Super entrainment of muscle sympathetic nerve activity during sinusoidal galvanic vestibular stimulation

Sinusoidal galvanic vestibular stimulation (sGVS), delivered at frequencies ranging from 0.08-2.0 Hz, induces vestibular illusions of side-to-side motion and robust modulation of muscle sympathetic nerve activity (MSNA) to the lower legs. We have previously documented, in seated subjects, de novo synthesis of bursts of MSNA that are temporally locked to the sinusoidal stimulus rather than to the cardiac-related rhythm. Here we tested the hypothesis that this vestibular entrainment of MSNA is higher in the upright than in the supine position. MSNA was recorded from the common peroneal nerve in 10 subjects lying on a tilt table. Bipolar binaural sinusoidal GVS (±2 mA, 200 cycles) was applied to the mastoid processes at 0.2, 0.8 and 1.4 Hz in the supine and upright (75°) positions. In four subjects, super entrainment of MSNA occurred during sGVS, with strong bursts locked to one phase of the sinusoidal stimulus. This occurred more prominently in the upright position. On average, cross-correlation analysis revealed comparable vestibular modulation of MSNA in both positions at 0.2 Hz (84.9 ± 3.6 % and 78.7 ± 5.7 %), 0.8 Hz (77.4 ± 3.9 % and 74.4 ± 8.9 %), and 1.4 Hz (69.8 ± 4.6 % and 80.2 ± 7.4 %). However, in the supine position, there was a significant linear fall in the magnitude of vestibular modulation with increasing frequency, whereas this was not present in the upright position. We conclude that vestibular contributions to the control of blood pressure are higher in the upright position.

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Dissociable roles of preSMA in motor sequence chunking and hand switching - a TMS study

Motor chunking, grouping of individual movements into larger units, is crucial for sequential motor performance. The pre-supplementary motor area (preSMA) is involved in chunking and in other related processes such as task-switching, response-selection, and response inhibition, that are crucial for organizing sequential movements. However, previous studies have not systematically differentiated the pre-SMA's role in motor chunking and hand-switching, thus leaving its relative contribution to each of these processes unclear. The aim of this study is to demonstrate the differential role of preSMA in motor chunking and hand-switching. We designed motor sequences in which different kinds of hand-switches (switching towards the right or left hand or continuing with the right hand) were counterbalanced across between- and within-chunk sequence points. 18 healthy, right-handed participants practiced four short sub-sequences (chunks) of key-presses. In a subsequent task, these chunks had to be concatenated into one long sequence. We applied double-pulse TMS over left preSMA or left M1, at sequence initiation, between chunks, or within chunks. TMS over left preSMA significantly slowed the next response when stimulation was given between chunks, but only if a hand-switch towards the contralateral (right) hand was required. PreSMA stimulation within chunks did not interfere with responses. TMS over left M1 delayed responses with the contralateral hand, both within and between chunks. Both preSMA and M1 stimulation decreased response times at sequence initiation. These results suggest that left preSMA is not necessary for chunking per se, but rather for organizing more complex movements that require chunking and hand-switching simultaneously.

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A switching cost for motor planning

Movement planning consists in choosing the intended endpoint of the movement and selecting the motor program that will bring the effector on the endpoint. It is widely accepted that movement endpoint is updated on a trial-by-trial basis with respect to the observed errors and that the motor program for a given movement follows the rules of optimal feedback control. Here, we show clear limitations of these theories. First, participants could not tune their motor program appropriately for each individual trial. This was true even when the participants selected the width of the target that they reached toward or when they had learned the appropriate motor program previously. These data are compatible with the existence of a switching cost for motor planning, which relates to the drop of performance due to an imposed switch of motor programs. This cost of switching shares many features of costs reported in cognitive task switching experiments and, when tested in the same participants, was correlated with it. Second, we found that randomly changing the width of a target over the course of a reaching experiment prevents the motor system from updating the endpoint of movements on the basis of the performance on the previous trial if the width of the target has changed. These results provide new insights into the process of motor planning and how it relates to optimal control theory and to an action selection based on the reward consequences of the motor program rather than based on the observed error.

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Physiology and Anatomy of Neurons in the Medial Superior Olive (MSO) of the Mouse

In mammals with good low frequency hearing, the medial superior olive (MSO) computes sound location by comparing differences in the arrival time of a sound at each ear, called interaural time disparities (ITDs). Low frequency sounds are not reflected by the head and therefore level differences and spectral cues are minimal or absent leaving ITDs as the only cue for sound localization. Although mammals with high frequency hearing and small heads (e.g. bats, mice) barely experience ITDs, the MSO is still present in these animals. Yet, aside from studies in specialized bats, in which the MSO appears to serve functions other than ITD processing, it has not been studied in small mammals that do not hear low frequencies. Here we describe neurons in the mouse brainstem that share prominent anatomical, morphological and physiological properties with the MSO in species known to use ITDs for sound localization. However, these neurons also deviate in some important aspects from the typical MSO, including a less refined arrangement of cell bodies, dendrites and synaptic inputs. In vitro, the vast majority of neurons exhibited a single, onset action potential in response to suprathreshold depolarization. This spiking pattern is typical of MSO neurons in other species and is generated from a complement of Kv1, Kv3 and I_H currents. In vivo, mouse MSO neurons show bilateral excitatory and inhibitory tuning as well as an improvement in temporal acuity of spiking during bilateral acoustic stimulation. The combination of classical MSO features like those observed in gerbils combined with more unique features similar to those observed in bats and opossums make the mouse MSO an interesting model for exploiting genetic tools to test hypotheses about the molecular mechanisms and evolution of ITD processing.

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Circuits for Presaccadic Visual Remapping

Saccadic eye movements rapidly displace the image of the world that is projected onto the retinas. In anticipation of each saccade, many neurons in the visual system shift their receptive fields. This presaccadic change in visual sensitivity, known as remapping, was first documented in the parietal cortex and has been studied in many other brain regions. Remapping requires information about upcoming saccades via corollary discharge. Analyses of neurons in a corollary discharge pathway that targets the frontal eye field (FEF) suggest that remapping may be assembled in the FEF's local microcircuitry. Complementary data from reversible inactivation, neural recording, and modeling studies provide evidence that remapping contributes to transsaccadic continuity of action and perception. Multiple forms of remapping have been reported in the FEF and other brain areas, however, and questions remain about reasons for these differences. In this review of recent progress, we identify three hypotheses that may help to guide further investigations into the structure and function of circuits for remapping.

