Late-onset UC represents an important issue for the near future, but its outcomes and relative therapeutic strategies are yet poorly studied.
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Τρίτη 4 Οκτωβρίου 2016
Disease patterns in late-onset ulcerative colitis: Results from the IG-IBD “AGED study”
Patient preferences for inflammatory bowel disease treatment objectives
There is currently little evidence about what treatment objectives most interest patients with inflammatory bowel disease (IBD).
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The effect of CYP3A5 genetic polymorphisms on adverse events in patients with ulcerative colitis treated with tacrolimus
Tacrolimus is an immunosuppressive agent, used in the remission induction therapy of ulcerative colitis (UC).
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Antibiotics, intestinal dysbiosis and risk of celiac disease
We read with deep interest the recent original article published in Digestive & Liver Diseases by Simre et al. [1] about a multicentric cohort and the differences in the cumulative incidence of coeliac disease between Finland and Estonia.
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Beta blockers and cirrhosis, 2016
To date, non-selective beta blockers (NSBBs) are a cornerstone in the treatment of portal hypertension. During the last years, our understanding of the potential benefits of early initiation of NSBB treatment, their effects beyond the prevention of variceal bleeding (i.e., their non-hemodyamic effects), as well as potential detrimental effects in patients with advanced disease has continuously evolved. In addition, we have learned that not all NSBBs are equal. Due to its additional anti-α1-adrenergic activity, carvedilol has been shown to be more potent in decreasing portal pressure, but might lead to more pronounced decreases in systemic arterial pressure, when compared to conventional NSBBs.
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Doctors use 'Hamilton' songs to fight flu
Doctors and staff dance, sing and rap the "10 Flu Commandments."
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Allergan Demonstrates a Strong Commitment to America's First Responders Donating Over $1 Million Worth of REFRESH® Eye Drops
DUBLIN, Ireland July, 2016 - Allergan plc is pleased to announce that it is leading the effort to alleviate discomfort of dry eye symptoms for America's heroes and has exceeded its goal of donating $1 million worth of REFRESH® eye drops to our nation's first responders. Last summer, Allergan kicked off the REFRESH AMERICA campaign aiming to help everyday heroes alleviate their discomfort ...
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Primary Care Screening Methods and Outcomes for Asylum Seekers in New York City
Abstract
Effective screening in primary care among asylum-seekers in the US is critical as this population grows. This study aimed to evaluate disease prevalence and screening methods in this high-risk group. Two hundred ten new clients from 51 countries, plus Tibet, who were accepted into a program for asylum seekers from 2012 to 2014 were included. Screening rates and outcomes for infectious, non-communicable, and mental illnesses were evaluated. Screening rates were highest for PTSD, depression, hepatitis B, and latent tuberculosis. Seventy-one percent of clients screened positive for depression and 55 % for PTSD, followed by latent tuberculosis (41 %), hypertension (10 %), hepatitis B (9.4 %), and HIV (0.8 %). Overall screening rates were high. Point of care testing was more effective than testing that required a repeat visit. A large psychiatric and infectious disease burden was identified. These findings can inform future primary care screening efforts for asylum seekers in the US.
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Doctors use 'Hamilton' songs to fight flu
Doctors and staff dance, sing and rap the "10 Flu Commandments."
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Doctors use 'Hamilton' songs to fight flu
Doctors and staff dance, sing and rap the "10 Flu Commandments."
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Network analysis of mitonuclear GWAS reveals functional networks and tissue expression profiles of disease-associated genes
Abstract
While mitochondria have been linked to many human diseases through genetic association and functional studies, the precise role of mitochondria in specific pathologies, such as cardiovascular, neurodegenerative, and metabolic diseases, is often unclear. Here, we take advantage of the catalog of human genome-wide associations, whole-genome tissue expression and expression quantitative trait loci datasets, and annotated mitochondrial proteome databases to examine the role of common genetic variation in mitonuclear genes in human disease. Through pathway-based analysis we identified distinct functional pathways and tissue expression profiles associated with each of the major human diseases. Among our most striking findings, we observe that mitonuclear genes associated with cancer are broadly expressed among human tissues and largely represent one functional process, intrinsic apoptosis, while mitonuclear genes associated with other diseases, such as neurodegenerative and metabolic diseases, show tissue-specific expression profiles and are associated with unique functional pathways. These results provide new insight into human diseases using unbiased genome-wide approaches.
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High dose of green tea infusion normalized spiral artery density in rats treated with the depot-medroxyprogesterone acetate
2016-10-04T12-55-11Z
Source: Journal of Intercultural Ethnopharmacology
Emilda AS, Nora Veri, Alchalidi Alchalidi.
Aim: The purpose of the present study was to investigate the effects of green tea on the spiral artery density and endometrial thickness in female rats treated with the depot-medroxyprogesterone acetate (DMPA). Material and Methods: A total of twenty-four female rats were randomly divided into four groups: the control group (no treatment), the DMPA-treated group and the group treated with DMPA and green tea of various doses (165 and 330 mg/gram of body weight per day). Spiral artery density and endometrial thickness were subjected to histopathological analysis. Results: Spiral artery density decreased in the DMPA-treated group, despite the insignificant difference (P > 0.05). With regard to the administration of green tea at doses of 165 and 330 mg/gram of body weight per day, only green tea at the high dose was capable of significantly preventing a decrease in spiral artery density (P 0.05). Meanwhile, the administration of DMPA and/or DMPA with green tea did not cause significant changes in endometrial thickness relative to the control group (P > 0.05). Conclusions: DMPA induced a decrease in spiral artery density, despite the insignificant differences, and these changes could be normalized by the administration of high doses of green tea. Therefore, green tea could be a candidate herb to prevent the adverse effects of the contraceptive DMPA.
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Geraniol attenuates hydrogen peroxide-induced liver fatty acid alterations in male rats
2016-10-04T12-55-11Z
Source: Journal of Intercultural Ethnopharmacology
Ahmet Ozkaya, Zafer Sahin, Ahmet Orhan Gorgulu, Abdurrauf Yuce, Sait Celik.
Background: Hydrogen peroxide (H2O2) is an oxidant agent and this molecule naturally occurs in the body as a product of aerobic metabolism. Geraniol is a plant-derived natural antioxidant. Aim of the present study was to determine the role of geraniol on hepatic fatty acids alterations following H2O2-induced oxidative stress in male rats. Methods: After randomization, male wistar rats were divided into four groups (n=7 each group). Geraniol (50 mg/kg, dissolved in corn oil) and H2O2 (16 mg/kg, dissolved in distilled water) were administered by an intraperitoneal injection. Administrations were performed during 30 days with one day interval. Results: Administration of H2O2 resulted with a significant increase in malondialdehyde and a significant decrease in glutathione peroxidase and glutathione level; geraniol restored its effects on liver. However, hepatic catalase activities were significantly higher in H2O2, geraniol and geraniol+H2O2 groups than control group. The ratio of hepatic total saturated fatty acids increased in H2O2-treated animals compared with control. In addition, hepatic total unsaturated fatty acids reduced in H2O2 group compared with control. The percentages of both hepatic total saturated and unsaturated fatty acids werent different between geraniol+H2O2 and control groups. Conclusions: H2O2-induced oxidative stress may affect fatty acids composition in liver and body. Geraniol can partly restore oxidative hepatic damage because it cannot completely reverse the H2O2-induced increase in hepatic catalase activities. Moreover, this natural compound can regulate hepatic total saturated and unsaturated fatty acids percentages against H2O2-induced alterations.
