Δευτέρα, 12 Σεπτεμβρίου 2016

WFNR Franz Gerstenbrand Award Announcement



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Effects of Unilateral Upper Limb Training in Two Distinct Prognostic Groups Early After Stroke: The EXPLICIT-Stroke Randomized Clinical Trial

Background and Objective. Favorable prognosis of the upper limb depends on preservation or return of voluntary finger extension (FE) early after stroke. The present study aimed to determine the effects of modified constraint-induced movement therapy (mCIMT) and electromyography-triggered neuromuscular stimulation (EMG-NMS) on upper limb capacity early poststroke. Methods. A total of 159 ischemic stroke patients were included: 58 patients with a favorable prognosis (>10° of FE) were randomly allocated to 3 weeks of mCIMT or usual care only; 101 patients with an unfavorable prognosis were allocated to 3-week EMG-NMS or usual care only. Both interventions started within 14 days poststroke, lasted up until 5 weeks, focused at preservation or return of FE. Results. Upper limb capacity was measured with the Action Research Arm Test (ARAT), assessed weekly within the first 5 weeks poststroke and at postassessments at 8, 12, and 26 weeks. Clinically relevant differences in ARAT in favor of mCIMT were found after 5, 8, and 12 weeks poststroke (respectively, 6, 7, and 7 points; P < .05), but not after 26 weeks. We did not find statistically significant differences between mCIMT and usual care on impairment measures, such as the Fugl-Meyer assessment of the arm (FMA-UE). EMG-NMS did not result in significant differences. Conclusions. Three weeks of early mCIMT is superior to usual care in terms of regaining upper limb capacity in patients with a favorable prognosis; 3 weeks of EMG-NMS in patients with an unfavorable prognosis is not beneficial. Despite meaningful improvements in upper limb capacity, no evidence was found that the time-dependent neurological improvements early poststroke are significantly influenced by either mCIMT or EMG-NMS.



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ApoE and SNAP-25 Polymorphisms Predict the Outcome of Multidimensional Stimulation Therapy Rehabilitation in Alzheimers Disease

Background. Alzheimer's disease (AD) is a highly prevalent neurodegenerative disorder. Rate of decline and functional restoration in AD greatly depend on the capacity for neural plasticity within residual neural tissues; this is at least partially influenced by polymorphisms in genes that determine neural plasticity, including Apolipoprotein E4 (ApoE4) and synaptosomal-associated protein of 25 kDa (SNAP-25). Objective. We investigated whether correlations could be detected between polymorphisms of ApoE4 and SNAP-25 and the outcome of a multidimensional rehabilitative approach, based on cognitive stimulation, behavioral, and functional therapy (multidimensional stimulation therapy [MST]). Methods. Fifty-eight individuals with mild-to-moderate AD underwent MST for 10 weeks. Neuro-psychological functional and behavioral evaluations were performed blindly by a neuropsychologist at baseline and after 10 weeks of therapy using Mini-Mental State Examination (MMSE), Functional Living Skill Assessment (FLSA), and Neuropsychiatric Inventory (NPI) scales. Molecular genotyping of ApoE4 and SNAP-25 rs363050, rs363039, rs363043 was performed. Results were correlated with MMSE, NPI and FLSA scores by multinomial logistic regression analysis. Results. Polymorphisms in both genes correlated with the outcome of MST for MMSE and NPI scores. Thus, higher overall MMSE scores after rehabilitation were detected in ApoE4 negative compared to ApoE4 positive patients, whereas the SNAP-25 rs363050(G) and rs363039(A) alleles correlated with significant improvements in behavioural parameters. Conclusions. Polymorphisms in genes known to modulate neural plasticity might predict the outcome of a multistructured rehabilitation protocol in patients with AD. These data, although needing confirmation on larger case studies, could help optimizing the clinical management of individuals with AD, for example defining a more intensive treatment in those subjects with a lower likelihood of success.



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Macrostructural and Microstructural Brain Lesions Relate to Gait Pathology in Children With Cerebral Palsy

Background. Even though lower-limb motor disorders are core features of spastic cerebral palsy (sCP), the relationship with brain lesions remains unclear. Unraveling the relation between gait pathology, lower-limb function, and brain lesions in sCP is complex for several reasons; wide heterogeneity in brain lesions, ongoing brain maturation, and gait depends on a number of primary motor functions/deficits (eg, muscle strength, spasticity). Objective. To use a comprehensive approach combining conventional MRI and diffusion tensor imaging (DTI) in children with sCP above 3 years old to relate quantitative parameters of brain lesions in multiple brain areas to gait performance. Methods. A total of 50 children with sCP (25 bilateral, 25 unilateral involvement) were enrolled. The investigated neuroradiological parameters included the following: (1) volumetric measures of the corpus callosum (CC) and lateral ventricles (LVs), and (2) DTI parameters of the corticospinal tract (CST). Gait pathology and primary motor deficits, including muscle strength and spasticity, were evaluated by 3D gait analysis and clinical examination. Results. In bilateral sCP (n = 25), volume of the LV and the subparts of the CC connecting frontal, (pre)motor, and sensory areas were most related to lower-limb functioning and gait pathology. DTI measures of the CST revealed additional relations with the primary motor deficits (n = 13). In contrast, in unilateral sCP, volumetric (n = 25) and diffusion measures (n = 14) were only correlated to lower-limb strength. Conclusions. These results indicate that the combined influence of multiple brain lesions and their impact on the primary motor deficits might explain a large part of the gait pathology in sCP.



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Evaluation of a Physical Activity Intervention for Adults With Brain Impairment: A Controlled Clinical Trial

Background. Individuals with brain impairment (BI) are less active than the general population and have increased risk of chronic disease. Objective. This controlled trial evaluated the efficacy of a physical activity (PA) intervention for community-dwelling adults with BI. Methods. A total of 43 adults with BI (27 male, 16 female; age 38.1 ± 11.9 years; stage of change 1-3) who walked as their primary means of locomotion were allocated to an intervention (n = 23) or control (n = 20) condition. The intervention comprised 10 face-to-face home visits over 12 weeks, including a tailored combination of stage-matched behavior change activities, exercise prescription, community access facilitation, and relapse prevention strategies. The control group received 10 face-to-face visits over 12 weeks to promote sun safety, healthy sleep, and oral health. Primary outcomes were daily activity counts and minutes of moderate-to-vigorous-intensity PA (MVPA) measured with the ActiGraph GT1M at baseline (0 weeks), postintervention (12 weeks) and follow-up (24 weeks). Between-group differences were evaluated for statistical significance using repeated-measures ANOVA. Results. MVPA for the intervention group increased significantly from baseline to 12 weeks (20.8 ± 3.1 to 31.2 ± 3.1 min/d; P = .01), but differences between baseline and 24 weeks were nonsignificant (20.8 ± 3.1 to 25.3 ± 3.2 min/d; P = .28). MVPA changes for the control group were negligible and nonsignificant. Between-group differences for change in MVPA were significant at 12 weeks (P = .03) but not at 24 weeks (P = .49). Conclusion. The 12-week intervention effectively increased adoption of PA in a sample of community-dwelling adults with BI immediately after the intervention but not at follow-up. Future studies should explore strategies to foster maintenance of PA participation.



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Skilled Bimanual Training Drives Motor Cortex Plasticity in Children With Unilateral Cerebral Palsy

Background. Intensive bimanual therapy can improve hand function in children with unilateral spastic cerebral palsy (USCP). We compared the effects of structured bimanual skill training versus unstructured bimanual practice on motor outcomes and motor map plasticity in children with USCP. Objective. We hypothesized that structured skill training would produce greater motor map plasticity than unstructured practice. Methods. Twenty children with USCP (average age 9.5; 12 males) received therapy in a day camp setting, 6 h/day, 5 days/week, for 3 weeks. In structured skill training (n = 10), children performed progressively more difficult movements and practiced functional goals. In unstructured practice (n = 10), children engaged in bimanual activities but did not practice skillful movements or functional goals. We used the Assisting Hand Assessment (AHA), Jebsen-Taylor Test of Hand Function (JTTHF), and Canadian Occupational Performance Measure (COPM) to measure hand function. We used single-pulse transcranial magnetic stimulation to map the representation of first dorsal interosseous and flexor carpi radialis muscles bilaterally. Results. Both groups showed significant improvements in bimanual hand use (AHA; P < .05) and hand dexterity (JTTHF; P < .001). However, only the structured skill group showed increases in the size of the affected hand motor map and amplitudes of motor evoked potentials (P < .01). Most children who showed the most functional improvements (COPM) had the largest changes in map size. Conclusions. These findings uncover a dichotomy of plasticity: the unstructured practice group improved hand function but did not show changes in motor maps. Skill training is important for driving motor cortex plasticity in children with USCP.



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Performance Variability as a Predictor of Response to Aphasia Treatment

Background. Performance variability in individuals with aphasia is typically regarded as a nuisance factor complicating assessment and treatment. Objective. We present the alternative hypothesis that intraindividual variability represents a fundamental characteristic of an individual's functioning and an important biomarker for therapeutic selection and prognosis. Methods. A total of 19 individuals with chronic aphasia participated in a 6-week trial of imitation-based speech therapy. We assessed improvement both on overall language functioning and repetition ability. Furthermore, we determined which pretreatment variables best predicted improvement on the repetition test. Results. Significant gains were made on the Western Aphasia Battery-Revised (WAB) Aphasia Quotient, Cortical Quotient, and 2 subtests as well as on a separate repetition test. Using stepwise regression, we found that pretreatment intraindividual variability was the only predictor of improvement in performance on the repetition test, with greater pretreatment variability predicting greater improvement. Furthermore, the degree of reduction in this variability over the course of treatment was positively correlated with the degree of improvement. Conclusions. Intraindividual variability may be indicative of potential for improvement on a given task, with more uniform performance suggesting functioning at or near peak potential.



