in the hemodynamic response occurred 0-2 s after bolus onset, when the majority of swallows occurred. The peak hemodynamic response 2-7 s after bolus onset were significantly higher in the sensory than the motor area in the right hemisphere. The mean hemodynamic response 17-22 s after bolus onset was highest in the motor regions of both hemispheres, and greater in the sour and infusion condition than in the water condition. Genetic taster status did not alter changes in swallowing frequency or hemodynamic response. As sour taste significantly increased swallowing and cortical activation equally with and without slow infusion, increases in the cortical swallowing were due to sour taste.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2ajHQrc
via IFTTT

Mechanical effort predicts the selection of ankle over hip strategies in non-stepping postural responses

Experimental studies have shown that a continuum of ankle and hip strategies is used to restore posture following an external perturbation. Postural responses can be modeled by feedback control with feedback gains that optimize a specific objective. On the one hand, feedback gains that minimize effort have been used to predict muscle activity during perturbed standing. On the other hand, hip and ankle strategies have been predicted by minimizing postural instability and deviation from upright posture. It remains unclear, however, whether and how effort minimization influences the selection of a specific postural response. We hypothesize that the relative importance of minimizing mechanical work versus postural instability influences the strategy used to restore upright posture. This hypothesis was investigated based on experiments and predictive simulations of the postural response following a backward support surface translation. Peak hip flexion angle was significantly correlated with three experimentally determined measures of effort, i.e. mechanical work, mean muscle activity and metabolic energy. Furthermore, a continuum of ankle and hip strategies was predicted in simulation when changing the relative importance of minimizing mechanical work and postural instability, with increased weighting of mechanical work resulting in an ankle strategy. In conclusion, the combination of experimental measurements and predictive simulations of the postural response to a backward support surface translation showed that the trade-off between effort and postural instability minimization can explain the selection of a specific postural response in the continuum of potential ankle and hip strategies.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2b4j2QO
via IFTTT

The Effect of Phenytoin on Sodium Conductances in Rat Hippocampal CA1 Pyramidal Neurons

The anti-epileptic drug phenytoin (PHT) is thought to reduce the excitability of neural tissue by stabilising sodium channels (NaV) in inactivated states (Rogawski and Loscher 2004). It has been suggested the fast inactivated state ("I_F") is the main target (Kuo and Bean, 1994), though slow inactivation ("I_S") has also been implicated (Quandt, 1988). Other studies on local anaesthetics with similar effects on sodium channels have implicated the NaV voltage sensor interactions (Muroi and Chanda, 2009). Here, we re-examine the effect of PHT in both equilibrium and dynamic transitions between fast and slower forms of inactivation in rat hippocampal CA1 pyramidal neurons. The effects of PHT on fast, slow and another identified "intermediate" inactivation processes were observed. The effect of enzymatic removal of fast inactivation was also studied as well as effects on the residual persistent sodium current (I_NaP). A computational model based on a gating charge interaction was derived that reproduced a range of PHT effects on NaV equilibrium and state transitions. No effect of PHT on I_F was observed, rather phenytoin appeared to facilitate the occupancy of other closed states, either through enhancement of slow inactivation or through formation of analogous drug-bound states. The overall significance of these observations is that our data are inconsistent with the commonly held view that the archetypal Nav channel inhibitor phenytoin stabilises fast inactivation states, and we demonstrate that conventional slow inactivation "I_S" as well as a more recently identified "intermediate" duration inactivation process I₁ are the primary functional targets of phenytoin. Additionally, we show that the traditional explanatory frameworks based on the "modulated receptor hypothesis" (Hille 1976) can be substituted by simple, physiologically plausible interactions with voltage sensors. Additionally_aP was not preferentially inhibited compared with peak I_Na at short latencies (50 ms) by PHT.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2ajIYe4
via IFTTT

Rate modulation of human anconeus motor units during high-intensity dynamic elbow extensions

Investigations of high-intensity isometric fatiguing protocols report decreases in motor unit firing rates (MUFRs), but little is known regarding changes in MUFRs following fatigue induced by high-intensity dynamic contractions. Our purpose was to evaluate MUFRs of the anconeus (an accessory elbow extensor) and elbow extension power production as a function of time to task failure (TTF) during high-velocity fatiguing concentric contractions against a moderately heavy resistance. Fine-wire intramuscular electrode pairs were inserted into the anconeus to record MUs in 12 male participants (25 ± 3 yr), over repeated sessions on separate days. MUs were tracked throughout a three-stage, varying load dynamic elbow extension protocol designed to extend the task duration for >1 min thereby inducing substantial fatigue. Mean MUFRs and peak power were calculated for three relative time ranges: 0–15% TTF (beginning), 45–60% TTF (middle) and 85–100% TTF (end). Mean duration of the overall fatigue protocol was ~80 s. Following the protocol, isometric maximum voluntary contraction (MVC), highest velocity at 35% MVC load, and peak power decreased 37, 60, and 64% compared with baseline, respectively. Data from 20 anconeus MUs tracked successfully throughout the protocol indicated a reduction in MUFRs in relation to power loss from 36 Hz/160 W (0–15% TTF) to 28 Hz/97 W (45–60% TTF) to 23 Hz/43 W (85–100% TTF). During these high-intensity maximal effort concentric contractions, anconeus MUFRs decreased substantially (>35%). Although the absolute MUFRs were higher in the present study than those reported previously for other muscles during sustained high-intensity isometric tasks, the relative decrease in MUFRs was similar between the two tasks.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2aTA20d
via IFTTT

The slow component of pulmonary O2 uptake accompanies peripheral muscle fatigue during high-intensity exercise

During constant-power output (PO) exercise above lactate threshold (LT), pulmonary O₂ uptake (Vo_2p) features a developing slow component (Vo_2pSC). This progressive increase in O₂ cost of exercise is suggested to be related to the effects of muscle fatigue development. We hypothesized that peripheral muscle fatigue as assessed by contractile impairment would be associated with the Vo_2pSC. Eleven healthy men were recruited to perform four constant-PO tests at an intensity corresponding to ~60 (very heavy, VH) where is 60% of the difference between LT and peak Vo_2p. The VH exercise was completed for each of 3, 8, 13, and 18 min (i.e., VH3, VH8, VH13, VH18) with each preceded by 3 min of cycling at 20 W. Peripheral muscle fatigue was assessed via pre- vs. postexercise measurements of quadriceps torque in response to brief trains of electrical stimulation delivered at low (10 Hz) and high (50 Hz) frequencies. During exercise, breath-by-breath Vo_2p was measured by mass spectrometry and volume turbine. The magnitude of Vo_2pSC increased (P < 0.05) from 224 ± 81 ml/min at VH3 to 520 ± 119, 625 ± 134, and 678 ± 156 ml/min at VH8, VH13, and VH18, respectively. The ratio of the low-to-high frequency (10/50 Hz) response was reduced (P < 0.05) at VH3 (–12 ± 9%) and further reduced (P < 0.05) at VH8 (–25 ± 11%), VH13 (–42 ± 19%), and VH18 (–46 ± 16%), mirroring the temporal pattern of Vo_2pSC development. The reduction in 10/50 Hz ratio was correlated (P < 0.001, r² = 0.69) with Vo_2pSC amplitude. The temporal and quantitative association of decrements in muscle torque production and Vo_2pSC suggest a common physiological mechanism between skeletal muscle fatigue and loss of muscle efficiency.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2aVBnjX
via IFTTT

Effect of 23-day muscle disuse on sarcoplasmic reticulum Ca2+ properties and contractility in human type I and type II skeletal muscle fibers

Inactivity negatively impacts on skeletal muscle function mainly through muscle atrophy. However, recent evidence suggests that the quality of individual muscle fibers is also altered. This study examined the effects of 23 days of unilateral lower limb suspension (ULLS) on specific force and sarcoplasmic reticulum (SR) Ca²⁺ content in individual skinned muscle fibers. Muscle biopsies of the vastus lateralis were taken from six young healthy adults prior to and following ULLS. After disuse, the endogenous SR Ca²⁺ content was ~8% lower in type I fibers and maximal SR Ca²⁺ capacity was lower in both type I and type II fibers (–11 and –5%, respectively). The specific force, measured in single skinned fibers from three subjects, decreased significantly after ULLS in type II fibers (–23%) but not in type I fibers (–9%). Western blot analyses showed no significant change in the amounts of myosin heavy chain (MHC) I and MHC IIa following the disuse, whereas the amounts of sarco(endo)plasmic reticulum Ca²⁺-ATPase 1 (SERCA1) and calsequestrin increased by ~120 and ~20%, respectively, and the amount of troponin I decreased by ~21%. These findings suggest that the decline in force and power occurring with muscle disuse is likely to be exacerbated in part by reductions in maximum specific force in type II fibers, and in the amount of releasable SR Ca²⁺ in both fiber types, the latter not being attributable to a reduced calsequestrin level. Furthermore, the ~3-wk disuse in human elicits change in SR properties, in particular a more than twofold upregulation in SERCA1 density, before any fiber-type shift.