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What happens when the calls finally catch up to you?
By Aryeh Myers, EMS1 Contributor
For the past month, I haven't seen the inside of an ambulance. I haven't seen an ambulance station. I haven't seen a patient.
I woke up one morning, and with six hours before I had to leave home for my next shift, my world went black and my head filled with fear. Images of a call from a few days earlier played back in my mind, mixing themselves with a call from years ago, and the scene from a car crash that was probably the trigger for my journey into the world of PTSD. It was a mash-up of unrecognizable, unforgettable and unfamiliar faces.
Suddenly, I couldn't see straight. I could barely even stand. My face burned with tears and my body was wracked with pain. I shook uncontrollably. The thought of sitting in an ambulance, of facing patients, of having them rely on me, filled me with terror and dread. I called in sick, booking two days leave and assumed that it was just one of those of things. That I'd just get over it.
That night I didn't sleep. Nor did I sleep the night after that. The days were filled with flashbacks I could not control. I prayed for the relief of sleep at night however, the nights were disturbed by visions amplified by darkness, making them 10 times worse, and I waited for the relief of daylight. I've been there before, but I didn't recognize it then for what it was, and those times it was nowhere near as crippling. This time, I knew what I was facing. This time, I was ready for a fight.
Post-Traumatic Stress Disorder, or PTSD, is not a dirty word. Misunderstood, definitely, but not dirty.
As I've said before, we see sights that should never be seen, and while I admit that some people are less affected than others, there is no way to become totally immune. There have been several posts recently describing the fear and the dented pride involved in admitting that there's a problem. However, it is not something to be ashamed of; although, I admit, that's exactly how I've behaved. I've hidden it from my friends and colleagues. I've hidden it from my family. The only person I can't hide it from is myself.
My main fear is losing the job I love. So this time, whilst hiding from the rest of the world, I sought help. I went to my doctor, explained what was going on. How I was feeling. Just that one simple act was the first step in the right direction. I didn't necessarily feel the burden was lifted, but I did feel there was someone who wanted to stand in my corner and fight alongside. I have taken a step that I probably should have done years ago and sought treatment.
I am not yet cured. Not by any stretch of the imagination. I'm not sure that I ever fully will be, but I am on the way. I still have flashbacks and moments of dread, both day and night, but I am learning to deal with them. I am learning what the triggers are and how to avoid them, or, if that's impossible, at least to recognize them and be prepared to fight.
I have seen PTSD hit too many times, seen too many lives ruined by failing to seek that help. I have seen too many in my position turn to drugs or alcohol or self-destruction as a coping mechanism. I have seen too many lives destroyed by hidden demons. I refuse to be one of them.
I started this week with a few days of simulations and assessments. Treating patients made of plastic and who always come back to life.
I'm one of the lucky ones. Tomorrow I'm going back to work.
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Effect of Plyometric Training on Vertical Jump Performance in Female Athletes: A Systematic Review and Meta-Analysis
Abstract
Background
Plyometric training is an effective method to prevent knee injuries in female athletes; however, the effects of plyometric training on jump performance in female athletes is unclear.
Objective
The aim of this systematic review and meta-analysis was to determine the effectiveness of plyometric training on vertical jump (VJ) performance of amateur, collegiate and elite female athletes.
Methods
Six electronic databases were searched (PubMed, MEDLINE, ERIC, Google Scholar, SCIndex and ScienceDirect). The included studies were coded for the following criteria: training status, training modality and type of outcome measures. The methodological quality of each study was assessed using the physiotherapy evidence database (PEDro) scale. The effects of plyometric training on VJ performance were based on the following standardised pre–post testing effect size (ES) thresholds: trivial (<0.20), small (0.21–0.60), moderate (0.61–1.20), large (1.21–2.00), very large (2.01–4.00) and extremely large (>4.00).
Results
A total of 16 studies met the inclusion criteria. The meta-analysis revealed that plyometric training had a most likely moderate effect on countermovement jump (CMJ) height performance (ES = 1.09; 95 % confidence interval [CI] 0.57–1.61; I 2 = 75.60 %). Plyometric training interventions of less than 10 weeks in duration had a most likely small effect on CMJ height performance (ES = 0.58; 95 % CI 0.25–0.91). In contrast, plyometric training durations greater than 10 weeks had a most likely large effect on CMJ height (ES = 1.87; 95 % CI 0.73–3.01). The effect of plyometric training on concentric-only squat jump (SJ) height was likely small (ES = 0.44; 95 % CI −0.09 to 0.97). Similar effects were observed on SJ height after 6 weeks of plyometric training in amateur (ES = 0.35) and young (ES = 0.49) athletes, respectively. The effect of plyometric training on CMJ height with the arm swing was likely large (ES = 1.31; 95 % CI −0.04 to 2.65). The largest plyometric training effects were observed in drop jump (DJ) height performance (ES = 3.59; 95 % CI −3.04 to 10.23). Most likely extremely large plyometric training effects on DJ height performance (ES = 7.07; 95 % CI 4.71–9.43) were observed following 12 weeks of plyometric training. In contrast, a possibly small positive training effect (ES = 0.30; 95 % CI −0.63 to 1.23) was observed following 6 weeks of plyometric training.
Conclusion
Plyometric training is an effective form of training to improve VJ performance (e.g. CMJ, SJ and DJ) in female athletes. The benefits of plyometric training on VJ performance are greater for interventions of longer duration (≥10 weeks).
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Slackline Training (Balancing Over Narrow Nylon Ribbons) and Balance Performance: A Meta-Analytical Review
Abstract
Background
Adequate static and dynamic balance performance is an important prerequisite during daily and sporting life. Various traditional and innovative balance training concepts have been suggested to improve postural control or neuromuscular fall risk profiles over recent years. Whether slackline training (balancing over narrow nylon ribbons) serves as an appropriate training strategy to improve static and dynamic balance performance is as yet unclear.
Objective
The aim was to examine the occurrence and magnitude of effects of slackline training compared with an inactive control condition on static and dynamic balance performance parameters in children, adults and seniors.
Data sources
Five biomedical and psychological databases (CINAHL, EMBASE, ISI Web of Knowledge, PubMed, SPORTDiscus) were screened using the following search terms with Boolean conjunctions: (slacklin* OR slack-lin* OR tight rop* OR tightrop* OR Slackline-based OR line-based OR slackrop* OR slack-rop* OR floppy wir* OR rop* balanc* OR ropedanc* OR rope-danc*)
Study selection
Randomized and non-randomized controlled trials that applied slackline training as an exercise intervention compared with an inactive control condition focusing on static and dynamic balance performance (perturbed and non-perturbed single leg stance) in healthy children, adults and seniors were screened for eligibility.