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A Critical Evaluation of the Methodological Obstacles to Translating Cell-Based Research Into an Effective Treatment for People With Parkinsons Disease

The remarkable scientific and technological advances in the field of cell research have not been translated into viable restorative therapies for brain disorders. In this article, we examine the best available evidence for the clinical efficacy of reconstructive intracerebral transplantation in people with Parkinson's disease (PD), with the aim of identifying methodological obstacles to the translation process. The major stumbling block is the fact that the potential contributions of people with neural grafts and the effects of the physical and social environment in which they recover have not been adequately investigated and applied to advancing the clinical stages of the research program. We suggest that the biopsychosocial model along with emerging evidence of targeted rehabilitation can provide a useful framework for conducting research and evaluation that will ensure the best possible outcomes following intracerebral transplantation for PD.



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Long-Term Exercise Improves Memory Deficits via Restoration of Myelin and Microvessel Damage, and Enhancement of Neurogenesis in the Aged Gerbil Hippocampus After Ischemic Stroke

Background. The positive correlation between therapeutic exercise and memory recovery in cases of ischemia has been extensively studied; however, long-term exercise begun after ischemic neuronal death as a chronic neurorestorative strategy has not yet been thoroughly examined. Objective. The purpose of this study is to investigate possible mechanisms by which exercise ameliorates ischemia-induced memory impairment in the aged gerbil hippocampus after transient cerebral ischemia. Methods. Treadmill exercise was begun 5 days after ischemia-reperfusion (I-R) and lasted for 1 or 4 weeks. The animals were sacrificed 31 days after the induction of ischemia. Changes in short-term memory, as well as the hippocampal expression of markers of cell proliferation, neuroblast differentiation, neurogenesis, myelin and microvessel repair, and growth factors were examined by immunohistochemistry and/or western blots. Results. Four weeks of exercise facilitated memory recovery despite neuronal damage in the stratum pyramidale (SP) of the hippocampal CA1 region and in the polymorphic layer (PoL) of the dentate gyrus (DG) after I-R. Long-term exercise enhanced cell proliferation and neuroblast differentiation in a time-dependent manner, and newly generated mature cells were found in the granule cell layer of the DG, but not in the SP of the CA1 region or in the PoL of the DG. In addition, long-term exercise ameliorated ischemia-induced damage of myelin and microvessels, which was correlated with increased BDNF expression in the CA1 region and the DG. Conclusions. These results suggest that long-term treadmill exercise after I-R can restore memory function through replacement of multiple damaged structures in the ischemic aged hippocampus.



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Xplore Technologies: Mobile Computing

One size doesn't fit all for Public Safety

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Celiac disease and the risk of kidney diseases: A systematic review and meta-analysis

Previous epidemiologic studies attempting to demonstrate the risk of kidney diseases among patients with celiac disease (CD) have yielded inconsistent results. This meta-analysis was conducted with the aims to summarize all available evidence.

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When it comes to measuring the patient experience, EMS falls short

By Jay Fitch, Ph.D.

How can we know if we're improving EMS if we don't ask the patients and the communities we serve"

The IHI Triple Aim has become a widely accepted framework for improvement efforts in health care and one of its three parts is the patient experience. I'm surprised for a number of reasons that the State of EMS report found that the majority of agencies are not truly measuring patient satisfaction.

Risk management
The top reason I'm surprised is that improving the patient experience is basic risk management. Research and common sense both tell us that patients who are less satisfied with their providers will be more likely to complain and possibly to file lawsuits.

Especially in EMS, where the public's expectations of what actual medical care we can provide are often low, our attitude and the way we communicate with a patient might be the most important aspect of the care we provide. We could do everything technically right and save a life, but treat the patient's family with disrespect and we'll receive a complaint.

Another paramedic can literally get everything wrong, but if that medic smiles and provides comfort, he or she may well receive commendations.

Patient care
We also need to understand that the patient experience is part of patient care. We can't separate technical and clinical skills from communication and empathy. They are equal components of providing prehospital medical care.

It was discouraging to see that nearly half of the Fitch/EMS1 Cohort agencies only track complaints or don't really measure patient satisfaction at all, and that only a quarter of the agencies use a third party to measure patient experience.

Tracking only complaints leads to a punitive view of improving the patient experience, looking only for the worst examples and often chastising the caregivers involved. Truly measuring patient satisfaction and trying to improve it often involves seeking out the good examples.

I once heard of an agency that noticed one practitioner consistently received great feedback from patients. Instead of focusing on punishing the bad apples, the organization's leaders focused on what that one paramedic did differently and how they could replicate those actions throughout the agency.

Reimbursement
Perhaps measuring the patient experience has yet to catch on in EMS because people fail to see the financial incentive. Unlike hospitals, whose reimbursement levels could be impacted by patients' responses to the Hospital Consumer Assessment of Healthcare Providers and System survey, EMS providers do not see an obvious tie between economics and patient satisfaction.

In fact, leaders might perceive an economic disincentive. There is a small cost to measuring patient satisfaction using an outside vendor, which is the best way to ensure an objective response that can help your organization improve.

Some agencies may have started measuring the patient experience only because they expect the Centers for Medicare and Medicaid Services to expand use of patient satisfaction measures from hospital reimbursement to other areas, like ambulance transport. But predicting the precise future of health care reimbursement remains a murky proposition, and many agencies would rather wait and see.

Regardless of future financial incentives, EMS leaders should recognize that in some ways, measuring the patient experience is the best way to measure the performance of an EMS system. Many agencies rely on operational measures such as response time to assess their system, but we have come to realize that response time is only clinically important for a small number of critical conditions. On the clinical side, the most common measures are cardiac arrest survival or intubation success rates — metrics that examine important processes and outcomes, but look at only a tiny fraction of total calls.

Measuring patient and family satisfaction is a way to look at performance of the entire system on every call. Patients, families and bystanders will judge the overall experience with EMS from the time they dial 911 until they are in a bed in the emergency department and talking to hospital staff.

How we demonstrate not just clinical care, but people care — through our interactions, our ability to explain what's happening, our efforts to provide comfort — is just as important as our IV success rates or whether we obtained two sets of vitals.

How we act on each call, especially in the first and the last few minutes, can make a lasting impression on our patients and probably a difference in how they feel about their caregivers. Calling 911 is usually an anxiety-filled event, and when we take people from their homes to a strange and stressful environment like the emergency department, wheeling them in on their back, feet first — well, it can be a terrifying experience.

Whether or not the patient experience impacts an agency financially or not shouldn't be the only motivator for asking patients for feedback and measuring satisfaction. At the end of the day, alleviating patients' fears, reducing their anxiety and displaying compassion should be part of our core mission. And if we're not actively measuring whether we're achieving that mission, we're probably not going to know when we fall short — or how to do it better.

About the author
Jay Fitch, Ph.D., is the founding partner and president of the public safety consulting firm Fitch & Associates. In addition to consulting, Dr. Fitch frequently speaks at conferences and serves as the program chair for the Pinnacle Leadership Forum. Contact Jay directly at jfitch@emprize.net.



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Did Hillary Clinton have an episode of 'Sunday syncope'?

hc.jpg

By Greg Friese

On Sunday, September 11, Hillary Clinton was reported to abruptly leave a 9/11 anniversary ceremony. Video shows Clinton being assisted into a van stumbling. It was later reported that she was dehydrated and has a new diagnosis of pneumonia.

In my response area, which includes a lot of churches and geriatric parishioners, we anticipated the diagnosis 'Sunday syncope' when we were called out for an "elderly female who fainted during church service."

With limited information available, my intent isn't to diagnosis a patient I didn't assess or treat. Rather, I think Clinton's case presents an interesting opportunity to review a common call type. As you consider the incident, ask yourself or discuss with your partner, company or squad the following questions about general weakness and syncope:

1. What are the anticipated patient problems"
Enroute to any call, EMS providers should be anticipating potential patient problems based on the dispatch information. If responding to a call for a 68-year-old who reports sudden weakness and possibly witnessed stumbling or fainting, what is on your anticipated problem list and what additional information do you want to have"

A cautious practitioner prioritizes likely problems from most severe or critical to least stable. At the top of my list for general weakness in a geriatric or close to geriatric patient is myocardial infarction or stroke. Midway down the list, I include hypovolemia and hyperglycemia. A simple — if there is such a thing — fainting episode is at the bottom of the list, but I am not sure if fainting can ever be idiopathic.

The anticipated problem list launches the patient assessment process before patient contact is ever made. New providers can use this enroute mental preparation to review associated signs and pertinent negatives, as well as the questions to most quickly reduce the number of anticipated problems to a working diagnosis. Also, make equipment decisions — what you carry to the patient — based on the dispatch information and the anticipated problem list.

2. How do you manage the treatment location"
More often than not, the church service kept going after the patient fainted in the pews. We either arrived to find our patient in the rear of the church or being tended to in the pew as the praying and singing continued around them. Our usual practice was to quickly assist awake patients out of the church and then begin treatment. If the patient is pulseless and/or apneic, treat them where you find them.

It seems reasonable that a dignitary like Clinton would leave the memorial service to receive assessment and treatment in a different location. A presidential nominee, like all patients, deserves privacy and protection from the watchful eye of professional and citizen journalists. Always keep in mind that moving the patient, even partially toward the receiving hospital, is part of the treatment process.

3. What is the patient's history"
Use the SAMPLE history to narrow the anticipated problem list. A churchgoer often had a recent history of standing up quickly from a sitting position. Be a detective and dig deeper to find out other history that might have contributed to the sudden loss of consciousness.

  • Is the patient taking any medications for heart or blood pressure problems"
  • What are the patient's most recent food and fluid consumption"
  • Does the patient have recent history of cough, fever, diarrhea or vomiting"

On Sunday evening, Clinton's pneumonia diagnosis was reported. Fatigue from poor sleep — almost always a complication of pneumonia persistent coughing and the malaise from being ill is consistent with her reported presentation as she was helped into a van.