from Physiology via xlomafota13 on Inoreader http://ift.tt/2aPLjgS
via IFTTT

The inter-rater reliability of the International Classification of Functioning, Disability and Health set for spinal cord injury nursing

The International Classification of Functioning, Disability and Health (ICF) has potential to be used as a clinical assessment instrument directly. However, difficulty in operationalizing the ICF qualifiers has led to unsatisfactory inter-rater reliability of ICF instruments in previous studies. The ICF set for spinal cord injury (SCI) nursing contains a group of categories that can reflect the functioning of SCI patients from the perspective of nurses. The aim of this study was to explore the inter-rater reliability of the ICF set for SCI nursing. Detailed measuring guidelines were prepared for each category of the ICF set. Two trained nurses then used the ICF set to independently rate 40 SCI patients within the first 3 days after their admission. The results showed that the percentage of the observed agreement between the nurses ranged from 42.5 to 100% (median 75%, interquartile range 62.5–87.5%). The weighted κ ranged from −0.03 to 1.00 (median 0.68, interquartile range 0.45–0.84). A total of 50 categories (79.4%) showed weighted κ greater than 0.4 and 39 categories (61.9%) had weighted κ greater than 0.6. The medians of the weighted κ for the body functions, body structures, activity and participation and environmental factors components were 0.6, 0.64, 0.84, and 0.11, respectively. This study indicated that the inter-rater reliability of the ICF set for SCI nursing was acceptable. Establishment of detailed measuring guidelines could help reduce the differences between raters. Simpler and clearer measuring guidelines are recommended and the definitions of some categories need to be clarified in future studies.

from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2az1EFU
via IFTTT

Measuring functioning and disability after a disaster: results from the typhoon Haiyan/Yolanda-affected areas of the Philippines

The most commonly reported data after natural disasters are the number of deceased and displaced and the structural and economic damage, whereas disability data are often lacking. Our study assessed disability among the survivors of the Haiyan/Yolanda typhoon that struck Philippines in 2013 and is aimed to identify which context-level variables are associated with higher disability. We used a cross-sectional design and administered a household questionnaire, an individual sociodemographic questionnaire, and the WHODAS 2.0 to 1982 adults. Logistic regression analysis was carried out to address the degree to which demographic variables, effects of the typhoon, individual health state, and rural or urban residence were associated with higher disability. Those aged above 65, employed individuals, students, those not living in their households, and those with one or more health condition or rating their own as health moderate or very poor had higher likelihood of having severe disability. Survivors living in rural contexts and those who received tools/materials to repair their houses were less likely to have higher disability. This study outlines that disability can and should be used as an indicator in surveys after emergencies to identify the most vulnerable groups, thus guiding policies, reconstruction strategies, and health and social interventions.

from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2az2fra
via IFTTT

Constraint-induced movement therapy as a rehabilitation intervention for upper extremity in stroke patients: systematic review and meta-analysis

Constraint-induced movement therapy (CIMT) is a neurorehabilitation technique designed to improve upper extremity motor functions after stroke. This review aimed to investigate evidence of the effect of CIMT on upper extremity in stroke patients and to identify optimal methods to apply CIMT. Four databases (MEDLINE, EMBASE, CINHAL, and PEDro) and reference lists of relevant articles and reviews were searched. Randomized clinical trials that studied the effect of CIMT on upper extremity outcomes in stroke patients compared with other rehabilitative techniques, usual care, or no intervention were included. Methodological quality was assessed using the PEDro score. The following data were extracted for each trial: patients' characteristics, sample size, eligibility criteria, protocols of CIMT and control groups, outcome measurements, and the PEDro score. A total of 38 trials were identified according to the inclusion criteria. The trials included were heterogeneous in CIMT protocols, time since stroke, and duration and frequency of treatment. The pooled meta-analysis of 36 trials found a heterogeneous significant effect of CIMT on upper extremity. There was no significant effect of CIMT at different durations of follow-up. The majority of included articles did not fulfill powered sample size and quality criteria. The effect of CIMT changed in terms of sample size and quality features of the articles included. These meta-analysis findings indicate that evidence for the superiority of CIMT in comparison with other rehabilitative interventions is weak. Information on the optimal dose of CIMT and optimal time to start CIMT is still limited.

from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2az1Chk
via IFTTT

The effectiveness of a self-management occupational therapy intervention on activity performance in individuals with multiple sclerosis-related fatigue: a randomized-controlled trial

Purpose to evaluate the effectiveness of an individual self-management occupational therapy intervention program (SMOoTh) versus relaxation on the performance of and satisfaction with relevant daily activities in individuals with multiple sclerosis (MS)-related fatigue. in a single-blind randomized-controlled trial, 31 patients with MS (SMOoTh: n=17, relaxation: n=14) were randomly allocated to three individual sessions focusing on pacing, prioritizing, ergonomics, and self-management (SMOoTh) or on stress management and relaxation (relaxation). Outcomes (blind assessor): Canadian Occupational Performance Measure (COPM) (primary), Modified Fatigue Impact Scale, Checklist Individual Strength and Short-Form Health Measure. COPM improved in the SMOoTh and relaxation group after the intervention and 3 months later (COPM performance: F=13.1, P=0.001 and COPM satisfaction: F=10.4, P=0.001); nonsignificant group differences showed a trend in favor of SMOoTh. Modified Fatigue Impact Scale, Checklist Individual Strength, and most of the Short-Form Health Measure subscales did not change. Clinically relevant changes in COPM performance scores were found in 71 and 27% of patients in the SMOoTh versus the relaxation group. Both interventions seem to be feasible approaches to improve performance of and satisfaction with relevant daily activities in people with MS, with a sustained effect after 3 months. Neither program altered change fatigue (impact) or quality of life. Future studies with larger sample sizes are needed.

from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2az1Epo
via IFTTT

The effectiveness of external sensory cues in improving functional performance in individuals with Parkinson’s disease: a systematic review with meta-analysis

A systematic review with meta-analysis was performed to investigate the effect external sensory cued therapy on activities of daily living (ADL) performance that include walking and daily tasks such as dressing for individuals with Parkinson's disease (PD). A detailed computer-aided search of the literature was applied to MEDLINE, Cumulative Index to Nursing and Allied Health Literature, EMBASE and PubMed. Studies investigating the effects of external sensory cued therapy on ADL performance for individuals with PD in all stages of disease progression were collected. Relevant articles were critically reviewed and study results were synthesized by two independent researchers. A data-analysis method was used to extract data from selected articles. A meta-analysis was carried out for all randomized-controlled trials. Six studies with 243 individuals with PD were included in this review. All six studies yielded positive findings in favour of external sensory cues. The meta-analysis showed that external sensory cued therapy improved statistically after treatment (P=0.011) and at follow-up (P

from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2az21A5
via IFTTT

Examining hand dominance using dynamometric grip strength testing as evidence for overwork weakness in Charcot–Marie–Tooth disease: a systematic review and meta-analysis

This systematic review with a meta-analysis of studies was carried out to evaluate the potential of overwork weakness on the basis of grip strength of dominant and nondominant hands in individuals with Charcot–Marie–Tooth disease (CMT). Numerous electronic databases were searched from the earliest records to February 2016. Studies of any design including participants older than 18 years of age with a confirmed diagnosis of CMT that measured grip strength of both hands using dynamometric testing were eligible for inclusion. Of 12 593 articles identified following removal of duplicates, five articles fulfilled the criteria. A total of 166 participants, mostly with CMT1 or CMT2, were described from the studies included. Hand and finger pinch grip strength for the dominant compared with the nondominant hand was not statistically different. There is no definitive evidence that preferential use of the dominant hand in CMT impairs function relative to the nondominant hand. Thus, robust exercise trials of progressive resistance training are needed to understand the extent of adaptations possible and provide evidence of the safety of such regimens.

from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2az1A90
via IFTTT

Validity and reliability of the Chinese version of the Daily Living Self-Efficacy Scale among stroke patients