Data extraction
Eligibility and study quality [Physiotherapy Evidence Database (PEDro) scale] were independently assessed by two researchers. Standardized mean differences (SMDs) calculated as weighted Hedges' g served as main outcomes in order to compare slackline training versus inactive control on slackline standing as well as dynamic and static balance performance parameters. Statistical analyses were conducted using a random-effects, inverse-variance model.
Results
Eight trials (mean PEDro score 6.5 ± 0.9) with 204 healthy participants were included. Of the included subjects, 35 % were children or adolescents, 39 % were adults and 26 % were seniors. Slackline training varied from 4 to 6 weeks with 16 ± 7 training sessions on average, ranging from 8 to 28 sessions. Mean overall slackline training covered 380 ± 128 min. Very large task-specific effects in favor of slackline training compared with the inactive control condition were found for slackline standing time {SMD 4.63 [95 % confidence interval (CI) 3.67–5.59], p < 0.001}. Small and moderate pooled transfer effects were observed for dynamic [SMD 0.52 (95 % CI 0.08–0.96), p = 0.02] and static [SMD 0.30 (95 % CI −0.03 to 0.64), p = 0.07] standing balance performance, respectively.
Conclusions
Slackline training mainly revealed meaningful task-specific training effects in balance performance tasks that are closely related to the training content, such as slackline standing time and dynamic standing balance. Transfer effects to static and dynamic standing balance performance tasks are limited. As a consequence, slackline devices should be embedded into a challenging and multimodal balance training program and not used as the sole form of training.
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Differences in Patterns of Mortality Between Foreign-Born and Native-Born Workers Due to Fatal Occupational Injury in the USA from 2003 to 2010
Abstract
This study assesses differences mortality patterns and relative hazard due to fatal occupational injuries between native and immigrant workers in the US. Fatal occupational injury data from 2003 to 2010 were examined using survival analysis based on proportional hazards models controlling for categorical variables of race, gender, occupation, and industry. Workers are stratified based on whether they are native to the US (n = 31952) or born abroad (n = 7096). Foreign-born workers are further stratified into region of birth. Foreign-born workers had an adjusted hazard ratio of 1.148 (95 % CI 1.109:1.189) relative to native workers. Stratifying foreign-born workers into region of origin revealed significantly higher adjusted risk of work fatality relative to native workers for most foreign regions. Of fatally injured workers, foreign-born workers have shorter survival before succumbing to traumatic injury during their time of occupational 'exposure' in the workforce. Native-born workers tend to incur fatal injuries at older ages after longer 'exposure'.
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Novel DNMT3A germline mutations are associated with inherited Tatton-Brown-Rahman syndrome
ABSTRACT
Tatton-Brown-Rahman syndrome (TBRS) was recently described in 13 isolated cases with de novo mutations in the DNMT3A gene. This autosomal dominant condition is characterized by tall stature, intellectual disability and a distinctive facial appearance. Here, we report six cases of inherited TBRS caused by novel DNMT3A germline mutations. The affected individuals belong to two sib-ships: 4 from an Old Order Amish family in America and 2 from a French Canadian family in Canada. All of them presented with characteristic features of TBRS, including dysmorphic facial features, increased height, intellectual disability, and variable additional features. We performed clinical exome sequencing and identified two mutations in the DNMT3A gene, a c.2312G>A (p.Arg771Gln) missense mutation in the Amish family and a c.2296_2297delAA (p.Lys766Glufs*15) small deletion in the French Canadian family. Parental DNA analysis by Sanger sequencing revealed that the Amish mutation was inherited from the healthy mosaic father. This study reflects the first cases with inherited TBRS and expands the phenotypic spectrum of TBRS.
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How marijuana legalization impacts trauma
NEW ORLEANS — As marijuana use has increased, the visits to Colorado emergency departments has increased. The types and incidences of injuries secondary to marijuana intoxication were described by Howard Kim, MD at the EMS World Expo.
Kim briefly described the pathophysiology of marijuana toxicity and presented data from Colorado after the legalization of marijuana for recreational use. The presentation specifically explored the impact of legalized marijuana on trauma from motor vehicle collisions, butane hash oil burns and acute psychosis violence.
Currently, 25 states allow for medical use of marijuana and four states — Washington, Oregon, Colorado and Alaska — allow for recreational marijuana use. Four additional states will vote on legalization in November and many other states are considering marijuana legalization. Because of the increasing legalization and usage, EMS providers everywhere are likely to encounter patients with trauma secondary to marijuana intoxication.
Memorable quotes on trauma from marijuana legalization
Here are memorable quotes from Kim's presentation on the impact of legalized marijuana in Colorado.
"A drug doesn't need to be legal for patients to use. As legalization has increased so has usage across the United States. More adults are using marijuana and using it more days in a year and more adults are likely to use it."
"THC content of marijuana has tripled in last decade."
"Ingested marijuana is delayed two to three hours which has led to lots of problems."
Key takeaways on trauma secondary to marijuana toxicity
Here are the key takeaways from Kim's presentation on trauma secondary to marijuana toxicity.
Supportive care for intoxication
Treat marijuana intoxication based on the patient's symptoms. Most care for intoxication is supportive. For example, agitation and psychosis is treated with sedation.
Toxicity related trauma
Marijuana toxicity puts patients at risk of traumatic injury. The most common trauma is motor vehicle collisions from alterations in perception and motor dysfunction. Researchers have showed the risk of a fatal motor-vehicle collision doubles with marijuana use. The decision to apply spinal motion restrictions is complicated when the patient's mental status is compromised from marijuana toxicity.
Burns from butane hash oil happen during production of the oil. Colorado experienced a sharp increase in butane hash oil injuries after marijuana legalization. Victims were predominately male and had significant burn injuries. Burn care for butane hash oil burns is similar to other types of burn injuries.
Case reports, the lowest quality evidence, give limited insight into marijuana toxicity caused psychosis. Acute psychosis is not an uncommon patient presentation, but it doesn't prove marijuana leads to violent death. Kim discussed a Denver Health protocol and case series to administer ketamine to patients experiencing excited delirium.
Pediatric accidental ingestion
Colorado has experienced an increased incidence of pediatric marijuana exposures through accidental ingestion of a marijuana edible. The pediatric presentation is more likely to be CNS depression, rather than ingestion. During the assessment of a somnolent child, make sure to consider marijuana ingestion and ask parents and caregivers if there are drugs in the house.
Learn more:
- Child ER visits for marijuana on the rise following legalization
- Pot tourism overwhelms Colo. emergency rooms
- Remember 2 Things: Patient complications from high-dose and high-potency marijuana
- Remember 2 Things: Legal marijuana use still has consequences
- Prehospital use of ketamine
- When overdoses go wild: Protecting the EMS provider
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10 best PowerPoint alternatives for EMS educators
Microsoft PowerPoint has been a core piece of presentation and educational software since the 1990's. Yet while PowerPoint allowed educators to revolutionize the way they delivered information, many stuck with familiar lecture techniques, essentially just reading lists of facts from the screen. Death by PowerPoint is still dreaded in classrooms, lecture halls and conference venues across the globe more than 20 years later.
