Παρασκευή, 7 Οκτωβρίου 2016

A New Technical Approach for Fluoroscopy-Guided Transforaminal Epidural Steroid Injection at Fusion Level in Patients with Transforaminal Lumbar Interbody Fusion (TLIF) Surgery

BACKGROUND CONTEXT: Transforaminal epidural steroid injection (TESI) is one of the treatment methods for postdiscectomy neuritis and epidural fibrosis. Our experience in patients who underwent transforaminal lumbar interbody fusion (TLIF) surgery, conventional posterolateral approach, lead to either extraforaminal or lateral placement of the needle in respect to the foramina because the metallic rod blocked the needle trajectory for routine posterolateral approach. Thus, in most of the cases, a far lateral posterolateral approach with longer needle was needed; however, potential difficulties in directing and controlling the needle from a longer distance must be considered.

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Improving Navigation Performance in Spine Surgery: A Human Factors Approach

BACKGROUND CONTEXT: Intraoperative computed tomography image-guided navigation (CT-IGN) has made a tremendous impact on spine surgery. However, the complexities of workflow and the interplay between the surgeon, operating room team and navigation technology have never been described. Using a novel human factors analysis approach, we successfully studied spinal navigation workflow to understand relationships between learning curves, operative phase, and workflow disruptions. We categorized these flow disruptions in an attempt to identify potential improvements in using CT-IGN in spine surgery.

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Genome Report: Whole Genome Sequence of Two Wild-Derived Mus musculus domesticus Inbred Strains, LEWES/EiJ and ZALENDE/EiJ, with Different Diploid Numbers

Wild-derived mouse inbred strains are becoming increasingly popular for complex traits analysis, evolutionary studies, and systems genetics. Here we report the whole-genome sequencing of two wild-derived mouse inbred strains, LEWES/EiJ and ZALENDE/EiJ, of Mus musculus domesticus origin. These two inbred strains were selected based on their geographic origin, karyotype, and use in ongoing research. We generated 14X and 18X coverage sequence, respectively, and discovered over 1.1 million novel variants, most of which are private to one of these strains. This report expands the number of wild-derived inbred genomes in Mus genus from six to eight. The sequence variation can be accessed via an online query tool; variant calls (VCF format) and alignments (BAM format) are available for download from a dedicated ftp site. Finally, the sequencing data has also been stored in a lossless, compressed, indexed format using the multi-string Burrows-Wheeler transform. All data can be used without restriction.



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Heme oxygenase-1-dependent central cardiorespiratory adaptations to chronic intermittent hypoxia in mice

Chronic intermittent hypoxia (CIH) increases sympathetic tone and respiratory instability. Our previous work showed that chronic hypoxia induces the oxygen-sensing enzyme heme oxygenase-1 (HO-1) within the C1 sympathoexcitatory region and the pre-Bötzinger complex (pre-BötC). We therefore examined the effect of CIH on time course of induced expression of HO-1 within these regions and determined whether the induction of HO-1 correlated with changes in respiratory, sigh frequency, and sympathetic responses (spectral analysis of heart rate) to acute hypoxia (10% O2) during 10 days of exposure to CIH in chronically instrumented awake wild-type (WT) and HO-1 null mice (HO-1–/–). HO-1 was induced within the C1 and pre-BötC regions after 1 day of CIH. There were no significant differences in the baseline respiratory parameters between WT and HO-1–/–. Prior to CIH, acute hypoxia increased respiratory frequency in both WT and HO-1–/–; however, minute diaphragm electromyogram activity increased in WT but not HO-1–/–. The hypoxic respiratory response after 1 and 10 days of CIH was restored in HO-1–/–. CIH resulted in an initial significant decline in 1) the hypoxic sigh frequency response, which was restored in WT but not HO-1–/–, and 2) the baseline sympathetic activity in WT and HO-1–/–, which remained stable subsequently in WT but not in HO-1–/–. We conclude that 1) CIH induces expression of HO-1 in the C1 and pre-BötC regions within 1 day and 2) HO-1 is necessary for hypoxia respiratory response and contributes to the maintenance of the hypoxic sigh responses and baseline sympathetic activity during CIH.