The aim of this study was to examine the reliability and validity of the Chinese version of the Daily Living Self-Efficacy Scale (DLSES) in stroke patients. In total, 172 participants were recruited from a local hospital in China. The internal consistent reliability and convergent validity of the total scale and activities of daily living (ADL) and psychosocial functioning subscales were examined and factor analysis was carried out. Cronbach's αs for the Chinese version of the DLSES, ADL subscale, and psychosocial subscale were 0.96, 0.90, and 0.95, respectively. In the factor analysis, two factors (ADL and psychosocial functioning) were extracted, explaining 84.4% of the total variance in self-efficacy (χ2/d.f.=2.19, root mean square error of approximation=0.08, normed fit index=0.95, comparative fit index=0.98, incremental fit index=0.98). Convergent validity was confirmed by positive relationships between the Chinese version of the DLSES and the Modified Fall Efficacy Scale (r=0.87). The ADL subscale was associated positively with the Barthel Index (r=0.74) and the psychosocial functioning subscale was associated negatively with the Functional Activities Questionnaire (r=−0.73) and Center for Epidemiologic Studies Depression Scale (r=−0.44). The Chinese version of the DLSES was shown to be a reliable and valid measure of self-efficacy in stroke patients.

from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2az1uOR
via IFTTT

The relationship between static posturography measures and specific cognitive domains in individuals with multiple sclerosis

There are still limitations as to the understanding of the cognitive–postural control relationship in people with multiple sclerosis (PwMS). The aim of the current study' was to examine the relationship between cognition with measures of posturography in PwMS. The study was cross-sectional comprising 253 PwMS (162 women) with a mean age of 42.0 (SD=14.0). All participants completed a computerized cognitive test battery designed to evaluate multiple cognitive domains (Mindstreams; NeuroTrax) and static posturography tests (Zebris Medical GmbH). PwMS were divided into four levels of disability on the basis of their Expanded Disability Status Scale (EDSS) score: very mild (EDSS: 0–2.0), mild (EDSS: 2.5–3.5), moderate (EDSS: 4.0–5.5), and severe (EDSS: 6.0–6.5; using a walking aid). Significant correlations were observed between cognitive domains and posturography measures. However, the correlations were different between the disability subgroups. For the mild group, significant correlation scores were observed between the balance measures to the executive function and motor skills cognitive domains (Pearson's ρ=∼0.3 and ∼0.4, respectively). As for the moderate group, significant correlation scores were observed in memory and verbal function (Pearson's ρ=∼0.4 and ∼0.4, respectively). Attention was the only cognitive domain correlated significantly with posturography measures in the severe group (Pearson's ρ=∼0.55). Our study found that posturography measures are related to cognition in PwMS. However, the associations vary in terms of cognitive domains and disability levels.

from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2az1M8f
via IFTTT

Dilemmatic group memberships of hard-of-hearing employees during the process of acquiring and adapting to the use of hearing aids

We describe how hard-of-hearing (HOH) employees renegotiate both their existing and new group memberships when they acquire and begin to use hearing aids (HAs). Our research setting was longitudinal and we carried out a theory-informed qualitative analysis of multiple qualitative data. When an individual discovers that they have a hearing problem and acquire a HA, their group memberships undergo change. First, HOH employees need to start negotiating their relationship with the HOH group. Second, they need to consider whether they see themselves as members of the disabled or the nondisabled employee group. This negotiation tends to be context-bound, situational, and nonlinear as a process, involving a back-and-forth movement in the way in which HOH employees value different group memberships. The dilemmatic negotiation of new group memberships and the other social aspects involved in HA rehabilitation tend to remain invisible to rehabilitation professionals, occupational healthcare, and employers.

from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2az1zBY
via IFTTT

Influence of repetitive peripheral magnetic stimulation on neural plasticity in the motor cortex related to swallowing

The aim of this study was to evaluate the effect of repetitive peripheral magnetic stimulation at two different frequencies (20 and 30 Hz) on cortical excitability in motor areas related to swallowing in healthy individuals. The study participants were 10 healthy normal volunteers (two women and eight men, age range 25–36 years). Repetitive peripheral magnetic stimulation was applied to the submandibular muscle using a parabolic coil at the site where contraction of the suprahyoid muscles was elicited. Stimulation was continued for 10 min (total 1200 pulses) at 20 Hz on 1 day and at 30 Hz on another day, with the stimulation strength set at 90% of the intensity that elicited pain. The motor-evoked potential amplitude of suprahyoid muscles was assessed before, immediately after, and 30 min after stimulation. Stimulations at both 20 and 30 Hz significantly increased motor-evoked potential amplitude (P

from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2az2mCQ
via IFTTT

Cognitive reserve and preinjury educational attainment: effects on outcome of community-based rehabilitation for longer-term individuals with acquired brain injury

The cognitive reserve hypothesis has been proposed to account for the mismatch between brain pathology and its clinical expression. The aim of the current research was to explore, in a longitudinal data set, the effects of level of educational attainment before brain injury (cognitive reserve) and clinical factors on the level of rehabilitation-induced changes in disability and community integration. Participants in receipt of postacute rehabilitation were assessed at induction to the service and again at between 14 and 18 months of follow-up while still in service on changes in aspects of their abilities, adjustment and participation (Mayo Portland Adaptability Indices) and community integration (Community Integration Questionnaire). Controlling for type and severity of injury, age at onset of injury and duration of time since injury, participants with higher previous educational attainment showed significantly greater changes over the course of rehabilitation on adjustment to their injury and participation, but not on abilities, or community integration following postacute rehabilitation. Level of education would appear to be an important element of cognitive reserve in brain injury that serves to aid responses to postacute rehabilitation in terms of an individual's adjustment to disability and participation.

from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2az2ceY
via IFTTT

Effect of kinesio tape application on hemiplegic shoulder pain and motor ability: a pilot study

The aim of our single-group pre–post design pilot study was to evaluate the short-term effect of kinesio taping (KT) application on pain and motor ability of hemiplegic shoulder pain (HSP) patients. Eleven poststroke patients with HSP hospitalized in the Department of Neurology C, Loewenstein Rehabilitation Hospital, Raanana, Israel, received a KT application in addition to their usual rehabilitation protocol. KT, consisting of one to three strips according to a predefined algorithm, was applied to the painful shoulder region. A 10 cm Visual Analog Scale of shoulder pain at rest and at arm movement, active and passive pain-free abduction range of motion, Box & Blocks, and Fugl-Meyer upper extremity motor assessment were performed before treatment and 24 h after wearing the KT. After applying the KT, there was no significant change in any variables. Short-term KT application, used in our study, produced no change in shoulder pain, range of motion, or ability of upper limb in HSP patients. Additional studies should evaluate the effect of long-term application and different types of KT applications on HSP.

from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2az1zSq
via IFTTT

Genome-wide scans reveal variants at EDAR predominantly affecting hair straightness in Han Chinese and Uyghur populations

Abstract

Hair straightness/curliness is one of the most conspicuous features of human variation and is particularly diverse among populations. A recent genome-wide scan found common variants in the Trichohyalin (TCHH) gene that are associated with hair straightness in Europeans, but different genes might affect this phenotype in other populations. By sampling 2899 Han Chinese, we performed the first genome-wide scan of hair straightness in East Asians, and found EDAR (rs3827760) as the predominant gene (P = 4.67 × 10⁻¹⁶), accounting for 3.66 % of the total variance. The candidate gene approach did not find further significant associations, suggesting that hair straightness may be affected by a large number of genes with subtle effects. Notably, genetic variants associated with hair straightness in Europeans are generally low in frequency in Han Chinese, and vice versa. To evaluate the relative contribution of these variants, we performed a second genome-wide scan in 709 samples from the Uyghur, an admixed population with both eastern and western Eurasian ancestries. In Uyghurs, both EDAR (rs3827760: P = 1.92 × 10⁻¹²) and TCHH (rs11803731: P = 1.46 × 10⁻³) are associated with hair straightness, but EDAR (OR 0.415) has a greater effect than TCHH (OR 0.575). We found no significant interaction between EDAR and TCHH (P = 0.645), suggesting that these two genes affect hair straightness through different mechanisms. Furthermore, haplotype analysis indicates that TCHH is not subject to selection. While EDAR is under strong selection in East Asia, it does not appear to be subject to selection after the admixture in Uyghurs. These suggest that hair straightness is unlikely a trait under selection.

from Genetics via xlomafota13 on Inoreader http://ift.tt/2aVkfe4
via IFTTT

A 1.35 Mb DNA fragment is inserted into the DHMN1 locus on chromosome 7q34–q36.2

Abstract

Distal hereditary motor neuropathies predominantly affect the motor neurons of the peripheral nervous system leading to chronic disability. Using whole genome sequencing (WGS) we have identified a novel structural variation (SV) within the distal hereditary motor neuropathy locus on chromosome 7q34–q36.2 (DHMN1). The SV involves the insertion of a 1.35 Mb DNA fragment into the DHMN1 disease locus. The source of the inserted sequence is 2.3 Mb distal to the disease locus at chromosome 7q36.3. The insertion involves the duplication of five genes (LOC389602, RNF32, LMBR1, NOM1, MNX1) and partial duplication of UBE3C. The genomic structure of genes within the DHMN1 locus are not disrupted by the insertion and no disease causing point mutations within the locus were identified. This suggests the novel SV is the most likely DNA mutation disrupting the DHMN1 locus. Due to the size and position of the DNA insertion, the gene(s) directly affected by the genomic re-arrangement remains elusive. Our finding represents a new genetic cause for hereditary motor neuropathies and highlights the growing importance of interrogating the non-coding genome for SV mutations in families which have been excluded for genome wide coding mutations.

