Πέμπτη, 29 Σεπτεμβρίου 2016

Potpourri for the holiday season.

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No abstract available

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Timing of postoperative respiratory emergencies: when do they really occur?.

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Purpose of review: Opioid-induced postoperative respiratory depression has garnered attention and calls for vigilance. However, a higher level of monitoring equates to increased use of hospital resources and is impractical to apply for all postoperative patients. Understanding the temporal pattern of postoperative respiratory emergency occurrences would allow for improved triage of monitoring resources for high-risk patients. Our objective is to describe the temporal pattern of risk of postoperative opioid-induced respiratory failure. Recent findings: The literature suggests that postoperative opioid-induced respiratory depression is more frequent and severe than previously believed. In response, national patient advocacy groups have proposed improved postoperative monitoring of high-risk patients, especially those with sleep-disordered breathing. Published series of patients who have had adverse respiratory events suggest that the first 24 postsurgical hours comprise the period of highest risk, with most events occurring within the first 12 h. Further, study findings have suggested that adverse respiratory events often occur shortly after administration of opioid analgesics. Summary: Emerging evidence indicates that the first postsurgical day carries the highest risk of adverse respiratory events, and this risk is often associated with opioid administration. Resources for increased monitoring should be directed to these high-risk times. Copyright (C) 2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Day surgery regional anesthesia in children: safety and improving outcomes, do they make a difference?.

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Purpose of review: The objective of this review is to provide an overview of recent developments in pediatric regional anesthesia and elucidate outcomes as it relates to patient safety and overall satisfaction. Recent findings: Since the inception of the Pediatric Regional Anesthesia Network database, the acquisition of data has enabled the pediatric anesthesiologist to extrapolate results and translate them into useful outcomes. Despite the growing trend to provide regional anesthesia in the pediatric population, there continues to be a paucity of available research studies to evaluate outcomes of various regional nerve blocks. This review serves as a conduit to explore the most recent data available, in each regional anesthetic technique, as it relates to outcomes such as analgesia, patient safety and satisfaction. Summary: Despite the limited number of randomized controlled trials evaluating the safety of individual regional anesthetic techniques, the growing body of data, such as presented in the Pediatric Regional Anesthesia Network database, suggests a high degree of safety in performing various regional anesthetic modalities. Modern medicine should continue to embrace the use of regional anesthesia, particularly in the ambulatory setting, to reduce perioperative pain and improve patient outcomes. Copyright (C) 2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Effect of Dry Needling on Thigh Muscle Strength and Hip Flexion in Elite Soccer Players.

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Purpose: Increase in muscle force, endurance and flexibility is desired in elite athletes in order to improve performance and avoid injuries but often hindered by occurence of myofascial trigger points. Dry needling (DN) has been shown effective in eliminating myofascial trigger points. Methods: This randomized controlled study in 30 elite youth soccer players of a professional soccer Bundesliga Club investigated the effects of four weekly sessions of DN plus water-pressure-massage on thigh muscle force and range-of-motion of hip flexion. A group receiving placebo-LASER plus water-pressure-massage and a group with no intervention served as controls. Data was collected at baseline (M1), treatment end (M2) and four-week follow-up (M3). Furthermore a 5-month muscle injury follow-up was performed. Results: DN showed significant improvement of muscular endurance of knee extensors at M2 (p=0.039) and M3 (p=0.008) compared to M1 (M1:294.6+/-15.4nm/s, M2:311+/-25Nm/s; M3:316.0+/-28.6nm/s) and knee flexors at M2 compared to M1 (M1:163.5+/-10.9Nm/s, M2:188.5+/-16.3Nm/s) as well as hip flexion (M1:81.5+/-3.3[degrees], M2:89.8+/-2.8[degrees]; M3:91.8+/-3.8[degrees]). Compared to placebo (3.8+/-3.8[degrees]) and control (1.4+/-2.9[degrees]) DN (10.3+/-3.5[degrees]) showed a significant (p=0.01 and p=0.0002) effect at M3 compared to M1 on hip flexion; compared to non-treatment control (-10+/-11.9Nm) DN (5.2+/-10.2Nm) also significantly (p=0.049) improved maximum force of knee extensors at M3 compared to M1. During the rest of the season muscle injuries were less frequent in the DN group compared to control groups. Conclusion: DN showed a significant effect on muscular endurance and hip flexion range-of-motion that persisted 4 weeks post-treatment. Compared to placebo it showed a significant effect on hip flexion that persisted 4 weeks post-treatment and compared to non-intervention control a significant effect on maximum force of knee extensors 4 weeks post-treatment in elite soccer players. (C) 2016 American College of Sports Medicine

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Exercise and Transversus Abdominis Muscle Atrophy after 60 d Bed Rest.

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Purpose: To investigate atrophy in the deep abdominal muscles, spinal extensors and the impact of high-load resistive exercise with and without whole body vibration following 60d of strict bed-rest. Methods: 24 subjects underwent 60-days of head-down tilt bed-rest and performed either resistive vibration exercise (RVE), resistive exercise only (RE) or no exercise control (2nd Berlin BedRest Study). The thickness of the transversus abdominis, internal oblique and erector spinae muscles and area of the multifidus muscle were measured bilaterally via real-time ultrasound. 'Intent to treat' analysis was implemented and p-values were adjusted by the false discovery rate method. Results: At end-bed-rest, transversus abdominis thickness was reduced by 18.3% in the inactive group (p=0.00011) with no significant change in the RVE (-4.0%; p=0.014 versus control) or RE (-5.0%; p=0.10 versus control) groups. In the inactive subjects, internal oblique thickness reduced by 10.6% (p=0.0025) and by 7% (p>0.05) in each of the training groups. Lengthening of the lumbar spine was greatest on day 1 (+7.4%, p=0.004) and 2 (+6.3%, p=0.004; day 54: +4.1%, p=0.023). Extensor atrophy and spinal lengthening was not impacted by exercise. No significant difference was seen between RVE and RE. Conclusion: Bed-rest leads to atrophy of the transversus abdominis and internal oblique muscles. The exercise program, which implemented lower-limb and back extension exercises against shoulder restraints, was able to reduce atrophy seen in transversus abdominis in bed-rest. (C) 2016 American College of Sports Medicine

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Repeated Prolonged Exercise Decreases Maximal Fat Oxidation in Older Men.

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Introduction/Purpose: Fat metabolism and muscle adaptation was investigated in 6 older trained men (age: 61 +/- 4 years; VO2max: 48 +/- 2 mL kg-1 min-1) following repeated prolonged exercise). Methods: 2706 km (1,681 miles) cycling was performed over 14 days and a blood sample and a muscle biopsy were obtained at rest after an overnight fast before and 30 hours after the completion of the cycling. VO2-max and maximal fat oxidation were measured using incremental exercise tests. Heart rate was continuously sampled during cycling to estimate exercise intensity. Results: The daily duration of exercise was 10 hours and 31 +/- 37 min and the mean intensity was 53 +/- 1 % of VO2max. Body weight remained unchanged. VO2max and maximal fat oxidation rate decreased by 6 +/- 2 % (P = 0.04) and 32 +/- 8 % (P

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The Impact of Paravertebral Block Analgesia on Breast Cancer Survival After Surgery.