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Central command does not suppress baroreflex control of cardiac sympathetic nerve activity at the onset of spontaneous motor activity in the decerebrate cat

Our laboratory has reported that central command blunts the sensitivity of the aortic baroreceptor-heart rate (HR) reflex at the onset of voluntary static exercise in animals. We have examined whether baroreflex control of cardiac sympathetic nerve activity (CSNA) and/or cardiovagal baroreflex sensitivity are altered at the onset of spontaneously occurring motor behavior, which was monitored with tibial nerve activity in paralyzed, decerebrate cats. CSNA exhibited a peak increase (126 ± 17%) immediately after exercise onset, followed by increases in HR and mean arterial pressure (MAP). With development of the pressor response, CSNA and HR decreased near baseline, although spontaneous motor activity was not terminated. Atropine methyl nitrate (0.1-0.2 mg/kg iv) with little central influence delayed the initial increase in HR but did not alter the response magnitudes of HR and CSNA, while atropine augmented the pressor response. The baroreflex-induced decreases in CSNA and HR elicited by brief occlusion of the abdominal aorta were challenged at the onset of spontaneous motor activity. Spontaneous motor activity blunted the baroreflex reduction in HR by aortic occlusion but did not alter the baroreflex inhibition of CSNA. Similarly, atropine abolished the baroreflex reduction in HR but did not influence the baroreflex inhibition of CSNA. Thus it is likely that central command increases CSNA and decreases cardiac vagal outflow at the onset of spontaneous motor activity while preserving baroreflex control of CSNA. Accordingly, central command must attenuate cardiovagal baroreflex sensitivity against an excess rise in MAP as estimated from the effect of muscarinic blockade.



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Attenuation of visual reafferent signals in the parietal cortex during voluntary movement

It is well established that the cortical processing of somatosensory and auditory signals is attenuated when they result from self-generated actions compared with external events. This phenomenon is thought to result from an efference copy of motor commands used to predict the sensory consequences of an action through a forward model. The present work examined whether attenuation also takes place for visual reafferent signals from the moving limb during voluntary reaching movements. To address this issue, EEG activity was recorded in a condition in which visual feedback of the hand was provided in real time and compared with a condition in which it was presented with a 150-ms delay, thus creating a mismatch between the predicted and actual visual consequences of the movement. Results revealed that the amplitude of the N1 component of the visual event-related potential evoked by hand visual feedback over the parietal cortex was significantly smaller when presented in real time compared with when it was delayed. These data suggest that the cortical processing of visual reafferent signals is attenuated when they are correctly predicted, likely as a result of a forward model.



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Repetition priming of motor activity mediated by a central pattern generator: the importance of extrinsic vs. intrinsic program initiators

Repetition priming is characterized by increased performance as a behavior is repeated. Although this phenomenon is ubiquitous, mediating mechanisms are poorly understood. We address this issue in a model system, the feeding network of Aplysia. This network generates both ingestive and egestive motor programs. Previous data suggest a chemical coding model: ingestive and egestive inputs to the feeding central pattern generator (CPG) release different modulators, which act via different second messengers to prime motor activity in different ways. The ingestive input to the CPG (neuron CBI-2) releases the peptides feeding circuit activating peptide and cerebral peptide 2, which produce an ingestive pattern of activity. The egestive input to the CPG (the esophageal nerve) releases the peptide small cardioactive peptide. This model is based on research that focused on a single aspect of motor control (radula opening). Here we ask whether repetition priming is observed if activity is triggered with a neuron within the core CPG itself and demonstrate that it is not. Moreover, previous studies demonstrated that effects of modulatory neurotransmitters that induce repetition priming persist. This suggests that it should be possible to "prime" motor programs triggered from within the CPG by first stimulating extrinsic modulatory inputs. We demonstrate that programs triggered after ingestive input activation are ingestive and programs triggered after egestive input activation are egestive. We ask where this priming occurs and demonstrate modifications within the CPG itself. This arrangement is likely to have important consequences for "task" switching, i.e., the cessation of one type of motor activity and the initiation of another.



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COW URINE- THERAPEUTIC VALUE

2016-10-07T20-24-21Z
Source: International Journal of Livestock Research
RAJESH KUMAR SAHU, NELAPATI KRISHNAIAH, PUTTURU RAMYA, POLURU ANUSHA.
Cow is believed as gift of god for the people. Now a days several diseases are occurring to human society which are incurable. Cow urine is panacea of all diseases and used for the treatment of diseases like blood pressure, diabetes, cancer, skin disorder, constipation, AIDS etc. Cow urine contains all the substances which are present in human body. Consumption of cow urine helps in maintaining the balance of body constituents as well as curing of several diseases.