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

Leadership, Organizational Climate, and Perceived Burden of Evidence-Based Practice in Mental Health Services

Abstract

The use of evidence-based practices (EBPs) is associated with favorable client outcomes, yet perceived burden of using EBPs may affect the adoption and implementation of such practices. Multilevel path analysis was used to examine the associations of transformational leadership with organizational climate, and their associations with perceived burden of using EBPs. Results indicated significant relationships between transformational leadership and empowering and demoralizing climates, and between demoralizing climate and perceived burden of EBPs. We found significant indirect associations of leadership and perceived burden through organizational climate. Findings suggest that further research is needed to examine the extent to which improving leadership and organizational climate may reduce perceived burden and use of EBPs with the ultimate goal of enhancing quality of care.

from Health via xlomafota13 on Inoreader http://ift.tt/2avsvyI
via IFTTT

Characterizing the Quality Workforce in Private U.S. Child and Family Behavioral Health Agencies

Abstract

Behavioral health agencies have been encouraged to monitor performance and improve service quality. This paper characterizes the workforce charged with these tasks through a national survey of 238 behavioral health quality professionals. A latent class analysis suggests only 30 % of these workers report skills in both basic research and quality-specific skills. Respondents wanted to learn a variety of research and data analytic skills. The results call into question the quality of data collected in behavioral health agencies and the conclusions agencies are drawing from their data. Professional school and continuing education programs are needed to prepare this workforce.

from Health via xlomafota13 on Inoreader http://ift.tt/2awwVsx
via IFTTT

Comparison of fusion rate and clinical results between CaO-SiO2-P2O5-B2O3 bioactive glass ceramics spacer with titanium cages in posterior lumbar interbody fusion

The CaO-SiO2-P2O5-B2O3 glass ceramics spacer generates chemical bonding to adjacent bones with high mechanical stability to produce a union with the endplate and ultimately, stability.

from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2aj7mN1
via IFTTT

Anterior decompression with fusion vs. posterior decompression with fusion for massive cervical ossification of the posterior longitudinal ligament with a ≥50% canal occupying ratio: a multi-center retrospective study

Previous studies have shown that compared to laminoplasty, anterior decompression with fusion (ADF) is superior for postoperative neurological improvement in patients with massive cervical ossification of the posterior longitudinal ligament (OPLL) with a ≥50% canal occupying ratio. However, it is unknown which method, ADF or posterior decompression with fusion (PDF), is more effective for the treatment of massive OPLL.

from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2b3IQgg
via IFTTT

Validation of data quality in the Swedish National Register for Oesophageal and Gastric Cancer

British Journal of Surgery

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

Influence of perineural invasion in predicting overall survival and disease free survival in patients with locally advanced stage II/III gastric cancer

The American Journal of Surgery

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

Selecting optimal surgical procedures for intraductal papillary mucinous neoplasm (IPMN): An analysis based on the Surveillance, Epidemiology, and End Result registry database

European Journal of Surgical Oncology

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

Motility, digestive and nutritional problems in esophageal atresia

Paediatric Respiratory Reviews

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

Elevated circulating irisin is associated with lower risk of insulin resistance: association and path analyses of obese Chinese adults

BMC Endocrine Disorders

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2atTl0z
via IFTTT

Comparative effectiveness and cost-effectiveness of a multi-target stool DNA test to screen for colorectal neoplasia

Gastroenterology

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

Effect of Modifiable Risk Factors on Preterm Birth: A Population Based-Cohort

Abstract

Objectives The purpose of this study is to evaluate the prevalence, impact, and interaction of short interpregnancy interval (IPI), pre-pregnancy body mass index (BMI) category, and pregnancy weight gain (PWG) on the rate of preterm birth. Methods This is a population-based retrospective cohort study using vital statistics birth records from 2006 to 2011 in OH, US, analyzing singleton live births to multiparous mothers with recorded IPI (n = 393,441). Preterm birth rate at <37 weeks gestational age was compared between the referent pregnancy (defined as normal pre-pregnancy maternal BMI, IPI of 12–24 months, and Institute of Medicine (IOM) recommended PWG) and those with short or long IPI, abnormal BMI (underweight, overweight, and obese), and high or low PWG (under or exceeding IOM recommendations). Results Only 6 % of the women in this study had a referent pregnancy, with a preterm birth rate of 7.6 % for this group. Short IPIs of <6 and 6–12 months were associated with increased rates of preterm birth rate to 12.9 and 10.4 %, respectively. Low PWG compared to IOM recommendations for pre-pregnancy BMI class was also associated with increased preterm birth rate of 13.2 % for all BMI classes combined. However, the highest rate of preterm birth of 25.2 % occurred in underweight women with short IPI and inadequate weight gain with _adjOR 3.44 (95 % CI 2.80, 4.23). The fraction of preterm births observed in this cohort that can be attributed to short IPIs is 5.9 %, long IPIs is 8.3 %, inadequate PWG is 7.5 %, and low pre-pregnancy BMI is 2.2 %. Conclusions Our analysis indicates that a significant proportion of preterm births in Ohio are associated with potentially modifiable risk factors. These data suggest public health initiatives focused on preterm birth prevention could include counseling and interventions to optimize preconception health and prenatal nutrition.

from Health via xlomafota13 on Inoreader http://ift.tt/2arZQg6
via IFTTT

Group Prenatal Care Attendance: Determinants and Relationship with Care Satisfaction

Abstract

Objectives Group prenatal care results in improved birth outcomes in randomized controlled trials, and better attendance at group prenatal care visits is associated with stronger clinical effects. This paper's objectives are to identify determinants of group prenatal care attendance, and to examine the association between proportion of prenatal care received in a group context and satisfaction with care. Methods We conducted a secondary data analysis of pregnant adolescents (n = 547) receiving group prenatal care in New York City (2008–2012). Multivariable linear regression models were used to test associations between patient characteristics and percent of group care sessions attended, and between the proportion of prenatal care visits that occurred in a group context and care satisfaction. Results Sixty-seven groups were established. Group sizes ranged from 3 to 15 women (mean = 8.16, SD = 3.08); 87 % of groups enrolled at least five women. Women enrolled in group prenatal care supplemented group sessions with individual care visits. However, the percent of women who attended each group session was relatively consistent, ranging from 56 to 63 %. Being born outside of the United States was significantly associated with higher group session attendance rates [B(SE) = 11.46 (3.46), p = 0.001], and women who received a higher proportion of care in groups reported higher levels of care satisfaction [B(SE) = 0.11 (0.02), p < 0.001]. Conclusions Future research should explore alternative implementation structures to improve pregnant women's ability to receive as much prenatal care as possible in a group setting, as well as value-based reimbursement models and other incentives to encourage more widespread adoption of group prenatal care.

from Health via xlomafota13 on Inoreader http://ift.tt/2aPbwgs
via IFTTT

Hurricane Charley Exposure and Hazard of Preterm Delivery, Florida 2004

Abstract

Objective Hurricanes are powerful tropical storm systems with high winds which influence many health effects. Few studies have examined whether hurricane exposure is associated with preterm delivery. We aimed to estimate associations between maternal hurricane exposure and hazard of preterm delivery. Methods We used data on 342,942 singleton births from Florida Vital Statistics Records 2004–2005 to capture pregnancies at risk of delivery during the 2004 hurricane season. Maternal exposure to Hurricane Charley was assigned based on maximum wind speed in maternal county of residence. We estimated hazards of overall preterm delivery (<37 gestational weeks) and extremely preterm delivery (<32 gestational weeks) in Cox regression models, adjusting for maternal/pregnancy characteristics. To evaluate heterogeneity among racial/ethnic subgroups, we performed analyses stratified by race/ethnicity. Additional models investigated whether exposure to multiples hurricanes increased hazard relative to exposure to one hurricane. Results Exposure to wind speeds ≥39 mph from Hurricane Charley was associated with a 9 % (95 % CI 3, 16 %) increase in hazard of extremely preterm delivery, while exposure to wind speed ≥74 mph was associated with a 21 % (95 % CI 6, 38 %) increase. Associations appeared greater for Hispanic mothers compared to non-Hispanic white mothers. Hurricane exposure did not appear to be associated with hazard of overall preterm delivery. Exposure to multiple hurricanes did not appear more harmful than exposure to a single hurricane. Conclusions Hurricane exposure may increase hazard of extremely preterm delivery. As US coastal populations and hurricane severity increase, the associations between hurricane and preterm delivery should be further studied.