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{alpha}7 nAChR agonist enhances neural plasticity in the hippocampus via a GABAergic circuit

Agonists of the α7 nicotinic acetylcholine receptor (α7 nAChR) have entered clinical trials as pro-cognitive agents for treating schizophrenia and Alzheimer's disease. The most advanced compounds are orthosteric agonists which occupy the ligand binding site. At the molecular level, agonist activation of α7 nAChRs is reasonably well understood. However, the consequences of activating α7 nAChRs on neural circuits underlying cognition remain elusive. Here we report that an α7 nAChR agonist (FRM-17848) enhances long-term potentiation (LTP) in rat septo-hippocampal slices far below the cellular EC₅₀, but at a concentration that coincides with multiple functional outcome measures as we reported in Stoiljkovic et al. In this same concentration range, we observed a significant increase in spontaneous gamma-aminobutyric acid (GABA) inhibitory postsynaptic currents and a moderate suppression of excitability in whole-cell recordings from rat CA1 pyramidal neurons. This modulation of GABAergic activity is necessary for the LTP-enhancing effects of FRM-17848, since inhibiting GABA_A α5 subunit-containing receptors fully reversed the effects of the α7 nAChR agonist. These data suggest that α7 nAChR agonists may increase synaptic plasticity in hippocampal slices, at least in part, through a circuit-level enhancement of a specific subtype of GABAergic receptor.

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Combined effects of resistance training and calorie restriction on mitochondrial fusion and fission proteins in rat skeletal muscle

Recent studies have demonstrated that resistance exercise leads not only to muscle hypertrophy, but it also improves mitochondrial function. Because calorie restriction (CR) has been suggested as a way to induce mitochondrial biogenesis, we examined the effects of resistance training with or without CR on muscle weight and key mitochondrial parameters in rat skeletal muscle. Four weeks of resistance training (thrice/wk) resulted in increased gastrocnemius muscle weight by 14% in rats fed ad libitum (AL). The degree of muscle-weight increase via resistance training was lower in rats with CR (7.4%). CR showed no effect on phosphorylation of mammalian target of rapamycin (mTOR) signaling proteins rpS6 and ULK1. Our results revealed that CR resulted in elevated levels of peroxisome proliferator-activated receptor- coactivator-1α (PGC-1α) protein, a known master regulator of mitochondrial biogenesis. Resistance training alone also resulted in increased PGC-1α levels in skeletal muscle. The magnitude of the increase in PGC-1α was similar in rats in both the CR and AL groups. Moreover, we found that resistance training with CR resulted in elevated levels of proteins involved in mitochondrial fusion (Opa1 and Mfn1), and oxidative phosphorylation, whereas there was no effect of CR on the fission-regulatory proteins Fis1 and Drp1. These results indicate that CR attenuates resistance training-induced muscle hypertrophy, and that it may enhance mitochondrial adaptations in skeletal muscle.

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Lipopolysaccharide exposure during the early postnatal period adversely affects the structure and function of the developing rat carotid body

The carotid body (CB) substantially influences breathing in premature infants by affecting the frequency of apnea and periodic breathing. In adult animals, inflammation alters the structure and chemosensitivity of the CB, yet it is not known if this pertains to neonates. We hypothesized that early postnatal inflammation leads to morphological and functional changes in the developing rat CB, which persists for 1 wk after the initial provoking insult. To test our hypothesis, we exposed rat pups at postnatal day 2 (P2) to lipopolysaccharide (LPS; 100 μg/kg) or saline (SAL) intraperitoneally. At P9-10 (1 wk after treatment), LPS-exposed animals had significantly more spontaneous intermittent hypoxic (IH) events, attenuated ventilatory responses to changes in oxygen tension (measured by whole body plethysmography), and attenuated hypoxic chemosensitivity of the carotid sinus nerve (measured in vitro), compared with SAL-exposed controls. These functional changes were associated with the following: 1) increased inflammatory cytokine mRNA levels; 2) decreased volume of supportive type II cells; and 3) elevated dopamine levels (a major inhibitory neuromodulator) within the CB. These findings suggest that early postnatal inflammation in newborn rats adversely affects the structure and function of the CB and is associated with increased frequency of intermittent desaturations, similar to the phenomenon observed in premature infants. Furthermore, this is the first newborn model of spontaneous intermittent desaturations that may be used to understand the mechanisms contributing to IH events in newborns.

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Membrane progesterone receptor-{beta}, but not -{alpha}, in dorsal brain stem establishes sex-specific chemoreflex responses and reduces apnea frequency in adult mice

We tested the hypothesis that membrane progesterone receptors (mPR) contribute to respiratory control in adult male and female mice. Mice were implanted with osmotic minipumps for continuous infusion of small interfering RNA (siRNA) directed against mPRα, mPRβ, or a control solution in the fourth ventricle (to target brain stem respiratory areas) for 14 days. We then performed respiratory and metabolic recordings by whole body plethysmography at rest and in response to hypoxia (12% O₂) or hypercapnia (5% CO₂, 5 min each). For each treatment, we have verified with immunohistochemistry that the staining intensity of mPRα or mPRβ in the brain stem is decreased. At rest, the siRNA against mPRα and mPRβ increased respiratory frequency in males only. The siRNA against mPRβ almost tripled the frequency of apneas in male and in female mice, while the siRNA against mPRα had no effect. Regarding respiratory chemoreflex, the siRNA against mPRβ suppressed the response to hypoxia in male and female mice and reduced by ~50% the response to hypercapnia, while the siRNA against mPRα had more limited effects. Interestingly, control females had higher ventilatory response to hypoxia and hypercapnia than males, and these sex-specific effects were suppressed by the siRNA against mPRβ, whereas they were still present after treatment with the siRNA against mPRα. We conclude that mPRβ reduces apnea frequency in male and female mice and establishes sex-specific ventilatory chemoreflex.

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Presence of dipalmitoylphosphatidylcholine from the lungs at the active hydrophobic spots in the vasculature where bubbles are formed on decompression

Most severe cases of decompression illness are caused by vascular bubbles. We showed that there are active hydrophobic spots (AHS) on the luminal aspect of ovine blood vessels where bubbles are produced after decompression. It has been suggested that AHS may be composed of lung surfactant. Dipalmitoylphosphatidylcholine (DPPC) is the main component of lung surfactants. Blood samples and four blood vessels, the aorta, superior vena cava, pulmonary vein, and pulmonary artery, were obtained from 11 slaughtered sheep. Following exposure to 1,013 kPa for 20.4 h, we started photographing the blood vessels 15 min after the end of decompression for a period of 30 min to determine AHS by observing bubble formation. Phospholipids were extracted from AHS and from control tissue and plasma for determination of DPPC. DPPC was found in all blood vessel samples and all samples of plasma. The concentration of DPPC in the plasma samples (n = 8) was 2.04 ± 0.90 μg/ml. The amount of DPPC in the AHS which produced four or more bubbles (n = 16) was 1.59 ± 0.92 μg. This was significantly higher than the value obtained for AHS producing less than four bubbles and for control samples (n = 19) (0.97 ± 0.61 μg, P = 0.027). DPPC leaks from the lungs into the blood, settling on the luminal aspect of the vasculature to create AHS. Determining the constituents of the AHS might pave the way for their removal, resulting in a dramatic improvement in diver safety.