So with this list of alternatives to PowerPoint, I also issue a warning: Before you change your software, you must first change how you think about teaching. Consider what techniques may be best for a particular EMS education lesson then choose the program that fits that method. Any EMT or paramedic educator who expects new software to improve the same old lecture techniques is headed for disappointment — both for them and for their students.
1. Keynote
Probably the most frequently used alternative to PowerPoint is Apple's Keynote. Developed for Steve Jobs to roll out new Apple products, Keynote shares many of the same functions and features as PowerPoint. Keynote can import and export PowerPoint files.
The primary difference is that Keynote uses a different process to create the slides themselves. This gives educators the potential to look at presenting their material in new and different ways.
Consider using Keynote the way Jobs did. Keynote helps you build simple, visually oriented slides with little text. This will help you use your slide deck to tell a relatable story rather than bombard your audience with bullet lists of facts.
2. Haiku (and Canva and eMaze and MS Sway)
If you like the idea of presenting striking slides with clear graphics and a straightforward message, then get ready for the next generation of slide deck software in Haiku, Canva, eMaze and Microsoft Sway. These programs are geared for building presentations with graphics that illustrate your ideas and to help you create slides quickly, simply and elegantly with built in keyword-based image-search.
3. Prezi
If you want to show your class how different things are related to each other, Prezi is a fantastic program. Picture a gigantic sheet of paper or background photograph over which you can move a camera, zooming in and out to illustrate how things are connected like the three components of the circulatory system — the pump, the pipes and the fluid. While the fly and zoom effects can get nauseating if overused, Prezi is the go to tool to show students how to get from here to there.
4. Powtoon (and GoAnimate)
If you are looking for more animation features than Prezi can provide, consider Powtoon and GoAnimate. Just like Prezi and many other presentation apps on this list, they can be used for standalone presentations or to create a mini-presentation to illustrate a concept inside of a larger presentation.
5. Google Slides (and Zoho Show, and Slides)
If you are working with others to produce your slide deck, then you'll definitely want to try Google Slides. Like Google docs, Slides is built from the ground up for collaboration. For example, educators in different locations or students in the same class work together on a presentation. Google Slides is great for co-presenters who aren't together in the same room until the day they present together. With similar functionality, also check out Zoho Show and Slides.
6. SpicyNodes (and Mindmeister)
If you are looking to do more student-centered presentations, consider mind-mapping programs SpicyNodes and Mindmeister. White board and pen and paper mind maps have long been used by educators to diagram and visually organize information around a central concept. The educator usually provides the central concept and the students contribute the related information and everyone works together to make the connections. Programs like these will help you bring mind-mapping techniques to the big screen.
7. NearPod (and DisplayNote)
If you are looking to go fully interactive, consider using NearPod or DisplayNote to connect the presentation at the front of the room with the small screens that every student brings with them to class. These classroom collaboration programs allow students to keep your slides for themselves, make notes on your slides with their own devices, like tablets and smartphones, and even share their work with you and their classmates.
8. Flowvella (and Glogster and Good Labs)
If your goal is to create a tutorial or self-guided presentation for students, programs like Flowvella, Glogster or Good Labs are the way to go. More than just static documents, students can move through these presentations at their own pace, interacting with the sections of the presentation that interest them, all without the educator present.
9. Slide Dog (and Projeqt)
If mash-ups are your thing, SlideDog and Projeqt are the way to go. They let you combine a wide variety of media from video formats to PDFs to websites to PowerPoint and beyond into a single presentation. They can even incorporate up to the minute live information automatically streamed directly from the internet.
10. PowerPoint
Once you start thinking about presenting in new ways, you will start thinking about PowerPoint in a new light. With new and streamlined features, PowerPoint remains a potent presentation tool. Like any tool, what it does depends on how the educator chooses to use it. In the right hands it can be like an artist's paint brush. Used incorrectly it can be like a wooden club.
Whatever you preference for presentations, you can now go into the world with more tools in your presentation tool box. All that remains is for you to choose and practice with available tools to better create student centered education in a digital world.
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Pleiotropic function of TRPV4 ion channels in the central nervous system
TRPV4 ion channels are osmo-mechano-TRP channels with pleiotropic function and expression in many different types of tissues and cells. They have also been found involved in pain and inflammation. Studies have focused on the role of TRPV4 in peripheral sensory neurons, but its expression and function in central nervous glial cells and neurons has also been documented. In this overview, based on the senior author's lecture at the recent physiology meeting in Dublin, we concisely review evidence of TRPV4 expression and function in the CNS, and how TRPV4 function can be modulated for therapeutic benefit of neuro-psychiatric disorders. Novel TRPV4-inhibitory compounds developed recently in the authors' lab will also be discussed.
This article is protected by copyright. All rights reserved
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10 best PowerPoint alternatives for EMS educators
Before changing presentation software, first change how you think about teaching EMT and paramedic students.
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Why crush injury is important to treat early
Crush injury from structure collapse and EMS treatment priorities described at EMS World Expo World Trauma Symposium.
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Modelling of the optimal bupivacaine dose for spinal anaesthesia in ambulatory surgery based on data from systematic review
BACKGROUND: Spinal bupivacaine is used for day-case surgery but the appropriate dose that guarantees hospital discharge is unknown. OBJECTIVE: We sought to determine the spinal bupivacaine dose that prevents delayed hospital discharge in ambulatory surgery. DESIGN: Systematic review of clinical trials. DATA SOURCES: Comprehensive search in electronic databases of studies published between 1996 and 2014 reporting the use of spinal bupivacaine in ambulatory patients. Additional articles were retrieved through hyperlinks and by manually searching reference lists in original articles, review articles and correspondence published in English and French. MAIN OUTCOME MEASURES: Data were used to calculate, motor block duration and discharge time, an estimated maximal effect (Emax: maximum theoretical time of motor block) and the effective dose to obtain half of Emax (D50) with 95% confidence intervals (CIs). A simulation was performed to determine the dose corresponding to a time to recovery of 300 min for motor function, and 360 min for discharge, in 95% of the patients. RESULTS: In total, 23 studies (1062 patients) were included for analysis of the time to recovery of motor function, and 12 studies (618 patients) for the time to hospital discharge. The Emax for recovery of motor function was 268 min [95% CI (189 to 433 min)] and the D50 was 3.9 mg [95% CI (2.3 to 6.2 mg)]. A 7.5-mg dose of bupivacaine enables resolution of motor block and ambulation within 300 min in 95% of the patients. A 5-mg dose or less was associated with an unacceptable failure rate. CONCLUSION: Ambulatory surgery is possible under spinal anaesthesia with bupivacaine although the dose range that ensures reliable anaesthesia with duration short enough to guarantee ambulatory management is narrow.from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2dGTWgf
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To streamline the guideline challenge: The European Society of Anaesthesiology policy on guidelines development
No abstract available