Background and Objectives: The impact of regional anesthesia on breast cancer recurrence is controversial. We tested the hypothesis that the use of paravertebral block (PVB) analgesia during breast cancer surgery prolongs the recurrence-free survival (RFS) and overall survival (OS) of women with breast cancer. Methods: Seven hundred ninety-two women with nonmetastatic breast cancer were included in this retrospective study. Patients were divided based on the administration of PVB analgesia for mastectomy surgeries. One hundred ninety-eight (25%) were given a PVB, the remainder were treated with opioid-based analgesia. Propensity score matching was developed using several variables. Univariate and multivariate analyses were used to assess the impact of PVB analgesia on RFS and OS. Results: The median follow-up times for RFS and OS were 5.8 and 6 years, respectively. In the propensity score matching model, a total of 396 women were included in each group of treatment (non-PVB group, n = 198 vs PVB group, n = 198). As expected, the fentanyl consumption was significantly lower in PVB (122.8 +/- 77.85 [mu]g) patients than non-PVB subjects (402.23 +/- 343.8 [mu]g). Other variables were not statistically significant. After adjusting for several important covariates, the analysis indicated that the use of PVB is not associated with a significant change in RFS [1.60 (0.81-3.16), P = 0.172] or OS [1.28 (0.55-3.01)] survival. Discussion: This retrospective study does not support the hypothesis that the use of regional analgesia is associated with longer survival after surgery for breast cancer. Copyright (C) 2016 by American Society of Regional Anesthesia and Pain Medicine.

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Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation for Postoperative Analgesia: Could Neurostimulation Replace Continuous Peripheral Nerve Blocks?.

No abstract available

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The Optimal Analgesic Block for Total Knee Arthroplasty.

Peripheral nerve block for total knee arthroplasty is ideally motor sparing while providing effective postoperative analgesia. To achieve these goals, one must understand surgical dissection techniques, distribution of nociceptive generators, sensory innervation of the knee, and nerve topography in the thigh. Copyright (C) 2016 by American Society of Regional Anesthesia and Pain Medicine.

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A Randomized Controlled Trial of Ultrasound Versus Nerve Stimulator Guidance for Axillary Brachial Plexus Block.

Background: Ultrasound-guided techniques improve outcomes in regional anesthesia when compared with traditional techniques; however, this assertion has not been studied with novices. The primary objective of this study was to compare sensory and motor block after axillary brachial plexus block when performed by novice trainees allocated to an ultrasound- or nerve-stimulator-guided group. A secondary objective was to compare the rates of skill acquisition between the 2 groups. Methods: This study was a prospective, randomized, observer-blinded, 2-arm controlled trial. Anesthesia trainees participating in this trial were novices to axillary brachial plexus block and sonography. All trainee participants underwent a standardized training program. The primary outcome was combined sensory and motor block in the relevant territories 30 minutes after completion of block. A global rating scale was used to assess trainee block performance. Results: The study was ceased after 12 trainees completed 153 blocks. There was no difference between groups in combined motor/sensory score (P = 0.28) or as a function of block number (P = 0.38). There was no difference in onset between groups (P = 0.38). In both groups, there was an increase in the global rating scale score (P

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Determining the Learning Curve for Acquiring Core Sonographic Skills for Ultrasound-Guided Axillary Brachial Plexus Block.

Background and Objectives: The objectives of this study were to determine the learning curve for capturing sonograms and identifying anatomical structures relevant to ultrasound-guided axillary brachial plexus block and to determine if massed was superior to distributed practice for this core sonographic skill. Methods: Ten University of Melbourne, third- or fourth-year Doctor of Medicine students were randomized to massed or distributed practice. Participants performed 15 supervised learning sessions comprising scanning followed by feedback. A "sonographic proficiency score" was calculated by summing parameters in acquiring and interpreting the sonogram, and identifying relevant anatomical structures. Results: Between the 1st and 10th sessions, the proficiency scores increased (P = 0.043). Except for one, all participants had relatively rapid increases in their "sonographic proficiency scores." There was no difference in proficiency scores between the 15th and 10th sessions (P > 0.05). There was no difference in scores between groups for the first session, (P = 0.40), 15th session (P = 0.10), or at any time. There was no difference in the slope of the increase in "sonographic proficiency score" over the first 10 scanning sessions between groups [massed, 1.1 (0.32); distributed, 0.90 (0.15); P = 0.22) presented as mean (SD)]. The 95% confidence interval for the difference in slopes between massed and distributed groups was -0.15 to 0.56. Conclusions: The proficiency of participants in capturing sonograms and identifying anatomical structures improved significantly over 8 to 10 learning sessions. Because of sample size issues, we cannot make a firm conclusion regarding massed versus distributed practice for this core sonographic skill. Copyright (C) 2016 by American Society of Regional Anesthesia and Pain Medicine.

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Screening and Optimization of Nerve Targets and Parameters Reveals Inhibitory Effect of Pudendal Stimulation on Rat Bladder Hypersensitivity.

Background and Objectives: Neuromodulation has been reported to reliably improve symptoms of bladder overactivity and sometimes pain. The effect of electrical stimulation of several nerve pathways demonstrated to alter cystometric responses to bladder distension was examined on nociceptive responses in models of bladder hypersensitivity. Methods: Bladder hypersensitivity was produced by several published methods including neonatal inflammation, acute inflammation, and chronic stress. Effects of different sites of stimulation (L6 and T13 nerve roots, proximal and distal pudendal nerves [PNs]) on nociceptive reflex responses to urinary bladder distension in urethane-anesthetized female rats were assessed and a parametric analysis of parameters of stimulation was performed. Results: Bilateral biphasic stimulation of the proximal PNs resulted in statistically significant inhibition of visceromotor and cardiovascular responses to bladder distension in rats made hypersensitive by neonatal bladder inflammation. We found a range of optimal stimulation frequencies (5-10 Hz) which produced robust inhibitory effects when using short pulse widths (100-240 [mu]s). Onset of inhibition was within minutes and persisted for several minutes after the stimulus was discontinued. Use of bilateral PN stimulation in acute inflammation and stress-induced hypersensitivity models as well as unilateral stimulation, very distal PN cutaneous branch stimulation, and stimulation of the T13 and L6 nerve roots all proved ineffective with the parameters used. Conclusions: This study suggests that inhibitory effects of bilateral PN stimulation can be evoked in a rodent hypersensitivity model at relatively low frequencies with short pulse widths. The onset of effect is rapid, which suggests the potential for treating episodic pain in painful bladder disorders. Copyright (C) 2016 by American Society of Regional Anesthesia and Pain Medicine.