from Health via xlomafota13 on Inoreader http://ift.tt/2arZXZ1
via IFTTT

Altered corticospinal function during movement preparation in humans with spinal cord injury

Abstract

Corticospinal output is modulated in a task-dependent manner during the preparatory phase of upcoming movements in humans. Whether this ability is preserved after spinal cord injury (SCI) is unknown. In this study, we examined motor evoked potentials elicited by cortical (MEPs) and subcortical (CMEPs) stimulation of corticospinal axons and short-interval intracortical inhibition in the first dorsal interosseous muscle in the preparatory phase of a reaction-time task where individuals with chronic incomplete cervical SCI and age-matched controls needed to suppress (NOGO) or initiate (GO) ballistic index finger isometric voluntary contractions. Reaction times were prolonged in SCI participants compared with control subjects and stimulation was provided ∼90 ms prior to movement onset in each group. During NOGO trials, both MEPs and CMEPs remained unchanged compared to baseline in SCI participants but were suppressed in control subjects. Notably, during GO trials, MEPs increased to a similar extent in both groups but CMEPs increased only in controls. The magnitude of short-interval intracortical inhibition increased in controls but not in SCI subjects during NOGO trials and decreased in both groups in GO trials. These novel observations reveal that humans with incomplete cervical SCI have an altered ability to modulate corticospinal excitability during movement preparation when there is a need to suppress but not to execute upcoming rapid finger movements, which is likely related to impaired transmission at a cortical and spinal level. Thus, deficits in corticospinal transmission after human SCI extend to the preparatory phase of upcoming movements.

This article is protected by copyright. All rights reserved

from Physiology via xlomafota13 on Inoreader http://ift.tt/2ahiIBk
via IFTTT

Duodenal Disaccharidase Activities During and After Weaning Off Parenteral Nutrition in Pediatric Intestinal Failure.

Aims: Data on factors affecting absorptive function in children with intestinal failure (IF) are sparse. We evaluated duodenal disaccharidase activities and inflammation in relation to parenteral nutrition (PN) and intestinal resection in pediatric onset IF. Methods: Disaccharidase (maltase, sucrase, and lactase) activities and histologic inflammation were evaluated from duodenal biopsies in 58 patients during PN (n = 23) or full enteral nutrition (n = 40) and in 43 matched controls. The first and the last post resection biopsies were analyzed separately after 4.3 (1.2-9.7) years and 6.5 (2.3-12.4) years, respectively. Results: During PN, maltase and sucrase activities were 1.6-fold lower and mucosal inflammation more frequent (22% vs 3%) when compared to matched controls (P

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2aP9xse
via IFTTT

The Complex Relationship Between Diet and Phospholipid Fatty Acids in Children With Cystic Fibrosis.

Objectives: Altered total plasma n-6 and n-3 fatty acids are common in cystic fibrosis (CF). Whether alterations extend to plasma phosphatidylcholine (PC) and phosphatidylethanolamine (PE) and are explained by diet is unclear. This study was to describe the dietary intake of a large group of children with CF and to determine whether dietary fat composition explains differences in plasma PC and PE fatty acids between children with and without CF. Methods: Dietary intake was assessed using a food frequency questionnaire. Venous blood was collected. Plasma PC and PE were separately analyzed for fatty acids. Results: Children with CF, n = 74, consumed more calories and fat (g/d and % energy), with significantly more saturates mainly from dairy foods and less polyunsaturates including linoleic acid (LA), arachidonic acid (ARA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) (% fat) than reference children, n = 71. A subset of children with CF, not differing in dietary intake from the larger group, had significantly lower LA and DHA, but higher EPA in plasma PC but had higher LA and lower ARA and DHA in plasma PE, compared to a subset of reference children. In both groups, LA intake and LA in plasma PC and PE were not associated. EPA and DHA intakes were positively associated with EPA and DHA, respectively in plasma PC, but not PE, in reference children only. Conclusion: The fatty acid composition of plasma PC and PE is altered in CF. Fatty acid differences between children with and without CF are inconsistent between PC and PE and are not explained by dietary fat. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2arXwG6
via IFTTT

Prevalence, Clinical Profile and Outcome of Ascitic Fluid Infection in Children With Liver Disease.

Objectives: Pediatric literature on spontaneous bacterial peritonitis (SBP) is limited. We evaluated the prevalence, subtypes, clinical profile and effect on outcome of ascitic fluid infection (AFI) in children with liver disease. Methods: Children with liver disease related ascites and subjected to paracentesis were classified as No-AFI and AFI (SBP, culture negative neutrocytic ascites [CNNA] and monomicrobial non-neutrocytic bacterascites). Clinical and laboratory parameters, in-hospital mortality and outcome in follow-up were noted. Results: 262 children (163 boys; age-84[1-240] months, chronic liver disease [CLD, n-173], non-CLD [n-89]) were enrolled. 28.6% (n = 75) had SBP/CNNA, more common in CLD than non-CLD (55/173 [31.7%] vs. 20/89 [22.4%]; p = 0.1). 50.6% SBP/CNNA cases were symptomatic for AFI. Gram negative bacilli were isolated from 70% SBP cases. 25% (18/72) CLD children with AFI had a poor hospital outcome, with INR, Child-Pugh score and gastrointestinal bleeding predicting outcome on multivariate analysis. CLD patients with SBP had higher in-hospital mortality (10/20 vs. 5/35; p = 0.01) than those with CNNA, but similar Child-Pugh score (12[7-15] vs. 11[7-14]; p = 0.1), recurrence of AFI (3/9 vs. 6/24; p = 0.6) and mortality in follow-up (22.2% vs. 25%; p = 0.1). CLD patients with SBP/CNNA had higher mortality over one year follow-up than no-AFI (24.2% [8/33] vs. 12.2% [7/57]; p = 0.1) but the difference was not significant. Conclusions: 28.6% children with liver disease related ascites have SBP/CNNA; 50% are symptomatic. CLD patients with SBP/CNNA have an AFI recurrence of 27.2% and mortality of 24% over 1year follow-up. CLD with SBP is similar to CNNA except for higher in-hospital mortality. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2aP8uZq
via IFTTT

Cognitive Abilities of Children With Neurological and Liver Forms of Wilson's Disease.

Cognitive impairment in adult patients suffering from Wilson's disease is now more clearly described, even in liver forms of the disease. Although this condition can appear during childhood, the cognitive abilities of children have not yet been reported in a substantial case series. This retrospective study included 21 children with Wilson's disease who had undergone general cognitive assessment. The results argue in favour of a poor working memory capacity in the liver form of the disease, and more extensive cognitive impairments in its neurological form. Extensive neuropsychological investigations on all children suffering from Wilson's disease are thus required. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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

A Comparison of Patients' and Doctors' Reports on Health Related Quality of Life in Celiac Disease.

Objective: To investigate whether implementation of a coeliac disease (CD)-specific health related quality of life (HRQOL) questionnaire would add value to CD follow-up visits; we compared patients' self-reported CD-specific HRQOL with the physician's report provided during a regular CD follow-up visit in children and young adults. Methods: A cross-sectional study in the control group of a study on self-management in CD (CoelKids). Eligible patients had CD for >=1year and were

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2aP9xbI
via IFTTT

The Addition of Epinephrine to Proxymetacaine or Oxybuprocaine Solution Increases the Depth and Duration of Cutaneous Analgesia in Rats.

Background: The aim of this experiment was to investigate the interaction between epinephrine and 2 local anesthetics (proxymetacaine or oxybuprocaine) using subcutaneous injections under the hairy skin, thereby simulating infiltration blocks. Methods: Using a rat model of cutaneous trunci muscle reflex in response to local skin pinpricks, the anesthetic properties of proxymetacaine and oxybuprocaine alone and in combination with epinephrine as an infiltrative anesthetic were tested. Isobolographic analysis was used for the analgesic interactions between adjuvant epinephrine and the local anesthetics. Lidocaine was used as a control group. Results: Oxybuprocaine, proxymetacaine, and lidocaine elicited a dose-dependent block to pinpricks. On the 50% effective dose (ED50) basis, their relative potencies were proxymetacaine [0.126 (0.113-0.141) [mu]mol] greater than oxybuprocaine [0.208 (0.192-0.226) [mu]mol] greater than lidocaine [6.331 (5.662-7.079) [mu]mol] (P

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2b1OwHm
via IFTTT

Relative Contribution of Adjuvants to Local Anesthetic for Prolonging the Duration of Peripheral Nerve Blocks in Rats.