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Anaesthesia and orphan disease: Hutchinson–Gilford progeria syndrome, a case report and summary of previous cases
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Work stress and satisfaction in relation to personality profiles in a sample of Dutch anaesthesiologists: A questionnaire survey
BACKGROUND: Working in anaesthesia is stressful, but also satisfying. Work-related stress can have a negative impact on mental health, whereas work-related satisfaction protects against these harmful effects. OBJECTIVE(S): How work stress and satisfaction are experienced may be related to personality. Our aim was to study the relationship between personality and perception of work in a sample of Dutch anaesthesiologists. DESIGN: Questionnaire survey. SETTING: Data were collected in the Netherlands from July 2012 until December 2012. PARTICIPANTS: We sent electronic questionnaires to all 1955 practising resident and consultant members of the Dutch Anaesthesia Society. Of those, 655 (33.5%) were returned and could be used for analysis. MAIN OUTCOME MEASURES: The questionnaires assessed general work-related stress and satisfaction and anaesthesia-specific stress. A factor analysis was performed on the stress and satisfaction questionnaires. Personality traits were assessed using the Big Five Inventory. To identify personality profiles, a cluster analysis was performed on the Big Five Inventory. Scores of the extracted factors contributing to job stress and satisfaction were compared between the profiles we identified. RESULTS: Our analysis extracted six factors concerning general job stress. Of those, the emotionally difficult caseload contributed the most to job stress. The analysis also extracted four factors concerning general job satisfaction. Good relationships with patients and their families and being appreciated by colleagues contributed the most to satisfaction. The cluster analysis resulted in two distinct personality profiles: a distressed profile (n = 215) and a resilient profile (n = 440). General and anaesthesia-specific job stress was significantly higher and job satisfaction was significantly lower in the distressed profile, compared with the resilient profile. Experience of the emotionally difficult caseload did not differ between the two profiles CONCLUSION: Personality profiles were found to be related to anaesthesiologists' experience of work-related stress and satisfaction. One-third of the anaesthesiologists in our sample were categorised as distressed and are at risk of developing work-related mental health problems.from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2cQf0uR
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Epidural abscess after epidural analgesia in children: report of two cases
No abstract availablefrom Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2cQeVHk
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Stressors in anaesthesiology: development and validation of a new questionnaire: A cross-sectional study of Portuguese anaesthesiologists
BACKGROUND: Stress in anaesthesiologists is a common and multifactorial problem related to patients, colleagues and organisations. The consequences of stress include depression, work–home conflicts and burnout. Reduction in stress can be achieved by reducing the number and magnitude of stressors or by increasing resilience strategies. OBJECTIVES: We have created the self-reporting 'Stress Questionnaire in Anaesthesiologists' (SQA), to qualify the sources of stress in anaesthesiologists' professional lives, and measure the level of associated stress. Our study aimed to develop and validate the SQA using exploratory and confirmatory factor analyses. Construct validity was assessed through correlations between SQA and negative psychological outcomes as well as by comparing perception of stress among different known groups. DESIGN: A questionnaire-based cross-sectional, correlational, observational study. SETTINGS: The study was conducted between January 2014 and December 2014, throughout different anaesthesia departments in Portuguese hospitals. Data collection was from a representative subset at one specific time point. PARTICIPANTS: A sample of 710 anaesthesia specialists and residents from Portugal. MAIN OUTCOME MEASURES: The primary outcome measure was to identify specific stressors in anaesthesiologists. Secondary outcome was the association between stressors and burnout, depression symptoms, anxiety, stress, rumination, satisfaction with life and functional impairment. RESULTS: The exploratory analysis showed the SQA is a tri-dimensional instrument and confirmatory analysis showed the tri-dimensional structure presented good model fit. The three dimensions of SQA correlated positively with other stress measures and burnout, but negatively with satisfaction with life. CONCLUSION: SQA is a well adjusted measure for assessing stressors in anaesthesia physicians and includes clinical, organisational and team stress factors. Results showed that the SQA is a robust and reliable instrument.from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2cQeSLP
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Impact of age on anaesthesiologists’ competence: A narrative review
The international anaesthesia community is getting older, in line with trends worldwide, and as men and women age there is the risk that psychophysiological decline could have an impact on clinical practice. Impairment of technical and nontechnical skills could have a negative impact on patients' safety and outcomes. The ageing process may not necessarily go hand-in-hand with a predictable pattern of decreased competence as not all aspects of functional decline are affected at the same rate and to the same extent. The development of simulation has provided a means of detecting and perhaps reversing the decline in ability associated with age. The introduction of recertification based on an assessment of competence at simulation sessions could play a crucial role in maintaining a high standard of patient care and an appropriate level of patient safety.from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2cQeBsj
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The efficacy of local infiltration analgesia in the early postoperative period after total knee arthroplasty: A systematic review and meta-analysis
BACKGROUND: Local infiltration analgesia (LIA) has emerged as an alternative treatment for postoperative pain after total knee arthroplasty (TKA). Its efficacy remains inconclusive with inconsistent results from previous studies and meta-analyses. There is no agreement on which local anaesthetic agent and infiltration technique is most effective and well tolerated. OBJECTIVE: The objective was to compare LIA after primary TKA with placebo or no infiltration in terms of early postoperative pain relief, mobilisation, length of hospital stay (LOS) and complications when used as a primary treatment or as an adjunct to regional anaesthesia. The role of injection sites, postoperative injection or infusion and multimodal drug injection with ketorolac were also explored. DESIGN: A systematic review and meta-analysis of randomised controlled trials (RCTs). DATA SOURCES: A literature search was performed using PubMed and SCOPUS up to September 2015. ELIGIBILITY CRITERIA: RCTs comparing LIA with placebo or no infiltration after primary TKA in terms of pain score and opioid consumption at 24 and 48 h, mobilisation, LOS and complications were included. RESULTS: In total 38 RCTs were included. LIA groups had lower pain scores, opioid consumption and postoperative nausea and vomiting, higher range of motion at 24 h and shorter LOS than no injection or placebo. After subgroup analysis, intraoperative peri-articular but not intra-articular injection had lower pain score at 24 h than no injection or placebo with the pooled mean difference of pain score at rest of −0.89 [95% CI (−1.40 to −0.38); I2 = 92.0%]. Continuing with postoperative injection or infusion reduced 24-h pain score with the pooled mean difference at rest of −1.50 [95% CI (−1.92 to −1.08); I2 = 60.5%]. There was no additional benefit in terms of pain relief during activity, opioid consumption, range of movement or LOS when LIA was used as an adjunct to regional anaesthesia. Four out of 735 patients receiving LIA reported deep knee infection, three of whom had had postoperative catheter placement. CONCLUSION: LIA is effective for acute pain management after TKA. Intraoperative peri-articular but not intra-articular injection may be helpful in pain control up to 24 h. The use of postoperative intra-articular catheter placement is still inconclusive. The benefit of LIA as an adjunctive treatment to regional anaesthesia was not demonstrated.from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2cQdUiw