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Labor Epidural Intolerance Due to a Congenitally Narrowed Spinal Canal.

Reports exist of severe upper back pain of unknown etiology after administration of large volumes into the epidural space. We present a case of an otherwise healthy parturient who developed severe upper back and neck pain after receiving only a small volume of epidural medication. Magnetic resonance imaging revealed a congenitally narrowed spinal canal because of short pedicle syndrome. Epidural injectate occupies and compresses a percentage of the spinal canal and its neuronal contents. This may result in pain and epidural intolerance when continued injectate reaches a critical point, a threshold that is lower with shortened pedicles or congenital spinal stenosis. We believe a similar mechanism may explain the pain that patients sometimes experience after administration of large epidural volumes. Copyright (C) 2016 by American Society of Regional Anesthesia and Pain Medicine.

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Knee rotationplasty: motion of the body centre of mass during walking.

Knee rotationplasty (KRP) is a type of surgery in which the rotated ankle serves as a new knee after being removed for bone tumor. Although this limb salvage surgery is rarely indicated in properly selected patients, it may offer functional advantages over transfemoral amputation, and more durable results compared with a prosthesis. The walking mechanics of adult patients after KRP is believed to be close to that of below-knee amputees. In this study, we evaluated steady-state walking of KRP patients from the viewpoint of the overall muscle power needed to keep the body centre of mass in motion. Three adult patients after KRP, all athletes, were evaluated. Ground reactions during walking were recorded during six subsequent strides on a force treadmill. The positive mechanical work and power sustaining the motion of the centre of mass and the recovery of muscle energy due to the pendulum-like mechanism of walking were computed and compared with those obtained in previous studies from above-knee, below-knee amputees and healthy individuals. In KRP patients, walking was sustained by a muscle power output which was 1.4-3.6 times lower during the step performed on the rotated limb than on the subsequent step. The recovery of muscle energy was slightly lower (0.9) or higher (1.3-1.4 times) on the affected side. In two out of the three KRP patients, our findings were more similar to those from above-knee amputees than to those from below-knee amputees. After KRP, the rotated limb does not necessarily provide the same power provided by below-knee amputation. This may have a relevance for the paralympic classification of KRP athletes. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://ift.tt/1hexVwJ Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Synaptic signalling and plasticity: emerging new players



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Listen to brain networks responding to placebos!



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Issue Information



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Unveiling visuomotor control of bipedal stance, step by step



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Rapid and reliable smooth extubation – Comparison of fentanyl with dexmedetomidine: A randomized, double-blind clinical trial

P Rani, VR Hemanth Kumar, M Ravishankar, T Sivashanmugam, R Sripriya, M Trilogasundary

Anesthesia: Essays and Researches 2016 10(3):597-601

Background: Fentanyl and dexmedetomidine have been tried to attenuate airway and circulatory reflexes during emergence and extubation individually but have not been compared with respect to the level of sedation to evolve a reliable technique for rapid and smooth extubation. Aim: To compare the effects of fentanyl and dexmedetomidine in attenuating airway and circulatory reflexes during emergence and extubation of the endotracheal tube. Setting and Design: This double-blind, randomized, controlled study was done in patients undergoing surgery under general anesthesia belonging to the American Society of Anesthesiologists physical status 1 or 2. Methodology: All patients received a standardized anesthetic protocol. Patients were randomized to receive either fentanyl 1 μg/kg or dexmedetomidine 0.75 μg/kg. Fifteen minutes before expected last surgical suture, isoflurane was cutoff and equal amount of test solution was given when train-of-four ratio was 0.3. The degree of sedation, airway, and circulatory responses at the time of suction and extubation were analyzed. Statistical Analysis Used: Chi-square test for nonparametric data and t-test for parametric data. Results: Heart rate (HR) was comparable in both the groups until endotracheal extubation. Later, there was rise in HR in fentanyl group. There was stastisticaly significant drop in blood pressure at 5 min after test drug administration in both the groups. Airway response for suctioning and extubation was better in dexmedetomidine group and it was associated with better sedation score than fentanyl group. Conclusion: Single dose of 0.75 μg/kg dexmedetomidine given 15 min before extubation provides smooth extubation when compared to fentanyl.

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Anesthetic management of intestinal obstruction: A postgraduate educational review

S Parthasarathy, R Sripriya, N Krishnaveni

Anesthesia: Essays and Researches 2016 10(3):397-401

Intestinal obstruction is associated with significant morbidity and mortality. Scientific assessment of the cause, site of obstruction, appropriate correction of the fluid deficit and electrolyte imbalance with preoperative stabilization of blood gases is ideal as a preoperative workup. Placement of a preoperative epidural catheter especially in the thoracic interspace takes care of perioperative pain and stress reduction. Intraoperative management by controlled general anesthesia administering a relative high inspired fraction of oxygen with invasive monitoring in selected sick cases is mandatory. Preoperative monitoring and stabilizing raised intra-abdominal pressure reduces morbidity. Caution should be exercised during opening and closure of abdomen to avoid cardiorespiratory ill effects. There should be an emphasis on avoiding hypothermia. The use of nonsteroidal anti-inflammatory drugs may worsen sick, fragile patients. The use of sugammadex rather than neostigmine will obscure certain controversies in the healing of intestinal anastomotic site. Replacement of blood loss continued correction of fluids and electrolytes with possible postoperative mechanical ventilation in sick cases may improve outcomes in these patients.

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Pediatric difficult intubation in a rare genetic disorder made easy with Airtraq laryngoscope

Deepak Dwivedi, Vidhu Bhatnagar, Urvashi Tandon, Kavitha Jinjil

Anesthesia: Essays and Researches 2016 10(3):684-685



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Palonosetron and granisetron in postoperative nausea vomiting: A randomized double-blind prospective study

Amrita A Gugale, Pradnya Milind Bhalerao

Anesthesia: Essays and Researches 2016 10(3):402-407

Background: Postoperative nausea and vomiting (PONV) is a common occurrence after laparoscopic surgeries. A number of pharmacological agents (antihistamines, butyrophenones, dopamine receptor antagonists) have been tried of which the 5-hydroxytryptamine type 3 receptor antagonists are devoid of most side effects and highly effective in prevention and treatment of PONV. Thus, we evaluated the effectiveness of granisetron and palonosetron in prevention of PONV after laparoscopic surgeries under general anesthesia. Aims: We conducted a study to evaluate the effectiveness of granisetron and palonosetron, to compare the duration of action and side effects if any, in patients undergoing elective laparoscopic surgery under general anesthesia. Settings and Design: This was a prospective, randomized, double-blinded, comparative study. Sixty patients (18–65 years of age) of the American Society of Anesthesiologists Grade I and II undergoing elective laparoscopic surgeries were considered. Materials and Methods: They were randomly allocated into one of the two groups (Group G and Group P) of thirty patients each. Group G received injection granisetron 0.05 mg/kg; Group P received injection palonosetron 1.5 mcg/kg intravenous bolus 30 min before the induction of anesthesia. Statistical Tests: All statistical analyses were performed using the SPSS® statistical package version 18.0 (Chicago: SPSS Inc). Two independent sample t-test was used for quantitative data, and the χ2 or Fisher's exact test was used for qualitative data. A difference was regarded as statistically significant at a P< 0.05. Results: The need for rescue antiemetic was significantly lower in Group P in the 24–72 h postoperative period (ρ - 0.007). The PONV score was significantly less in Group P in the same period (ρ - 0.008). The incidence of side effects was statistically insignificant in both the groups (ρ - 0.999). Conclusion: Prophylactic therapy with palonosetron is more effective than granisetron in the prevention of PONV after laparoscopic surgeries under general anesthesia.