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Green tea extract does not affect exogenous glucose appearance but reduces insulinemia with glucose ingestion in exercise recovery

We reported that supplementation with green tea extract (GTE) lowered the glycemic response to an oral glucose load following exercise but via an unknown mechanism. Here we examined the effect of supplementation with GTE on plasma glucose kinetics upon ingestion of a glucose beverage during exercise recovery. Eleven healthy, sedentary men (21±2 y; BMI=23±4 kg•m-2, VO2peak=38±7 ml•kg-1•min-1; mean±SD) ingested GTE (350 mg) or placebo (PLA) thrice daily for 7-d in a double-blind, crossover design. In the fasted state, a primed constant infusion of [U-13C6] glucose was started, and 1-h later, subjects performed a graded-exercise test (25 Watts/3 min) on a cycle ergometer. Immediately post-exercise, subjects ingested a 75g glucose beverage containing 2g of [6,6-2H2] glucose, and blood samples were collected every 10-min for 3-h of recovery. The rate of carbohydrate oxidation was lower during exercise after GTE vs. PLA (1.26±0.34 vs. 1.48±0.51 g•min-1, P=0.04). Glucose area under the curve (AUC) was not different between treatments after drink ingestion (GTE=1067±133 vs. PLA=1052±91 mM•180 min, P=0.91). Insulin AUC was lower after GTE vs. PLA (5673±2153 vs. 7039±2588 µIU•180 min, P=0.05), despite similar rates of glucose appearance (GTE=0.42±0.16 vs. PLA=0.43±0.13, g•min-1, P=0.74) and disappearance (GTE=0.43±0.14 vs. PLA=0.44±0.14, g•min-1, P=0.57). We conclude that short-term GTE supplementation did not affect glucose kinetics following ingestion of an oral glucose load post-exercise; however, GTE was associated with attenuated insulinemia. These findings suggest GTE lowers the insulin required for a given glucose load during post-exercise recovery, which warrants further mechanistic studies in humans



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The effect of body mass and gender on the accuracy of respiratory magnetometers for measurement of end expiratory lung volumes.

Respiratory magnetometers are increasingly being used in sleep studies to measure changes in end expiratory lung volume (EELV), including in obese obstructive sleep apnea (OSA) patients. Despite this, the accuracy of magnetometers has not been confirmed in obese patients, nor compared between genders. Thus, we compared spirometer-measured and magnetometer-estimated lung volume and tidal volume changes during voluntary end-expiratory lung volume changes of 1.5L, 1L, and 0.5L above, and 0.5L below, functional respiratory capacity (FRC) in supine normal weight (BMI<25kg/m2) and healthy obese (BMI>30kg/m2) men and women. Two different magnetometer calibration techniques proposed by Banzett (2) and Sackner (28) were assessed. Across all groups and target volumes, magnetometers overestimated spirometer-measured EELV by approximately 65mL (p<0.001) with no difference between techniques (p=0.07). The Banzett method overestimated the spirometer EELV change in normal weight women for all target volumes except +0.5L whereas no differences between mass or gender groups were observed for the Sackner technique. The variability of breath-to-breath measures of EELV was significantly higher for obese compared to non-obese subjects and was higher for the Sackner than Banzett technique. On the other hand, for tidal volume both calibration techniques underestimated spirometer measurements (p< 0.001), with the underestimation being more marked for the Banzett than Sackner technique (p=0.03), in obese than normal weight (p<0.001) and in men than in women (p=0.003). These results indicate that both body mass and gender affect the accuracy of respiratory magnetometers in measuring EELV and tidal volume.



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Modulation of respiratory output by cervical epidural stimulation in the anesthetized mouse.