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Testosterone inhibits expression of lipogenic genes in visceral fat by an estrogen-dependent mechanism

The influence of the aromatase enzyme on the chronic fat-sparing effects of testosterone requires further elucidation. Our purpose was to determine whether chronic anastrozole (AN, an aromatase inhibitor) treatment alters testosterone-mediated lipolytic/lipogenic gene expression in visceral fat. Ten-month-old Fischer 344 rats (n = 6/group) were subjected to sham surgery (SHAM), orchiectomy (ORX), ORX + treatment with testosterone enanthate (TEST, 7.0 mg/wk), or ORX + TEST + AN (0.5 mg/day), with drug treatment beginning 14 days postsurgery. At day 42, ORX animals exhibited nearly undetectable serum testosterone and 29% higher retroperitoneal fat mass than SHAM animals (P < 0.001). TEST produced a ~380-415% higher serum testosterone than SHAM (P < 0.001) and completely prevented ORX-induced visceral fat gain (P < 0.001). Retroperitoneal fat was 21% and 16% lower in ORX + TEST than SHAM (P < 0.001) and ORX + TEST + AN (P = 0.007) animals, while serum estradiol (E₂) was 62% (P = 0.024) and 87% (P = 0.010) higher, respectively. ORX stimulated lipogenic-related gene expression in visceral fat, demonstrated by ~84–154% higher sterol regulatory element-binding protein-1 (SREBP-1, P = 0.023), fatty acid synthase (P = 0.01), and LPL (P < 0.001) mRNA than SHAM animals, effects that were completely prevented in ORX + TEST animals (P < 0.01 vs. ORX for all). Fatty acid synthase (P = 0.061, trend) and LPL (P = 0.043) mRNA levels were lower in ORX + TEST + AN than ORX animals and not different from SHAM animals but remained higher than in ORX + TEST animals (P < 0.05). In contrast, the ORX-induced elevation in SREBP-1 mRNA was not prevented by TEST + AN, with SREBP-1 expression remaining ~117–171% higher than in SHAM and ORX + TEST animals (P < 0.01). Across groups, visceral fat mass and lipogenic-related gene expression were negatively associated with serum testosterone, but not E₂. Aromatase inhibition constrains testosterone-induced visceral fat loss and the downregulation of key lipogenic genes at the mRNA level, indicating that E₂ influences the visceral fat-sparing effects of testosterone.

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Effects of pacing modality on noninvasive assessment of heart rate dependency of indices of large artery function

Studies investigating the relationship between heart rate (HR) and arterial stiffness or wave reflections have commonly induced HR changes through in situ cardiac pacing. Although pacing produces consistent HR changes, hemodynamics can be different with different pacing modalities. Whether the differences affect the HR relationship with arterial stiffness or wave reflections is unknown. In the present study, 48 subjects [mean age, 78 ± 10 (SD), 9 women] with in situ cardiac pacemakers were paced at 60, 70, 80, 90, and 100 beats per min under atrial, atrioventricular, or ventricular pacing. At each paced HR, brachial cuff-based pulse wave analysis was used to determine central hemodynamic parameters, including ejection duration (ED) and augmentation index (AIx). Wave separation analysis was used to determine wave reflection magnitude (RM) and reflection index (RI). Arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV). Pacing modality was found to have significant effects on the HR relationship with ED (P = 0.01), central aortic pulse pressure (P = 0.01), augmentation pressure (P < 0.0001), and magnitudes of both forward and reflected waves (P = 0.05 and P = 0.003, respectively), but not cfPWV (P = 0.57) or AIx (P = 0.38). However, at a fixed HR, significant differences in pulse pressure amplification (P < 0.001), AIx (P < 0.0001), RM (P = 0.03), and RI (P = 0.03) were observed with different pacing modalities. These results demonstrate that although the HR relationships with arterial stiffness and systolic loading as measured by cfPWV and AIx were unaffected by pacing modality, it should still be taken into account for studies in which mixed pacing modalities are present, in particular, for wave reflection studies.

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Human motor control of landing from a drop in simulated microgravity

Landing on the ground on one's feet implies that the energy gained during the fall be dissipated. The aim of this study is to assess human motor control of landing in different conditions of fall initiation, simulated gravity, and sensory neural input. Six participants performed drop landings using a trapdoor system and landings from self-initiated counter-movement jumps in microgravity conditions simulated in a weightlessness environment by different pull-down forces of 1-, 0.6-, 0.4-, and 0.2 g. External forces applied to the body, orientation of the lower limb segments, and muscular activity of 6 lower limb muscles were recorded synchronously. Our results show that 1) subjects are able to land and stabilize in all experimental conditions; 2) prelanding muscular activity is always present, emphasizing the capacity of the central nervous system to approximate the instant of touchdown; 3) the kinetics and muscular activity are adjusted to the amount of energy gained during the fall; 4) the control of landing seems less finely controlled in drop landings as suggested by higher impact forces and loading rates, plus lower mechanical work done during landing for a given amount of energy to be dissipated. In conclusion, humans seem able to adapt the control of landing according to the amount of energy to be dissipated in an environment where sensory information is altered, even under conditions of non-self-initiated falls.

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Effect of betamethasone, surfactant, and positive end-expiratory pressures on lung aeration at birth in preterm rabbits

Antenatal glucocorticoids, exogenous surfactant, and positive end-expiratory pressure (PEEP) ventilation are commonly provided to preterm infants to enhance respiratory function after birth. It is unclear how these treatments interact to improve the transition to air-breathing at birth. We investigated the relative contribution of antenatal betamethasone, prophylactic surfactant, and PEEP (3 cmH₂O) on functional residual capacity (FRC) and dynamic lung compliance (C_DL) in preterm (28 day GA) rabbit kittens at birth. Kittens were delivered by cesarean section and mechanically ventilated. FRC was calculated from X-ray images, and C_DL was measured using plethysmography. Without betamethasone, PEEP increased FRC recruitment and C_DL. Surfactant did not further increase FRC, but significantly increased C_DL. Betamethasone abolished the benefit of PEEP on FRC, but surfactant counteracted this effect of betamethasone. These findings indicate that low PEEP levels are insufficient to establish FRC at birth following betamethasone treatment. However, surfactant reversed the effect of betamethasone and when combined, these two treatments enhanced FRC recruitment irrespective of PEEP level.

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Are Y o u Ready For The STORM ? Hodet Over Vann=Head Over (the) Water ...