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Correlation of quality of life scores to clinical outcome of lumbar epidural steroids in chronic low back pain

Saru Singh, Kulvinder Singh, Ruchi Gupta, Nayyamat Kaur, Pranav Bansal, Sanjeet Singh

Anesthesia: Essays and Researches 2016 10(3):574-579

Context and Aim: The assessment of severity of low back pain includes subjective questionnaires to quantify the impact on routine life. The objective of current study was to correlate various quality of life (QOL) scores to the clinical outcome measured as improvement in Visual Analog Score (VAS) after interventional treatment. Subjects and Methods: Fifty-one consecutive chronic low backache patients were assessed for pain intensity using VAS, revised Oswestry Disability Index (ODI), Quebec's, Roland–Morris disability questionnaire (RMDQ), and depression score at presentation. All subjects received interventional therapy complemented with physiotherapy; changes in scores were evaluated at 2 weekly intervals till 12 weeks. Type of Study: Prospective, observational, cohort study. Results: All scores depicted highly significant statistical improvement over baseline scores (P < 0.001). The Pearson correlation of VAS with rest of the scores showed that all variables correlate well with VAS at various time periods till 3 months. However, the best outcome predictor for VAS in QOL scores was Oswestry score as well as depression score which had an additive predictive effect. Among the QOL scores best intercorrelation was found with ODI and RMDQ scores at baseline as well as at all treatment follow-ups. Interpretation and Conclusion: ODI and depression score closely parallel trends of reduction in VAS indicating that these scores may be the best outcome predictor after interventional treatment of pain. Among QOL scores ODI and RMDQ evaluated in the current study record comparable degree of physical incapacity; the exception is Quebec's score.

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Evaluation of clonidine as an adjuvant to bupivacaine in wound infiltration for providing postoperative analgesia after abdominal hysterectomy

Venkatesh Selvaraj

Anesthesia: Essays and Researches 2016 10(3):408-413

Background: Clonidine is an effective adjuvant to local anesthetics in peripheral nerve blocks. We studied the effect of clonidine as an adjuvant in wound infiltration for postoperative analgesia. Aim: To evaluate the role of clonidine as an adjuvant to bupivacaine in wound infiltration in terms of quality and duration of postoperative analgesia in patients undergoing total abdominal hysterectomy. Settings and Study Design: Prospective, randomized, double-blinded study. Materials and Methods: One hundred patients of American Society of Anesthesiologists I–II posted for abdominal hysterectomy were randomly allotted to two groups. Group A received wound infiltration with 45 ml of 0.25% bupivacaine with 3 μg/kg clonidine while Group B received wound infiltration with 45 ml of 0.25% bupivacaine. A standard general anesthesia technique was used in all the patients. Postoperative analgesia was provided with injection ketorolac 0.5 mg/kg intravenous infusion and tramadol being the rescue analgesic. Postoperative pain score, duration of effective analgesia before the first rescue analgesic, percentage of patients requiring rescue analgesic at different time intervals, and total number of rescue analgesic doses in 24 h were compared between the groups. Statistical Analysis: Difference between the bivariate samples in independent groups with Mann–Whitney U-test. For categorical data, Chi-square test was used. Results: Clonidine group has better pain score, longer duration of effective analgesia, lower percentage of patients requiring rescue analgesic, and less number of doses of rescue analgesia in the first 24 h. Conclusion: We conclude that Clonidine 3 μg/kg is an effective adjuvant to bupivacaine for wound infiltration in terms of quality and duration of postoperative analgesia following total abdominal hysterectomy.

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A comparative study on effect of addition of clonidine and fentanyl as adjuvants to local anaesthetics for subarachnoid block in patients undergoing lumbar laminectomies

Umesh K Dash, S Kiran, Urvashi Tandon, Kavitha Jinjil

Anesthesia: Essays and Researches 2016 10(3):618-623

Background: The synergism between local anesthetic agents such as bupivacaine with intrathecal adjuvants such as opioids and clonidine is well established. Aims: This study evaluates the clinical efficacy of clonidine75 μg versus fentanyl 25 μg as adjuvants to bupivacaine for spinal anesthesia. Settings and Design: A prospective, randomized, parallel arm study was conducted over a period of 12 months in a tertiary care hospital. Materials and Methods: Sixty patients were divided randomly into two groups, Group C and Group F. Patients in Group C received 2.5 ml of 0.5% bupivacaine heavy mixed with 0.5 ml (75 μg) clonidine intrathecally, and patients in Group F received 2.5 ml of 0.5% bupivacaine heavy mixed with 0.5 ml (25 μg) fentanyl intrathecally. Statistical Analysis: Data were analyzed using statistical tests for comparison of means. Results: The mean durations of sensory block was 253.3 and 249.6 minutes in group C and group F respectively, which was statistically not significant (P = 0.76). The mean durations of motor block were 302.3 and 293.6 min, respectively, in Group C and Group F, which were also statistically not significant (P = 0.53). The mean durations of postoperative analgesia were 653.4 and 611.2 min, respectively, in Group C and Group F, which were statistically not significant (P = 0.09). Mean heart rate after 10 min was 82.5 in Group C and 87.2 in Group F, which was statistically not significant (P = 0.29), and mean arterial pressure in mmHg after 10 min was 96.3 in Group C and 97.3 in Group F, which was also statistically not significant (P = 0.86). Conclusion: Both clonidine 75 μg and fentanyl 25 μg when used as adjuvants to bupivacaine in the subarachnoid block have comparable beneficial results in terms of duration of analgesia, duration of motor blocks, and hemodynamic stability and also have a comparable incidence of complications.