Many of my 'Sunday syncope' patients, after a series of probing questions, usually had a recent history of not feeling well and had not had their usual breakfast before church. Some ended up having more serious signs and symptoms, like confusion, fever, hypotension and tachypnea leading us towards a diagnosis of sepsis.

What is your experience assessing and treating Sunday syncope" Add your suggestions for assessment and care in the comments.



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EMS Instructor - Lowcountry Regional EMS Council

The Lead EMS Instructor shall: 1. Serve as the primary classroom instructor for paramedic programs conducted by the Council 2. Advising prospective and current students on course placement, curriculum, and program requirements 3. Evaluate student mastery of skills and competencies required by course outcomes. 4. Manage clinical experiences at area hospital and field clinical areas 5. Instruct EMT and ...

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W.Va. EMS agency raises money for longest-serving paramedic

By Ann Kennell
The Dominion Post

MONONGALIA COUNTY, W.Va. — Mon EMS is raising money for the state's longest-serving EMT who needs another operation after complications from a previous surgery.

Gary Strohlein was one of the first paramedics in the state and has worked for Mon EMS for 40 years. Recently, Strohlein had a routine hip replacement and suffered numerous complications. The original four-to-six weeks that he was supposed to be out of work have grown into a six-month recovery process.

His coworkers at Mon EMS created a GoFundMe account to help raise money for his upcoming operation and to help support him while he continues recovering without pay.

Capt. Natalie Cornell is a paramedic at Mon county EMS and has known Strohlein for 17 years.

"I met Gary Strohlein back in 1999, he was one of my EMT instructors," Cornell said. " 'Stroh' is a very caring and compassionate person. He has dedicated his entire life to helping others."

Cornell said that after his surgery, Strohlein's hip was dislocated several times, plus he's been battling infection for months. Strohlein eventually had to be transferred to a hospital in Pittsburgh that specializes in hip replacement complications. There, he learned that he would never return to work.

"He is too young for retirement," Cornell said. "We started the GoFundMe as an easy way to contribute to Strohlein until he can get back on his feet."

Chris Hackett, an EMT at Mon EMS, is managing the GoFund Me page and is excited to be a part of something that will help his coworker.

" 'Stroh' is a caring and selfless man. As long as I have known him, he has always been willing to help anyone who needed it. He is extremely know-ledgeable about field medicine, and makes sure to pass on that knowledge," Hackett said. "He is quick to crack a joke and is always smiling and laughing — even when he was in pain because of his hip, I've never seen him in a bad mood."

The goal for the GoFundMe is $10,000; the page has raised $2,275. All donations will go toward helping pay Strohlein's medical bills, and for groceries and any home modifications he may need.

"People should get involved to help give back to a man that has given so much to his community for the past 40 years," Hackett said. "All he has ever wanted to do was to serve his community and help people in their time of need. Now, it is our time as a community, and as his coworkers and friends, to come together to help him. No one deserves it more than him."

To donate visit, http://ift.tt/2cln4Wd

Copyright 2016 The Dominion Post



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Remifentanil for labor analgesia: a comprehensive review

Abstract

Japan has seen significant developments in obstetric anesthesia in recent years, including the establishment of the Japanese Society of Obstetric Anesthesia and Perinatology. However, labor pain, which is one of the most important issues in obstetric practice, is still not treated aggressively. The rate of epidural administration for labor analgesia is very low in Japan as compared to other developed countries. Remifentanil has been used for labor analgesia, as part of general anesthesia for cesarean delivery, as well as for various fetal procedures around the world. Intravenous patient-controlled analgesia (IVPCA) with remifentanil is considered to be a reasonable option for labor pain relief. Several studies have demonstrated its efficacy with minimal maternal and neonatal adverse effects. On the other hand, reports of cases of maternal cardiac and respiratory arrest with remifentanil IVPCA within the past couple of years have redirected our attention to its safe use. Remifentanil IVPCA warrants one-to-one nursing monitoring, appropriate education of healthcare providers, continuous maternal oxygen saturation monitoring, end-tidal CO2 monitoring, and availability of both maternal and neonatal resuscitation equipment. This article provides an overview of knowledge and principles of using remifentanil IVPCA for labor analgesia and introduces its potential usage in Japan.



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Sigmoid volvulus after caesarean section

Publication date: Available online 12 September 2016
Source:Arab Journal of Gastroenterology
Author(s): Asem Ahmed Elfert, Eslam Saber Esmail, Ibrahim Shibl S. Eldin




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Air Force nurses honored for reviving drowning boy

By Tim O'Neil
St. Louis Post-Dispatch

ST. LOUIS — Air Force nurses Michelle Trujillo and Linda Clarkson, co-workers and best friends, rested from a bean-bag game at a country lake resort. A crowd gathered around a boy lying motionless on the beach.

Clarkson noticed the commotion near the water's edge. "Let's go," she said, and grabbed Trujillo's arm.

Moving through the crowd, they shouted for someone to call 911 and knelt before the boy, Issiah Wiest, whose body was blue. He was not breathing and had no pulse.

Trujillo began chest compressions for cardiopulmonary resuscitation. Clarkson kept the 9-year-old boy's airway open and gave him breaths.

"We thought there was no way this kid was going to make it," Trujillo said. "All we could do was what we were trained to do."

An off-duty emergency medical technician ran to his car and retrieved his bag. Other nurses visiting the resort offered assistance.

After what seemed a long time — a bystander's best guess was about 10 minutes — Issiah began breathing and coughing up water. Trujillo and Clarkson had cleared his lungs and restored breathing before an ambulance arrived a short time later.

Issiah, now 10, goes to school in Potosi.

"They are courageous and awesome," Darrell Branch, a friend of the boy's family, said of the two nurses. "They saved a boy's life. He went from dead to one night in a hospital."

Trujillo, 37, and Clarkson, 45, are nurses with the rank of captain with the 375th Medical Group at Scott Air Force Base. Friends since they met while attending Chamberlain College of Nursing in Maryland Heights, they are assigned to the base family clinic.

For reviving Issiah, they received commendations from the Air Force and were honored in April by the Greater St. Louis Region of the American Red Cross for the military category of its 2016 heroes ceremony.

It happened on Labor Day weekend in 2015. Trujillo and Clarkson and their husbands and children had gone to Lost Valley Lake Resort, near Owensville, Mo., with their trailer campers for the holiday. Branch, who then was dating Issiah's mother, took the boy and two of his own children to his father's campsite at Lost Valley.

Branch and the children went to the swimming beach. The nurses and their families went there to play a bean-bag game similar to washers or horseshoes. Branch said he was watching the kids and saw Issiah splashing in water just above his waist.

Some moments later, a teenager swimming near the buoy line felt something bump against him. The teen and two friends grabbed Issiah and pulled him to the beach, alerting people nearby.

That's when the nurses ran to him and began CPR. The ambulance arrived about 20 minutes later.

With Issiah's heart not pumping, his odds for survival weren't good — fewer than 10 percent of people who suffer cardiac arrest outside of a medical setting survive. CPR serves more to get blood to the brain than to restore heart function, but it roughly doubles the chance of recovery, according to the Red Cross.

Trujillo and Clarkson knew that. "Our instincts and training kicked in," said Clarkson.

As they continued working on Issiah, Clarkson noticed a pulse in the boy's carotid, or neck, artery. Trujillo stopped compressions and saw the boy breathe. They turned him onto his side and he vomited water.

Paramedics with the Gerald Area Ambulance District rushed him to Mercy Hospital in Washington, Mo. He was transferred to Mercy Hospital St. Louis, in Creve Coeur, and discharged the following day. At that time, Issiah and his mother, Sarah Wiest, lived in Festus.

The boy's family treated the nurses to a thank-you party in October back at Lost Valley Lake. Branch, 33, now lives in Kansas City, where he is a commercial window-washer, and keeps in touch with the Wiests.

Clarkson grew up in Crestwood and graduated from Lindbergh High School in 1989. Trujillo is from Knoxville, Tenn. They joined the Air Force upon graduation from nursing school in 2010 and, after assignments elsewhere, were reunited at Scott. Clarkson and her husband, Gerald Clarkson, of Kirkwood, now live in O'Fallon, Ill. Trujillo and her husband, Jeff Blankenship, live in Shiloh.

Their families still go on camping trips.

Copyright 2016 the St. Louis Post-Dispatch



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12-Lead ECG case: A tale of too many Q waves

An 88-year-old woman was brought to the emergency department by paramedics. She was hypotensive and weak. She was able to answer questions with brief answers. Her breath sounds were decreased in the bases. She had been sick for about four days without calling for help, and was found by someone on the fifth day very ill. This is her ECG.

The findings on this ECG include elevated, flat-topped or domed ST segments in V2 through V6. Sometimes called tombstone ST segments, these are in the anterior wall, in the area supplied by the left coronary artery's anterior descending branch (LAD). Other notable findings include:

  • Pathological Q waves in V2 through V6. Pathological Q waves indicate necrosis of the myocardium, which is usually permanent.
  • ST elevation and flattening in Leads I and aVL, which indicates high lateral wall injury. This is the area of the LAD and the left circumflex artery.
  • Pathological Q waves in II, III and aVF. More necrosis, but this time the ST segments are not elevated. This is the inferior wall, usually supplied by the right coronary artery (RCA).
  • ST segments convex upward — frowning — in II, III and aVF. These indicate ST elevation which is resolving.

What does the ECG tell us"
This patient is having an acute anterior-lateral wall MI. Further, the pathological Q waves tell us that hours have passed since the onset of the blockage and there has been irreversible damage to the anterior wall. Picture that area of her heart not contracting at all. In addition, her inferior wall has pathological Q waves, which means more necrosis, no contraction and abnormal ST segments.

Are pathological Q waves an important EMS finding"
Remember, pathological Q waves signify necrosis. ST elevation indicates injury. Injured tissue contracts poorly because of stunning. Dead tissue does not contract at all.