Background and Objectives: A chemically compatible, safe 4-drug multimodal formulation of bupivacaine combined with 3 adjuvants (clonidine, buprenorphine, and dexamethasone) has been proposed for long-lasting single-injection peripheral nerve blocks in patients. However, the relative importance of each of the adjuvants of the 4-drug formulation in producing long-lasting nerve blocks has not been determined. The aim of this study in rats was to determine which adjuvants (clonidine, buprenorphine, or dexamethasone) are essential for producing a long-lasting nerve block. Methods: After baseline sensory and motor responses were recorded, 0.1 mL of drug solution was injected into the sciatic notch of rats. Animals were reevaluated at 10-minute intervals after injection for the absence or presence of sensory and motor response in the sciatic nerve. The 4-drug formulation of 0.25% bupivacaine plus all 3 adjuvants (clonidine, buprenorphine, and dexamethasone), 0.25% bupivacaine with 1 or 2 of the adjuvants added separately, and 0.25% bupivacaine alone were compared for duration of nerve block. Results: The 4-drug multimodal solution produced a longer duration of sensory and motor nerve block than 0.25% bupivacaine alone (P

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

Effect of positive end-expiratory pressure administration on intraocular pressure in laparoscopic cholecystectomy: Randomised controlled trial

No abstract available

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2b1ONde
via IFTTT

Use of rocuronium and sugammadex in renal transplantation: Problems that must be considered

No abstract available

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

Language: another cause of publication bias

No abstract available

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2b1O5g6
via IFTTT

Propofol, but not ketamine or midazolam, exerts neuroprotection after ischaemic injury by inhibition of Toll-like receptor 4 and nuclear factor kappa-light-chain-enhancer of activated B-cell signalling: A combined in vitro and animal study

BACKGROUND: Propofol, midazolam and ketamine are widely used in today's anaesthesia practice. Both neuroprotective and neurotoxic effects have been attributed to all three agents. OBJECTIVE: To establish whether propofol, midazolam and ketamine in the same neuronal injury model exert neuroprotective effects on injured neurones in vitro and in vivo by modulation of the Toll-like receptor 4-nuclear factor kappa-light-chain-enhancer of activated B cells (TLR-4-NF-κB) pathway. DESIGN AND SETTING: Cell-based laboratory (n = 6 repetitions per experiment) and animal (n = 6 per group) studies using a neuronal cell line (SH-SY5Y cells) and adult Sprague-Dawley rats. INTERVENTIONS: Cells were exposed to oxygen-glucose deprivation before or after treatment using escalating, clinically relevant doses of propofol, midazolam and ketamine. In animals, retinal ischaemia (60 min) was induced followed by reperfusion and randomised treatment with saline or propofol. MAIN OUTCOME MEASURES: Neuronal cell death was determined using flow-cytometry (mitochondrial membrane potential) and lactate dehydrogenase (LDH) release. Nuclear factor NF-κB and hypoxia-inducible factor 1 α-activity were analysed by DNA-binding ELISA, expression of NF-κB-dependent genes and TLR-4 by luciferase-assay and flow-cytometry, respectively. In animals, retinal ganglion cell density, caspase-3 activation and gene expression (TLR-4, NF-κB) were used to determine in vivo effects of propofol. Results were compared using ANOVA (Analysis of Variance) and t test. A P value less than 0.05 was considered statistically significant. RESULTS: Post-treatment with clinically relevant concentrations of propofol (1 to 10 μg ml−1) preserved the mitochondrial membrane potential in oxygen-glucose deprivation-injured cells by 54% and reduced LDH release by 21%. Propofol diminished TLR-4 surface expression and preserved the DNA-binding activity of the protective hypoxia-inducible factor 1 α transcription factor. DNA-binding and transcriptional NF-κB-activity were inhibited by propofol. Neuronal protection and inhibition of TLR-4-NF-κB signalling were not consistently seen with midazolam or ketamine. In vivo, propofol treatment preserved rat retinal ganglion cell densities (cells mm−2, saline 1504 ± 251 vs propofol 2088 ± 144, P = 0.0001), which was accompanied by reduced neuronal caspase-3, TLR-4 and NF-κB expression. CONCLUSION: Propofol, but neither midazolam nor ketamine, provides neuroprotection to injured neuronal cells via inhibition of TLR-4-NF-κB-dependent signalling.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2b1NYRU
via IFTTT

Effects of remifentanil on pharyngeal swallowing: A double blind randomised cross-over study in healthy volunteers

BACKGROUND: Exposure to remifentanil increases the incidence of pulmonary aspiration in healthy volunteers. This effect may be explained by impairment of airway defence mechanisms and/or altered swallowing function. Pressure-flow analysis is a technique that allows objective assessment of swallowing based on pressure-impedance patterns recorded during bolus swallowing. OBJECTIVES: The aim of this study was to use pressure-flow analysis to quantify the effect of remifentanil on healthy pharyngeal swallowing and to compare these effects with morphine. DESIGN: A double-blind, randomised, cross-over study. SETTING: A tertiary care teaching hospital. VOLUNTEERS: Eleven young volunteers (mean age, 23 years) and seven older volunteers (mean age, 73 years). INTERVENTIONS: Volunteers were studied twice and received either a target-controlled remifentanil infusion (target concentrations: young, 3 ng ml−1; old, 2 ng ml−1) or a bolus injection of morphine (dose: young, 0.1 mg kg−1; old, 0.07 mg kg−1). Pharyngeal pressure and impedance were recorded with an indwelling catheter while swallowing 10 boluses of liquid during each measuring phase. Variables defining swallowing function were calculated and compared to determine drug effects. MAIN OUTCOME MEASURES: Pharyngeal pressure-flow variables following remifentanil exposure. RESULTS: Changes produced by remifentanil in the measured variables were consistent with greater dysfunction of swallowing. Both the strength of the pharyngeal contractions and pharyngeal bolus propulsion were reduced, whereas flow resistance was increased. The swallow risk index, a global index of swallowing dysfunction, increased overall. At the experimental doses tested, morphine produced similar, but less extensive effects on swallowing. CONCLUSION: Remifentanil induced dysfunction of the pharyngeal swallowing mechanism. This may contribute to an increased risk of aspiration. TRIAL REGISTRATION: NCT01924234 (http://ift.tt/PmpYKN ).

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2b1O5Nu
via IFTTT

Significantly prolonged neuromuscular blockade after a single dose of rocuronium: The importance of monitoring

No abstract available

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2ahen0V
via IFTTT

Satisfaction and safety using dexmedetomidine or propofol sedation during endoscopic oesophageal procedures: A randomised controlled trial

BACKGROUND: Dexmedetomidine possesses anxiolytic and hypnotic properties without respiratory side-effects, making it theoretically an ideal sedative agent for endoscopic procedures. OBJECTIVE: We aimed to compare satisfaction and safety among outpatients receiving sedation with dexmedetomidine or propofol for endoscopic oesophageal procedures. DESIGN: A randomised controlled study. SETTING: Endoscopic intervention suite at the Academic Medical Centre in Amsterdam, Netherlands. PARTICIPANTS: Patients aged at least 18 years, and American Society of Anesthesiologists' physical status 1 to 3. INTERVENTION: Total 63 patients were randomised to receive either dexmedetomidine (D) or propofol (P). Pain was treated with alfentanil in both groups. MAIN OUTCOME MEASURES: The primary outcomes were patients' and endoscopists' satisfaction levels measured by validated questionnaires (1 = very dissatisfied; 7 = highly satisfied). A secondary outcome was safety, determined by blood pressure, heart rate and oxygen saturation during and after the procedure, and respiratory rate and noninvasive cardiac output during the procedure. RESULTS: Satisfaction of patients [median (IQR); group D, 5.0 (3.75 to 5.75) vs. group P, 6.25 (5.3 to 6.5)] and satisfaction of gastroenterologists [group D, 5.0 (4.4 to 5.8) vs. group P, 6.0 (5.4 to 6.0)] were lower in group D (both P 

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

Inhaled anaesthetics and nitrous oxide: Complexities overlooked: things may not be what they seem

This review re-examines existing pharmacokinetic and pharmacodynamic concepts of inhaled anaesthetics. After showing where uptake is hidden in the classic FA/FI curve, it is argued that target-controlled delivery of inhaled agents warrants a different interpretation of the factors affecting this curve (cardiac output, ventilation and blood/gas partition coefficient). Blood/gas partition coefficients of modern agents may be less important clinically than generally assumed. The partial pressure cascade from delivered to inspired to end-expired is re-examined to better understand the effect of rebreathing during low-flow anaesthesia, including the possibility of developing a hypoxic inspired mixture despite existing machine standards. Inhaled agents are easy to administer because they are transferred according to partial pressure gradients. In addition, the narrow dose–response curves for the three end points of general anaesthesia (loss of response to verbal command, immobility and autonomic reflex control) allow the clinical use of MACawake, MAC and MACBAR to determine depth of anaesthesia. Opioids differentially affect these clinical effects of inhaled agents. The effect of ventilation–perfusion relationships on gas uptake is discussed, and it is shown how moving beyond Riley's useful but simplistic model allows us to better understand both the concept and the magnitude of the second gas effect of nitrous oxide. It is argued that nitrous oxide remains a clinically useful drug. We hope to bring old (but ignored) and new (but potentially overlooked) information into the educational and clinical arenas to stimulate discussion among clinicians and researchers. We should not let technology pass by our all too engrained older concepts.