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Dexmedetomidine as an adjuvant to levobupivacaine in supraclavicular brachial plexus block: A novel anesthetic approach

Arvinder Pal Singh, Malika Mahindra, Ruchi Gupta, Sukhminder Jit Singh Bajwa

Anesthesia: Essays and Researches 2016 10(3):414-419

Aims and Objectives: Supplementation of dexmedetomidine produces a dose-dependent sedation, anxiolysis and analgesia without respiratory depression. This study was conducted to evaluate the possible effect of dexmedetomidine as an adjuvant to levobupivacaine for supraclavicular brachial plexus block in upper limb surgery. Settings and Design: Tertiary care institute, Department of Anaesthesiology and Intensive Care, a placebo-controlled study. Materials and Methods: After obtaining Ethical Committee approval, a randomized, double-blind, placebo-controlled study was conducted on sixty American Society of Anesthesiologists physical status I and II patients in the age group of 18–60 years, divided randomly into two groups, Group I received 30 ml of 0.5% levobupivacaine with 1 ml of isotonic sodium chloride solution and Group II received 30 ml of 0.5% levobupivacaine and 1 ml (100 mcg) of dexmedetomidine for supraclavicular brachial plexus block. The onset and duration of sensory and motor blockade, duration of analgesia (DOA) and any adverse effects were noted. At the end of the study, data were compiled and analyzed using appropriate statistical tests. The value of P< 0.05 was considered significant. Results: Demographic profile was comparable in both the groups. The time to onset of sensory and motor block was 10.54 ± 2.333 min and 12.21 ± 2.529 min in Group I while it was 3.24 ± 0.951 min and 2.83 ± 1.197 min in Group II, respectively. The duration of sensory and motor block was 7.79 ± 2.007 h and 9.18 ± 1.701 h in Group I, and it was 16.31 ± 2.606 h and 17.52 ± 2.098 h in Group II, respectively. The DOA was 678.68 ± 20.492 min in Group I and 1273.79 ± 83.139 min in Group II. On statistical comparison, these values were highly significant (P < 0.001). Side effects such as nausea, vomiting, hypoxemia, pruritis, or urinary retention were not observed in either of the groups. Conclusion: Dexmedetomidine shortens the onset time for sensory and motor block significantly and prolongs DOA as well when used with levobupivacaine for supraclavicular brachial plexus block, without increasing the incidence of any adverse effects.

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Cold bupivacaine versus magnesium sulfate added to room temperature bupivacaine in sonar-guided femoral and sciatic nerve block in arthroscopic anterior cruciate ligament reconstruction surgery

Ashraf Elsayed Alzeftawy, Ahmad Ali El-Daba

Anesthesia: Essays and Researches 2016 10(3):667-673

Background: Cooling of local anesthetic potentiates its action and increases its duration. Magnesium sulfate (MgSo4) added to local anesthetic prolongs the duration of anesthesia and postoperative analgesia with minimal side effects. Aim: The aim of this prospective, randomized, double-blind study was to compare the effect of cold to 4°C bupivacaine 0.5% and Mg added to normal temperature (20–25°C) bupivacaine 0.5% during sonar-guided combined femoral and sciatic nerve blocks on the onset of sensory and motor block, intraoperative anesthesia, duration of sensory and motor block, and postoperative analgesia in arthroscopic anterior cruciate ligament (ACL) reconstruction surgery. Patients and Methods: A total of 90 American Society of Anesthesiologists classes I and II patients who were scheduled to undergo elective ACL reconstruction were enrolled in the study. The patients were randomly allocated to 3 equal groups to receive sonar-guided femoral and sciatic nerve blocks. In Group I, 17 ml of room temperature (20–25°C) 0.5% bupivacaine and 3 ml of room temperature saline were injected for each nerve block whereas in Group II, 17 ml of cold (4°C) 0.5% bupivacaine and 3 ml of cold saline were injected for each nerve block. In Group III, 17 ml of room temperature 0.5% bupivacaine and 3 ml of MgSo4 5% were injected for each nerve block. The onset of sensory and motor block was evaluated every 3 min for 30 min. Surgery was started after complete sensory and motor block were achieved. Intraoperatively, the patients were evaluated for heart rate and mean arterial pressure, rescue analgesic and sedative requirements plus patient and surgeon satisfaction. Postoperatively, hemodynamics, duration of analgesia, resolution of motor block, time to first analgesic, total analgesic consumption, and the incidence of side effects were recorded. Results: There was no statistically significant difference in demographic data, mean arterial pressure, heart rate, and duration of surgery. Onset of both sensory and motor block was significantly shorter in both Groups II and III compared to Group I. Intraoperative anesthetic quality was comparable between groups with good patient and surgeon satisfaction. The time to first analgesia was significantly longer in Groups II and III compared to Group I with nonsignificant difference between each other. Moreover, the total opioid consumption was significantly lower in Groups II and III and duration of analgesia and motor block were significantly longer in Groups II and III compared to Group I. There was no difference in the incidence of side effects. Conclusions: The use of cold 0.5% bupivacaine or the addition of Mg to normal temperature 0.5% bupivacaine prolongs the sensory and motor block duration without increasing side effects and enhances the quality of intra- and post-operative analgesia with better patient satisfaction in sonar-guided femoral and sciatic nerve block for arthroscopic ACL reconstruction surgery.

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Efficacy of lipophilic vs lipophobic opioids in addition to hyperbaric bupivacaine for patients undergoing lower segment caeserean section

Amit Agrawal, Veena Asthana, JP Sharma, Vineeta Gupta

Anesthesia: Essays and Researches 2016 10(3):420-424

Background: Subarachnoid block is the preferred technique for providing anesthesia for patients undergoing cesarean section. Various pharmacological agents in added to local anesthetics (LA) modify their original effects in terms of block characteristics and quality of analgesia. However, there is ongoing debate about this practice of using adjuncts with LA. We tested whether addition of lipophilic versus lipophobic opioids to LA gives any clinical benefits to maternal and fetal outcome when used in these patients requiring spinal anesthesia. Subjects and Methods: Sixty American Society of Anesthesiologists I and II parturients, undergoing elective cesarean section requiring subarachnoid block, were included in our study. The parturients were allocated randomly to three groups of 20 each to receive bupivacaine 12.5 mg (Group I), bupivacaine 12.5 mg + morphine 0.2 mg (Group II), bupivacaine 12.5 mg + fentanyl 25 μg (Group III), preservative free physiological saline 0.9% was added to all the solutions to achieve a total volume of 4 ml. The parameters studied were the time of onset, sensory level of the block achieved, total duration of analgesia, any need of rescue analgesics, maternal side effects, and fetal outcome. Results: Onset of block was early 4.30 ± 0.12 min in Group III as compared to Group I 4.64 ± 0.28 min and Group II 4.505 ± 0.22 min. Mean duration of analgesia (hours) was higher in Group II 15.91 ± 0.96 h as compared to Group I 1.95 ± 0.55 h and Group III 4.39 ± 0.2 h. Incidence of nausea, vomiting, and shivering was more in the control group as compared to study groups, whereas sedation and pruritus were seen more in the study groups. No adverse effects on fetus were seen with use of opioids and comparable Apgar scores were noted. Conclusion: Addition of intrthecal fentanyl causes rapid onset of block whereas intrathecal morphine provides prolonged analgesia with comparable neonatal wellbeing.