So, it is not surprising that this patient presented in shock. It is easy to recognize that this is cardiogenic shock caused by pump failure, not hypovolemia. The patient is hypotensive and hypoperfused. What do you think a fluid bolus would do to her"

Do pathological Q waves indicate an old MI"
They can. Unlike ST elevation, pathological Q waves in the left ventricle rarely go away. They remain as a scar or injury on the heart for life.

When we see pathological Q waves with normal ST segments and T waves, the acute phase is over. When the Q waves are accompanied by ST elevation, we know this is an acute MI that has, unfortunately, developed necrotic areas.

Of course, the clinical findings help tremendously. Remember, this patient was sick for four days and then got worse. She most likely had the inferior wall MI four days ago, and then today had the anterior wall MI.

What causes the Q waves on the ECG"
Some leads have a normal Q wave, which indicates the septum depolarizing from left to right, and slightly ahead of the rest of the ventricular muscle. The rest of the QRS complex is comprised of a combination of forces in the left ventricle — right to left — and the forces in the right ventricle — left to right. The ECG machine combines information from the two ventricles to produce a QRS that is mostly influenced by the large left ventricle.

When part of the left ventricle is killed, the dead cells no longer depolarize. Electronically, that area becomes a dead "hole" in the heart. The ECG electrode positioned over the dead zone would have normally seen depolarization waves coming toward it — now it sees nothing from that area, as if it is looking through a hole.

The ECG machine will record the forces on the other side of the heart, unopposed by the tissue that is dead. In other words, the dead area is removed from the equation. The forces from the opposite side of the heart produce a negative deflection — a pathological Q wave. Areas that have pathological Q waves have a full-thickness injury that has resulted in necrotic tissue which does not depolarize, conduct or contract.

Pathological Q waves are:

  • Wider than 1 mm which is 1 little block or 40 ms.
  • More than 2 mm deep which is 2 little blocks.
  • 25 percent or more of the total vertical size of the QRS.
  • Seen in leads V1 through V3 since these leads never have a normal Q wave.

Q waves that look pathological may be seen in Leads III and or aVR as a normal variant.

What happened to the patient"
She was quickly taken to the cath lab. The findings on the patient's cardiac cath were:

  • 100 percent occlusion of the proximal LCA, at the bifurcation of the circumflex artery. Anterior-lateral MI.
  • Occlusive lesion of the RCA that had spontaneously reperfused after the clot dissolved over time, indicating inferior wall MI that occurred several days ago.

The patient suffered cardiac arrest during the procedure and was resuscitated. Her LCA was opened and she was admitted to the cardiovascular ICU on balloon pump support. Sadly, she died approximately three hours later.

In this case, the huge number of pathologic Q waves are an ECG sign of necrotic tissue over a very large percentage of the myocardium. Dead tissue does not contract. Overwhelming pump failure — cardiogenic shock — is rarely survivable.

Our goal is to prevent the formation of pathological Q waves by getting patients to intervention as quickly as possible. Time is muscle. It is just as important for EMS providers to educate people about the importance of calling 911 when they have cardiac symptoms.



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Critical Care Transport Paramedic – Airlink - NHRMC

Critical Care Transport Paramedic – Airlink Full-Time, Rotating Schedule New Hanover Regional Medical Center Wilmington, NC AirLink specialty care transport team of the New Hanover Regional Medical Center - Emergency Transport Services seeks full-time Paramedics for its growing air and ground program. AirLink is the only licensed critical care transport program serving the coastal southeast North ...

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Paramedic – Vitalink - NHRMC

Paramedic – Vitalink Full-Time, Evening New Hanover Regional Medical Center Wilmington, NC The Staff Paramedic provides high quality patient care and safe medical transport to sick and injured patients in all age groups. Develops a plan of care for each patient that is consistent with approved treatment protocols, policies and procedures. Responsible for the operation of emergency vehicles. Essential ...

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Staff Nurse – Vitalink - NHRMC

Staff Nurse – Vitalink Full-Time, Rotating Schedule New Hanover Regional Medical Center Wilmington, NC The Staff RN provides high quality patient care and safe medical transport to sick and injured patients in all age groups. Essential Responsibilities: Collaborates with team and initiates care plan based on patient assessment and significant other input/data. Continuously reviews and revises ...

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Efficacy and Safety of Ribavirin with Sofosbuvir Plus Ledipasvir in Patients with Genotype 1 Hepatitis C: A Meta-Analysis

Abstract

Background

Sofosbuvir and ledipasvir with or without ribavirin (RBV) regimens (SLR vs. SL) have exhibited promising results for the treatment of patients with hepatitis C virus (HCV) genotype 1 infection.

Aim

To comprehensively compare the efficacy and safety of the SL and SLR regimen for the treatment of chronic HCV genotype 1 infections.

Methods

The Cochrane Library, PubMed, Web of Science, and EMBASE databases were searched. Only RCTs that compared the efficacy and safety of SL or SLR regimen for the treatment of chronic HCV genotype 1 infection were included. The primary outcome measures were the sustained virological response weeks 12 (SVR12) post-treatment and adverse events (AEs).

Results

Seven studies comprising 2601 patients were included. Compared with the SL regimen, SLR yielded a similar probability of having an SVR12 (RR 1.002, 95 % CI 0.998, 1.017, P = 0.780). Based on subgroup analyses, the addition of RBV to the 8-week SL regimen improved the SVR12 rate. However, the SLR regimen for 12 or 24 weeks did not show a superior SVR12 rate regardless of treatment history and the presence or absence of cirrhosis. The pooled incidence of AEs was higher in patients that received the SLR treatment regimen (RR 1.140, 95 % CI 1.095, 1.187, P = 0.000).

Conclusions

The 12-week or 24-week SL regimen with a low incidence of AEs is as effective and well tolerated as the SLR regimen for the treatment of patients with chronic HCV genotype 1 infection.



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W.Va. EMS agency raising money for longest-serving paramedic

By Ann Kennell
The Dominion Post

MONONGALIA COUNTY, W.Va. — Mon EMS is raising money for the state's longest-serving EMT who needs another operation after complications from a previous surgery.

Gary Strohlein was one of the first paramedics in the state and has worked for Mon EMS for 40 years. Recently, Strohlein had a routine hip replacement and suffered numerous complications. The original four-to-six weeks that he was supposed to be out of work have grown into a six-month recovery process.

His coworkers at Mon EMS created a GoFundMe account to help raise money for his upcoming operation and to help support him while he continues recovering without pay.

Capt. Natalie Cornell is a paramedic at Mon county EMS and has known Strohlein for 17 years.

"I met Gary Strohlein back in 1999, he was one of my EMT instructors," Cornell said. " 'Stroh' is a very caring and compassionate person. He has dedicated his entire life to helping others."

Cornell said that after his surgery, Strohlein's hip was dislocated several times, plus he's been battling infection for months. Strohlein eventually had to be transferred to a hospital in Pittsburgh that specializes in hip replacement complications. There, he learned that he would never return to work.

"He is too young for retirement," Cornell said. "We started the GoFundMe as an easy way to contribute to Strohlein until he can get back on his feet."

Chris Hackett, an EMT at Mon EMS, is managing the GoFund Me page and is excited to be a part of something that will help his coworker.

" 'Stroh' is a caring and selfless man. As long as I have known him, he has always been willing to help anyone who needed it. He is extremely know-ledgeable about field medicine, and makes sure to pass on that knowledge," Hackett said. "He is quick to crack a joke and is always smiling and laughing — even when he was in pain because of his hip, I've never seen him in a bad mood."

The goal for the GoFundMe is $10,000; the page has raised $2,275. All donations will go toward helping pay Strohlein's medical bills, and for groceries and any home modifications he may need.

"People should get involved to help give back to a man that has given so much to his community for the past 40 years," Hackett said. "All he has ever wanted to do was to serve his community and help people in their time of need. Now, it is our time as a community, and as his coworkers and friends, to come together to help him. No one deserves it more than him."

To donate visit, http://ift.tt/2cln4Wd

Copyright 2016 The Dominion Post



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EMS job interview tips: 5 things you need to know to get hired

You've worked hard to graduate from EMT or paramedic school and have been invited to interview for the job of your dreams. Here are five ways to ensure you'll impress your potential employer and leave the interview with a smile on your face and, hopefully, with a job offer in hand.

1. Do your research
Whether applying for a job with a fire department or a private ambulance service, study up on the agency to know such things as its history, management team, the target hazards (e.g. highways, railroad tracks, rivers) in their response zone, receiving hospitals, the call volume and types of calls and in what areas the agency hopes to grow in the future.

You can find this information in the annual report most agencies publish, which is often available on their website. During your interview, sprinkle this information in your answers where it is appropriate and you will impress your potential employers with the depth of your preparedness and with your interest in them.

Also, don't forget to schedule a few ride-alongs or station visits before your interview to meet the crew. Talk to friends you might have who are already working at the agency to collect additional information.

2. Ready for duty
Your potential employers must be able to envision you in the role in order to hire you. Therefore, walk into the interview room and demonstrate the same kind of command presence that you would display on a 911 call. Be confident, look everyone in the eye and address each one with a firm handshake.

Regarding dress, wear a suit and tie for the interview, but also don't be afraid to dress the same way you would on an ambulance for a skills test. My testing outfit was a blue pair of 5.11 tactical pants, duty boots and a black golf shirt. Along with looking the part, I also felt like I was on-shift and running a call so my skills and scenarios were more focused.

3. Have your answers ready
After many interviews for both fire department and private ambulance jobs, I've noticed many interviewers ask the same basic questions. You're often asked to start with a quick two minute introduction about yourself and what goals you have for the future. Following this, be prepared to answer such questions as:

  • Why do you want to work here"
  • What have you done to prepare"
  • Why are you the best candidate"
  • What is your greatest strength" One of your weaknesses"
  • Describe a time when you handled a difficult situation"

Have your answers ready with real examples from your life to show your words in action. Remember to relate each answer back to the specific agency and job for which you're applying. Try to choose some stories that show other aspects of your life outside of fire and EMS, such as community service involvement, your family or being a member of a team.

