Τετάρτη, 24 Αυγούστου 2016

Hypoxia and hypercapnia inhibit hypothalamic orexin neurons in rats

Evidence of impaired function of orexin neurons has been found in individuals with cardiorespiratory disorders such as obstructive sleep apnea (OSA) and sudden infant death syndrome (SIDS), but the mechanisms responsible are unknown. Individuals with OSA and SIDS experience repetitive breathing cessations and/or rebreathing of expired air, resulting in hypoxia/hypercapnia (H/H). In this study we examined the responses of fluorescently identified rat orexin neurons in the lateral hypothalamus to acute H/H to test if and how these neurons alter their activity and function during this challenge. Experiments were conducted in an in-vitro slice preparation using voltage-clamp and current-clamp configurations. H/H (10 min) induced hyperpolarization accompanied by rapid depression and finally cessation of firing activity in orexin neurons. Hypoxia alone had similar but less potent effects. H/H did not alter the frequency of inhibitory glycinergic postsynaptic currents. The frequency of GABAergic currents was diminished but only at min 8-10 of H/H. In contrast, the frequency of excitatory glutamatergic postsynaptic events was diminished as early as min 2-4 of H/H. In the presence of glutamatergic receptor blockers the inhibitory effects of H/H on the firing activity and membrane potential of orexin neurons persisted, but to a lesser extent. In conclusion, both direct alteration of postsynaptic membrane properties and diminished glutamatergic neurotransmission likely contributes to the inhibition of orexin neurons by H/H. These mechanisms could be responsible for the decreased function of orexin in individuals at risk for OSA and SIDS.



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A neuronal lactate uptake inhibitor slows recovery of extracellular ion concentration changes in the hippocampal CA3 region by affecting energy metabolism.

Astrocyte derived lactate supports pathologically enhanced neuronal metabolism but its role under physiological conditions is still a matter of debate. Here, we determined the contribution of astrocytic neuronal lactate shuttle to maintenance of ion homeostasis and energy metabolism. We tested for the effects of α-cyano-4-hydroxycinnamic acid (4-CIN), which could interfere with energy metabolism by blocking monocarboxylate-transporter 2 (MCT2) mediated neuronal lactate uptake, on evoked potentials, stimulus induced changes in K+, Na+, Ca2+ and oxygen concentrations as well as on changes in flavin adenine dinucleotide (FAD) autofluorescence in the hippocampal area CA3. MCT2 blockade by 4-CIN reduced synaptically evoked but not antidromic population spikes. This effect was dependent on the activation of KATP channels indicating reduced neuronal ATP synthesis. By contrast, lactate receptor activation by 3,5-dihydroxybenzoic acid (3,5-DHBA) resulted in increased antidromic and orthodromic population spikes suggesting that 4-CIN effects are not mediated by lactate accumulation and subsequent activation of lactate receptors. Recovery kinetics of all ion transients were prolonged and baseline K+ concentration became elevated by blockade of lactate uptake. Lactate contributed to oxidative metabolism as both baseline respiration and stimulus induced changes in pO2 were decreased, while FAD fluorescence increased likely due to a reduced conversion of FAD into FADH2. These data suggest that lactate shuttle contributes to regulation of ion homeostatsis and synaptic signaling even in the presence of ample glucose.



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Dynamic compensation mechanism give rise to period and duty cycle level sets in oscillatory neuronal models

Rhythmic oscillation in neurons can be characterized by various attributes such as the oscillation period and duty cycle. The values of these features depend on the amplitudes of the participating ionic currents, which can be characterized by their maximum conductances values. Recent experimental and theoretical work has shown that the values of these attributes can be maintained constant for different combinations of two or more ionic currents of varying conductances, defining what is known as level sets in conductance-space. In two-dimensional conductance-spaces, a level set is a curve, often a line, along which a particular oscillation attribute value is conserved. In this work we use modeling, dynamical systems tools (phase-space analysis), and numerical simulations to investigate the possible dynamic mechanisms responsible for the generation of period and duty cycle levels sets in simplified (linearized and FitzHugh-Nagumo) and conductance-based (Morris-Lecar) models of neuronal oscillations. A simplistic hypothesis would be that the tonic balance between ionic currents with the same or opposite effective signs is sufficient to create level sets. According to this hypothesis, the dynamics of each ionic current during a given cycle are well captured by some constant quantity (e.g. maximal conductances) and the phase-plane diagrams are identical, or are almost identical (e.g. cubic-like nullclines with the same maxima and minima), for different combinations of these maximal conductances. In contrast, we show that these mechanisms are dynamic and involve the complex interaction between the nonlinear voltage dependencies and the effective time scales at which the ionic current's dynamical variables operate.



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A systematic analysis of neurons with large somatosensory receptive fields covering multiple body regions in the secondary somatosensory area of macaque monkeys

Previous neurophysiological studies performed in macaque monkeys have revealed complex somatosensory responses in the secondary somatosensory area (SII), such as large receptive fields (RFs) as well as bilateral ones. However, systematic analyses of neurons with large RFs have not been performed. In the present study, we recorded single-unit activities in SII of awake macaque monkeys to systematically investigate large RFs by dividing the whole body into four body regions (head, trunk, forelimb, and hindlimb). Recorded neurons were classified into two types according to whether the RFs were confined to one body region: single- (n = 817) and combined- (n = 282) body region types. These two types were distinct in terms of the percentage of bilateral RFs: 55% in the single-region type and 90% in the combined type, demonstrating that two types of RF enlargement occur simultaneously in the combined type, namely, RF convergence from different body regions and RF convergence from both hemibodies. Among the combined-type RFs, two tendencies of RF convergence were found: (1) the distal parts of the limbs (i.e., hand and foot) and the mouth are interconnected, and (2) the trunk RFs extend continuously toward the distal parts of the limb and head to cover the entire body surface. Our distribution analysis on unfolded maps clarified that neurons having RFs with these two tendencies were distributed within specific subregions in SII.