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

Preload dependency determines the effects of phenylephrine on cardiac output in anaesthetised patients: A prospective observational study

BACKGROUND: Although phenylephrine is widely used in the operating room to control arterial pressure, its haemodynamic effects remain controversial. OBJECTIVE: We hypothesised that the effect of phenylephrine on cardiac output is affected by preload dependency. DESIGN: A prospective observational study. SETTING: Single-centre, University Hospital of Caen, France. PATIENTS: Fifty ventilated patients undergoing surgery were studied during hypotension before and after administration of phenylephrine. MAIN OUTCOME MEASURES: Cardiac index (CI), stroke volume (SV), corrected flow time, mean arterial pressure, pulse pressure variations (PPV) and systemic vascular resistance index were used to assess effects of changes in preload dependency. RESULTS: Twenty seven (54%) patients were included in the preload-dependent group (PPV ≥ 13%) and 23 (46%) in the preload-independent group (PPV 

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

S100B protein and neuron-specific enolase as predictors of cognitive dysfunction after coronary artery bypass graft surgery: A prospective observational study

BACKGROUND: Postoperative cognitive dysfunction (POCD) may be related to the systemic inflammatory response and an increase in serum markers of brain injury such as S100B protein and neuron-specific enolase (NSE). OBJECTIVE: The study aims to evaluate the association between POCD and serum levels of S100B and NSE after coronary artery bypass grafting surgery (CABG). DESIGN: Prospective observational study. SETTING: Single university teaching hospital. PATIENTS: We investigated 88 patients undergoing CABG. MAIN OUTCOMES MEASURES: Cognitive function was measured preoperatively, and at the 21st and 180th postoperative days (i.e. 6 months after surgery). S100B protein and NSE serum levels were evaluated preoperatively, after induction of anaesthesia, at the end of surgery and at 6 and 24 h after surgery. RESULTS: The incidence of POCD was 26.1% at 21 days after surgery and 22.7% at 6 months after surgery. Increased serum levels of S100B protein and NSE were observed postoperatively and may indicate brain damage. CONCLUSION: Although serum levels of S100B protein and NSE are both significantly increased postoperatively, our findings indicate that serum levels of S100B protein may be more accurate than NSE in the detection of POCD after CABG. TRIAL REGISTRATION: NCT01550159.

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

Predicting stroke volume and arterial pressure fluid responsiveness in liver cirrhosis patients using dynamic preload variables: A prospective study of diagnostic accuracy

BACKGROUND: Predicting whether a fluid challenge will elicit 'fluid responsiveness' in stroke volume (SV) and arterial pressure is crucial for managing hypovolaemia and hypotension. Pulse pressure variation (PPV), SV variation (SVV) and the plethysmographic variability index (PVI) have been shown to predict SV fluid responsiveness, and the PPV/SVV ratio has been shown to predict arterial pressure fluid responsiveness under various conditions. However, these variables have not been investigated in liver cirrhosis patients. OBJECTIVE: The objective was to evaluate SV and arterial pressure fluid responsiveness in liver cirrhosis patients by using dynamic preload and vascular tone variables. DESIGN: A prospective study of diagnostic accuracy. SETTINGS: A single-centre trial conducted from November 2013 to April 2015. PATIENTS: Thirty-one adult patients, recipients of a living donor liver transplantat. INTERVENTION: An intraoperative fluid challenge with 10 ml kg−1 of 0.9% normal saline. MAIN OUTCOME MEASURES: PPV, SVV, cardiac index and systemic vascular resistance index were measured using the Pulse index Continuous cardiac system. The PVI and perfusion index were measured using the Masimo Radical 7 co-oximeter. The PPV, SVV and PVI were measured to investigate SV fluid responsiveness, and the PPV/SVV ratio, perfusion index and systemic vascular resistance index were measured to investigate arterial pressure fluid responsiveness. RESULTS: The areas under the receiver operating characteristic curves for PPV, SVV and PVI were 0.794, 0.754 and 0.800, respectively (all P 

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2aheQA3
via IFTTT

Relationship between timing of sugammadex administration and development of laryngospasm during recovery from anaesthesia when using supraglottic devices: A randomised clinical study

No abstract available

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2b1OOxZ
via IFTTT

Effects of neoadjuvant chemo or chemoradiotherapy for oesophageal cancer on perioperative haemodynamics: A prospective cohort study within a randomised clinical trial

BACKGROUND: Neoadjuvant chemoradiotherapy might improve oncological outcome compared with chemotherapy after surgery for oesophagus or gastrooesophageal junction cancer. However, radiotherapy may induce cardiovascular side-effects that could increase the risk of perioperative adverse effects and postoperative morbidity. OBJECTIVES: The aim of this study was to compare the perioperative haemodynamics in patients undergoing oesophagectomy following neoadjuvant chemotherapy or chemoradiotherapy for cancer. DESIGN: A prospective single-centre cohort study within a randomised multi-centre trial. SETTING: A Swedish University Hospital from January 2009 to March 2013. PATIENTS: A total of 31 patients (chemotherapy 17, chemoradiotherapy 14) included in a multi-centre trial randomising chemotherapy vs. chemoradiotherapy and operated at Karolinska University Hospital, Huddinge. INTERVENTIONS: Cisplatin and 5-fluorouracil, either with or without concurrent radiotherapy (40 Gy), were given prior to surgery. Cardiac function was assessed with LiDCOplus (LiDCO Ltd, London, United Kingdom), echocardiography, troponin T and N-terminal pro-B-type natriuretic peptide, before, during and after surgery. MAIN OUTCOME MEASURES: The primary outcome was the interaction effect of the neoadjuvant treatment on stroke volume index during the perioperative period. Secondary outcomes were the interaction effects of oxygen delivery index, cardiac index, echocardiography and biochemical markers. RESULTS: The groups were matched regarding comorbidities, but patients in the chemoradiotherapy group were older (66 vs. 60 years P = 0.03). Haemodynamic values changed in a similar way in both groups during the study period. The chemoradiotherapy group had a lower cardiac index before surgery (2.9 vs. 3.4 l min−1 m−2, P = 0.03). On the third postoperative day, both groups displayed a hyperdynamic state compared with baseline, with no increase in troponin T, and a similar increase in N-terminal pro-B-type natriuretic peptide. CONCLUSION: Neoadjuvant chemoradiotherapy for oesophageal or gastrooesophageal junction cancer seems to induce only a marginal negative effect on cardiac function compared with neoadjuvant chemotherapy. This difference did not remain when patients' haemodynamics were challenged by surgery. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01362127.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2b1O4sy
via IFTTT

Evaluation of a modified in-plane ultrasound technique for routine arterial catheterisation: A prospective observational study

No abstract available

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2b1OMpG
via IFTTT

Early matrix metalloproteinase-9 concentration in the first 48 h after aneurysmal subarachnoid haemorrhage predicts delayed cerebral ischaemia: An observational study