Respiration is produced and controlled by well-characterized brainstem nuclei, but the contributions of spinal circuits to respiratory control and modulation remain under investigation. Many respiratory studies are conducted in in vitro preparations (e.g., brainstem slice) obtained from neonatal rodents. While informative, these studies do not fully recapitulate the complex afferent and efferent neural circuits that are likely to be involved in eupnea (i.e., quiet breathing). To begin to investigate spinal contributions to respiration, we electrically stimulated the cervical spinal cord during unassisted respiration in anesthetized, intact mice. Specifically, we used epidermal electrical stimulation at 20 Hz and varied current intensity to map changes in respiration. Stimulating at 1.5 mA at cervical level 3 (C3) consistently caused a significant increase in respiratory frequency compared to pre-stimulation baseline and when compared to sham stimulations. The increase in respiratory frequency persisted for several minutes after epidural stimulation ceased. There was no change in tidal volume, and the estimated minute ventilation was increased as a consequence of the increase in respiratory frequency. Sigh frequency also increased during epidural stimulation at C3. Neither the increase in respiratory frequency nor the increase in sighing were observed after stimulation at other dorsal cervical levels. These findings suggest that the spinal circuits involved in the modulation of eupnea and sighing may be preferentially activated by specific endogenous inputs. Moreover, the cervical spinal cord may play a role in respiratory modulation that affects both eupneic respiration and sigh production in intact, adult mice.



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REGIONAL GAS TRANSPORT IN THE HETEROGENEOUS LUNG DURING OSCILLATORY VENTILATION

Regional ventilation in the injured lung is heterogeneous and frequency-dependent, making it difficult to predict how an oscillatory flow waveform at a specified frequency will be distributed throughout the periphery. To predict the impact of mechanical heterogeneity on regional ventilation distribution and gas transport, we developed a computational model of distributed gas flow and CO2 elimination during oscillatory ventilation from 0.1 to 30 Hz. The model consists of a three dimensional airway network of a canine lung, with heterogeneous parenchymal tissues to mimic effects of gravity and injury. Model CO2 elimination during single frequency oscillation was validated against previously published experimental data (Venegas et al., J. Appl. Physiol. 60:1025-1030, 1986). Simulations of gas transport demonstrated a critical transition in flow distribution at the resonant frequency, where the reactive components of mechanical impedance due to airway inertia and parenchymal elastance were equal. For frequencies above resonance, the distribution of ventilation became spatially clustered and frequency-dependent. These results indicate that regional distribution of ventilation and gas exchange, in addition to global CO2 elimination, should be important factors for determining the appropriate frequency settings during oscillatory ventilation in the heterogeneous lung.



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EFFECTS OF BODY POSITION ON EXERCISE CAPACITY AND PULMONARY VASCULAR PRESSURE-FLOW RELATIONSHIPS

There has been revival of in interest in exercise testing of the pulmonary circulation for the diagnosis of pulmonary vascular disease, but there still is uncertainty about body position and the most relevant measurements. Doppler echocardiography pulmonary hemodynamic measurements were performed at progressively increased workload in 26 healthy adult volunteers in supine, semi-recumbent and upright positions which were randomly assigned at 24 hours intervals. Mean pulmonary artery pressure (mPAP) was estimated from the maximum tricuspid regurgitation jet velocity. Cardiac output (CO) was calculated from the left ventricular outflow velocity-time integral. Pulmonary vascular distensibility α-index, the % change of vessel diameter per mmHg of mPAP, was calculated from multi-point mPAP-CO plots. Body position did not affect maximum oxygen uptake (VO2max), maximum respiratory exchange ratio, ventilatory equivalent for carbon dioxide or slope of mPAP-CO relationships which was on average of 1.5 ± 0.4 mmHg/L/min. Maximum mPAP, CO, and total pulmonary vascular resistance (TPR) were respectively of 34 ± 4 mmHg, 18 ± 3 L/min, and 1.9 ± 0.3 Wood units. However, the semi-recumbent position was associated with a 10 % decrease in maximum workload. Furthermore, CO-workload or CO-VO2 relationships were nonlinear and too variable for a reliable prediction of CO. Thus, these results suggest that body position does not affect maximum exercise testing of the pulmonary circulation when results are expressed as mPAP-CO or maximum TPR. Maximum workload is decreased in semi-recumbent as compared to upright exercise. Workload or VO2 cannot reliably be used as surrogates for CO.