"" We offer training in water rescue , river rescue and water safety , as well as a dealer rescue equipment and safety equipment. We also offer water activities,rafting&consulting -water safety and rescue. "" River rescue, water rescue, surface rescue , rescuer, Head Above Water: Lars Fossum - Tlf: +4792261844 Mail: lars@hodeovervann.no

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Are Y o u Ready For The STORM ? Hodet Over Vann=Head Over (the) Water ...

"" We offer training in water rescue , river rescue and water safety , as well as a dealer rescue equipment and safety equipment. We also offer water activities,rafting&consulting -water safety and rescue. "" River rescue, water rescue, surface rescue , rescuer, Head Above Water: Lars Fossum - Tlf: +4792261844 Mail: lars@hodeovervann.no

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Are Y o u Ready For The STORM ? Hodet Over Vann=Head Over (the) Water ...

"" We offer training in water rescue , river rescue and water safety , as well as a dealer rescue equipment and safety equipment. We also offer water activities,rafting&consulting -water safety and rescue. "" River rescue, water rescue, surface rescue , rescuer, Head Above Water: Lars Fossum - Tlf: +4792261844 Mail: lars@hodeovervann.no

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Winner Ambulance tender Norway:VW Amarok

"Volkswagen Amarok was simply the best in all categories, but yes, we were surprised even then it was left as the winner. The car has many advantages, -a good weight reserve, which means that there is a lot of weight to go on a stretcher, passengers, patients and equipment.-Very effective to load in and out of, and it is good for noise in the patient compartment, says project leader for procurement of Health Innkjøpsservice (PSHE), Kjetil Sønvis. Amarok won the tender in class less than 3.5 tonnes in competition with trotters as Volkswagen Caravelle. The cars are rebuilt in Finland, and can be run with regular certificate. All the cars get all-wheel drive and diesel engine. - However, had they been able to offer it, we had ordered some with 2 wheel drive and petrol engine too, he says."" https://www.youtube.com/watch?v=cWoGzlTXQ9Y https://youtube/LN_WwgTo9As ExEMTNor

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To be g o o d , you must train - A l o t t ..!Camp Torpomoen

Training cost money... ( A 135 took a bath some years ago,during training,water-jobs :-/ -Crew OK:-) ).It is staff, time to train, helos. enough for all bases to have serviced machines att anny time, and a dedicated training-helo, for use att training-base, or touring lokal bases, for shorter training sessions, around contry. The Gov. pays for the daily operation, but members pay for mutch of "the extra" ... Permanent trainig base, Hiering the best experts from around the world, to learn more in different skills, research, Response-car for all crews on stand-by, more... Like "HEMSwx"-Cameras:Advanced weather camera with two/three DSLR Cameras.Taking pics. every quarter.Images sent via mobile net.to all air ambulance bases in country.Images on big screen on bases operating theaters or on tablet / smartphone.Provides very good pictures,especially at night.Also provides info. on temperature and airpressure.Today,deployed 32"HEMSwx"Cams. across country,goal=40 more w.i.this year.ExEMTNo

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Are Y o u Ready For The STORM ? Hodet Over Vann=Head Over (the) Water ...

"" We offer training in water rescue , river rescue and water safety , as well as a dealer rescue equipment and safety equipment. We also offer water activities,rafting&consulting -water safety and rescue. "" River rescue, water rescue, surface rescue , rescuer, Head Above Water: Lars Fossum - Tlf: +4792261844 Mail: lars@hodeovervann.no

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Winner Ambulance tender Norway:VW Amarok

"Volkswagen Amarok was simply the best in all categories, but yes, we were surprised even then it was left as the winner. The car has many advantages, -a good weight reserve, which means that there is a lot of weight to go on a stretcher, passengers, patients and equipment.-Very effective to load in and out of, and it is good for noise in the patient compartment, says project leader for procurement of Health Innkjøpsservice (PSHE), Kjetil Sønvis. Amarok won the tender in class less than 3.5 tonnes in competition with trotters as Volkswagen Caravelle. The cars are rebuilt in Finland, and can be run with regular certificate. All the cars get all-wheel drive and diesel engine. - However, had they been able to offer it, we had ordered some with 2 wheel drive and petrol engine too, he says."" https://www.youtube.com/watch?v=cWoGzlTXQ9Y https://youtube/LN_WwgTo9As ExEMTNor

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To be g o o d , you must train - A l o t t ..!Camp Torpomoen

Training cost money... ( A 135 took a bath some years ago,during training,water-jobs :-/ -Crew OK:-) ).It is staff, time to train, helos. enough for all bases to have serviced machines att anny time, and a dedicated training-helo, for use att training-base, or touring lokal bases, for shorter training sessions, around contry. The Gov. pays for the daily operation, but members pay for mutch of "the extra" ... Permanent trainig base, Hiering the best experts from around the world, to learn more in different skills, research, Response-car for all crews on stand-by, more... Like "HEMSwx"-Cameras:Advanced weather camera with two/three DSLR Cameras.Taking pics. every quarter.Images sent via mobile net.to all air ambulance bases in country.Images on big screen on bases operating theaters or on tablet / smartphone.Provides very good pictures,especially at night.Also provides info. on temperature and airpressure.Today,deployed 32"HEMSwx"Cams. across country,goal=40 more w.i.this year.ExEMTNo

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Winner Ambulance tender Norway:VW Amarok

"Volkswagen Amarok was simply the best in all categories, but yes, we were surprised even then it was left as the winner. The car has many advantages, -a good weight reserve, which means that there is a lot of weight to go on a stretcher, passengers, patients and equipment.-Very effective to load in and out of, and it is good for noise in the patient compartment, says project leader for procurement of Health Innkjøpsservice (PSHE), Kjetil Sønvis. Amarok won the tender in class less than 3.5 tonnes in competition with trotters as Volkswagen Caravelle. The cars are rebuilt in Finland, and can be run with regular certificate. All the cars get all-wheel drive and diesel engine. - However, had they been able to offer it, we had ordered some with 2 wheel drive and petrol engine too, he says."" https://www.youtube.com/watch?v=cWoGzlTXQ9Y https://youtube/LN_WwgTo9As ExEMTNor

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To be g o o d , you must train - A l o t t ..!Camp Torpomoen

Training cost money... ( A 135 took a bath some years ago,during training,water-jobs :-/ -Crew OK:-) ).It is staff, time to train, helos. enough for all bases to have serviced machines att anny time, and a dedicated training-helo, for use att training-base, or touring lokal bases, for shorter training sessions, around contry. The Gov. pays for the daily operation, but members pay for mutch of "the extra" ... Permanent trainig base, Hiering the best experts from around the world, to learn more in different skills, research, Response-car for all crews on stand-by, more... Like "HEMSwx"-Cameras:Advanced weather camera with two/three DSLR Cameras.Taking pics. every quarter.Images sent via mobile net.to all air ambulance bases in country.Images on big screen on bases operating theaters or on tablet / smartphone.Provides very good pictures,especially at night.Also provides info. on temperature and airpressure.Today,deployed 32"HEMSwx"Cams. across country,goal=40 more w.i.this year.ExEMTNo