BACKGROUND: Delayed cerebral ischaemia from vasospasm is an important cause of complications and death after aneurysmal subarachnoid haemorrhage. There is currently no established biomarker for identifying patients at high risk of delayed cerebral ischaemia. OBJECTIVE: Considering the important role of inflammation in the pathogenesis of delayed cerebral ischaemia, we investigated whether matrix metalloproteinase-9 (MMP-9) may be an efficient biomarker for predicting elayed cerebral ischaemia after subarachnoid haemorrhage. DESIGN: Single-centre prospective observational study. SETTING: Neuroscience Critical Care Unit of a teaching hospital. PARTICIPANTS: Thirty consecutive patients with severe subarachnoid haemorrhage requiring external ventricular drainage were enrolled during 2013 and 2014. INTERVENTIONS: Blood and cerebrospinal fluid (CSF) were sampled within the first 24 h and between 48 and 72 h after admission. We evaluated the activity and concentrations of MMP-9 and endothelin-1 with zymography and ELISA. Patients were allocated to groups with delayed cerebral ischaemia (n = 16) or without delayed cerebral ischaemia (n = 14). RESULTS: Within 24 h, median [interquartile range] MMP-9 concentrations in CSF were significantly higher in patients with delayed cerebral ischaemia (47 [21 to 102] ng ml−1) than in those without delayed cerebral ischaemia (4 [2 to 13] ng ml−1, P = 0.001). CSF MMP-9 activity and endothelin-1 concentrations were correlated (r = 0.6, P = 0.02). The areas under the receiver operating characteristic curves were 0.73 (95% confidence interval [0.53 to 0.87]) and 0.91 (95% confidence interval [0.75 to 0.98]) for MMP-9 concentrations in plasma and CSF, respectively, at 24 h to predict delayed cerebral ischaemia CSF MMP-9 concentrations more than 14.3 ng ml−1 at 24 h predicted the occurrence of delayed cerebral ischaemia with a sensitivity and specificity of 88 and 86%, respectively. After multivariate logistic analysis, only CSF MMP-9 concentrations at 24 h predicted the occurrence of delayed cerebral ischaemia (P = 0.01). CONCLUSION: MMP-9 concentrations in both plasma and CSF, measured within 48 h after subarachnoid haemorrhage, were highly predictive of the occurrence of delayed cerebral ischaemia within the first 2 weeks. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT02397759.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2b1Oek1
via IFTTT

Oxford Handbook of Anaesthesia, 4th edn

No abstract available

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

Why Does Threshold Level Change in Transcranial Motor-evoked Potentials During Surgery for Supratentorial Lesions?.

Background: Rising threshold level during monitoring of motor-evoked potentials (MEP) using transcranial electrical stimulation (TES) has been described without damage to the motor pathway in the cranial surgery, suggesting the need for monitoring of affected and unaffected hemisphere. We aimed to determine the factors that lead to a change in threshold level and to establish reliable criteria for adjusting stimulation intensity during surgery for supratentorial lesions. Materials and Methods: Between October 2014 and October 2015, TES-MEP were performed in 143 patients during surgery for unilateral supratentorial lesions in motor-eloquent brain areas. All procedures were performed under general anesthesia using a strict protocol to maintain stable blood pressure. MEP were evaluated bilaterally to assess the percentage increase in threshold level, which was considered significant if it exceeded 20% on the contralateral side beyond the percentage increase on the ipsilateral side. Patients who developed a postoperative motor deficit were excluded. Volume of subdural air was measured on postoperative magnetic resonance imaging. Logistic regression was performed to identify factors associated with the intraoperative recorded changes in threshold level. Results: A total of 123 patients were included in the study. On the affected side, 82 patients (66.7%) showed an increase in threshold level, which ranged from 2% to 48% and 41 patients (33.3%) did not show any change. The difference to the unaffected side was under 20% in all patients. The recorded range of changes in the systolic and mean pressure did not exceed 20 mm Hg in any of the patients. Pneumocephalus was detected on postoperative magnetic resonance imaging scans in 87 patients (70.7%) and 81 of them (93.1%) had an intraoperative increase in threshold level on either sides. Pneumocephalus was the only factor associated with an increase in threshold level on the affected side (P

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2aAo0UN
via IFTTT

The effects of different types of ankle-foot orthoses on postural responses in individuals with walking impairments.

The aim of this study was to examine the immediate and long-term effects of different ankle-foot orthosis (AFO) types on postural responses in patients with various pathological conditions who, because of their walking disorders, wore an AFO. A total of 37 patients with different pathological conditions who visited the outpatient clinic for orthotics because of walking problems, already used or were referred for an AFO and had no other impairments that may influence balance were included in the study. The participants were divided into four groups according to the type of AFO that they wore. The postural responses were assessed with and without AFO using two force-plates following perturbations in different directions at the level of the pelvis. The centre of pressure was examined in the sagittal and frontal plane and compared with the normative data from healthy individuals. The results showed an improvement in postural responses to the lateral and backward perturbation directions when wearing the AFO, particularly responses in the anterior-posterior direction. The best results were achieved with the custom-made posterior leaf spring AFO for correction of equinovarus deformity. The time of wearing the AFO had an impact on postural responses in perturbation directions where the patients could not rely only on AFO. The custom-made AFO improved overall postural responses, especially dynamic stability, in lateral directions, whereas all stiff AFOs contributed towards an improvement in responses to all perturbations to the affected side. Results showed that long-term use of an AFO can be important for the overall improvement of postural responses. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2aHFLmQ
via IFTTT

Clinical Performance and Safety of Closed-Loop Systems: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Automated systems can improve the stability of controlled variables and reduce the workload in clinical practice without increasing the risks to patients. We conducted this review and meta-analysis to assess the clinical performance of closed-loop systems compared with manual control. Our primary outcome was the accuracy of closed-loop systems in comparison with manual control to maintain a given variable in a desired target range. The occurrence of overshoot and undershoot episodes was the secondary outcome. METHODS: We retrieved randomized controlled trials on accuracy and safety of closed-loop systems versus manual control. Our primary outcome was the percentage of time during which the system was able to maintain a given variable (e.g., bispectral index or oxygen saturation) in a desired range or the proportion of the target measurements that was within the required range. Our secondary outcome was the percentage of time or the number of episodes that the controlled variable was above or below the target range. The standardized mean difference and 95% confidence interval (CI) were calculated for continuous outcomes, whereas the odds ratio and 95% CI were estimated for dichotomous outcomes. RESULTS: Thirty-six trials were included. Compared with manual control, automated systems allowed better maintenance of the controlled variable in the anesthesia drug delivery setting (95% CI, 11.7%-23.1%; percentage of time, P 75%). We observed a significant reduction of episodes of overshooting and undershooting when closed-loop systems were used. CONCLUSIONS: The use of automated systems can result in better control of a given target within a selected range. There was a decrease of overshooting or undershooting of a given target with closed-loop systems. (C) 2016 International Anesthesia Research Society

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

A Brief Period of Hypothermia Induced by Total Liquid Ventilation Decreases End-Organ Damage and Multiorgan Failure Induced by Aortic Cross-Clamping.

BACKGROUND: In animal models, whole-body cooling reduces end-organ injury after cardiac arrest and other hypoperfusion states. The benefits of cooling in humans, however, are uncertain, possibly because detrimental effects of prolonged cooling may offset any potential benefit. Total liquid ventilation (TLV) provides both ultrafast cooling and rewarming. In previous reports, ultrafast cooling with TLV potently reduced neurological injury after experimental cardiac arrest in animals. We hypothesized that a brief period of rapid cooling and rewarming via TLV could also mitigate multiorgan failure (MOF) after ischemia-reperfusion induced by aortic cross-clamping. METHODS: Anesthetized rabbits were submitted to 30 minutes of supraceliac aortic cross-clamping followed by 300 minutes of reperfusion. They were allocated either to a normothermic procedure with conventional ventilation (control group) or to hypothermic TLV (33[degrees]C) before, during, and after cross-clamping (pre-clamp, per-clamp, and post-clamp groups, respectively). In all TLV groups, hypothermia was maintained for 75 minutes and switched to a rewarming mode before resumption to conventional mechanical ventilation. End points included cardiovascular, renal, liver, and inflammatory parameters measured 300 minutes after reperfusion. RESULTS: In the normothermic (control) group, ischemia-reperfusion injury produced evidence of MOF including severe vasoplegia, low cardiac output, acute kidney injury, and liver failure. In the TLV group, we observed gradual improvements in cardiac output in post-clamp, per-clamp, and pre-clamp groups versus control (53 +/- 8, 64 +/- 12, and 90 +/- 24 vs 36 +/- 23 mL/min/kg after 300 minutes of reperfusion, respectively). Liver biomarker levels were also lower in pre-clamp and per-clamp groups versus control. However, acute kidney injury was prevented in pre-clamp, and to a limited extent in per-clamp groups, but not in the post-clamp group. For instance, creatinine clearance was 4.8 +/- 3.1 and 0.5 +/- 0.6 mL/kg/min at the end of the follow-up in pre-clamp versus control animals (P = .0004). Histological examinations of the heart, kidney, liver, and jejunum in TLV and control groups also demonstrated reduced injury with TLV. CONCLUSIONS: A brief period of ultrafast cooling with TLV followed by rapid rewarming attenuated biochemical and histological markers of MOF after aortic cross-clamping. Cardiovascular and liver dysfunctions were limited by a brief period of hypothermic TLV, even when started after reperfusion. Conversely, acute kidney injury was limited only when hypothermia was started before reperfusion. Further work is needed to determine the clinical significance of our results and to identify the optimal duration and timing of TLV-induced hypothermia for end-organ protection in hypoperfusion states. (C) 2016 International Anesthesia Research Society

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2atFD7I
via IFTTT