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Incidence and severity of chronic pain after caesarean section: A systematic review with meta-analysis
BACKGROUND: The frequency of caesarean section has increased dramatically in recent decades. Despite this, robust data regarding the consequences of caesarean section in terms of developing chronic postsurgical pain (CPSP) are still lacking. OBJECTIVE: This systematic review analysed the incidence and severity of CPSP in women 3 to less than 6, 6 to less than 12, and at least 12 months after caesarean section. DESIGN: Systematic review of prospective and retrospective observational studies and randomised controlled trials with meta-analysis. DATA SOURCE: We searched MEDLINE to May 2015. ELIGIBILITY CRITERIA: We included all studies investigating the incidence and/or severity of CPSP at least 3 months after caesarean section. The primary outcome was chronic postsurgical wound pain (CPSP 'wound'). Secondary outcomes were persistent pain in the back area, pelvic region or reported as residual pain, and severity of 'birth-related' chronic pain. RESULTS: Meta-analysis using the random-effects model based on 15 studies (n = 4475) reporting CPSP 'wound' at 3 to less than 6 months after caesarean section revealed an incidence of 15.4% [95% confidence interval (CI): 9.9 to 20.9%]. For 6 to less than 12 and at least 12 months after caesarean section, the incidence of CPSP 'wound' was estimated at 11.5% (95% CI: 8.1 to 15.0%, n = 3345) and 11.2% (95% CI: 7.4 to 15.0%, n = 3451), respectively. Meta-regression analysis using the publication year as predictor revealed stable CPSP 'wound' incidences at each postoperative time slot from 2002 to the present. Of those patients who reported chronic pain, 9.6% (95% CI: 0.0 to 21.0%) had severe pain, 23.5% (95% CI: 10.0 to 37.0%) had moderate pain and 49.2% (95% CI: 18.9 to 79.4%) had mild pain at 6 months. LIMITATIONS: Major limitations are high statistical heterogeneity of the meta-analyses and inconsistencies in reporting severity of chronic 'birth-related' pain. CONCLUSION: This meta-analysis finds a clinically relevant incidence of CPSP 'wound' after caesarean section ranging from 15% at 3 months to 11% at 12 months or longer that has been largely stable in recent years.from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2cQfZLt
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Clinical concentrations of morphine are cytotoxic on proliferating human fibroblasts in vitro
BACKGROUND: Morphine and other opioids are routinely used systemically and as wound infusions in the postoperative period. Their effect on wound and fracture healing remains unclear. OBJECTIVE: The primary outcome was to assess the potential cytotoxicity of clinically relevant concentrations of morphine on human fibroblasts. DESIGN: Laboratory in-vitro study. SETTING: Institute of Physiology, Zurich Center for Integrative Human Physiology, University of Zurich. MATERIALS: Monolayers of human fibroblasts. INTERVENTION(S): Exposure of human fibroblast monolayers to several concentrations of morphine, for different periods of time, with and without an artificially induced inflammatory process. MAIN OUTCOME MEASURES: Cell count, cell viability, cell proliferation and apoptosis. RESULTS: A concentration, time and exposure-dependent cytotoxic effect of morphine-mediated apoptosis was observed. Simulated inflammatory conditions seemed to lessen toxic effects. CONCLUSION: Cytotoxic effects of morphine are exposure, time and concentration dependent. Simulating aspects of inflammatory conditions seems to increase resistance to morphine cytotoxicity especially in the presence of higher concentration and longer exposure times.from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2cQf11U
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Anaesthesia and orphan disease: sedation with ketofol in two patients with Joubert syndrome
No abstract available
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Is there any analgesic benefit from preoperative vs. postoperative administration of etoricoxib in total knee arthroplasty under spinal anaesthesia?: A randomised double-blind placebo-controlled trial
BACKGROUND: Optimal postoperative analgesia is a challenge for the anaesthesiologist, with the ideal combination of methods, drugs, doses and timing of administration still the subject of research. The COX-2 inhibitors are a class of NSAIDs that may provide useful perioperative analgesia but the optimal timing of administration has not been elucidated. OBJECTIVE: We hypothesised that etoricoxib given 1 h before total knee arthroplasty under spinal anaesthesia will decrease the cumulative dose of intravenous and subcutaneous morphine required to maintain pain intensity of 3 or less on a 10-point numerical rating scale (NRS) during the first postoperative 48 h compared with the same dose of etoricoxib given after surgery. DESIGN: Randomised, double-blind, placebo-controlled trial. SETTING: University hospital, between January and September, 2014. PATIENTS: Overall, 165 patients scheduled for total knee arthroplasty under spinal anaesthesia. INTERVENTIONS: The patients were randomised into one of three groups: the ETORICOX-PREOP group received etoricoxib 120 mg orally 1 h before surgery, one placebo pill at the end of surgery and a further 120 mg etoricoxib after 24 h; the ETORICOX-POSTOP group received one placebo pill 1 h before surgery and etoricoxib 120 mg at the end of surgery and after 24 h. The PLACEBO group received one placebo pill 1 h before surgery, one at end of surgery and a third after 24 h. MAIN OUTCOME MEASURES: The primary outcome measure was the cumulative dose of intravenous and subcutaneous morphine required during the first postoperative 48 h to maintain a 10-point numerical pain rating scale value of 3 or less. Secondary outcomes measures were duration of analgesia from initiation of spinal anaesthesia until the first analgesic requirement and the side-effects of the treatment. RESULTS: The quantity of morphine over the first postoperative 48 h required by the ETORICOX-PREOP group (44 ± 16 mg) and the ETORICOX-POSTOP group (52 ± 23 mg) were both significantly less than the PLACEBO group (71 ± 20 mg) (P = 0.001), demonstrating a morphine-sparing effect of etoricoxib of the order of 30%; the difference between the PRE vs. POST groups was statistically significant (P = 0.02), favouring a preemptive analgesic effect. Also, there was evidence of a longer time to first analgesia compared with PLACEBO in the PREOP group (P = 0.02) but no significant difference between PREOP and POSTOP groups (P = 0.30). There was no difference in side-effects among the three study groups and there were no serious adverse effects of etoricoxib. CONCLUSION: Preemptive administration of etoricoxib 120 mg orally in patients undergoing total knee arthroplasty under spinal anaesthesia is superior to postoperative administration of the same dose in terms of its morphine-sparing effect during the first postoperative 48 h, but not in prolonging the time to first analgesia, and is associated with a similar incidence of side-effects. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT 02534610.from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2dGTDlX
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The laryngeal mask airway in elective paediatric day case ENT surgery: a prospective audit
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Why crush injury is important to treat early
NEW ORLEANS — Crush injury, secondary to collapsed structure, presents a unique rescue and patient care challenge for EMS providers. Jeff Elder, MD, described trauma patients with crush injury at the World Trauma Symposium, a one day trauma-focused session at the EMS World Expo.
The medical component is just one aspect of a complex technical rescue from a collapsed structure. Elder discussed the importance of a medical specialist, a rescue paramedic with specialized skills and equipment, to provide care to collapsed structure victims.
Memorable quotes
Here are memorable quotes from Elder on the challenges of collapsed structure and confined space rescue.
"This is not your traditional 911 call. It (collapsed structure) requires additional training and expertise. There is a lot going on other than taking care of the trauma patient."
"Preparation is the most important. Hundreds of hours of training are required. If you don't do training the other nine points (from FDNY 10 point list) of collapse rescue are going to fall by the way side."
"Crush injury is the actual physical crush of muscle groups, extremities — whatever is being squeezed. Crush syndrome is the systemic manifestation of all the bad stuff that results from the crush injury."