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An elegant new test of corticospinal tract function during surgery: more work to be done

The early results of a new test of corticospinal tract (CST) integrity are reported in this issue of Clinical Neurophysiology (Andrews et al., 2016). The authors are to be congratulated for their thoughtfully conceived and precisely executed study. The manuscript is also highly readable and well-illustrated. It bears the mark of an investigatory group perfectly at home within the exigencies of spinal cord circuitry.

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Utility of Electroencephalography: Experience from a U.S. Tertiary Care Medical Center

Electroencephalography (EEG) is the gold-standard test for diagnosing seizures, especially subclinical emergencies, including non-convulsive status epilepticus (NCSE) (DeLorenzo et al., 1998; Claassen et al., 2004; Laccheo et al., 2015). However, conventional scalp EEG with glued electrodes is very resource-intensive, requiring dedicated, specially trained, personnel and expensive equipment (Kull and Emerson, 2005). Furthermore, the additional time needed for interpretation can delay its impact on patient care up to 22-48 hours (Quigg et al., 2001; Kämppi et al., 2013).

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3D-printed head models for navigated non-invasive brain stimulation

Recent years have seen considerable interest in the clinical use of noninvasive brain stimulation (NIBS), including transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (tES) (Hummel et al., 2005; Dayan et al., 2013; Fox et al., 2013; Dunlop et al., 2016; Otal et al., 2016). One promising avenue of research that advances towards minimizing interindividual differences in patients' responses to NIBS integrates brain imaging data, particularly functional and structural brain connectivity, to provide personalized, guided stimulation in clinical contexts (Fox et al., 2013; Dunlop et al., 2016; Otal et al., 2016).

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Guidelines for preoperative investigations for elective surgery at Queen Elizabeth Hospital: effects on practices, outcomes, and costs

We endeavor to assess the impact of introduction of guidelines for preoperative investigations (PIs) on anesthetic practices and costs and compare their efficacy to current practices.

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The Malley Crossover Ambulance

Malley Industries is the first manufacturer in North America to create a state-of-the-art ambulance using the spacious RAM ProMaster. The new Malley Crossover Ambulance provides interior space comparable to more expensive modulars and has the capacity to accommodate a bariatric stretcher. Developed in collaboration with industry stakeholders and more than 1,000 paramedics, our innovative research and development team designed an ambulance that would: • Enhance safety and comfort • Improve access to patients and equipment • Maximize interior space

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Admiration, respect for caregivers everywhere

aleppo_fc-1.jpg

Over the years I have made claims about the occupational hazards facing EMS providers. Bloodborne pathogens, violence, ambulance crashes and the myriad of musculoskeletal injuries suffered from every day lifting and moving are part and parcel of field care medicine. Even as the industry works to improve workplace safety, EMTs and paramedics continue to face career-ending events on a daily basis.

Then, a video of a little boy spreads through the internet over the weekend, and it puts things into perspective.

The boy was just pulled from the remains of his home in Aleppo, Syria after it was hit by bombs. A rescuer is seen carrying the child from the wreckage into the back of an ambulance. The rescuer places the boy in the jump seat and goes back to help rescue others. The child is mute and appears dazed. His head is bloody and his clothes and body are covered in concrete dust.

It's very hard to fathom what it must be like to be a civilian EMS provider working to rescue victims of war. Mainstream media often romanticizes or overly dramatizes the working conditions of a war zone.

The simple fact is the work is not romantic or dramatic. It is ugly, hard and gruesome. A civil defense group known as the White Helmets has been a large part of Syria's EMS and rescue system in antigovernment held territories since the conflict began. Funded by various outside agencies, the group has reportedly lost 134 of its own members during the fighting. The group members are apparently targeted by opposing forces as they attempt to rescue civilians.

In the U.S., we get understandably anxious and upset when we have to deal with the occasional carnage of violence and the rare mass casualty event. I'm not sure if I can begin to understand what it feels like to respond to such incidents on a daily basis. It's no wonder that most veteran combat medics or corpsmen rarely talk about their experiences in active war theaters; and the constant threat of being killed for doing your job is the stuff of nightmares and post-traumatic stress.

Mind you, I am not choosing a side in the conflict. I don't have to agree or disagree with the political aspects of the conflict in order to admire and respect those who unquestioningly respond to the call for help, even at great peril to one's own life.

I'm proud that in some small way, my work is connected to theirs even though we are literally worlds apart both geographically and ideologically. Just as it is with my fellow EMS providers at home, I hope and pray for their physical and emotional well-being as they do the best they can.



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Visual motion detection and habitat preference in Anolis lizards

Abstract

The perception of visual stimuli has been a major area of inquiry in sensory ecology, and much of this work has focused on coloration. However, for visually oriented organisms, the process of visual motion detection is often equally crucial to survival and reproduction. Despite the importance of motion detection to many organisms' daily activities, the degree of interspecific variation in the perception of visual motion remains largely unexplored. Furthermore, the factors driving this potential variation (e.g., ecology or evolutionary history) along with the effects of such variation on behavior are unknown. We used a behavioral assay under laboratory conditions to quantify the visual motion detection systems of three species of Puerto Rican Anolis lizard that prefer distinct structural habitat types. We then compared our results to data previously collected for anoles from Cuba, Puerto Rico, and Central America. Our findings indicate that general visual motion detection parameters are similar across species, regardless of habitat preference or evolutionary history. We argue that these conserved sensory properties may drive the evolution of visual communication behavior in this clade.