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The effect of endothelin A and B receptor blockade on cutaneous vascular and sweating responses in young males during and following exercise in the heat

During exercise, cutaneous vasodilation and sweating responses occur, whereas these responses rapidly decrease during postexercise recovery. We hypothesized that the activation of endothelin A (ETA) receptors, but not endothelin B (ETB) receptors, attenuate cutaneous vasodilation during high-intensity exercise and contribute to the subsequent postexercise suppression of cutaneous vasodilation. We also hypothesized that both receptors increase sweating during and following high-intensity exercise. Eleven males (24 ± 4 years) performed an intermittent cycling protocol consisting of two 30-min bouts of moderate- (40% VO2peak) and high- (75% VO2peak) intensity exercise in the heat (35°C), each separated by a 20- and 40-min recovery period, respectively. Cutaneous vascular conductance (CVC) and sweat rate were evaluated at four intradermal microdialysis skin sites: 1) lactated Ringer (Control), 2) 500 nM BQ123 (a selective ETA receptor blocker), 3) 300 nM BQ788 (a selective ETB receptor blocker), or 4) a combination of BQ123+BQ788. There were no between-site differences in CVC during each exercise bout (all P > 0.05), however, CVC following high-intensity exercise was greater at BQ123 (56 ± 9 %max) and BQ123+BQ788 (55 ± 14 %max) sites relative to the Control site (43 ± 12 %max) (all P ≤ 0.05). Sweat rate did not differ between sites throughout the protocol (all P > 0.05). We show that neither ETA nor ETB receptors modulate cutaneous vasodilation and sweating responses during and following moderate- and high-intensity exercise in the heat, with the exception that ETA receptors may partly contribute to the suppression of cutaneous vasodilation following high-intensity exercise.



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Whole-body heat stress attenuates the pressure response to muscle metaboreceptor stimulation in humans

The effects of whole-body heat stress on sympathetic and cardiovascular responses to stimulation of muscle metaboreceptors and mechanoreceptors remains unclear. We examined the muscle sympathetic nerve activity (MSNA), blood pressure and heart rate in 14 young healthy subjects during fatiguing isometric handgrip exercise, post exercise circulatory occlusion (PECO), and passive muscle stretch during PECO. The protocol was performed under normothermic and whole-body heat stress (increase internal temperature ~0.6 °C via a heating suit) conditions. Heat stress increased the resting MSNA and heart rate. Heat stress did not alter the mean blood pressure (MAP), heart rate and MSNA responses (i.e. changes) to fatiguing exercise. During PECO, whole-body heat stress accentuated the heart rate response (5.8 ± 1.5 to 10.0 ± 2.1 beats/min, P = 0.03), did not alter the MSNA response (16.4 ± 2.8 to 17.3 ± 3.8 bursts/min, P = 0.74), and lowered the MAP response (20 ± 2 to 12 ± 1 mmHg, P < 0.001). Under normothermic conditions, passive stretch during PECO evoked significant increases in MAP and MSNA (both P < 0.001). Of note, heat stress prevented the MAP and MSNA responses to stretch during PECO (both P > 0.05). These data suggest that whole-body heat stress attenuates the pressor response due to metaboreceptor stimulation, and the sympathetic nerve response due to mechanoreceptor stimulation.



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A lethal tension pneumothorax during minimally invasive coronary artery bypass surgery: Can transesophageal echocardiography pick it?

Dharmesh Radheshyam Agrawal, Sathyaki Purushottam Nambala

Annals of Cardiac Anaesthesia 2016 19(4):747-749

Minimally invasive cardiac surgery is establishing itself as the standard of care across the world. MICS CABG is currently performed in only a few centers. Hemodynamics disturbances are peculiar during MICS CABG due to space constraints. We report a 70-year-old man who underwent MICS CABG who developed tension pneumothorax during revascularization that was diagnosed in a novel way.

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Role of hybrid operating room in surgery for the right atrial thrombus, pulmonary thrombi, and ventricular septal rupture after myocardial infarction

Ajmer Singh, Yatin Mehta, Rajiv Parakh, Vijay Kohli, Naresh Trehan

Annals of Cardiac Anaesthesia 2016 19(4):717-721

Free-floating right heart thrombi are uncommon and need emergency treatment in view of their tendency to dislodge and cause pulmonary embolism. We report a successful surgical management of a patient who had large mobile right atrial thrombus, bilateral pulmonary thrombi, coronary artery disease, and postmyocardial infarction ventricular septal rupture (VSR). The patient underwent coronary angiography, inferior vena cava filter placement, removal of thrombi from the right atrium and pulmonary arteries, repair of VSR, and coronary artery bypass graft surgery in a hybrid operating room.