"Monitor patient, get fluids going, extricate patient and begin treatment for crush syndrome. It's a full court press. You do everything."
Key takeaways on crush injury and syndrome
Here are the key takeaways from Elder's presentation.
People get trapped
Confined space incidents, which create crush injuries, result from accidental or intentional collapse of structure and trenches. Incidents can also occur in industrial settings and often involve machinery.
Faulty construction is the top reason worldwide for building collapse. Collapse rescue survivors can be found in voids. The size and availability of voids — lean to, v-shape, pancake — depends on the type of structure and how it collapsed.
Rescuers use a variety of tools to look (fiber-optic cameras), listen (listening devices) or sniff (search dogs) for victims. The patient contact phase of a collapse rescue includes disentanglement (getting the patient out), packaging (bundling the patient for extrication from the rubble safely) and removal (from collapse to definitive care).
Patient assessment in collapsed and confined spaces
Initial contact with the patient, even as limited as being able to access a single extremity or simply speak with the patient, starts the assessment process. It just takes one arm or a foot to get some vital signs. Being able to talk to the patient or hear the patient speaking is enough for an assessment of level of consciousness. Begin assessment and treatment before the patient is released or extricated.
Early and prolonged care for critical patients
It's likely the most severely injured patients will take the most time to find, disentangle and package for extrication from the rubble. Anticipate traumatic injuries from penetrating, blunt and primary blast mechanisms.
The goal of treatment is to identify crush injury and try to prevent the manifestations or minimize the damage of crush syndrome. Start intravenous fluid administration as soon as possible, potentially hours before the patient is released from the collapse. The patient urinating in the hole during rescue is a good sign.
Urine output, a sign of proper hydration, is important for removing toxins and maintaining kidney function. Urine alkalization with sodium bicarbonate also helps prevent crush syndrome. Patient care is likely to be prolonged and often begins before the patient is removed from the scene. Use 12-EKG monitoring to identify hyperkalemia — peaked T waves — and begin treatment as soon as possible following ACLS protocol (calcium, sodium bicarbonate, albuterol).
EMS operations are not limited to patient care
EMS providers may be called upon to monitor incident safety, provide rehab services and rescuer monitoring and treat minor injuries to rescuers. Elder shared a rehab tip to distribute six ounce water bottles to responders receiving rehab. At a recent deployment, responders drank water more regularly when given a small bottle they could gulp instead of a large bottle to sip from.
Learn more about collapse structure and MCI response:
- 4 important considerations for victims of collapsed structures
- When disaster strikes in the US, the National Disaster Medical System responds
- 10 tips for ambulance staging at mass casualty incidents
- Syrian White Helmet rescue workers focus of Netflix documentary
- Why EMS providers should watch 'The White Helmets'
Top Tweets
Monitor & suspect hyperkalaemia in crush injury. Treate pre-release to try to shift the potassium into the cells. #EMSWorldExpo #crushinjury http://pic.twitter.com/24iiINjlCV
— Carrie Thomas (@doccarrie) October 4, 2016
Crush injury syndrome some of sickest patients, arrhytmias kill immediately. Pre-release treatment. Get them peeing with IVFs. #EMSWorldExpo http://pic.twitter.com/SanQVRt4ba
— Carrie Thomas (@doccarrie) October 4, 2016
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Sierra Wireless launches industry-leading LTE-Advanced multi-network platform for first responders, field services and transit
Vancouver, Canada – October, 2016 – Sierra Wireless (NASDAQ: SWIR) (TSX: SW), a leading provider of fully integrated end-to-end solutions for Internet of Things (IoT) applications, today announced the availability of the AirLink® MG90, a high performance LTE-Advanced vehicle networking platform that provides secure, always-on mobile connectivity. The MG90 builds on the success of the ...
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New "ICU"/hyperbaric therapy chamber at Oslo University Hospital:
This is about time.Did 50M."Club Dive"in the old one, 1985... This is a different world. TV/Video/Radio.Full intensive care capable. For better treatment of emergency(Dive-medical,CO intox,-other,. On the roof of the Emergency building(50 tonn(+The Hwy.building),-near the Heliport.) And: The worlds deepest concert -303 Meters(994feet) below the surface of the sea: https://youtube/_YtCHHpZNxo (Time 59,30=This is the closest thing to crasy) Full documentary,(-or just the concert? It starts at 28,52) :http://ift.tt/1NuXCu7 ExEMTNor
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New "ICU"/hyperbaric therapy chamber at Oslo University Hospital:
This is about time.Did 50M."Club Dive"in the old one, 1985... This is a different world. TV/Video/Radio.Full intensive care capable. For better treatment of emergency(Dive-medical,CO intox,-other,. On the roof of the Emergency building(50 tonn(+The Hwy.building),-near the Heliport.) And: The worlds deepest concert -303 Meters(994feet) below the surface of the sea: https://youtube/_YtCHHpZNxo (Time 59,30=This is the closest thing to crasy) Full documentary,(-or just the concert? It starts at 28,52) :http://ift.tt/1NuXCu7 ExEMTNor
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New "ICU"/hyperbaric therapy chamber at Oslo University Hospital:
This is about time.Did 50M."Club Dive"in the old one, 1985... This is a different world. TV/Video/Radio.Full intensive care capable. For better treatment of emergency(Dive-medical,CO intox,-other,. On the roof of the Emergency building(50 tonn(+The Hwy.building),-near the Heliport.) And: The worlds deepest concert -303 Meters(994feet) below the surface of the sea: https://youtube/_YtCHHpZNxo (Time 59,30=This is the closest thing to crasy) Full documentary,(-or just the concert? It starts at 28,52) :http://ift.tt/1NuXCu7 ExEMTNor
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A community based cross sectional study on gender preference, awareness and attitude regarding sex determination among married women in rural field practice areas of North Karnataka, India
2016-10-04T06-23-23Z
Source: International Journal of Community Medicine and Public Health
Rajesh R. Kulkarni, Manjusha Bandireddy, Nagamani Sahiti Bayyapu Reddy.
Background: Female infanticide has been practiced in India since 1789. The child sex ratio in India is declining from 947 to 927 girls for 1000 boys within a span of ten years. This decline can be attributed to arrival of affordable and widespread adoption of Ultrasound in the early 1990s in India. Like other countries around the world, India is patriarchal. A set hierarchy prevails in all tiers of its social order, and a fanatic preference for male children is especially common in India. Still in India value system based son mania prevails. In this view our study regarding awareness and attitude towards gender preferences was relevant. Objective of the study was to evaluate gender preference, awareness and attitude regarding sex determination among married women in rural field practice Areas of North Karnataka, India. Methods: Community based cross-sectional study conducted by interviewing married women of reproductive age group attending general OPD and antenatal clinics in rural field practice areas. Statistical analysis was done by tables and charts in percentage. Results: In this study when asked about gender preferences most (49.4%) of the study subjects showed interest towards male child. Majorities (91%) of study participants were unaware about the pre natal sex determination, 4.5% were aware and 3.8% knew that sex determination was done in both private and government hospitals. When enquired about the method of sex determination majority (84%) were unaware, 15% knew that it is done by Ultrasonography. Among the study participants 75% were unaware about the fact that sex determination is considered as a crime in India and in the remaining, only 13% knew that there is a 13% knew that there is a strict punishment or penalty exists in India for sex determination. Conclusions: In present study we found that son preference is still more in rural areas. Government should impose High fines and should take strict judicial action against parents who try to kill their unborn baby girl. More IEC activities to create awareness about ill effects of female feticide among rural women.