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Single-dose effects on the P3no-go ERP component predict clinical response to stimulants in pediatric ADHD

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Publication date: October 2016
Source:Clinical Neurophysiology, Volume 127, Issue 10
Author(s): Geir Ogrim, Ida Emilia Aasen, Jan Ferenc Brunner
ObjectiveApproximately 30% of children and adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) and treated with stimulants are considered non-responders (non-REs). Reliable predictors of response are missing. We examined changes in Event-Related Potentials (ERPs) induced by a single dose of stimulant medication in order to predict later clinical response.MethodsERPs were registered twice during performance of a visual cued go/no-go task in 87 ADHD patients (27 girls) aged 8–18years; the second recording on a single dose of stimulant medication, followed by a systematic medication trial lasting 4weeks. Based on the four-week trial, participants were categorized as responders (REs, N=62) or non-REs (N=25). Changes among REs and non-REs in ERP components (cueP3, CNV, P3go, N2no-go, P3no-go) and behavioral-test variables were then compared.ResultsREs and non-REs differed significantly in medication-induced changes in P3no-go, cue-P3, CNV, omission errors, reaction time, and reaction-time variability. The largest effect size was found for P3no-go amplitude (p<.001; d=1.76). Changes in P3no-go and omission errors correctly classified 90% of the REs and 76% of the non-REs, when controlling for the age of the participants.ConclusionClinical response to stimulants can be predicted by assessing single-dose changes in the P3no-go ERP component amplitude.SignificanceChanges in P3no-go may be a clinically useful marker of response to stimulants.



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Neural correlates of attention bias in posttraumatic stress disorder

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Publication date: October 2016
Source:Clinical Neurophysiology, Volume 127, Issue 10
Author(s): Noa Herz, Inbal Reuveni, Abraham Goldstein, Tuvia Peri, Shaul Schreiber, Yuval Harpaz, Omer Bonne
ObjectivePatients suffering from posttraumatic stress disorder (PTSD) exhibit hyper arousal symptoms and attention problems which were frequently investigated using the P3 event-related potentials (ERPs). Our study aimed at providing more precise knowledge of the functional significance of the P3 alteration seen in PTSD by revealing its spatio-temporal dynamics.MethodsFifteen PTSD patients and fifteen healthy trauma-exposed controls participated in a three-tone "oddball" task while their brain activity was recorded by magnetoencephalography (MEG). They were asked to detect rare target tones and ignore standard tones and infrequent threatening distractors. An adaptive spatial-filter method (SAM beamformer) was applied for source estimation.ResultsCompared with controls, PTSD patients had more incorrect responses to standard stimuli. On the brain level, PTSD patients showed hyperactivity in the dorsolateral prefrontal cortex and anterior cingulate cortex in response to standard sounds, decreased activity in those regions in response to threatening distractors, and decreased orbitofrontal activity in response to target stimuli.ConclusionsIncreased frontal activation in response to standard, neutral, stimuli may reflect greater resource allocation dedicated to cognitive control mechanisms during routine functioning in PTSD. Decreased frontal activation in response to rare stimuli may reflect subsequently reduced residual resources for detecting rare stimuli and for emotion regulation. This may explain the hypervigilance and attention problems commonly reported by patients.SignificanceThe current findings contribute to a better understanding of the mechanisms underlying the attention deficiency in PTSD, and highlight altered activity in specific frontal regions as potential biomarkers.



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Early EEG findings in tuberous sclerosis complex presenting with apneic seizures soon after birth

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Publication date: October 2016
Source:Clinical Neurophysiology, Volume 127, Issue 10
Author(s): Liudmila Kharoshankaya, Deirdre M. Murray, Conor Bogue, Caroline Ahearne, Brendan P. Murphy, Geraldine B. Boylan




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Cross-Sectional Associations of Objectively-Measured Physical Activity and Sedentary Time with Body Composition and Cardiorespiratory Fitness in Mid-Childhood: The PANIC Study

Abstract

Background

The minimum intensity of physical activity (PA) that is associated with favourable body composition and cardiorespiratory fitness (CRF) remains unknown.

Objective

To investigate cross-sectional associations of PA and sedentary time (ST) with body composition and CRF in mid-childhood.

Methods

PA, ST, body composition and CRF were measured in a population-based sample of 410 children (aged 7.6 ± 0.4 years). Combined heart-rate and movement sensing provided estimates of PA energy expenditure (PAEE, kJ/kg/day) and time (min/day) at multiple fine-grained metabolic equivalent (MET) levels, which were also collapsed to ST and light PA (LPA), moderate PA (MPA) and vigorous PA (VPA). Fat mass index (FMI, kg/m2), trunk fat mass index (TFMI, kg/m2) and fat-free mass index (FFMI, kg/m2.5) were derived from dual-energy X-ray absorptiometry. Maximal workload from a cycle ergometer test provided a measure of CRF (W/kg FFM). Linear regression and isotemporal substitution models were used to investigate associations.

Results

The cumulative time above 2 METs (221 J/min/kg) was inversely associated with FMI and TFMI in both sexes (p < 0.001) whereas time spent above 3 METs was positively associated with CRF (p ≤ 0.002); CRF increased and adiposity decreased dose-dependently with increasing MET levels. ST was positively associated with FMI and TFMI (p < 0.001) but there were inverse associations between all PA categories (including LPA) and adiposity (p ≤ 0.002); the magnitude of these associations depended on the activity being displaced in isotemporal substitution models but were consistently stronger for VPA. PAEE, MPA and to a greater extent VPA, were all positively related to CRF (p ≤ 0.001).

Conclusions

PA exceeding 2 METs is associated with lower adiposity in mid-childhood, whereas PA of 3 METs is required to benefit CRF. VPA was most beneficial for fitness and fatness, from a time-for-time perspective, but displacing any lower-for-higher intensity may be an important first-order public health strategy.

Clinical trial registry number (website): NCT01803776 (http://ift.tt/2bPuOjq).



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Admiration, respect for caregivers everywhere

Over the years I have made claims about the occupational hazards facing EMS providers. Bloodborne pathogens, violence, ambulance crashes and the myriad of musculoskeletal injuries suffered from every day lifting and moving are part and parcel of field care medicine. Even as the industry works to improve workplace safety, EMTs and paramedics continue to face career-ending events on a daily basis.

Then, a video of a little boy spreads through the internet over the weekend, and it puts things into perspective.