Many employers especially value past work experiences which involved manual labor, challenging or austere work conditions or being part of a family business. If you grew up on a farm, led wilderness expeditions, worked in a restaurant kitchen or as a construction laborer make sure to relate the lessons you learned from those physically-demanding jobs. If you are a military veteran, make sure to relate those experiences to the job.

4. Ask questions
When the employer asks you if you have any questions, don't be afraid to pipe up. Find out what the agency's hiring timeline is. How many people do they expect to hire" What type of person would their ideal candidate be"

When they tell you specifically what they're looking for, succinctly restate your strengths that address their needs and how you'd be the perfect candidate for the job. The key is to present yourself as a confident and knowledgeable candidate who would be a wonderful addition to their team.

5. Follow up
After the interview, send an email to the hiring manager and to everyone with whom you met on the interview board to thank them for their time and consideration. Close the email by restating your interest in the job and your qualifications. If you really want to set yourself apart from the competition, send a hand-written note to each member of the interview committee.

An action such as this will distinguish you from the other candidates and their follow-up email will likely begin with the word "Congratulations."

I want to hear about your job interview success tips. Share your best ideas and recommendations in the comments.



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EMS job interview tips: 5 things you need to know to get hired

You've worked hard to graduate from EMT or paramedic school and have been invited to interview for the job of your dreams. Here are five ways to ensure you'll impress your potential employer and leave the interview with a smile on your face and, hopefully, with a job offer in hand.

1. Do your research
Whether applying for a job with a fire department or a private ambulance service, study up on the agency to know such things as its history, management team, the target hazards (e.g. highways, railroad tracks, rivers) in their response zone, receiving hospitals, the call volume and types of calls and in what areas the agency hopes to grow in the future.

You can find this information in the annual report most agencies publish, which is often available on their website. During your interview, sprinkle this information in your answers where it is appropriate and you will impress your potential employers with the depth of your preparedness and with your interest in them.

Also, don't forget to schedule a few ride-alongs or station visits before your interview to meet the crew. Talk to friends you might have who are already working at the agency to collect additional information.

2. Ready for duty
Your potential employers must be able to envision you in the role in order to hire you. Therefore, walk into the interview room and demonstrate the same kind of command presence that you would display on a 911 call. Be confident, look everyone in the eye and address each one with a firm handshake.

Regarding dress, wear a suit and tie for the interview, but also don't be afraid to dress the same way you would on an ambulance for a skills test. My testing outfit was a blue pair of 5.11 tactical pants, duty boots and a black golf shirt. Along with looking the part, I also felt like I was on-shift and running a call so my skills and scenarios were more focused.

3. Have your answers ready
After many interviews for both fire department and private ambulance jobs, I've noticed many interviewers ask the same basic questions. You're often asked to start with a quick two minute introduction about yourself and what goals you have for the future. Following this, be prepared to answer such questions as:

  • Why do you want to work here?
  • What have you done to prepare?
  • Why are you the best candidate?
  • What is your greatest strength? One of your weaknesses?
  • Describe a time when you handled a difficult situation?

Have your answers ready with real examples from your life to show your words in action. Remember to relate each answer back to the specific agency and job for which you're applying. Try to choose some stories that show other aspects of your life outside of fire and EMS, such as community service involvement, your family or being a member of a team.

Many employers especially value past work experiences which involved manual labor, challenging or austere work conditions or being part of a family business. If you grew up on a farm, led wilderness expeditions, worked in a restaurant kitchen or as a construction laborer make sure to relate the lessons you learned from those physically-demanding jobs. If you are a military veteran, make sure to relate those experiences to the job.

4. Ask questions
When the employer asks you if you have any questions, don't be afraid to pipe up. Find out what the agency's hiring timeline is. How many people do they expect to hire? What type of person would their ideal candidate be?

When they tell you specifically what they're looking for, succinctly restate your strengths that address their needs and how you'd be the perfect candidate for the job. The key is to present yourself as a confident and knowledgeable candidate who would be a wonderful addition to their team.

5. Follow up
After the interview, send an email to the hiring manager and to everyone with whom you met on the interview board to thank them for their time and consideration. Close the email by restating your interest in the job and your qualifications. If you really want to set yourself apart from the competition, send a hand-written note to each member of the interview committee.

An action such as this will distinguish you from the other candidates and their follow-up email will likely begin with the word "Congratulations."

I want to hear about your job interview success tips. Share your best ideas and recommendations in the comments.



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Role of respiratory changes on the modulation of arterial pressure in rats submitted to sino-aortic denervation

Sino-aortic denervated (SAD) rats present mean arterial pressure (MAP) similar to control rats. Since respiration modulates MAP, we hypothesized that conscious SAD rats present respiratory changes associated with the normal MAP. In this study we evaluated the cardiovascular and respiratory activities and arterial blood gases in control and SAD rats. Male juvenile Wistar rats (P19-P21) were submitted to SAD, sham surgery, or selective carotid bodies removal (CBX) and the three groups were evaluated 10 days after the surgery (SAD, n = 21, Sham, n = 18, CBX, n = 13). MAP in Sham, SAD and CBX was similar (P > 0.05), but the variability of MAP was significantly higher in SAD than in Sham and CBX rats (P < 0.0001). The duration of expiration and inspiration increased in SAD rats related to Sham and CBX rats, which resulted in a reduced respiratory frequency and minute ventilation (P < 0.05). PaO2 and hemoglobin saturation were reduced in SAD and CBX related to Sham rats, while PaCO2 was increased in SAD compared to Sham rats. The short and long-term respiratory variability were significantly higher in SAD than in Sham and CBX rats (P < 0.05). In addition, the falls of MAP during deep breaths were higher in SAD than in Sham and CBX rats (P < 0.0001). The data show that SAD rats present respiratory changes, which may be one of the compensatory mechanisms associated with the maintenance of normal levels of MAP in the absence of arterial baroreceptors.

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Estrogen upregulates the expression levels and functional activities of duodenal mucosal CFTR and SLC26A6

The incidence of duodenal ulcer is markedly lower in women than men, but the cause of the gender difference is not clear. The cystic fibrosis transmembrane conductance regulator (CFTR) and the solute linked carrier 26 gene family A6 (SLC26A6) are two key bicarbonate transport proteins to mediate duodenal mucosal bicarbonate secretion which is an important protective factor against acid-induced duodenal injury. This study aimed to investigate the effect of estrogen on the expressions and functional activities of CFTR and SLC26A6 in duodenal mucosa. We found that the expression levels of duodenal CFTR and SLC26A6 were markedly higher in young women of 20–30 years than in young men of 20–30 years and old women and men of 60–70 years. The expression levels of CFTR and SLC26A6 in young women were markedly higher in preovulatory phases than in premenstrual phases, which was consistent with the changes of serum estradiol levels. The further results showed that duodenal CFTR and SLC26A6 expression levels in female mice were markedly decreased after ovariectomy, and the supplement of estradiol reversed the changes of CFTR and SLC26A6. 17β-estradiol increased CFTR and SLC26A6 expression levels of human duodenocytes in experiments in vitro. Functional experiments showed that basal and forskolin- and prostaglandin E2-stimulated duodenal bicarbonate secretion in ovariectomized mice was markedly decreased, and, likewise, the supplement of 17β-estradiol reversed the changes. In conclusion, endogenous estrogen upregulates the expressions and functional activities of CFTR and SLC26A6 in duodenal mucosa, which could contribute to protecting duodenum and explaining the gender difference of duodenal ulcer prevalence.

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Quantifying cerebrovascular reactivity in anterior and posterior cerebral circulations during voluntary breath holding

The central respiratory chemoreflex contributes to blood gas homeostasis, particularly in response to accumulation of brainstem CO2. Cerebrovascular reactivity (CVR) affects chemoreceptor stimulation inversely through CO2 washout from brainstem tissue. Voluntary breath-holding imposes alterations in blood gases, eliciting respiratory chemoreflexes, potentially contributing to breath-hold duration (i.e., break-point). However, the effects of cerebrovascular reactivity on break-point have yet to be determined. We tested the hypothesis that the magnitude of CVR contributes directly to BHD in 23 healthy human participants. We developed and validated a cerebrovascular stimulus index methodology (SI; PETCO2/PETO2) to quantify CVR by correlating measured and interpolated values of PETCO2 (r = 0.95, P < 0.0001), PETO2 (r = 0.98, P < 0.0001), and SI (r = 0.94, P < 0.0001) during rebreathing. Using transcranial Doppler ultrasound, we then quantified the CVR of the middle (MCAv) and posterior (PCAv) cerebral arteries by plotting cerebral blood velocity against interpolated SI during a maximal end-inspiratory breath-hold. The MCAv CVR magnitude was larger than PCAv (P = 0.001; +70%) during breath-holding. We then correlated MCAv and PCAv CVR with the physiological (involuntary diaphragmatic contractions) and psychological (end-point) break-point, within-individuals. There were significant inverse but modest relationships between both MCAv and PCAv CVR and both physiological and psychological break-points (r[LEFTWARDS ARROW]0.53, P < 0.03). However, these relationships were absent when MCAv and PCAv cerebrovascular conductance reactivity was correlated with both physiological and psychological break-points (r > –0.42; P > 0.06). Although central chemoreceptor activation is likely contributing to break-point, our data suggests that CVR-mediated CO2 washout from central chemoreceptors plays no role in determining break-point, likely due to a reduced arterial-tissue CO2 gradient during breath-holding. (250 words)

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Inspiratory modulation of sympathetic activity is increased in female rats exposed to chronic intermittent hypoxia

Chronic intermittent hypoxia (CIH) induces sympathetic overactivity and hypertension in male rats. Enhanced respiratory modulation of sympathetic activity in juvenile male rats exposed to CIH occurs in the expiratory phase of the respiratory cycle, characterizing changes in respiratory-sympathetic coupling. Different from other experimental models of hypertension, CIH induces increase in arterial pressure in adult female rats similarly to that observed in male rats. However, the mechanisms underlying the hypertensive phenotype in CIH-female rats remain to be elucidated. Moreover, several evidences documented sex differences in the respiratory network activity in response to hypoxia. Considering that CIH-male rats present an increase in the respiratory modulation of sympathetic activity and there are sex differences in the respiratory network, we hypothesized that CIH-female rats develop an increase in the respiratory modulation of sympathetic activity different from CIH-male rats. In this study we investigated sympathetic and respiratory activities in juvenile female rats exposed to CIH using an in situ working heart-brainstem preparation. CIH-female rats develop changes in the respiratory pattern and changes in the respiratory-sympathetic coupling marked by sympathetic overactivity phase-locked to inspiration, which is different in relation to male rats exposed to CIH. This study revealed a specific respiratory-related mechanism for sympathetic overactivity linked to inspiration that explains, at least in part, the hypertensive phenotype in female rats exposed to CIH.