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Winner Ambulance tender Norway:VW Amarok

"Volkswagen Amarok was simply the best in all categories, but yes, we were surprised even then it was left as the winner. The car has many advantages, -a good weight reserve, which means that there is a lot of weight to go on a stretcher, passengers, patients and equipment.-Very effective to load in and out of, and it is good for noise in the patient compartment, says project leader for procurement of Health Innkjøpsservice (PSHE), Kjetil Sønvis. Amarok won the tender in class less than 3.5 tonnes in competition with trotters as Volkswagen Caravelle. The cars are rebuilt in Finland, and can be run with regular certificate. All the cars get all-wheel drive and diesel engine. - However, had they been able to offer it, we had ordered some with 2 wheel drive and petrol engine too, he says."" https://www.youtube.com/watch?v=cWoGzlTXQ9Y https://youtube/LN_WwgTo9As ExEMTNor

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To be g o o d , you must train - A l o t t ..!Camp Torpomoen

Training cost money... ( A 135 took a bath some years ago,during training,water-jobs :-/ -Crew OK:-) ).It is staff, time to train, helos. enough for all bases to have serviced machines att anny time, and a dedicated training-helo, for use att training-base, or touring lokal bases, for shorter training sessions, around contry. The Gov. pays for the daily operation, but members pay for mutch of "the extra" ... Permanent trainig base, Hiering the best experts from around the world, to learn more in different skills, research, Response-car for all crews on stand-by, more... Like "HEMSwx"-Cameras:Advanced weather camera with two/three DSLR Cameras.Taking pics. every quarter.Images sent via mobile net.to all air ambulance bases in country.Images on big screen on bases operating theaters or on tablet / smartphone.Provides very good pictures,especially at night.Also provides info. on temperature and airpressure.Today,deployed 32"HEMSwx"Cams. across country,goal=40 more w.i.this year.ExEMTNo

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Standard triple therapy versus sequential therapy for eradication of Helicobacter pylori in treatment naïve and retreat patients

Publication date: Available online 21 September 2016
Source:Arab Journal of Gastroenterology
Author(s): Adnan Abuhammour, Asad Dajani, Mohammed Nounou, Mohammed Zakaria
Background and study aimsUntreated Helicobacter pylori infection causes increased risk of gastric cancer, GI morbidity and mortality. Standard treatment for eradication of Helicobacter pylori infection, is the triple therapy which consists of a proton pump inhibitor; together with two antibiotics (amoxicillin 1000mg with clarithromycin 500mg or metronidazole 400mg) given twice daily for 7–14days. Recent evidence revealed, that cure rates of Helicobacter pylori infection with triple therapy had fallen below satisfactory targets. Sequential therapy consisting of a twice daily dose of a PPI for ten days with Amoxicillin given at 1000mg twice daily in the first 5days followed by clarithromycin 500mg and Metronidazole 400mg given twice daily in the subsequent 5days, was recommended to improve eradication rates. We performed a randomised open label study to compare the efficacy of sequential against triple therapy in Helicobacter pylori naive and retreat patients.Patients and methodsIn a randomised open label observational study 485 patients fulfilling inclusion and exclusion criteria were randomly assigned to be treated with triple therapy (n=231) or sequential therapy (n=254). Eradication of Helicobacter pylori was documented with ¹⁴C Urea breath test (UBT) performed 6weeks after the treatment.ResultsThe intention-to-treat eradication rate was better in sequential therapy group 84.6% than triple therapy 68% (p<0.001). Eradication rates were significantly higher for treatment naive than retreat patients in triple therapy group (70.5% and 58.3%, respectively, p<0.01). A trend of a better response was observed in eradication rate for treatment naive 88.55% versus retreat 74.6% in sequential therapy group but was not statistically significant (p=0.76). Compliance was similar in the two groups, however side effects were less and the clinical response was better in the sequential therapy group.



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Endoscopic ultrasonography-guided drainage combined with trans-duodenoscope cyclic irrigation technique for walled-off pancreatic necrosis

Endoscopic ultrasonography-guided drainage has been established as a good treatment modality in the management of walled-off pancreatic necrosis, but the unmanageable infection of postoperation is still a thorny problem due to the poor drainage ability for solid necrotic debris only through transmural stent and nasocystic catheter.

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Frequency of thiopurine methyltransferase mutation in patients of Mediterranean area with inflammatory bowel disease and autoimmune disorders

Few studies exist on the frequency of thiopurine methyltransferase (TPMT) mutation in patients from Southern Europe. We aimed to evaluate the frequency of TPMT mutation in a homogeneous Sicilian cohort of patients with inflammatory bowel disease (IBD), autoimmune and hematological disorders, the rate of thiopurine-related adverse events, and its association with the TPMT genotype.

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Implementation and adherence to osteoporosis screening guidelines among coeliac disease patients

There are no studies evaluating the implementation of American Gastroenterological Association (AGA) guidelines on osteoporosis screening in coeliac disease.

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A multicenter study of blood component transfusion in patients with liver cirrhosis in China: Patient characteristics, transfusion practice, and outcomes

Cirrhosis is a complex acquired disorder of hemostasis and patients frequently receive blood transfusions. But there is very limited data on patterns of blood use at a patient level.

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An unusual cause of cervical kyphosis

Acute fixed cervical kyphosis may be a rare presentation of conversion disorder, psychogenic dystonia, and potentially as a side effect from typical antipsychotic drugs. Haldol has been associated with acute dystonic reactions. In some cases, rigid deformities ensue. We are reporting a case of a fixed cervical kyphosis after the use of Haldol.

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Patient knowledge regarding radiation exposure from spinal imaging

Spine surgeons employ a high volume of imaging in the diagnosis and evaluation of spinal pathology. However, little is known regarding patients' knowledge of the radiation exposure associated with these imaging techniques.

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Quiescent Pluripotent Stem Cells Reside within Murine Peripheral Nerves that Can Be Stimulated to Proliferate by rhBMP-2 or by Nerve Trauma

The clinical use of recombinant human bone morphogenic protein 2 (rhBMP-2, Infuse®) has been associated with nerve related complications including new-onset sciatica, and retrograde ejaculation

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Independent Predictors of a Clinically Significant Improvement After Lumbar Fusion Surgery

Multiple studies have determined minimum clinically important difference (MCID) thresholds for EuroQOL-5 Dimensions (EQ-5D) scores in lumbar fusion patients. However, a comprehensive understanding of predictors for a CSI postoperatively does not exist.

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What is the optimal cut-off value of the axis-line-angle technique for evaluating trunk imbalance in coronal plane?