The boy was just pulled from the remains of his home in Aleppo, Syria after it was hit by bombs. A rescuer is seen carrying the child from the wreckage into the back of an ambulance. The rescuer places the boy in the jump seat and goes back to help rescue others. The child is mute and appears dazed. His head is bloody and his clothes and body are covered in concrete dust.

It's very hard to fathom what it must be like to be a civilian EMS provider working to rescue victims of war. Mainstream media often romanticizes or overly dramatizes the working conditions of a war zone.

The simple fact is the work is not romantic or dramatic. It is ugly, hard and gruesome. A civil defense group known as the White Helmets has been a large part of Syria's EMS and rescue system in antigovernment held territories since the conflict began. Funded by various outside agencies, the group has reportedly lost 134 of its own members during the fighting. The group members are apparently targeted by opposing forces as they attempt to rescue civilians.

In the U.S., we get understandably anxious and upset when we have to deal with the occasional carnage of violence and the rare mass casualty event. I'm not sure if I can begin to understand what it feels like to respond to such incidents on a daily basis. It's no wonder that most veteran combat medics or corpsmen rarely talk about their experiences in active war theaters; and the constant threat of being killed for doing your job is the stuff of nightmares and post-traumatic stress.

Mind you, I am not choosing a side in the conflict. I don't have to agree or disagree with the political aspects of the conflict in order to admire and respect those who unquestioningly respond to the call for help, even at great peril to one's own life.

I'm proud that in some small way, my work is connected to theirs even though we are literally worlds apart both geographically and ideologically. Just as it is with my fellow EMS providers at home, I hope and pray for their physical and emotional well-being as they do the best they can.



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EMT is a 'walking miracle' after being crushed by a piano

By Meredith Koch

Think hard — what is the most unbelievable, most unique call you have had? The longer you have been on the ambulance, the crazier your stories become.

Calls like delivering a baby in the backseat of a car on the side of a freeway in the middle of a snowstorm, getting kicked out of a patient's house on Christmas Eve or a guy coding in a Walgreens while shoplifting make-up, get added to your story deck that gets shared amongst colleagues and used for training sessions.

However, I would place a strong guess that no one, except for the crew at Colchester Rescue Squad (Vermont), can say they have responded to a call for a female paralyzed from a piano falling on top of her.

The leading causes of spinal cord injuries are motor vehicle crashes, falls, gunshots and sports-related accidents. According to the National Spinal Cord Injury Association, approximately 11,000 SCIs occur in the U.S. annually, with over half of the injuries affecting persons age 16-30. Many more men (81.2 percent) sustain SCIs.

On May 29, 2015, I became one of those 11,000 SCI incidents, one of the estimated 350,000 people living with an SCI in the U.S and part of the 20 percent of Americans overcoming a disability. I learned what it is like to be completely helpless, to be in so much pain that no pain scale applies and to put my life in the hands of the paramedics.

As an upright piano, weighing approximately 850 pounds, was getting moved out of the back of a pick-up truck, it came crashing into my back, causing me to crumple down to the ground. The piano fractured my sternum, shattered my L1 vertebrae causing significant compression to my spinal cord and instantly paralyzed me from the waist down.

Despite the excruciating pain, I was alert and oriented, knew exactly what was happening and did not hesitate in barking orders at my friends. The first three things out of my mouth, other than screaming in agony, were "Call 9-1-1. Get me a medic. I need pain meds."

Self-assessment and trauma exam
The blessing in disguise amidst my accident was that I was a volunteer EMT with Colchester Rescue Squad, and thus, I knew the paramedics who responded.

By the time the ambulance arrived, I had put my EMT experience to work and completed an initial rapid trauma assessment of myself. I determined that I had sharp pain in my upper right chest that prevented me from taking a deep breath, had unfathomable pain coming from my back, could move my arms and hands, could not move anything below my waist and had zero idea where my legs were in relation to my body or the ground.

I remember being thankful I was not a quadriplegic, that I had not hit my head on the way down to the ground, and that I did not feel like I was going to vomit. My friends at the scene were also EMTs and they had grabbed a first-in bag from the truck to take my vitals.

As I was lying on the ground, I alternated between screaming in pain and talking about what hurt or cursing out the ambulance for taking so long to get to me.

The paramedics arrive
In reality it only took six minutes for the Colchester Police and Colchester Rescue Squad to arrive. I let out a huge sigh of relief because not one, but two kickass paramedics stepped off the truck.

At that moment I knew I could give up control, trust that they would treat me intelligently and feel a bit calmer in their presence. Little did I know that every decision they would make over the course of the next hour would lead to my ability to walk again.

One of the paramedics immediately took control of holding manual c-spine stabilization, even though I knew not to move my head or neck. The other paramedic knelt next to me and asked in the most composed voice possible what was wrong.

He got in reply a detailed report from my self-assessment. I remember him joking how nice it would be if all his patients would tell him so succinctly and accurately what they were feeling.

The third crew member was immediately told by the crew chief to get equipment to backboard me as there was no doubt in anyone's mind that I had a spinal cord injury. I was trying my best to hold it together, to let adrenaline fuel my body and let humor tackle the immense fear I was feeling.

After a quick set of vitals, the excruciating process of moving me began. Having volunteered in EMS for 11 years at that point, I knew how a logroll worked and that amongst experienced crew members, it generally is not extensively discussed.

This logroll however, could go down as the most planned out, most precisely performed and scariest logroll of all time. Amidst screams of agony, I was log rolled onto my left side since the my upper right chest was in so much pain.

The crew chief performed a physical exam of my back and discovered noticeable deformity to my lower thoracic spine. Below that point, I stopped shrieking in pain and could no longer feel him palpating.

Despite no words being spoken by the EMS crew, I could tell there was a shift in the air due to an "oh crap this is not good" moment. Very carefully I was rolled onto the backboard, strapped down and my head immobilized.