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Intermittent hypoxia in obese Zucker rats: cardiometabolic and inflammatory effects

Obstructive Sleep Apnea (OSA) is associated with obesity with a high prevalence, and both co-morbidities are independent cardiovascular risk factors. Intermittent hypoxia (IH) is thought to be the main factor responsible for the OSA-related cardiometabolic alterations. This study aimed at assessing the respective impact of obesity and IH on the inflammatory and cardiometabolic state in rats. Lean and obese Zucker rats were exposed to normoxia or chronic IH, and metabolic and inflammatory parameters were assessed such as plasma lipids and glucose, serum leptin and adiponectin, liver cytokines, NF-κB activity and cardiac endothelin-1 levels. Myocardial infarct size was also evaluated following in vitro ischemia-reperfusion. Circulating lipids, insulin, HOMA-IR, leptin and adiponectin levels were higher in obese versus lean rats. Chronic IH did not have a significant impact on metabolic parameters in lean rats. In obese rats, IH increased glycaemia and HOMA-IR. Liver IL-6 and TNF-α levels were elevated in lean rats exposed to IH; obesity prevented the increase in IL-6 but not in TNF- α. Finally, IH exposure enhanced myocardial sensitivity to infarction in both lean and obese rats and increased cardiac endothelin-1 in lean but not obese rats. In conclusion, this study shows that the dyslipidemia and insulin resistance induced by obesity of genetic origin does not enhance the deleterious cardiovascular response to IH and may even partially protect against IH-induced inflammation.

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Growth charts for individuals with rhizomelic chondrodysplasia punctata

Rhizomelic chondrodysplasia punctata (RCDP) is a class of peroxisomal disorders characterized by defective plasmalogen biosynthesis. There are multiple recognized types of RCDP, all of which have autosomal recessive inheritance, and their associated genes are known: RCDP type 1 with PEX7, RCDP type 2 with GNPAT, RCDP type 3 with AGPS, RCDP type 4 with FAR1, and RCDP type 5 with PEX5. Among other medical/developmental issues, plasmalogen deficiency has a direct effect on bone growth and results in postnatal growth failure, the severity of which corresponds to the degree of plasmalogen deficiency. In order to document growth in patients with RCDP, we present detailed growth curves for length, weight, and head circumference derived from retrospective data from 23 individuals with RCDP types 1 and 2 confirmed by molecular and/or biochemical studies. We stratified growth curves by age as well as by plasmalogen level, with those with higher plasmalogens grouped as "non-classic." The growth charts presented here provide guidance to families and physician caretakers on the natural course of growth in individuals with RCDP during infancy into early childhood, and thus will have particular utility in setting expectations and guiding optimal feeding interventions in this population.© 2016 Wiley Periodicals, Inc.



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Marfan syndrome: Report of a complex phenotype due to a 15q21.1 contiguos gene deletion encompassing FBN1, and literature review

Marfan syndrome (MFS) is an autosomal dominant connective tissue disorder that primarily involves skeletal, ocular, and cardiovascular systems with large inter- and intra-familial variability in terms of age of onset, severity, and aortic disease. The causal gene, FBN1, encodes for fibrillin 1, a multi-domain glycoprotein essential for many biological functions, including deposition and formation of elastic fibers. Reports describing chromosomal alterations involving FBN1 are rare, but in the last years their number has increased after copy number state analyses, such as multiplex ligation-dependent probe amplification and microarray-based comparative genomic hybridization, were adopted as routine diagnostic tools. Herein we report a patient with MFS and an atypical facial appearance and neuropsychiatric involvement likely not attributable to MFS due to a 15q21.1 deletion that involves part of FBN1 and 13 additional contiguous genes listed in OMIM. We compare his phenotype with those of the few patients described in the literature who share similar 15q11.2 deletions. This report expands the phenotype of patients with 15q11.2 deletion involving FBN1 and its contiguous genes, and suggests a possible role for these other genes in the pathogenesis of the observed unusual clinical signs that are not explained by FBN1 haploinsufficiency. © 2016 Wiley Periodicals, Inc.



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Phenotype of 7q11.23 duplication: A family clinical series

Duplication 7q11.23 syndrome is the reciprocal of Williams–Beuren deletion syndrome. Studies have reported a recognizable phenotype, including autism, intellectual disability, speech, and language delay, social anxiety, and behavioral difficulties in these individuals. Previous studies revealed a variety of craniofacial abnormalities, brain malformations, and cardiac abnormalities, including aortic dilation. This patient series evaluates five family members aged 2 months to 35 years, all with confirmed 7q11.23 duplication syndrome. All had characteristic craniofacial findings and joint hyperextensibility, and three experienced broken bones/fractures with minimal trauma. Other features included frequent headaches, sleep problems, hydrocephalus, and in two of the children, mildly dilated aortic root, and ascending aorta. Psychological test results reveal borderline to low average nonverbal cognitive abilities and speech and language delays. All five family members with 7q11.23 syndrome meet criteria for autism spectrum disorder. Adaptive functioning is impaired for all four children, but higher for the children's father. The infant shows developmental delays in language and motor skills, but some improvements in reciprocal social behaviors over time. Two children exhibit hyperactivity and inattention, and the father and second youngest child exhibit anxiety. This family clinical series contributes to the growing literature on the phenotype of 7q11.23 microduplication syndrome across the age range. Physicians are encouraged to urge focused medical surveillance and intensive early intervention targeting speech-language and social reciprocity. © 2016 Wiley Periodicals, Inc.



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Application of whole-exome sequencing to unravel the molecular basis of undiagnosed syndromic congenital neutropenia with intellectual disability

Neutropenia can be qualified as congenital when of neonatal onset or when associated with extra-hematopoietic manifestations. Overall, 30% of patients with congenital neutropenia (CN) remain without a molecular diagnosis after a multidisciplinary consultation and tedious diagnostic strategy. In the rare situations when neutropenia is identified and associated with intellectual disability (ID), there are few diagnostic hypotheses to test. This retrospective multicenter study reports on a clinically heterogeneous cohort of 10 unrelated patients with CN associated with ID and no molecular diagnosis prior to whole-exome sequencing (WES). WES provided a diagnostic yield of 40% (4/10). The results suggested that in many cases neutropenia and syndromic manifestations could not be assigned to the same molecular alteration. Three sub-groups of patients were highlighted: (i) severe, symptomatic chronic neutropenia, detected early in life, and related to a known mutation in the CN spectrum (ELANE); (ii) mild to moderate benign intermittent neutropenia, detected later, and associated with mutations in genes implicated in neurodevelopmental disorders (CHD2, HUWE1); and (iii) moderate to severe intermittent neutropenia as a probably undiagnosed feature of a newly reported syndrome (KAT6A). Unlike KAT6A, which seems to be associated with a syndromic form of CN, the other reported mutations may not explain the entire clinical picture. Although targeted gene sequencing can be discussed for the primary diagnosis of severe CN, we suggest that performing WES for the diagnosis of disorders associating CN with ID will not only provide the etiological diagnosis but will also pave the way towards personalized care and follow-up. © 2016 Wiley Periodicals, Inc.



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Nance–Horan syndrome—The oral perspective on a rare disease

The present study describes seven patients with Nance–Horan syndrome, all referred to a specialized oral care unit in the Central Denmark Region. A literature search on "Nance Horan Syndrome" resulted in 53 publications among which 29 reported on dental findings. Findings reported in these papers have been systematized to obtain an overview of the reported findings and the terminology on dental morphology. All seven patients included in the present study showed deviations of crown morphology on incisors and/or molars. The only consistent and very clear dental aberration was alterations in the tooth morphology that is screwdriver-shaped incisors and bud molars being most pronounced in the permanent dentition, but were also present in the primary dentition. In addition, three patients had supernumerary teeth, and three had dental agenesis. In conclusion, a dental examination as a part of the diagnostic process may reveal distinct characteristics of the dental morphology, which could be of diagnostic value and facilitate an early diagnosis. In the description of molar morphology in NHS patients, it is recommended to use the term "bud molar." The combination of congenital cataract, screwdriwer-shaped incisors and bud-shaped molars is a strong clinical indication of Nance–Horan syndrome. © 2016 Wiley Periodicals, Inc.