Accurately evaluating the extent of trunk imbalance in the coronal plane is significant for patients before and after treatment. We preliminarily practiced a new method, axis-line-angle technique (ALAT), for evaluating coronal trunk imbalance with excellent intrao-bserver and inter-observer reliability. Radiologists and surgeons were encouraged to use this method in clinic. However, the optimal cut-off value of ALAT, determined the extent of coronal trunk imbalance, has not been calculated up to now.

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Unusual presentation of osteoblastoma as vertebra plana – a case report and review of literature:

Osteoblastoma is rare and accounts for 3% of all benign tumours and 1% of all bone tumours. The spine is the most common site of occurrence, constituting 32 to 45 % of all osteoblastomas. It has a strong predilection for the posterior elements, most often occurring in the lumbar spine.

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Disparities in reportable quality metrics by insurance status in the primary spine neoplasm population

Retrospective cohort study.

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The Craig Hospital Eye Evaluation Rating Scale – CHEERS

Oculomotor deficits in smooth pursuit, saccades, vestibular-ocular reflex (VOR), vergence and fixation are common problems seen after moderate to severe traumatic brain injury (TBI). No scale currently exists to rate these all together. The CHEERS (Craig Hospital Eye Evaluation Rating Scale) was designed to systematically quantify frequency and severity of eye movement deficits in TBI.

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Activity Limitation Stages Are Associated with Hospitalization Risk among Medicare Beneficiaries

Activity limitation stages based on activities of daily living (ADLs) and instrumental activities of daily living (IADLs) are associated with 3-year mortality in elderly Medicare beneficiaries, yet their associations with hospitalization risk in this population have not been studied.

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Rehabilitation Trends after Lower-Extremity Amputations in Canada

The heterogeneity of medical complications that lead to amputation has resulted in a diverse patient population with differing rehabilitation needs. However, the rehabilitation trends for patients with lower-extremity amputations across Canada have not been previously studied.

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Evaluating the functionality and usability of two novel wheelchair anti-rollback devices for ramp ascent in manual wheelchair users with spinal cord injury

Difficulty ascending ramps and inclines with a manual wheelchair adversely impacts everyday mobility and overall quality of life of manual wheelchair users. Currently, various anti-rollback devices are available to assist manual wheelchair users to ascend ramps and inclines. However, these devices have two main shortcomings, (i) restriction to backward motion limiting recovery from an overturning wheelie which is a safety concern and, (ii) difficulty in engaging/disengaging the device while on ramp.

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Endoscopic ultrasonography-guided drainage combined with trans-duodenoscope cyclic irrigation technique for walled-off pancreatic necrosis

Endoscopic ultrasonography-guided drainage has been established as a good treatment modality in the management of walled-off pancreatic necrosis, but the unmanageable infection of postoperation is still a thorny problem due to the poor drainage ability for solid necrotic debris only through transmural stent and nasocystic catheter.

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Frequency of thiopurine methyltransferase mutation in patients of Mediterranean area with inflammatory bowel disease and autoimmune disorders

Few studies exist on the frequency of thiopurine methyltransferase (TPMT) mutation in patients from Southern Europe. We aimed to evaluate the frequency of TPMT mutation in a homogeneous Sicilian cohort of patients with inflammatory bowel disease (IBD), autoimmune and hematological disorders, the rate of thiopurine-related adverse events, and its association with the TPMT genotype.

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Implementation and adherence to osteoporosis screening guidelines among coeliac disease patients

There are no studies evaluating the implementation of American Gastroenterological Association (AGA) guidelines on osteoporosis screening in coeliac disease.

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A multicenter study of blood component transfusion in patients with liver cirrhosis in China: Patient characteristics, transfusion practice, and outcomes

Cirrhosis is a complex acquired disorder of hemostasis and patients frequently receive blood transfusions. But there is very limited data on patterns of blood use at a patient level.

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A mutation in ADIPOR1 causes nonsyndromic autosomal dominant retinitis pigmentosa

Abstract

Retinitis pigmentosa (RP) is a clinically and genetically heterogeneous disorder characterized by night blindness, visual field constriction, and severely reduced visual acuity. Despite a number of genes being implicated in RP pathogenesis, the genetic etiology of the disease remains unknown in many patients. In this study, our aim was to identify the disease-causing mutation of a large Chinese family with autosomal dominant RP (adRP). Targeted exon capture sequencing was initially performed to screen mutations in known disease-causing genes, followed by exome sequencing. In doing so, a heterozygous mutation in ADIPOR1 (c.929A > G) that results in an amino acid substitution (p.Y310C) was identified to co-segregate with the disease phenotype in this family. Adipor1 is wildly expressed throughout the body, but appears to be enriched in the photoreceptor inner and outer segments. The p.Y310C mutation, predicted to affect the structure and function of the protein, was confirmed to affect protein folding and its subcellular localization in vitro. In addition, knockdown of adipor1 expression in a zebrafish model with morpholino (MO) preferentially reduced the number of rod photoreceptors, with no effect on the number of cones, a phenotype that is characteristic of RP. Furthermore, the knockdown phenotype was partially rescued by injecting wild-type, but not mutant, human ADIPOR1 mRNA. We conclude that ADIPOR1 is a novel adRP-causing gene and plays an important role in rod development and maintenance.

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Antibacterial synergy between Rosmarinic acid and antibiotics against Methicillin resistant Staphylococcus aureus

2016-09-21T13-13-14Z
Source: Journal of Intercultural Ethnopharmacology
Sanmuga Priya Ekambaram, Senthamil Selvan Perumal, Ajay Balakrishnan, Nathiya Marappan, Sabari Srinivasan Gajendran, Vinodhini Viswanathan.
Aim/Background: Medicinal plants have ability to resist microorganisms by synthesizing secondary metabolites such as phenols. Rosmarinic acid (RA) is a phenylpropanoid widely distributed in plants and well known as therapeutic and cosmetic agent. Methicillin-resistant Staphylococcus aureus (MRSA) which is resistant to all kinds of β-lactams, threatens even most potent antibiotics. To improve efficiency of antibiotics against multi-drug resistant bacteria and to reduce the antibiotic dose, the antibacterial activity and the synergistic effect of rosmarinic acid with standard antibiotics against Staphylococcus aureus (S. aureus) and MRSA was investigated. Materials and Methods: Antibacterial activity of RA against S. aureus and clinical isolate of MRSA was evaluated by agar well diffusion method. Minimum inhibitory concentration (MIC) of RA was determined by broth dilution method. Synergism of RA with various antibiotics against S. aureus and MRSA was studied by broth checker board method and time kill kinetic assay. Effect of RA on MSCRAMMs (Microbial Surface Components Recognising Adhesive Matrix Molecules) of S. aureus and MRSA was studied using sodium dodecyl sulphate - polyacrylamide gel electrophoresis (SDS-PAGE). Results: MIC of RA was found to be 0.8 mg/ml and 10 mg/ml against S. aureus and MRSA respectively. RA was synergistic with vancomycin, ofloxacin and amoxicillin against S. aureus and only with vancomycin against MRSA. The time kill analysis revealed that synergistic combinations were more effective than individual antibiotics. MSCRAMMs protein expression of S. aureus and MRSA was markedly suppressed by RA + vancomycin combination rather than RA alone. Conclusion: The synergistic effects of RA with antibiotics were observed against S. aureus and MRSA. RA showed inhibitory effect on the surface proteins MSCRAMMs. Even though RA was shown to exhibit synergistic effect with antibiotics, the MIC was found to be higher. Thus further studies on increasing the efficacy of RA can develop it as an adjuvant for antibiotics.