Important transport decision and destination
As the crew lifted me into the ambulance, I remember joking with the medics that I had great veins for them to stick me and that I was a lightweight for pain meds. Within minutes IV access was obtained via a 16 gauge in my left AC and an 18 gauge in my right AC without me even realizing it. A 4 mg IV Zofran dose was chased by a starting dose of 25 mcg IV fentanyl. With that, off we went, lights and sirens, to the University of Vermont Medical Center Emergency Department in Burlington.

The paramedic who was driving the ambulance made a decision that may seem trivial to some, but in hindsight, could be the reason I have any function in my lower extremities. He chose to take a longer, yet smoother route to the hospital in order to minimize my pain and the risk of the fractured vertebrae severing my spinal cord.

As you know, backboards are inherently uncomfortable. Now lie on one in a moving ambulance with part of your vertebrae sticking out your back.

A second dose of 25 mcg IV fentanyl was administered very soon after transport began. The fentanyl had barely touched how much pain I was experiencing.

The paramedic and EMT in the back of the ambulance did their very best to keep me talking and laughing, as well as to comfort me when the pain was too much to hold back tears. A final dose of 25 mcg fentanyl was pushed as we pulled into the emergency department parking lot to help me make it through the transfer and exams.

In a time of absolute fear, panic and helplessness, having a crew of compassionate providers made a world of difference. I trusted them implicitly, knew everything was done that should be done, and that I was in the best hands possible.

Trauma team activation
I knew I met the criteria for a trauma code; thus, it was no surprise to me when we were greeted by the entire trauma team. A whirlwind of activity ensued, from X-rays to head-to-toe physical exams to blood draws to additional pain medications to rectal exams.

I alternated between cracking jokes at my own expense, such as not being able to feel the rectal exam or how the male doctors could not get my earrings out for CT scan, to having minor freakouts about not being able to feel or move anything from the waist down. The last thing I remember is returning from the CT scan and being given a concoction of drugs to ease my pain and keep me from remembering how scared I was prior to surgery.

Birthday in the ICU
I woke up the next day, my 25th birthday, in the ICU surrounded by my family and discovered that I had undergone an eight-hour surgery to repair my L1 burst fracture and to alleviate the compression on my spinal cord. The pain was still overwhelming and I could barely move in bed. 

The doctors told me the pain was due to the extent of my surgery, which resulted in 84 staples to close three incisions. 

The spinal surgeon fused my T12-L2 vertebrae with two vertical titanium rods, four horizontal screws, a steel cage where my L1 vertebrae had been and human cadaver bone graft. 

Three days in the ICU, four days as an surgical inpatient, and a four-hour ride with UVM HealthNet Transport later, I began the official spinal cord injury rehabilitation process. 

Walking miracle
Spaulding Rehabilitation Hospital in Boston pushed me every single day of my month-long inpatient stay to find the strength to learn how to do basic activities such as sit up in bed, get dressed, stand, shower, walk and do stairs. 

In conjunction with adaptive sports, an exercise rehab program called Journey Forward in Canton, Mass. and outpatient physical therapy, I have regained function down to L4 in my spinal cord. 

I now frequently participate in adaptive rock climbing, cycling, skiing, a paralympic swim club, and most recently surfing. 

I ambulate using bilateral ankle-foot-orthoses and forearm crutches.

Being a paraplegic has hindered my ability to continue to volunteer in EMS. However, I am hopeful that in another three to six months I will be strong enough to resume volunteering as an Advanced EMT with Darien EMS Post 53 in Darien, Conn., where I have been a member since the age of 14.

In Boston, where I live now, there are no volunteer EMS agencies, but every time I see an ambulance go past, I miss it. Ultimately I would love to get involved in EMS education, especially related to spinal cord injuries.

Victims with SCI depend on EMS
There are days I forget I am a paraplegic and that I have all that titanium holding me together, but I never forget that I am a walking miracle due to the decisions the paramedics, the doctors, the nurses and my rehabilitation team made. In the heat of the moment, not one person lost their focus or rushed in how they moved or treated me.

With careful assessment and communication, EMS providers are the first line of defense for a SCI victim. We depend on you to give us the best shot at recovery by not damaging the spinal cord any further and getting us to a trauma center safely and efficiently to relieve the compression and to prevent further ischemic injury to the cord.

SCI patients will have a long rehab road ahead of them, but with today's biotechnology and specialized rehab programs, many of us, quadriplegics, hemiplegics, and paraplegics alike, are making significant recoveries. I can guarantee you we are not disabled, rather, we learn to be adaptively abled with our physical disability. If you don't believe me, go volunteer with adaptive sports or watch the Paralympics this September.

About the author
Meredith Koch began volunteering in EMS at the age of 14, quickly finding a passion for patient care and medical devices. After completing her Masters Degree in Biomechanical Engineering at the University of Vermont, she began working for Medtronic as a Cardiac Rhythm & Heart Failure Clinical Specialist. Since that fateful day in late May 2015, when she became a paraplegic, she has fought hard to make great strides in her recovery, attributing much of her success to her healthcare providers and adaptive sports.

Meredith can be followed on Instagram @bionicmere and the hashtag

Molecular cloning, characterization, and functional analysis of a gene encoding 3-hydroxy-3-methylglutaryl-coenzyme A synthase from Matricaria chamomilla

Abstract

3-Hydroxy-3-methylglutaryl-CoA synthase (HMGS) catalyzes the condensation of acetyl-CoA and acetoacetyl-CoA to form 3-hydroxy-3-methylglutaryl-CoA as the first committed enzyme in the mevalonate (MVA) pathway. HMGS plays an important role in the biosynthesis of the sesquiterpene, which is the main constituent of essential oil in Matricaria chamomilla. In this paper, a HMGS gene designated as McHMGS (GenBank Accession No. KU529970) was successfully cloned from M. chamomilla. The full-length cDNA of McHMGS was 1495-bp and contained a 1374-bp open reading frame. It encoded a 458-amino-acid protein with a calculated molecular weight of about 50.7 kDa and isoelectric point of 5.69. Sequence comparison revealed that McHMGS showed extensive homology with HMGSs from other plant species. Phylogenetic tree analysis indicated that McHMGS is clustered with the HMGS of Asteraceae in the dicotyledoneae clade. Further functional complementation of McHMGS in hmgs-deficient mutant yeast strain YSC6274 demonstrated that cloned McHMGS cDNA encodes a functional HMGS and mediates the MVA biosynthesis in yeasts. The tissue expression pattern analysis revealed that McHMGS expression level is highest in the flowers and lowest in the stems. Quantitative real-time PCR analysis showed that the expression of McHMGS was induced by MeJA, and the expression level is highest 24 h after induction. The characterization and expression of McHMGS can help in further studying the role of McHMGS gene in the biosynthesis of sesquiterpene in M. chamomilla.