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Gene variants as risk factors for gastroschisis

In a population-based case-control study in California of 228 infants, we investigated 75 genetic variants in 20 genes and risk of gastroschisis with regard to maternal age, race/ethnicity, vitamin use, and smoking exposure. We hypothesized that genes related to vascular compromise may interact with environmental factors to affect the risk of gastroschisis. Haplotypes were constructed for 75 gene variants using the HaploView program. Risk for gastroschisis associated with each gene variant was calculated for both the homozygotes and the heterozygotes, with the homozygous wildtypes as the referent. Risks were estimated as odds ratios (ORs) with 95% confidence intervals (CIs) by logistic regression. We found 11 gene variants with increased risk and four variants with decreased risk of gastroschisis for heterozygous (ORh) or homozygous variants (ORv) genotypes. These included NOS3 (rs1036145) ORh = 0.4 (95% CI: 0.2–0.7); NOS3 (rs10277237) ORv = 2.7 (95% CI: 1.3–6.0); ADD1 (rs12503220) ORh = 2.9 (95% CI: 1.6–5.4), GNB3 (rs5443) ORh = 0.2 (95% CI: 0.1–0.5), ORv = 0.4 (95% CI: 0.2–0.9); ICAM1 (rs281428) ORv = 6.9 (95% CI: 2.1–22.9), ICAM1 (rs3093030) ORv = 2.6 (95% CI: 1.2–5.6); ICAM4 (rs281438) ORv = 4.9 (95% CI: 1.4–16.6), ICAM5 (rs281417) ORh = 2.1 (95% CI: 1.1–4.1), ORv = 4.8 (95% CI: 1.7–13.6); ICAM5 (rs281440) ORh = 23.7 (95% CI: 5.5–102.5), ORv = 20.6 (95% CI: 3.4–124.3); ICAM5 (rs2075741) ORv = 2.2 (95% CI: 1.1–4.4); NAT1 ORv = 0.3 (95% CI: 0.1–0.9). There were additional associations between several gene variants and gastroschisis among women aged 20–24 and among mothers with and without vitamin use. NOS3, ADD1, ICAM1, ICAM4, and ICAM5 warrant further investigation in additional populations and with the interaction of additional environmental exposures. © 2016 Wiley Periodicals, Inc.



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The Bedside Dysmorphologist A Guide to Identifying and Assessing Congenital Malformations Second Edition



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Prevalence of nutritional deficiencies among school going adolescents of Ahmedabad city, Gujarat: a cross sectional study

2016-09-12T05-50-05Z
Source: International Journal of Advances in Medicine
Manish Rameshchandra Ramavat, Geet Gunjana, Vrunda S. Kelkar, Dwija A. Patel, Sana M. Saiyed, 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. Objective of the study was to study prevalence of nutritional deficiencies among school going adolescents of Ahmedabad city, Gujarat. Methods: The study was carried by Community Medicine Department, GMERS Medical College, Dharpur-Patan during period from September 2014 to July 2015. After taking the permission of principals of 9 schools and consent of the parents of adolescents, 842 adolescents from 10 schools of Ahmedabad city were examined for signs of various nutritional deficiencies. The data was collected by predesign, pretested proforma and analyzed using SPSS 17.0 (trial version). Results: Out of total 842 adolescents 409 (48.6%) were female. Mean age of the study adolescents was 15.8±1.96 years. Maximum numbers of the adolescents were in the age group of 10-14 years (60.5%). Mean age of female and male adolescents was 15.3±1.89 years and 15.9±2.02 years respectively. The study revealed that vitamin A deficiency was present in 59 (7.0%) children. Vitamin B complex deficiency signs were seen in 195 (23.2%) children. Vitamin C deficiency signs were seen in 88 (10.5%) children. PEM was observed in 111 (13.2%) children. Essential fatty acid deficiency was observed in 121 (14.4%) children. Conclusions: High prevalence of nutritional deficiencies among these adolescents needs great attention and health education.


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Immunization status of 12-23 months children in urban slums of Ahmedabad city, Gujarat, India: a cross sectional study

2016-09-12T05-50-05Z
Source: International Journal of Advances in Medicine
Chintu C. Chaudhari, Geet Gunjana, Vrunda S. Kelkar, Dwija A. Patel, Sana M. Saiyed, Nilesh Thakor.
Background: Immunization is one of the most cost effective methods of preventing childhood diseases and needs to be sustained with higher coverage for desired benefits. Objective of the study was to assess immunization coverage in children of 12-23 months of age group in urban slums of Ahmedabad city. Methods: Using the purposive sampling method, a cross sectional community based study was conducted in urban slum area (Vadaj area) of Ahmedabad city during July-November 2014. All 114 children of 12-23 months age group of the area were included after taking verbal informed consent of their parents or guardians. Vaccination status of the children was verified using the Mamta card. In conditions where the Mamta card was not available, the mother/parents were asked about the site of vaccinations to confirm the vaccines being given. Analysis of study was done by using appropriate statistical software. Results: Total 936 households were surveyed. There were 114 children in the 12-23 months age group. Mamta card or immunization record was available with 84 (73.6%) mothers of 12-23 months age group of children. Maximum coverage was seen for BCG (96.5%) followed by pentavalent first dose (90.3%). Measles 1st dose coverage was 81.5%.Overall, 80.7% of the children in the 12-23 months age group were fully immunized while only four children were unimmunized. Dropout rate percentage for pentavalent 1st dose to pentavalent 3rd dose was 4.4% while for pentavalent first dose to measles was 8.8%. Conclusions: Full immunization coverage was 80.7% which was better than the national surveys still the causes for no/partial vaccinations need to be addressed.


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Impact Of Training On Knowledge And Practices Of Nurses Regarding Hospital Infection Control In A Tertiary Care Centre

2016-09-12T05-48-43Z
Source: National Journal of Integrated Research in Medicine
R.Jyoti Chandak*, Poonam S.Loomba**,B.Mishra,V.Dogra***.
Background and objective:Nurses provide the first-hand bedside care to the patients in a hospital thus have a direct role in hospital infection control. Thus to improve hygiene behaviour of staff, training sessions on hospital infection control is necessary. The objective of this study was to assess the impact of training on knowledge and practices regarding hospital infection control amongst nursing staff working in tertiary care centre. Method: The study included 89 nurses from different wards and I.C.U. A pre-test and a post-test was conducted with a set of 20 self designed multiple choice questions in three days session of training covering important aspects of hospital infection control. Improvement in pre-test and post test for individual candidate was assessed and statistical data analysis was done. Results: Response rate of the questionnare was 100%.The mean pre-test score was 9(S.D 3.06) while mean post-test score was 14(S.D 6.34). The difference in pre-test and post-test was statistically significant(P

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Dedicated C-fibre viscerosensory pathways to central nucleus of the amygdala

Emotional state is impacted by changes in visceral function, including blood pressure, breathing and digestion. A main line of viscerosensory information processing occurs first in the NTS. Here, in rats, we examined the synaptic characteristics of visceral afferent pathways to the central nucleus of the amygdala (CeA) in brainstem slices by recording from retrogradely labelled NTS projection neurons. We simultaneously recorded neuron pairs: one dye positive (i.e. NTS-CeA) and a second unlabelled neighbor. Graded shocks to the solitary tract (ST) always (93%) triggered EPSCs at CeA projecting NTS neurons. Half of the NTS-CeA neurons received at least one primary afferent input (classed 'second order') indicating that viscerosensory information arrives at the CeA conveyed by a pathway involving as few as two synapses. The remaining NTS-CeA neurons received viscerosensory input only via polysynaptic pathways. In contrast, ∼3/4 of unlabelled neighboring neurons were directly connected to ST. NTS-CeA neurons received greater numbers of ST related inputs compared to unlabelled NTS neurons indicating that highly convergent viscerosensory signals reach the CeA. Remarkably, despite multi-fibre convergence, all single NTS-CeA neurons received inputs derived from only unmyelinated afferents (TRPV1 expressing C-fibres) or only non-TRPV1 ST afferent inputs – never a combination of both. Such segregation means that visceral afferent information followed separate lines to reach CeA. Their very different physiological activation profiles mean that these parallel visceral afferent pathways encode viscerosensory signals to the amygdala that may provide interoceptive assessments to impact behaviours.

This article is protected by copyright. All rights reserved



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Bamboo (Acidosasa edulis) shoot shell biochar: Its potential isolation and mechanism to perrhenate as a chemical surrogate for pertechnetate

Publication date: December 2016
Source:Journal of Environmental Radioactivity, Volume 165
Author(s): Hui Hu, Bangqiang Jiang, Huixiong Wu, Jubin Zhang, Xiaohui Chen
In this work, a biochar was prepared from bamboo (Acidosasa edulis) shoot shell through slow pyrolysis (under 300–700 °C). Characterization with various tools showed that the biochar surface was highly hydrophobic and also had more basic functional groups. Batch sorption experiments showed that the biochar had strong sorption ability to perrhenate (a chemical surrogate for pertechnetate) with maximum sorption capacity of 46.46 mg/g, which was significantly higher than commercial coconut shell activated carbon and some adsorbents reported previously. Desorption experiments showed that more than 94% of total perrhenate adsorbed could be recovered using 0.1 mol/L KOH as a desorption medium. Pearson correlation analysis showed that the recovery of perrhenate by the biochars was mainly through surface adsorption mechanisms involving both high hydrophobicity and high basic sites of biochar surface.

Graphical abstract

image


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Chemical fractionation of radium-226 in NORM contaminated soil from oilfields

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Publication date: December 2016
Source:Journal of Environmental Radioactivity, Volume 165
Author(s): Jamal Al Abdullah, Mohammad Said Al-Masri, Yusr Amin, Ibrahim Awad, Zuhair Sheaib
Contamination of soil with 226Ra is a common problem in the oilfields, leading to costly remediation and disposal programmes. The present study focuses on the chemical fractionation and mobility of 226Ra in contaminated soils collected from an oilfield using a three-step sequential extraction procedure (BCR). The total activity concentrations of 226Ra in contaminated soils were measured and found to be in the range from 1030 ± 90 to 7780 ± 530 Bq kg−1, with a mean activity concentration of 2840 ± 1840 Bq kg−1. The correlation between the total concentration of 226Ra and soil properties, mainly pH, LOI, Corg, clay and Ca, was investigated using the principal component analysis method (PCA). The chemical fractionation of 226Ra was studied using the sequential extraction method (BCR). The highest fraction of 226Ra (27–65%) was found to be in the acid-reducible fraction, which suggests that 226Ra is mainly bound to FeMn oxides. The BCR method showed that high percentages of 226Ra were found to be in mobile soil phases (between 45 and 99%). Consequently, groundwater contamination could occur due to the remobilization of 226Ra from soils under normal environmental conditions. However, the obtained results could be useful to reduce the volume of NORM wastes generated from the oilfields and decision-making process for final treatment and disposal of NORM-contaminated soil.