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Perioperative transesophageal echocardiography: State of the art 2016

Garima Arora, Navin C Nanda

Annals of Cardiac Anaesthesia 2016 19(4):576-579



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From the Editor's desk

Poonam Malhotra Kapoor

Annals of Cardiac Anaesthesia 2016 19(4):575-575



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Recent trends on hemodynamic monitoring in cardiac surgery

Dheeraj Arora, Yatin Mehta

Annals of Cardiac Anaesthesia 2016 19(4):580-583



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Transesophageal echo diagnosis of perioperative unusual transient left ventricular apical ballooning syndrome

Hugo Andrés Mantilla, Felix Ramón Montes, William F Amaya

Annals of Cardiac Anaesthesia 2016 19(4):733-736

Stress cardiomyopathy, or Takotsubo syndrome, is a widely recognized cardiac pathology with a clinical presentation similar to acute coronary syndrome and related to physical or emotional stress. Perioperatively, it is challenging to identify it given the variety of forms and scenarios in which it can present. We describe a 22-year-old patient with an atypical presentation of Takotsubo syndrome during anesthesia induction, which highlights the usefulness of transesophageal echocardiography for the initial diagnosis.

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Platelet aggregometry interpretation using ROTEM – PART – II

Vandana Bhardwaj, Poonam Malhotra Kapoor

Annals of Cardiac Anaesthesia 2016 19(4):584-586



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Sepsis in heart transplant recipients: Is the new definition applicable?

Sarvesh Pal Singh

Annals of Cardiac Anaesthesia 2016 19(4):757-757



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Transesophageal echocardiography in an atrioventricular septal defect

Rohan Magoon, Arindam Choudhury, Amita Sharma, Poonam Malhotra Kapoor

Annals of Cardiac Anaesthesia 2016 19(4):587-588



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Global end-diastolic volume an emerging preload marker vis-a-vis other markers - Have we reached our goal?

PM Kapoor, Vandana Bhardwaj, Amita Sharma, Usha Kiran

Annals of Cardiac Anaesthesia 2016 19(4):699-704

A reliable estimation of cardiac preload is helpful in the management of severe circulatory dysfunction. The estimation of cardiac preload has evolved from nuclear angiography, pulmonary artery catheterization to echocardiography, and transpulmonary thermodilution (TPTD). Global end-diastolic volume (GEDV) is the combined end-diastolic volumes of all the four cardiac chambers. GEDV has been demonstrated to be a reliable preload marker in comparison with traditionally used pulmonary artery catheter-derived pressure preload parameters. Recently, a new TPTD system called EV1000™ has been developed and introduced into the expanding field of advanced hemodynamic monitoring. GEDV has emerged as a better preload marker than its previous conventional counterparts. The advantage of it being measured by minimum invasive methods such as PiCCO™ and newly developed EV1000™ system makes it a promising bedside advanced hemodynamic parameter.

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Different transseptal puncture for different procedures: Optimization of left atrial catheterization guided by transesophageal echocardiography

Andrea Radinovic, Patrizio Mazzone, Giovanni Landoni, Eustachio Agricola, Damiano Regazzoli, Paolo Della Bella

Annals of Cardiac Anaesthesia 2016 19(4):589-593

Background: Left atrial catheterization through transseptal puncture is frequently performed in cardiac catheterization procedures. Appropriate transseptal puncture is critical to achieve procedural success. Aims: The aim of the study is to evaluate the feasibility of selective transseptal punctures, using a modified radiofrequency (RF) transseptal needle and transesophageal echocardiography (TEE), in different types of procedures that require specific sites of left atrial catheterization. Setting and Design: This was an observational trial in a cardiac catheterization laboratory of a teaching hospital. Materials and Methods: Patients undergoing different percutaneous procedures requiring atrial transseptal puncture such as atrial fibrillation (AF) ablation, left atrial appendage (LAA) occlusion, and mitral valve repair were included in the study. All procedures were guided by TEE and an RF transseptal needle targeting a specific region of the septum to perform the puncture. Statistical Analysis: The statistical analysis was descriptive only. Results: RF-assisted transseptal punctures were performed in six consecutive patients who underwent AF ablation (two patients), LAA closure (two patients), and mitral valve repair (two patients). In all patients, transseptal punctures were performed successfully at the desired site. No adverse events or complications were observed. Conclusions: Selective transseptal puncture, using TEE and an RF needle, is a feasible technique that can be used in multiple approaches requiring a precise site of access for left atrial catheterization.