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Prevalence of nutritional deficiencies other than anaemia among students of government commerce college of Gandhinagar, Gujarat: a cross sectional study

2016-08-24T08-49-23Z
Source: International Journal of Research in Medical Sciences
Uresh Jayantilal Jain, Varsha Shah, Nilesh Thakor.
Background: Adolescence and young adulthood are periods of critical development and transition. Adolescent constitutes over 23% of the population in India. Nutrition and health needs of the adolescent are more because of more requirements for growth spurt and increase in physical activity. The aim was to study prevalence of nutritional deficiencies other than anaemia among students of Government Commerce College. Methods: The study was carried by Medicine Department, GMERS Medical College, Gandhinagar, India during period from July 2016 to August 2016 in purposively selected government college of Gandhinagar city. After taking the permission of principal of college and consent of the students, 421 students were examined for signs of various nutritional deficiencies other than anaemia. The data was collected by predesigned, pretested proforma and analyzed using SPSS 17.0 (Trial Version). Results: Out of total 421 students 205 (48.6%) were female. Mean age of the study students was 19.8±1.66 years. Maximum numbers of the students were in the age group of 18-21 years (60.5%). Mean age of female and male students was 19.7±1.79 years and 19.9±2.01 years respectively. The study revealed that vitamin A deficiency was present in 28 (7.0%) students. Vitamin B complex deficiency signs were seen in 96 (23.1%) students. Vitamin C deficiency signs were seen in 44 (10.5%) students. PEM was observed in 55 (13.2%) students. Essential fatty acid deficiency was observed in 60 (14.4%) students. Conclusions: High prevalence of nutritional deficiencies among these students needs great attention and health education.


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Impact of educational intervention regarding hazards of obesity and its preventive measures among students of commerce colleges of Ahmedabad city, Gujarat, India

2016-08-24T08-49-23Z
Source: International Journal of Research in Medical Sciences
Varsha Shah, Uresh Jayantilal Jain, Nilesh Thakor.
Background: The prevalence of obesity has increased worldwide in almost every country in all the age groups. A college is a key location for educating students about health, hygiene and nutrition, and for putting in place interventions to promote the health of them. Objective of the study was to know the prevalence of obesity and overweight among students of commerce colleges of Ahmedabad city and to assess knowledge of these students regarding hazards of obesity and its preventive measures before and after educational interventional training. Methods: The present interventional study was undertaken during September 2011 to December 2011 in randomly selected 3 commerce colleges of Ahmedabad city, Gujarat. Total 627 students between the age group of 18 to 23 years were examined after taking written informed consent of their parents using pre-designed, pre-tested, semi-structured proforma. Anthropometric measurements were taken and BMI were calculated. The prevalence of overweight and obesity were determined based on the IOTF (International Obesity Task Force) criteria. Single educational training for 45 minutes was given to the students and their post-intervention knowledge for same was assessed after the training. Thus collected data was analyzed using SPSS 17 (Trial version). Results: Overall, the total number of obese adults identified in whole study population was 64 (10.2%) and numbers of overweight adults were 65 (10.3%). Baseline knowledge of the students regarding hazards of obesity like hypertension, cancer, heart attack and diabetes mellitus was 19.7%, 16.1%, 16.5% and 24.5% respectively which was significantly increased to 93.6%, 94.5%, 96.0% and 94.1% respectively after the intervention. Baseline knowledge of the students regarding preventive measure of obesity like avoiding junk food/ healthy diet, exercise and meditation was 23.6%, 24.4% and 25.9% respectively which was significantly increased to 95.3%, 96.9 and 97.4% respectively after the intervention. Conclusions: There was significant improvement in the knowledge regarding hazards of obesity and its preventive measures among college students after our single educational session.


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Drug utilization (DU) 90%: an innovative method in assessing quality of drug prescription with specific reference to non-steroidal anti-inflammatory drugs prescription

2016-08-24T07-22-50Z
Source: International Journal of Basic & Clinical Pharmacology
Kulkarni Dhananjay, Kokila B. N., Santosh Kumar Sahu, Ravindra Kumar G..
Background: DU90% is useful tool for assessing drug prescribing pattern. In this, drugs constituting 90% of the prescription volume are identified. Size of the DU90% segment helps us to assess rational prescribing. Large number of drugs in the DU90% segment indicates less rational prescribing, whereas small number suggests more rational prescribing. Methods: Study was carried out in orthopaedic out-patient department (OPD) for a period of three months. Only OPD based NSAID containing prescriptions were included. Data was analyzed based on demographic parameters, prescription indices, fixed dose combinations (FDC) and co-prescription of gastro-protective agents (GPA). DU90% was calculated based on defined daily dose (DDD) with their respective value in Anatomical Therapeutic Chemical (ATC) classification code. Defined daily dose is calculated as DDD/1000/day. Results: Diclofenac (38%) was the commonest NSAID prescribed. Diclofenac +chymotrypsin (25%) was the commonest FDC prescribed. Piroxicam (19%) was the commonest NSAID prescribed in monotherapy form. Co-prescription of GPA was high (96%). 5 of the 7 prescribed NSAIDs constitute to DU90% segment. Conclusions: Preferential cyclooxygenase-2 (COX-2) inhibitor NSAIDs were more preferred. Number of prescribed NSAIDs constituting to DU90% is more, thus prescription pattern needs further rationalization. Further large scale study is required to bring out more details about NSAID prescription pattern and its rational use.