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Studying factors affecting the indoor gamma radiation dose using the MCNP5 simulation software

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Publication date: December 2016
Source:Journal of Environmental Radioactivity, Volume 165
Author(s): M. Orabi
Different factors and parameters affecting the indoor gamma radiation dose are considered and investigated. The change of the dose with different positions inside the room is discussed. The relative doses are also calculated for different changes; with different room dimensions, different wall thicknesses, and different building material densities. Some other factors are also discussed. The study is carried out by executing some models designed by the MCNP version 5 simulation software. The calculations of the dose rates are performed by adopting a simple and convenient calculation model which is based on the obtained relative changes of the dose rates with the different factors.



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Going Viral: Why Eliminating the Burden of Hepatitis C Requires Enhanced Cooperation Between Specialists and Primary Care Providers



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Impact of Low Immunoglobulin G Levels on Disease Outcomes in Patients with Inflammatory Bowel Diseases

Abstract

Background

Inflammatory bowel diseases (IBDs) are considered immune-mediated disorders with dysregulated innate and adaptive immunities. Secondary immunogloblin deficiency can occur in IBD and its impact on the disease course of IBD is not clear.

Aims

We sought to determine associations between low IgG/G1 levels and poor clinical outcomes in IBD patients.

Methods

This historic cohort study was performed on IBD patients with obtained IgG/IgG1 levels. The primary outcome was defined as any IBD-related bowel resection surgery and/or hospitalization. Subgroup analyses assessed particular surgical outcomes in Crohn's disease (CD), ulcerative colitis (UC) or indeterminate colitis (IC), and ileal pouch–anal anastomosis (IPAA). The secondary outcomes included IBD drug escalations and C. difficile or cytomegalovirus infections.

Results

A total of 136 IBD patients had IgG/G1 levels checked and adequate follow-up, 58 (42.6 %) with normal IgG/G1 levels and 78 (57.4 %) having low levels. A total of 49 patients (62.8 %) with low immunoglobulin levels had IBD-related surgeries or hospitalizations, compared to 33 patients (56.9 %) with normal levels [odds ratio (OR) 1.28, 95 % confidence interval (CI) 0.64–2.56; p = 0.49]. Low IgG/G1 levels were associated with IBD-related surgery in CD in univariate analysis [hazard ratio (HR) 4.42, 95 % CI 1.02–19.23; p = 0.048] and in Kaplan–Meier survival curve analysis (p = 0.03), with a trend toward significance on multivariate analysis (HR 3.07, 95 % CI 0.67–14.31; p = 0.15). IBD patients with low IgG/G1 levels required more small bowel resections (12.8 vs. 1.7 %, p = 0.024) and 5-aminosalicylate initiations (28.2 vs. 13.8 %, p = 0.045).

Conclusions

Our study demonstrated a possible association between low IgG/G1 levels and poor outcomes in CD including surgery. Future implications include using immunoglobulin levels in IBD patients as a prognostic indicator or boosting humoral immunity as a treatment in this subset.



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Seeking the Cecum: Assessing Metrics in Fellow Procedural Training



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Development of an Inflammatory Bowel Disease Research Registry Derived from Observational Electronic Health Record Data for Comprehensive Clinical Phenotyping

Abstract

Background

Inflammatory bowel disease (IBD) is a heterogeneous collection of chronic inflammatory disorders of the digestive tract. Clinical, genetic, and pathological heterogeneity makes it increasingly difficult to translate efficacy studies into real-world practice. Our objective was to develop a comprehensive natural history registry derived from multi-year observational data to facilitate effectiveness and clinical phenotypic research in IBD.

Methods

A longitudinal, consented registry with prospectively collected data was developed at UPMC. All adult IBD patients receiving care at the tertiary care center of UPMC are eligible for enrollment. Detailed data in the electronic health record are accessible for registry research purposes. Data are exported directly from the electronic health record and temporally organized for research.

Results

To date, there are over 2565 patients participating in the IBD research registry. All patients have demographic data, clinical disease characteristics, and disease course data including healthcare utilization, laboratory values, health-related questionnaires quantifying disease activity and quality of life, and analytical information on treatment, temporally organized for 6 years (2009–2015). The data have resulted in a detailed definition of clinical phenotypes suitable for association studies with parameters of disease outcomes and treatment response. We have established the infrastructure required to examine the effectiveness of treatment and disease course in the real-world setting of IBD.

Conclusions

The IBD research registry offers a unique opportunity to investigate clinical research questions regarding the natural course of the disease, phenotype association studies, effectiveness of treatment, and quality of care research.



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Improving and accelerating the differentiation and functional maturation of human stem cell-derived neurons: role of extracellular calcium and GABA

Abstract

Neurons differentiated from pluripotent stem cells using established neural culture conditions often exhibit functional deficits. Recently, we have developed enhanced media which both synchronise the neurogenesis of pluripotent stem cell-derived neural progenitors and accelerate their functional maturation; together these media are termed SynaptoJuice. This pair of media are pro-synaptogenic and generate authentic, mature synaptic networks of connected forebrain neurons from a variety of induced pluripotent and embryonic stem cell lines. Such enhanced rate and extent of synchronised maturation of pluripotent stem cell-derived neural progenitor cells generates neurons which are characterised by a relatively hyperpolarized resting membrane potential, higher spontaneous and induced action potential activity, enhanced synaptic activity, more complete development of a mature inhibitory GABAA receptor phenotype and faster production of electrical network activity when compared to standard differentiation media. This entire process - from pre-patterned neural progenitor to active neuron - takes 3 weeks or less, making it an ideal platform for drug discovery and disease modelling in the fields of human neurodegenerative and neuropsychiatric disorders, such as Huntington's disease, Parkinson's disease, Alzheimer's disease or Schizophrenia.

This article is protected by copyright. All rights reserved



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Impact of country of birth on age at the time of diagnosis of hepatocellular carcinoma in the United States

Cancer

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Outcomes following repeat hepatic resection for recurrent metastatic colorectal cancer: A population-based study

The American Journal of Surgery

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Mast cells are associated with the onset and progression of celiac disease

The Journal of Allergy and Clinical Immunology

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FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab for metastatic colorectal cancer (FIRE-3): A post-hoc analysis of tumour dynamics in the final wild-type subgroup of this randomised double-blind phase 3 trial

The Lancet Oncology

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Early primary biliary cholangitis is characterised by brain abnormalities on cerebral magnetic resonance imaging

Alimentary Pharmacology and Therapeutics

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Distinct pathways of pathogenesis of intraductal oncocytic papillary neoplasms and intraductal papillary mucinous neoplasms of the pancreas

Virchows Archiv

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Histopathological findings of extra-ileal manifestations at initial diagnosis of Crohns disease-related ileitis

Virchows Archiv

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Laparoscopic azygoportal disconnection with and without splenectomy for portal hypertension

International Journal of Surgery

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Assessment of Vitamin D status in a group of Egyptian children with non alcoholic fatty liver disease (multicenter study)

Nutrition & Metabolism

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Metabolic dysfunction, obesity, and survival among patients with early-stage colorectal cancer

Journal of Clinical Oncology

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Improved detection of recurrent hepatocellular carcinomas in arterial phase with CAIPIRINHA-Dixon-TWIST-volumetric interpolated breath-hold examination

Investigative Radiology

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FORMULATION AND EVALUATION OF FAST MOUTH DISSOLVING CHEWABLE TABLET OF ALBENDAZOLE

2016-09-12T01-57-19Z
Source: Indo American Journal of Pharmaceutical Research
Dr. O. G. Bhusnure*, Shaikh Faisal Ekbal, Mane Jyoti, Sayyed Sarfaraz Ali, Hucche Bhimashankar, Surkute Ganesh.
Fast dissolving tablet format is designed to allow administration of an oral solid dose form in the absence of water or fluid intake. Such tablets readily dissolve or disintegrate in the saliva. Albendazole is anthalmentic agent which is used in disease like worms. As a vermicidal,albendazole causes degenerative alterations in the intestinal cells of the worm by binding to the colchicine-sensitive site of tubulin, thus inhibiting its polymerization or assembly into microtubules. It is a BCS class II drug. It exhibits poor bioavailability of about

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DEVELOPMENT OF VALIDATED SPECTROFLUORIMETRIC METHOD FOR THE ESTIMATION OF BUCLIZINE HYDROCHLORIDE FROM THE TABLET DOSAGE FORM

2016-09-12T01-57-19Z
Source: Indo American Journal of Pharmaceutical Research
A. Suganthi*, A. Fathimunnisa, S. Sumithra and T.K. Ravi.
Buclizine hydrochloride from its tablet dosage form was estimated by developing a novel validated indirect spectrofluorimetric method. Here the Buclizine hydrochloride was derivatized into nitro compound using nitrating mixture with an aid of heat which showed good fluorescence in water at 446 nm after excited at 350 nm. The calibration graph showed linear over the range 200-1000 ng/ml. The assay of buclizine hydrochloride in marketed formulations was found to be 98.96 ± 0.1586. Recovery values were close to 100% with the % RSD values of 0.432% and 0.673% at 50% and 100% level respectively. From the results of validation it was observed that the method was found to be simple, accurate, sensitive and reproducible. Hence the proposed method can be used for routine quality control analysis.


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