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New "ICU"/hyperbaric therapy chamber at Oslo University Hospital:
This is about time.Did 50M."Club Dive"in the old one, 1985... This is a different world. TV/Video/Radio.Full intensive care capable. For better treatment of emergency(Dive-medical,CO intox,-other,. On the roof of the Emergency building(50 tonn(+The Hwy.building),-near the Heliport.) And: The worlds deepest concert -303 Meters(994feet) below the surface of the sea: https://youtube/_YtCHHpZNxo (Time 59,30=This is the closest thing to crasy) Full documentary,(-or just the concert? It starts at 28,52) :http://ift.tt/1NuXCu7 ExEMTNor
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Influence of previous abdominal surgery on surgical outcomes between laparoscopic and open surgery in elderly patients with colorectal cancer: Subanalysis of a large multicenter study in Japan
Journal of Gastroenterology
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Effect of ventriculo-arterial coupling on transplant outcomes in cirrhotics: Analysis of pressure-volume curve relations
Journal of Hepatology
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Transarterial chemoembolization for metastatic neuroendocrine tumors with massive hepatic tumor burden: Is the benefit worth the risk?
Annals of Surgical Oncology
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Comparison of different methods of splenic hilar lymph node dissection for advanced upper- and/or middle-third gastric cancer
BMC Cancer
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Association of maternal prepregnancy BMI with metabolomic profile across gestation
International Journal of Obesity
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Management of para-aortic lymph node metastasis in colorectal patients: A systemic review
Surgical Oncology
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Effect of lower limb closed kinematic chain exercises on balance in patients with chemotherapy-induced peripheral neuropathy: a pilot study.
Because of the rising prevalence of cancer, many individuals are living with the side effects of cancer and its treatment. One of the possible side effects is chemotherapy-induced peripheral neuropathy (CIPN). The purpose of the study was to examine the effect of lower limb closed kinematic chain exercises on balance in patients with CIPN. The study design was a single group pre-post experimental one. The study was conducted at a tertiary care cancer hospital. A total of 25 individuals with CIPN and aged 30 years and older were recruited using the Modified Total Neuropathy Score higher than 5. Closed kinematic chain exercises were administered for a total of 15 sessions over 3 weeks. Patients were assessed at baseline using the mTNS and Berg Balance Scale and reassessed after 15 sessions. mTNS score decreased from 13.88 at baseline to 6.5 at the end of intervention, and the Berg Balance Scale increased from 26 at baseline to 42 after intervention, with a P-value of 0.00001. Exercises were effective in reducing symptoms in neuropathy and improving balance. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.
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Predictors of physical independence at discharge after stroke rehabilitation in a Dutch population.
The aim of this study was to identify predictors, available at admission, of physical independence at discharge from inpatient rehabilitation. Secondary aims were to identify predictors of functional gain and length of stay (LOS). We included 1310 adult stroke patients who were admitted for inpatient rehabilitation in five Dutch rehabilitation centres. Data on the Utrecht Scale for Evaluation of Clinical Rehabilitation at admission and discharge (physical and cognitive independence, mood, pain and fatigue), age, sex and in a subsample stroke characteristics as well were collected. A prediction model was created using random coefficient analysis. None of the stroke characteristics were independently associated with physical independence or functional gain at discharge, or LOS. Higher physical and cognitive independence scores and severe pain at admission were predictors of higher physical independence scores at discharge. Furthermore, lower physical independence scores, higher cognitive independence scores, less pain at admission and younger age predicted more functional gain. Finally, lower physical and cognitive independence scores at admission and younger age predicted longer LOS. Physical independence at admission was the most robust predictor for rehabilitation outcome in a Dutch rehabilitation setting. To a lesser extent, age, cognitive independence and pain predicted rehabilitation outcome after stroke. Treatment of cognition and pain should be taken into account during rehabilitation. Further work needs to be carried out to establish whether focusing on these factors improves outcome after rehabilitation. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.
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Reconstructing ERP amplitude effects after compensating for trial-to-trial latency jitter: A solution based on a novel application of residue iteration decomposition
Source:International Journal of Psychophysiology, Volume 109
Author(s): Guang Ouyang, Werner Sommer, Changsong Zhou
Stimulus-locked averaged event-related potentials (ERPs) are among the most frequently used signals in Cognitive Neuroscience. However, the late, cognitive or endogenous ERP components are often variable in latency from trial to trial in a component-specific way, compromising the stability assumption underlying the averaging scheme. Here we show that trial-to-trial latency variability of ERP components not only blurs the average ERP waveforms, but may also attenuate existing or artificially induce condition effects in amplitude. Hitherto this problem has not been well investigated. To tackle this problem, a method to measure and compensate component-specific trial-to-trial latency variability is required. Here we first systematically analyze the problem of single trial latency variability for condition effects based on simulation. Then, we introduce a solution by applying residue iteration decomposition (RIDE) to experimental data. RIDE separates different clusters of ERP components according to their time-locking to stimulus onsets, response times, or neither, based on an algorithm of iterative subtraction. We suggest to reconstruct ERPs by re-aligning the component clusters to their most probable single trial latencies. We demonstrate that RIDE-reconstructed ERPs may recover amplitude effects that are diminished or exaggerated in conventional averages by trial-to-trial latency jitter. Hence, RIDE-corrected ERPs may be a valuable tool in conditions where ERP effects may be compromised by latency variability.
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Ultrasound Guided Liver Biopsy with Gelatin Sponge Pledget Tract Embolization in Infants Weighing Less Than 10 kg.
Purpose: To describe and assess the technical success and safety of ultrasound guided liver biopsy with gelatin sponge pledget tract embolization technique in infants less than 10 kg across three tertiary pediatric hospitals. Materials and Methods: There were 67 pediatric patients weighing less than 10 kg (36 males; 31 females; average age 202 days; average weight 6 kg, range 1.5 kg to 9.9 kg) referred for liver biopsy performed with ultrasound guidance and gelatin sponge pledget tract embolization during a two year period. Patient history, procedural records, and clinical follow-up documents were retrospectively reviewed. Results: A total of 67 procedures were included. There was 100% technical success rate and all samples obtained provided adequate tissue for histological assessment. Average number of 18G biopsy passes was 3 (range 1-6). There were no procedure-related deaths. There was one complication (1%) in an 5 kg infant who was readmitted 36 hours after biopsy with a fever and after antibiotics were administered fully recovered. Biliary atresia was the most common underlying diagnosis (20%), while others included acute rejection (16%), biliary obstruction (7%). Conclusions: Ultrasound guided percutaneous liver biopsy with gelatin sponge pledget tract embolization technique in children less than 10 kg is safe, effective, and use of this technique may lead to a reduction in rates of adverse events reported in other pediatric series. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,
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