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Acute effects of moderate aerobic exercise on specific aspects of executive function in different age and fitness groups: A meta-analysis

Abstract

Whereas a wealth of studies have investigated acute effects of moderate aerobic exercise on executive function, the roles of age, fitness, and the component of executive function in this relationship still remain unclear. Therefore, the present meta-analysis investigates exercise-induced benefits on specific aspects of executive function in different age and aerobic fitness subgroups. Based on data from 40 experimental studies, a small effect of aerobic exercise on time-dependent measures (g = .35) and accuracy (g = .22) in executive function tasks was confirmed. The results further suggest that preadolescent children (g = .54) and older adults (g = .67) compared to other age groups benefit more from aerobic exercise when reaction time is considered as dependent variable. In contrast to age, aerobic fitness and the executive function component had no influence on the obtained effect sizes. Consequently, high aerobic fitness is no prerequisite for temporary improvements of the executive control system, and low- as well as high-fit individuals seem to benefit from exercise in a similar way. However, a higher sensitivity of executive function to acute aerobic exercise was found in individuals undergoing developmental changes. Therefore, preadolescent children and older adults in particular might strategically use a single aerobic exercise session to prepare for a situation demanding high executive control.



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Laparoscopic drainage of sub phrenic abscess

2016-08-24T06-47-08Z
Source: International Journal of Research in Medical Sciences
Ketan Vagholkar, Amish Pawanarkar, Balvinder Yadav, Aditya Deshpande, Suvarna Vagholkar.
Sub phrenic collections are a common sequel to hepatobiliary surgery. Prompt diagnosis and treatment are necessary to reduce the morbidity and mortality to a bare minimum. Contrast enhanced CT (CECT) scan is the best imaging modality to identify the location and approximate size of the collection. Laparoscopic drainage is the best option for treating sub phrenic abscesses. A case of a sub phrenic abscess drained laparoscopically is presented to highlight the efficacy of this approach.


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Comparison of intrathecal sufentanil and hyperbaric bupivacaine with intrathecal hyperbaric bupivacaine for caesarean section

2016-08-24T06-47-08Z
Source: International Journal of Research in Medical Sciences
Shweta Pravin Mhambrey, Shital S. Ahire, Sambharan Nayak.
Background: Sufentanil added to intrathecal bupivacaine for cesarean section has shown to improve intraoperative and postoperative analgesia without any adverse effects to the mother and neonate. In the present study we compare the effects of intrathecal sufentanil 5 µg and 8 mg of 0.5% hyperbaric bupivacaine with intrathecal 10 mg of 0.5% hyperbaric bupivacaine for caesarean section. Methods: This study was performed in a 60 pregnant patients undergoing elective LSCS under spinal anaesthesia in a randomized, prospective double blind comparative method in Lokmanya Tilak Municipal General Hospital after taking approval from hospital ethics committee. After fulfilling requirements of inclusion criteria patients were randomly divided into 2 groups of 30 each. Study group (BS) received intrathecal sufentanil 5 µg with 8 mg of 0.5% hyperbaric bupivacaine and the control group (B) received intrathecal 0.5% hyperbaric bupivacaine 10 mg. Pre, intra and postoperative investigations were made accordingly. Results: No significant differences were observed among demographic parameters like age, weight, height and duration of surgery (p>0.05). The results were statistically significant (p


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Eliminating Nox2 ROS production protects dystrophic skeletal muscle from pathological calcium influx assessed in vivo by manganese enhanced MRI

Abstract

Duchenne muscular dystrophy (DMD) is an X-linked progressive degenerative disease resulting from a mutation in the gene that encodes dystrophin, leading to decreased muscle mechanical stability and force production. Increased Nox2 ROS production and sarcolemmal Ca2+ influx are early indicators of disease pathology and eliminating Nox2 ROS production reduces aberrant calcium influx in young mdx mice, a model of DMD. Various imaging modalities have been used to study dystrophic muscle in vivo; however, they are based upon alterations in muscle morphology or inflammation. Manganese has been used to indirectly monitor calcium influx across the sarcolemma and may allow detection of molecular alterations in disease progression in vivo using manganese enhanced MRI (MEMRI). Therefore, we hypothesized eliminating Nox2 ROS production would decrease calcium influx in adult mdx mice and MEMRI would be able to monitor and differentiate disease status in dystrophic muscle. Both in vitro and in vivo data demonstrate eliminating Nox2 ROS protected against aberrant calcium influx and improved muscle function in dystrophic muscle. MEMRI was able to differentiate between different pathological states in vivo, with no long term effects on animal health or muscle function. We conclude that MEMRI is a viable, non-invasive technique to differentiate disease status and may provide a means to monitor and evaluate the effectiveness of potential therapies in dystrophic muscle.

This article is protected by copyright. All rights reserved



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Quantile regression and Bayesian cluster detection to identify radon prone areas

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Publication date: November 2016
Source:Journal of Environmental Radioactivity, Volume 164
Author(s): Annalina Sarra, Lara Fontanella, Pasquale Valentini, Sergio Palermi
Albeit the dominant source of radon in indoor environments is the geology of the territory, many studies have demonstrated that indoor radon concentrations also depend on dwelling-specific characteristics. Following a stepwise analysis, in this study we propose a combined approach to delineate radon prone areas. We first investigate the impact of various building covariates on indoor radon concentrations. To achieve a more complete picture of this association, we exploit the flexible formulation of a Bayesian spatial quantile regression, which is also equipped with parameters that controls the spatial dependence across data. The quantitative knowledge of the influence of each significant building-specific factor on the measured radon levels is employed to predict the radon concentrations that would have been found if the sampled buildings had possessed standard characteristics. Those normalised radon measures should reflect the geogenic radon potential of the underlying ground, which is a quantity directly related to the geological environment. The second stage of the analysis is aimed at identifying radon prone areas, and to this end, we adopt a Bayesian model for spatial cluster detection using as reference unit the building with standard characteristics. The case study is based on a data set of more than 2000 indoor radon measures, available for the Abruzzo region (Central Italy) and collected by the Agency of Environmental Protection of Abruzzo, during several indoor radon monitoring surveys.