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Caffeine for delayed recovery

Madhuri S Kurdi

Anesthesia: Essays and Researches 2016 10(3):689-690



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Impact of different intravenous fluids on blood glucose levels in nondiabetic patients undergoing elective major noncardiac surgeries

Ranjana Khetarpal, Veena Chatrath, Jagjit Kaur, Anju Bala, Harjeet Singh

Anesthesia: Essays and Researches 2016 10(3):425-431

Background: Intravenous (IV) fluids are an integral part of perioperative management. Intraoperative hyperglycemia is associated with poor clinical outcomes in patients undergoing major surgeries even in nondiabetics. Aim: This study was conducted to observe the effect of different maintenance fluid regimens on intraoperative blood glucose levels in nondiabetic patients undergoing major surgeries under general anesthesia. Settings and Design: Randomized double-blind study. Materials and Methods: One hundred nondiabetic patients of either sex were divided randomly into two Groups I and II of 50 each undergoing elective major surgeries of more than 90 min duration under general anesthesia. Both groups were given calculated dosage of IV fluids accordingly 4-2-1 formula while Group I was given Ringer lactate (RL) and Group II was given 0.45% dextrose normal saline and potassium chloride 20 mmol/L. Changes in vital parameters, % oxygen saturation, and urine output were monitored at regular intervals. Capillary blood glucose (CBG) was measured half-hourly until end of surgery. If CBG level was more than 150 mg%, then calculated dose of human insulin (CBG/100) was given as IV bolus dose. Statistical Analysis: Statistical analysis was done using SPSS 22.0 software (IBM Corporation, Armonk, New York, USA), paired t-test and Chi-square test. Results: A significant increase of CBG level and was observed during intraoperative and immediate postoperative period (P < 0.001) in Group II. Conclusion: RL solution is probably the alternative choice of IV fluid for perioperative maintenance and can be used as replacement fluid in nondiabetic patients undergoing major surgeries.

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Analgesic efficacy of ultrasound guided transversus abdominis plane block versus local anesthetic infiltration in adult patients undergoing single incision laparoscopic cholecystectomy: A randomized controlled trial

Ejas P Bava, Rashmi Ramachandran, Vimi Rewari, Chandralekha , Virinder Kumar Bansal, Anjan Trikha

Anesthesia: Essays and Researches 2016 10(3):561-567

Background: Transversus abdominis plane (TAP) block has been used to provide intra- and post-operative analgesia with single incision laparoscopic (SIL) bariatric and gynecological surgery with mixed results. Its efficacy in providing analgesia for SIL cholecystectomy (SILC) via the same approach remains unexplored. Aims: The primary objective of our study was to compare the efficacy of bilateral TAP block with local anesthetic infiltration for perioperative analgesia in patients undergoing SILC. Settings and Design: This was a prospective, randomized, controlled, double-blinded trial performed in a tertiary care hospital. Materials and Methods: Forty-two patients undergoing SILC were randomized to receive either ultrasound-guided (USG) bilateral mid-axillary TAP blocks with 0.375% ropivacaine or local anesthetic infiltration of the port site. The primary outcome measure was the requirement of morphine in the first 24 h postoperatively. Statistical Analysis: The data were analyzed using t-test, Mann–Whitney test or Chi-square test. Results: The 24 h morphine requirement (mean ± standard deviation) was 34.57 ± 14.64 mg in TAP group and 32.76 ± 14.34 mg in local infiltration group (P = 0.688). The number of patients requiring intraoperative supplemental fentanyl in TAP group was 8 and in local infiltration group was 16 (P = 0.028). The visual analog scale scores at rest and on coughing were significantly higher in the local infiltration group in the immediate postoperative period (P = 0.034 and P= 0.007, respectively). Conclusion: USG bilateral TAP blocks were not effective in decreasing 24 h morphine requirement as compared to local anesthetic infiltration in patients undergoing SILC although it provided some analgesic benefit intraoperatively and in the initial 4 h postoperatively. Hence, the benefits of TAP blocks are not worth the effort and time spent for administering them for this surgery.

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Lower limb surgeries under combined femoral and sciatic nerve block

Lipsy Bansal, Joginder Pal Attri, Pawan Verma

Anesthesia: Essays and Researches 2016 10(3):432-436

Introduction: Peripheral nerve blocks are gaining popularity for many infraumblical surgeries with the development of new techniques such as ultrasound and peripheral nerve stimulator. It provides stable hemodynamic, better, and prolonged postoperative analgesia. This study was carried out to see the effectiveness of combined femoral and sciatic nerve block with ropivacaine alone and by adding fentanyl. Materials and Methods: The study was carried out on 100 patients scheduled for lower limb surgeries and were randomly divided into two groups of 50 each. In Group A, patients received 20 ml of 0.5% ropivacaine for femoral nerve block and same dose for sciatic nerve block and in Group B, 25 μg fentanyl was added each for femoral nerve and sciatic nerve block along with ropivacaine. All hemodynamic parameters, onset and duration of sensory and motor blocks were noted. The patient characteristics were analyzed using the "Chi-square tests" and the intergroup comparison of the parametric data was carried out using the unpaired t-test using software IBM SPSS 17.0. Results: Combined femoral and sciatic nerve block provide longer duration of postoperative analgesia of about 12–13 h. All the above-mentioned parameters were statistically non-significant. Conclusion: Hence in this study, onset and duration of sensory and motor block was comparable in both groups. However postoperative analgesia was prolonged as compared to neuraxial blockade without any hemodynamic instability.

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A comparison of dexamethasone and clonidine as an adjuvant for caudal blocks in pediatric urogenital surgeries

Chandni Sinha, Bindey Kumar, Umesh Kumar Bhadani, Ajeet Kumar, Amarjeet Kumar, Alok Ranjan