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Evaluation of Anti-epileptic activity of Leaf extracts of Punica granatum on experimental models of epilepsy in mice

2016-09-21T13-13-14Z
Source: Journal of Intercultural Ethnopharmacology
Gollapalle L Viswanatha, Marikunte V Venkataranganna, NBL Prasad Prasad, Godavarthi Ashok.
Aims: This study was aimed to examine the anti-epileptic activity of leaf extracts of Punica granatum in experimental models of epilepsy in swiss albino mice. Methods: Petroleum ether (PLPG), methanolic (MLPG) and aqueous (ALPG) extracts of Punica granatum leaves were initially evaluated against 6-Hz-induced seizure model, the potent extract was further evaluated against maximal electroshock (MES) and pentylenetetrazole (PTZ)-induced convulsions. Further, the potent extractwas evaluated for itsinfluence on Gamma amino butyric acid (GABA) levels in brain, to explore the possible mechanism of action. In addition, the potent extract was subjected to actophotometer test to assess its possible locomotor activity deficit inducing action. Results: In6-Hz seizure test, the MLPG has alleviated 6-Hz-induced seizures significantly and dose dependently at doses 50, 100, 200 and 400 mg/kg. In contrast, PLPG and ALPG did not show any protection, only high dose of ALPG (400 and 800 mg/kg, p.o.) showed very slight inhibition. Based on these observations only MLPG was tested in MES and PTZ models. Interestingly, the MLPG (50, 100, 200 and 400 mg/kg) has offered significant and dose dependent protection against MES (P


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Evaluation of the potential effect of Allium sativum, Momordica charantia, Eugenia jambolana, Ocimum sanctum and Psidium guajava on intestinal P-glycoprotein in rats

2016-09-21T13-13-14Z
Source: Journal of Intercultural Ethnopharmacology
Devendra Kumar, Neerja Trivedi, Rakesh K Dixit.
Aims/Background: This study was evaluated synergistic effect of Polyherbal formulation (PHF) of Allium sativum L., Eugenia jambolana Lam., Momordica charantia L., Ocimum sanctum Linn and Psidium guajava L on p-glycoprotein of intestine. These five herbs were traditionally used for diabetes. These herbs are commonly present in ayurvedic product as antidiabetics in India. Methodology: PHF was prepared by five indigenous herbs. Different doses (50, 100 and 200 mg/kg/day) of was orally administered to Sprague-Dawley rats of different groups for multiple weeks except control groups. Alteration in Pgp expression was evaluated by RT-PCR and western blotting while modulation in activity of Pgp was evaluated using rhodamine 123 as transport substrate by in-situ absorption and everted gut sac method. Results: In PHF pretreated group received 50, 100 and 200 mg/kg/day for seven days, mRNA level decreased by 1.75, 2.45 and 2.37 fold respectively as compared to control. Similarly when PHF at dose of 100 mg/kg/day was given consequently for four weeks maximum decrease in Pgp expression level was observed only after one week and further increase in the treatment duration did not produce significant decrease compared to first week treatment. Pgp mediated transport of rhodamine 123 was significantly decreased with everted gut sac prepared from PHF pretreated rats (one week) compared to those prepared from vehicle treated rats. Conclusions: In conclusion, we report that PHF pretreatment down regulated the expression of intestinal Pgp and this down regulated intestinal Pgp would result in decreased functional activity. Additionally this down regulated Pgp expression might affect the bioavailability of antidiabetic Pgp substrate drugs.


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Complications of endoscopic retrograde cholangiopancreatography in pediatric patients; a systematic literature review and meta-analysis

The Journal of Pediatrics

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Fecal Neutrophil Gelatinase Associated Lipocalin (NGAL) as a biomarker for inflammatory bowel disease

Journal of Gastroenterology and Hepatology

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The importance of a high rectal pressure on strain in constipated patients: Implications for biofeedback therapy

Neurogastroenterology & Motility

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Optimal stapler cartridge selection according to the thickness of the pancreas in distal pancreatectomy

Medicine

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Risk of intussusception with rotavirus vaccine

The Indian Journal of Pediatrics

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Ultrasound-guided percutaneous microwave ablation for hepatocellular carcinoma: Clinical outcomes and prognostic factors

Journal of Cancer Research & Clinical Oncology

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The predictive value of pre-endoscopic risk scores to predict adverse outcomes in emergency department patients with upper gastrointestinal bleeding – a systematic review

Academic Emergency Medicine

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Connecting cancer biology and clinical outcomes to imaging in KRAS mutant and wild-type colorectal cancer liver tumors following selective internal radiation therapy with yttrium-90

Abdominal Imaging

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Effective treatment of benign biliary strictures with a removable, fully covered, self-expandable metal stent: A prospective, multicenter European study

United European Gastroenterology Journal

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Antioxidants from stem bark of Kigelia africana inhibits free radicals and membrane lipid damage in rat testes in vitro

2016-09-21T02-03-52Z
Source: Oxidants and Antioxidants in Medical Science
Jacob K. Akintunde, Daniel G. Akintunde, Emmanuel A. Irondi, Kehinde Babaita, Ramat Labaika, Ojo Sunday.
Objective: Bioactive ingredients of plants have been used as a central source of medicine and chemo-therapies for centuries. Nevertheless, the quantification and characterization of phytochemicals in methanol extract stem bark of Kigelia africana (MESBKA) will be highly advantageous if found affirmative. Methods: MESBKA was taken for gas chromatography-mass spectrometry (GC-MS) analysis. Thereafter, its effect on pro-oxidant induced hydroxyl radical and lipid peroxidation in rat's testes was evaluated. Results: The GC-MS analysis provided four peaks of eighteen different active compounds. Also, MESBKA contains antioxidants (polyunsaturated fatty acids, esters and poly alcohols) which are prophylactics of hydroxyl radicals and inhibitors of cyclooxygenase-2 (COX-2) in the testes. Furthermore, MESBKA inhibited pro-oxidants induced hydroxyl radicals and lipid peroxidation in rat's testes in a dose-dependent manner. Conclusion: The antioxidant content of Kigelia africana could have prevented inflammatory responses to enhance male fertility in rat. Isolation and translation of individual components of the plant would help to find new drugs to cure and/or prevent male infertility.