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Double valve replacement in a patient with implantable cardioverter defibrillator with severe left ventricular dysfunction

Girish Manjunath, Prakash Rao, Nagendra Prakash, BK Shivaram

Annals of Cardiac Anaesthesia 2016 19(4):724-727

Recent data from landmark trials suggest that the indications for cardiac pacing and implantable cardioverter defibrillators (ICDs) are set to expand to include heart failure, sleep-disordered breathing, and possibly routine implantation in patients with myocardial infarction and poor ventricular function.[1] This will inevitably result in more patients with cardiac devices undergoing surgeries. Perioperative electromagnetic interference and their potential effects on ICDs pose considerable challenges to the anesthesiologists.[2] We present a case of a patient with automatic ICD with severe left ventricular dysfunction posted for double valve replacement.

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Accidental arterial puncture during right internal jugular vein cannulation in cardiac surgical patients

Madan Mohan Maddali, Venkitaramanan Arun, Al-Ajmi Ahmed Wala, Maher Jaffer Al-Bahrani, Cheskey Manoj Jayatilaka, Arora Ram Nishant

Annals of Cardiac Anaesthesia 2016 19(4):594-598

Background: The primary aim of this study was to compare the incidence of accidental arterial puncture during right internal jugular vein (RIJV) cannulation with and without ultrasound guidance (USG). The secondary end points were to assess if USG improves the chances of successful first pass cannulation and if BMI has an impact on incidence of arterial puncture and the number of attempts that are to be made for successful cannulation. Settings and Design: Prospective observational study performed at a single tertiary cardiac care center. Material and methods: 255 consecutive adult and pediatric cardiac surgical patients were included. In Group I (n = 124) USG was used for the right internal jugular vein cannulation and in Group II (n = 81) it was not used. There were 135 adult patients and 70 pediatric patients. Statistical analysis: Demographic and categorical data were analyzed using Student 't' test and chi- square test was used for qualitative variables. Results: The overall incidence of accidental arterial puncture in the entire study population was significantly higher when ultrasound guidance was not used (P< 0.001). In subgroup analysis, incidence of arterial puncture was significant in both adult (P = 0.03) and pediatric patients (P< 0.001) without USG. First attempt cannulation was more often possible in pediatric patients under USG (P = 0.03). In adult patients USG did not improve first attempt cannulation except in underweight patients. Conclusions: USG helped in the avoidance of inadvertent arterial puncture during RIJV cannulation and simultaneously improved the chances of first attempt cannulation in pediatric and in underweight adult cardiac surgical patients.

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Transesophageal echocardiography-guided thrombectomy of intracardiac renal cell carcinoma without cardiopulmonary bypass

Fouad Ghazi Souki, Michael Demos, Lilibeth Fermin, Gaetano Ciancio

Annals of Cardiac Anaesthesia 2016 19(4):740-743

Advanced renal cell carcinoma (RCC) resection has important anesthetic management implications, particularly when tumor extends, suprahepatic, into the right atrium. Use of transesophageal echocardiogram (TEE) is essential in identifying tumor extension and guiding resection. Latest surgical approach avoids venovenous and cardiopulmonary bypass yet requires special precautions and interventions on the anesthesiologist's part. We present a case of Level IV RCC resected without cardiopulmonary bypass and salvaged by TEE guidance and detection of residual intracardiac tumor.

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Tricuspid annulus: A spatial and temporal analysis

Ziyad O Knio, Mario Montealegre-Gallegos, Lu Yeh, Bilal Chaudary, Jelliffe Jeganathan, Robina Matyal, Kamal R Khabbaz, David C Liu, Venkatachalam Senthilnathan, Feroze Mahmood

Annals of Cardiac Anaesthesia 2016 19(4):599-605

Background: Traditional two-dimensional (2D) echocardiographic evaluation of tricuspid annulus (TA) dilation is based on single-frame measurements of the septolateral (S-L) dimension. This may not represent either the axis or the extent of dynamism through the entire cardiac cycle. In this study, we used real-time 3D transesophageal echocardiography (TEE) to analyze geometric changes in multiple axes of the TA throughout the cardiac cycle in patients without right ventricular abnormalities. Materials and Methods: R-wave-gated 3D TEE images of the TA were acquired in 39 patients undergoing cardiovascular surgery. The patients with abnormal right ventricular/tricuspid structure or function were excluded from the study. For each patient, eight points along the TA were traced in the 3D dataset and used to reconstruct the TA at four stages of the cardiac cycle (end- and mid-systole, end- and mid-diastole). Statistical analyses were applied to determine whether TA area, perimeter, axes, and planarity changed significantly over each stage of the cardiac cycle. Results: TA area (P = 0.012) and perimeter (P = 0.024) both changed significantly over the cardiac cycle. Of all the axes, only the posterolateral-anteroseptal demonstrated significant dynamism (P < 0.001). There was also a significant displacement in the vertical axis between the points and the regression plane in end-systole (P < 0.001), mid-diastole (P = 0.014), and mid-systole (P < 0.001). Conclusions: The TA demonstrates selective dynamism over the cardiac cycle, and its axis of maximal dynamism is different from the axis (S-L) that is routinely measured with 2D TEE.