Anesthesia: Essays and Researches 2016 10(3):585-590

Background: Caudal block is a reliable regional analgesic technique for pediatric urogenital surgeries. Various adjuvants have been tried to enhance the duration of action of bupivicaine. Though clonidine is extensively used as an adjuvant in caudal anaesthesia, it can have troublesome adverse effects like bradycardia, hypotension and sedation. Lately dexamethasone has become popular as an adjuvant in paediatric caudals due to its safety profile. Aim: The aim of this study was to compare dexamethasone and clonidine coadministered with bupivicaine caudally in paediatric patients undergoing urogenital surgeries in terms of analgesia and adverse effects. Settings and Design: Prospective, double blinded randomised study. Subjects and Method: Sixty American Society of Anesthesiologists physical status I and II children, aged 1-6 years undergoing urogenital surgeries were allocated in 2 groups: Group I: 0.5 mL.kg−1 of 0.25% bupivicaine with dexamethasone 0.1 mg.kg−1 in 1 ml normal saline (NS) Group II: 0.5 mL.kg−1 of 0.25% bupivicaine with clonidine 1 μg.kg−1 diluted in 1 ml normal saline. The parameters studied included duration of analgesia, intraoperative and postoperative hemodynamics, sedation scores and incidence of adverse effects like wound dehiscence, bleeding, vomiting and respiratory depression. Statistical Analysis Used: Statistical analysis was carried out using Stata Version 10. After checking for the normality assumption, t-test for comparing means of two independent samples was used for comparing baseline continuous variables. P values <0.05 were considered significant. Results: Patients in Group II had longer duration of analgesia postoperatively. Patients in this group also had lower heart rate and more sedation scores. Conclusion: Our study shows that caudal dexamethasone is a good alternative to clonidine with more stable hemodynamics and lesser sedation scores in the immediate postoperative period. Both the drugs offer good analgesia postoperatively with the duration of analgesia more in clonidine.

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Efficacy and safety of propofol versus midazolam in fiberoptic endotracheal intubation

Radhe Sharan, Brij Mohan, Harkomal Kaur, Anju Bala

Anesthesia: Essays and Researches 2016 10(3):437-445

Background: Fiberoptic intubation is a technique commonly used for difficult airways. Conscious sedation is desirable to make this procedure tolerable, and it is essential that patients are cooperative, relaxed, and comfortable especially when difficult airway anatomy or pathology is encountered. Objective: To compare the safety and efficacy of propofol versus midazolam in oral fiberoptic endotracheal intubation in terms of hemodynamic changes, level of sedation, ease of intubation, and patient comfort and complications. Materials and Methods: In a prospective randomized study, 60 patients of age group 18–60 years and American Society of Anesthesiologists health classification of I and II with anticipated difficult intubation were randomly allocated into two groups. Both the groups were premedicated with injection glycopyrrolate 0.005 mg/kg and injection butorphanol 1 mg and nebulized with 4 ml of 4% lignocaine starting 20 min before the surgery. After that patients in Group I received intravenous propofol 1–2 mg/kg to a maximum of 2 mg/kg followed by 20 mg increments if needed and Group II received 0.05 mg/kg midazolam followed by 2 mg increments till the adequate level of sedation was reached. Patients were monitored for hemodynamic parameters, sedation according to observer's assessment of alertness score, intubation score, intubation time, patient comfort, satisfaction score, and complications, if any. Results were statistically analyzed. Results: The mean sedation score, patient comfort score, and patient satisfaction were greater in propofol group (P < 0.05) but there were no significant differences in hemodynamics, intubating conditions, and complications. Conclusion: We conclude that compared with midazolam, propofol provides better sedation for fiberoptic endotracheal intubation and better patient comfort and satisfaction.

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Expansion of the GLE1-associated arthrogryposis multiplex congenita clinical spectrum

Abstract

Mutations in GLE1 cause two recessive subtypes of Arthrogryposis Multiplex Congenita (AMC), a condition characterized by joint contractures at birth, and all previously reported patients died in the perinatal period. GLE1 related AMC has been almost exclusively reported in the Finnish population and is caused by a relatively common pathogenic splicing mutation in that population. Here, we report two non-Finnish brothers with novel compound heterozygous splicing mutations in GLE1, one of whom has survived to 12 years of age. We also demonstrate low levels of residual wild type transcript in fibroblasts from the surviving brother, suggesting that this residual wild-type transcript may contribute to the relatively longer-term survival in this family. We provide a detailed clinical report on the surviving patient, providing the first insight into the natural history of this rare neuromuscular disease. We also suggest that Lethal Congenital Contracture Syndrome 1 (LCCS1) and Lethal Arthrogryposis with Anterior Horn Disease (LAAHD), the two AMC subtypes related to GLE1, do not have sufficient clinical or molecular differentiation to be considered allelic disorders. Rather, GLE1 mutations cause a variable spectrum of AMC severity including a non-lethal variant described herein.

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Hematopoietically expressed homeobox (HHEX) gene polymorphism (rs5015480) is associated with increased risk of gestational diabetes mellitus

ABSTRACT

Gestational diabetes mellitus (GDM) is a metabolic disorder that occurs during pregnancy. HHEX and PROX1 are genetic loci associated with diabetes mellitus type 2. HHEX and PROX1 play significant roles in carbohydrate intolerance and diabetes because these transcription factors may be involved in the regulation of insulin secretion and in glucose and lipid metabolism. The aim of this study was to examine the association between HHEX (rs5015480) and PROX1 (rs340874) gene polymorphisms and GDM. This study included 204 pregnant women with GDM and 207 pregnant women with the normal glucose tolerance (NGT). The diagnosis of GDM was based on a 75-g oral glucose tolerance test at 24–28 weeks' gestation. There was a statistically significant prevalence of the HHEX rs5015480 CC genotype and C allele among women with GDM (C vs T allele, p = 0.021, odds ratio OR=1.40, 95% CI: 1.05–1.87). Statistically significant higher increase of body mass and BMI during pregnancy was found in women with the HHEX rs5015480 CC genotype. The results of our study suggest an association between the HHEX gene rs5015480 polymorphism and risk of GDM. The HHEX gene rs5015480 C allele may be a risk allele of GDM that is associated with increased BMI during pregnancy.

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Firefighter/Paramedic (Limited Term Grant Funded Position) - City of Fairfield

The Fairfield Fire Department is now hiring for Firefighter/Paramedic (Limited Term Grant Funded Position). The closing date is Wednesday, October 5, 2016 at 5:00 p.m. Pacific Time. NOTE: Minimum Qualifications: One (1) year recent full-time equivalent experience as a paramedic is required. One (1) year experience as a Fairfield reserve firefighter may be substituted for the oneyear paramedic experience ...

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FDA approves 'artificial pancreas' to manage diabetes

The new MiniMed 670G consists of a drug pump, a sensor that measures blood sugar and a tube that delivers the insulin.