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Multidirectional lip-closing force in adult females after short-term lip training

Summary

The purpose of this study was to investigate the multidirectional lip-closing force in adult females before and after short-term lip training. Sixty-six Japanese females participated in this study. The subjects performed lip training that involved maintaining 200 or 400 g of bottled water in the oral vestibule. The signals of directional lip-closing force were investigated in eight directions before training and 5 and 7 days after the lip training. The differences in the closing force between pre- and post-training were then analysed statistically. The lip-closing force increased in the following order: pre-training, 5 days post-training and 7 days post-training in every direction (P < 0·05). The patterns of the increase in the lip-closing force in the upper, lower, right and left directions as a result of the repetitions were similar. No significant differences were noted between the training effects with loads of 200 and 400 g. Our findings demonstrated that the lip-closing force was influenced by the short-term lip training.

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MiR-pharmacogenetics of methotrexate in childhood B-cell acute lymphoblastic leukemia.

Objectives: Methotrexate (MTX), the key drug in childhood B-cell acute lymphoblastic leukemia (B-ALL) therapy, often causes toxicity. An association between genetic variants in MTX transport genes and toxicity has been found. It is known that these transporters are regulated by microRNAs (miRNAs), and miRNA single nucleotide polymorphisms (SNPs) interfere with miRNA levels or function. With regard to B-cell ALL, we have previously found rs56103835 in miR-323b that targets ABCC4 associated with MTX plasma levels. Despite these evidences and that nowadays a large amount of new miRNAs have been annotated, studies of miRNA polymorphisms and MTX toxicity are almost absent. Therefore, the aim of this study was to determine whether there are other variants in miRNAs associated with MTX levels. Patients and methods: Blood samples of 167 Spanish patients with pediatric B-cell ALL treated with the LAL-SHOP protocol were analyzed. We selected all the SNPs described in pre-miRNAs with a minor allele frequency more than 1% (213 SNPs in 206 miRNAs) that could regulate MTX transporters because the miRNAs that target MTX transporter genes are not completely defined. Genotyping was performed with VeraCode GoldenGate platform. Results: Among the most significant results, we found rs56292801 in miR-5189, rs4909237 in miR-595, and rs78790512 in miR-6083 to be associated with MTX plasma levels. These miRNAs were predicted, in silico, to regulate genes involved in MTX uptake: SLC46A1, SLC19A1, and SLCO1A2. Conclusion: In this study, we detected three SNPs in miR-5189, miR-595, and miR-6083 that might affect SLC46A1, SLC19A1, and SLCO1A2 MTX transport gene regulation and could affect MTX levels in patients with pediatric B-cell ALL. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Treatment of Chilaiditi syndrome using laparoscopic surgery

Abstract

Chilaiditi syndrome is defined as the interposition of the bowel between the liver and right diaphragm. It is a rare disease and may be difficult to diagnose and manage. Treatment for asymptomatic patients with Chilaiditi is usually conservative and does not require surgical intervention, but surgery may be necessary if conservative treatment fails. This report describes a rare case of Chilaiditi syndrome causing small bowel obstruction and corrected using laparoscopic surgery.

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Bidirectional Approach of Video-Assisted Neck Surgery (BAVANS): Endoscopic complete central node dissection with craniocaudal view for treatment of thyroid cancer

Abstract

Introduction

Endoscopic thyroidectomy is a well-established surgical technique that is mainly performed for benign thyroid disease. We considered that endoscopic surgery could also be widely indicated for the treatment of thyroid cancer. We herein describe our new bidirectional approach of video-assisted neck surgery (BAVANS) for complete central node dissection in endoscopic thyroid cancer surgery.

Methods

BAVANS involves two different directional pathways to the cervical lesion. Before lymph node dissection, we perform endoscopic thyroidectomy via a conventional gasless precordial or axillary approach. After thyroidectomy, the surgeon repositions by the head of the patient and inserts three ports in front of the upper neck lesion in the submandibular area to approach the paratracheal lesion from an overhead-to-caudal direction.

Results

BAVANS allows for an excellent craniocaudal view and easy access to the peritracheal lymph nodes. Sixteen patients with papillary thyroid cancer underwent BAVANS and progressed satisfactorily after surgery. Of those patients, eight underwent total or near total thyroidectomy, and five patients underwent bilateral central node dissection. The average number of retrieved lymph nodes with unilateral central node dissection was nine, which was higher than that achieved with conventional open surgery. All patients began oral intake within 5 h after surgery. Postoperative Horner syndrome occurred in one patient. No other complications were noted.

Conclusions

BAVANS is a very effective surgical procedure that many endoscopic surgeons can perform safely and easily. It has both a cosmetic advantage and excellent curability in endoscopic thyroid cancer surgery.

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Combined assessment using optical colonoscopy and computed tomographic colonography improves the determination of tumor location and invasion depth

Abstract

Introduction

An accurate assessment of the depth of tumor invasion in patients with colon cancer is an important part of the preoperative evaluation. Whether computed tomographic colonography (CTC) or optical colonoscopy (OC) is better to accurately determine tumor location and invasion depth has not been definitively determined. The aim of this study was to determine the diagnostic accuracy of tumor localization and tumor invasion depth of colon cancer by preoperative OC alone or combined with CTC.

Methods

Study participants include 143 patients who underwent both preoperative CTC using automated CO₂ insufflation and OC from July 2012 to August 2013.

Results

The accuracy of tumor localization was significantly better with CTC than with OC (OC, 90%; CTC, 98%; P < 0.05). No tumor in the descending colon was localized accurately via OC alone. The accuracy of tumor invasion depth was better with CTC plus OC than with OC alone (OC, 55%; CTC, 73%; P < 0.05).

Conclusions

OC combined with CTC provides a more accurate preoperative determination of tumor localization and invasion depth than OC alone.

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Hypertension After Severe Traumatic Brain Injury: Friend or Foe?.

Traumatic brain injury (TBI) is a major public health problem, with severe TBI contributing to a large number of deaths and disability worldwide. Early hypotension has been linked with poor outcomes following severe TBI, and guidelines suggest early and aggressive management of hypotension after TBI. Despite these recommendations, no guidelines exist for the management of hypertension after severe TBI, although observational data suggests that early hypertension is also associated with an increased risk of mortality after severe TBI. The purpose of this review is to discuss the underlying pathophysiology of hypertension after TBI, provide an overview of the current clinical data on early hypertension after TBI, and discuss future research that should test the benefits and harms of treating high blood pressure in TBI patients. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved

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A Rare Complication of Spine Surgery: Case Report of Peripheral Facial Palsy.

No abstract available

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Editors' Note.

No abstract available

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