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Successful treatment of limy bile syndrome extending to the common bile duct by laparoscopic cholecystectomy and common bile duct exploration: A case report and literature review

Abstract

Limy bile syndrome extending to the common bile duct (CBD) is a rare condition that lacks a standardized treatment. Laparoscopic cholecystectomy with laparoscopic choledocholithotomy by CBD exploration is preferred because it preserves the function of the sphincter of the Vater's papilla and allows treatment of both lesions. A 37-year-old man who was receiving entecavir for chronic hepatitis B developed right upper quadrant pain. Abdominal ultrasonography revealed a calcified shadow in the gallbladder and CBD. Abdominal imaging revealed a liquid-like material identified by a calcified shadow in two phases separated by a fluid-fluid level. Abdominal and 3-D drip infusion cholangiography CT showed stones in the gallbladder and CBD with limy bile. The patient underwent laparoscopic cholecystectomy and choledocholithotomy. Intraoperatively, white–yellow-colored bile and stones were drained from the CBD. A C-tube was placed. Postoperatively, remnant stones and radiopaque materials were absent. The stones comprised of >95% calcium carbonate.



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A challenge between trainee education and patient safety: Does fellow participation impact postoperative outcomes following bariatric surgery?

Obesity Surgery

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Prevalence and survival benefit of adjuvant chemotherapy in stage III colon cancer patients: Comparison of overall and age-stratified results by multivariable modeling and propensity score methodology in a population-based cohort

Cancer Epidemiology

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Single-celled fungi multiply, alien-like, by fusing cells in host

UC San Diego News

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The efficacy and safety of direct acting antiviral treatment and clinical significance of drug-drug interactions in elderly patients with chronic hepatitis C virus infection

Alimentary Pharmacology and Therapeutics

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AGA releases animated infographic highlighting challenges faced by IBS patients

American Gastroenterological Association News

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During HCV and HCV-HIV infection elevated plasma Autotaxin is associated with LPA and markers of immune activation that normalize during IFN-free HCV therapy

The Journal of Infectious Diseases

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Two-year changes in circulating adiponectin, ectopic fat distribution and body composition in response to weight-loss diets: the POUNDS Lost Trial

International Journal of Obesity

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Obstructive sleep apnea is associated with an increased risk of colorectal neoplasia

Gastrointestinal Endoscopy

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A telephone intervention to achieve differentiation in dietary intake: A randomized trial in paediatric primary care

Pediatric Obesity

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Randomized clinical trial of oral and intravenous versus intravenous antibiotic prophylaxis for laparoscopic colorectal resection

British Journal of Surgery

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New types of African Salmonella associated with lethal infection

Wellcome Trust Sanger Institute News

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Salvage resection for recurrent or metastatic hepatocellular carcinoma after percutaneous ablation therapy

International Journal of Surgery

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Natural history of untreated hepatocellular carcinoma in a US cohort and the role of cancer surveillance

Clinical Gastroenterology and Hepatology

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Suspected non-celiac gluten sensitivity confirmed in few patients after gluten challenge in double-blind, placebo-controlled trials

Clinical Gastroenterology and Hepatology

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Frailty predicts risk of life-threatening complications and mortality after pancreatic resections

Surgery

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The role of biodegradable stents in the management of benign and malignant oesophageal strictures: A cohort study

The Surgeon

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Small intestinal injury in NSAID users suffering from rheumatoid arthritis or osteoarthritis

Rheumatology International

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Cutaneous manifestations in inflammatory bowel disease: A single institutional study of non-neoplastic biopsies over 13 years

Journal of Cutaneous Pathology

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Obscure gastrointestinal bleeding caused by small intestinal lipoma: a case report

Journal of Medical Case Reports

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Point-of-Care Ultrasound: Novel Technology to Routine Perioperative Assessment Tool.

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No abstract available

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Recent Insights Into Molecular Mechanisms of Propofol-Induced Developmental Neurotoxicity: Implications for the Protective Strategies.

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Mounting evidence has demonstrated that general anesthetics could induce developmental neurotoxicity, including acute widespread neuronal cell death, followed by long-term memory and learning abnormalities. Propofol is a commonly used intravenous anesthetic agent for the induction and maintenance of anesthesia and procedural and critical care sedation in children. Compared with other anesthetic drugs, little information is available on its potential contributions to neurotoxicity. Growing evidence from multiple experimental models showed a similar neurotoxic effect of propofol as observed in other anesthetic drugs, raising serious concerns regarding pediatric propofol anesthesia. The aim of this review is to summarize the current findings of propofol-induced developmental neurotoxicity. We first present the evidence of neurotoxicity from animal models, animal cell culture, and human stem cell-derived neuron culture studies. We then discuss the mechanism of propofol-induced developmental neurotoxicity, such as increased cell death in neurons and oligodendrocytes, dysregulation of neurogenesis, abnormal dendritic development, and decreases in neurotrophic factor expression. Recent findings of complex mechanisms of propofol action, including alterations in microRNAs and mitochondrial fission, are discussed as well. An understanding of the toxic effect of propofol and the underlying mechanisms may help to develop effective novel protective or therapeutic strategies for avoiding the neurotoxicity in the developing human brain. (C) 2016 International Anesthesia Research Society

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Active Management of Labor Epidural Analgesia Is the Key to Successful Conversion of Epidural Analgesia to Cesarean Delivery Anesthesia.

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No abstract available

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Smartphone Application-based Medical Devices: Twenty-first Century Data Democratization or Anarchy?.

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No abstract available

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