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Distinct and overlapping DNMT1 interactions with multiple transcription factors in erythroid cells: Evidence for co-repressor functions

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Publication date: Available online 28 September 2016
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms
Author(s): Dimitris N. Papageorgiou, Elena Karkoulia, Alexandra Amaral-Psarris, Pavel Burda, Katarzyna Kolodziej, Jeroen Demmers, Jörg Bungert, Tomas Stopka, John Strouboulis
DNMT1 is the maintenance DNA methyltransferase shown to be essential for embryonic development and cellular growth and differentiation in many somatic tissues in mammals. Increasing evidence has also suggested a role for DNMT1 in repressing gene expression through interactions with specific transcription factors. Previously, we identified DNMT1 as an interacting partner of the TR2/TR4 nuclear receptor heterodimer in erythroid cells, implicated in the developmental silencing of fetal β-type globin genes in the adult stage of human erythropoiesis. Here, we extended this work by using a biotinylation tagging approach to characterize DNMT1 protein complexes in mouse erythroleukemic cells. We identified novel DNMT1 interactions with several hematopoietic transcription factors with essential roles in erythroid differentiation, including GATA1, GFI-1b and FOG-1. We provide evidence for DNMT1 forming distinct protein subcomplexes with specific transcription factors and propose the existence of a "core" DNMT1 complex with the transcription factors ZBP-89 and ZNF143, which is also present in non-hematopoietic cells. Furthermore, we identified the short (17a.a.) PCNA Binding Domain (PBD) located near the N-terminus of DNMT1 as being necessary for mediating interactions with the transcription factors described herein. Lastly, we provide evidence for DNMT1 serving as a co-repressor of ZBP-89 and GATA1 acting through upstream regulatory elements of the PU.1 and GATA1 gene loci.



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Severe infantile male encephalopathy is a result of early post-zygotic WDR45 somatic mutation

Thumbnail image of graphical abstract

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Safety of secretin administration in children

Pancreas

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Four-Year Entecavir Therapy Reduces Hepatocellular Carcinoma, Cirrhotic Events, and Mortality in Chronic Hepatitis B Patients

Liver International

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Apparent diffusion coefficient and dynamic contrast-enhanced magnetic resonance imaging in pancreatic cancer: Characteristics and correlation with histopathologic parameters

Journal of Computer Assisted Tomography

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Community-based real-world treatment outcomes of sofosbuvir/ledipasvir in Asians with chronic hepatitis C virus genotype 6 in the United States

Journal of Viral Hepatitis

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Managing fecal incontinence in patients with myelomeningocele in Sub-Saharan Africa: Role of antegrade continence enema (ACE)

Journal of Pediatric Surgery

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Rescue therapy for helicobacter pylori eradication: a randomized non-inferiority trial of amoxicillin or tetracycline in bismuth quadruple therapy

The American Journal of Gastroenterology

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Hepatitis B virus infection in children of HBV-related chronic liver disease patients: A study of intra-familial HBV transmission

Hepatology International

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Pantoprazole or placebo for stress ulcer prophylaxis (pop-up): randomized double-blind exploratory study

Critical Care Medicine

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Treatment with cestode parasite antigens recruits CCR2+ myeloid cells, the adoptive transfer of which ameliorates colitis

Infection and Immunity

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Effect of severity of esophageal acidification on sleep vs wake periods in infants presenting with brief resolved unexplained events

The Journal of Pediatrics

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Dynamic article: percutaneous nerve evaluation versus staged sacral nerve stimulation for fecal incontinence

Diseases of the Colon and Rectum

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Mortality in children with complicated severe acute malnutrition is related to intestinal and systemic inflammation: An observational cohort study

American Journal of Clinical Nutrition

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Cost-effectiveness of drug monitoring of anti-TNF therapy in inflammatory bowel disease and rheumatoid arthritis: a systematic review

Journal of Gastroenterology

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Laparoscopic vs. open surgery for T4 colon cancer: A propensity score analysis

International Journal of Colorectal Disease

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Production of infectious HCV genotype 1b virus in cell culture using a novel Set of adaptive mutations

BMC Microbiology

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Implementation and adherence to osteoporosis screening guidelines among coeliac disease patients

Digestive and Liver Diseases

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Portal hypertension in children: High-risk varices, primary prophylaxis and consequences of bleeding

Journal of Hepatology

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Laparoscopy-assisted proximal gastrectomy with double tract anastomosis is beneficial for Vitamin B12 and iron absorption

Anticancer Research

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Post-natal erythromycin exposure and risk of infantile hypertrophic pyloric stenosis: A systematic review and meta-analysis

Pediatric Surgery International

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Beneficial effects of mucous fistula refeeding in necrotizing enterocolitis neonates with enterostomies

Journal of Pediatric Surgery

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Turnover of 137Cs in ‘soil–tree’ system: An experience of measuring the isotope flows in a Siberian conifer forest

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Publication date: December 2016
Source:Journal of Environmental Radioactivity, Volume 165
Author(s): Vladimir L. Gavrikov, Ruslan A. Sharafutdinov, Aleksandr R. Mitev
Little attention has been paid to the uptake of 137Cs in natural forests under low levels of the isotope fallout when no immediate ecological danger presents. Here we present the extended assessments of the soil-to-plant and canopy-to-litter flows of 137Cs recently evaluated in a native Siberian forested area. The area undergoes a typical after-fire long term succession, with light-conifer upper story being followed by undergrowth of Siberian fir and other dark-conifer species. The one-year-old needles of Siberian fir were found to accumulate the largest concentration of the isotope, 4.10 Bq/kg oven-dry weight during the first growth season, as compared with older needles that accumulated 4.67 Bq/kg oven-dry weight in 2–3 years of growth. Based on these data an approach was developed that, hypothetically, can allow one to estimate the 137Cs activity concentration in soil solutions. Direct activity measurements in the soil solutions were not possible. The isotope activity in soil solutions was estimated to be 0.0061–0.0105 Bq/L. Based on the original data from the litter fall the annual flow of the isotope from the upper canopy to on-ground litter was found to be 0.42–0.84 Bq/m2. The amount of 137Cs that returns yearly back from canopy with falling litter was estimated to be 0.012–0.015% of the total soil isotope content. A combination of the estimations obtained in our study with the values of global 137Cs fallout allowed us to assess the ages (the time of formation) of horizons of the soils in the area.



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Relationships between indoor radon concentrations, thermal retrofit and dwelling characteristics

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Publication date: December 2016
Source:Journal of Environmental Radioactivity, Volume 165
Author(s): Bernard Collignan, Eline Le Ponner, Corinne Mandin
A monitoring campaign was conducted on a sample of more than 3400 dwellings in Brittany, France from 2011 to 2014. The measurements were collected using one passive dosimeter per dwelling over two months during the heating season, according to the NF ISO 11665–8 (2013) standard. Moreover, building characteristics such as the period of construction, construction material, type of foundation, and thermal retrofit were determined using a questionnaire. The final data set consisted of 3233 houses with the measurement results and the questionnaire answers. Multivariate linear regression models were applied to explore the relationships between the indoor radon concentrations and building characteristics, particularly the thermal retrofit.The geometric mean of the indoor radon concentration was 155 Bq m−3 (with a geometric standard deviation of 3). The houses that had undergone a thermal retrofit had a higher average radon concentration than those that had not, which may have been due to a decrease in air permeability of the building envelope following rehabilitation work that did not systematically include proper management of the ventilation. Other building characteristics, primarily the building material and the foundation type, were associated with the indoor radon concentration. The indoor radon concentrations were higher in older houses built with granite or other stone, with a slab-on-grade foundation and without any ventilation system.



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