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Aortic valve homograft for revision surgery - transesophageal echocardiography considerations

Arindam Choudhury, Rohan Magoon, Poonam Malhotra Kapoor, P Rajashekar

Annals of Cardiac Anaesthesia 2016 19(4):752-753

Aortic root surgical anatomy and knowledge of the various homograft implantation techniques is of paramount importance to the attending anesthesiologist for echocardiographic correlation, estimation and accurately predicting aortic annular dimensions for the valve replacement in a case of diseased homograft.

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The myocardial protective effect of dexmedetomidine in high-risk patients undergoing aortic vascular surgery

Rabie Soliman, Gomaa Zohry

Annals of Cardiac Anaesthesia 2016 19(4):606-613

Objective: The aim of the study was to assess the effect of dexmedetomidine in high-risk patients undergoing aortic vascular surgery. Design: A randomized prospective study. Setting: Cairo University, Egypt. Materials and Methods: The study included 150 patients undergoing aortic vascular surgery. Intervention: The patients were classified into two groups (n = 75). Group D: The patients received a loading dose of 1 μg/kg dexmedetomidine over 15 min before induction and maintained as an infusion of 0.3 μg/kg/h to the end of the procedure. Group C: The patients received an equal volume of normal saline. The medication was prepared by the nursing staff and given to anesthetist blindly. Measurements: The monitors included the heart rate, mean arterial blood pressure, central venous pressure, electrocardiogram (ECG), serum troponin I level, end-tidal sevoflurane, and total dose of morphine in addition transthoracic echocardiography to the postoperative in cases with elevated serum troponin I level. Main Results: The dexmedetomidine decreased heart rate and minimized the changes in blood pressure compared to control group (P < 0.05). Furthermore, it decreased the incidence of myocardial ischemia reflected by troponin I level, ECG changes, and the development of new regional wall motion abnormalities (P < 0.05). Dexmedetomidine decreased the requirement for nitroglycerin and norepinephrine compared to control group (P < 0.05). The incidence of hypotension and bradycardia was significantly higher with dexmedetomidine (P < 0.05). Conclusion: The dexmedetomidine is safe and effective in patients undergoing aortic vascular surgery. It decreases the changes in heart rate and blood pressure during the procedures. It provides cardiac protection in high-risk patients reflected by decreasing the incidence of myocardial ischemia and serum level of troponin. The main side effects of dexmedetomidine were hypotension and bradycardia.

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Cardiac surgery-associated acute kidney injury

Christian Ortega-Loubon, Manuel Fernández-Molina, Yolanda Carrascal-Hinojal, Enrique Fulquet-Carreras

Annals of Cardiac Anaesthesia 2016 19(4):687-698

Cardiac surgery-associated acute kidney injury (CSA-AKI) is a well-recognized complication resulting with the higher morbid-mortality after cardiac surgery. In its most severe form, it increases the odds ratio of operative mortality 3–8-fold, length of stay in the Intensive Care Unit and hospital, and costs of care. Early diagnosis is critical for an optimal treatment of this complication. Just as the identification and correction of preoperative risk factors, the use of prophylactic measures during and after surgery to optimize renal function is essential to improve postoperative morbidity and mortality of these patients. Cardiopulmonary bypass produces an increased in tubular damage markers. Their measurement may be the most sensitive means of early detection of AKI because serum creatinine changes occur 48 h to 7 days after the original insult. Tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7 are most promising as an early diagnostic tool. However, the ideal noninvasive, specific, sensitive, reproducible biomarker for the detection of AKI within 24 h is still not found. This article provides a review of the different perspectives of the CSA-AKI, including pathogenesis, risk factors, diagnosis, biomarkers, classification, postoperative management, and treatment. We searched the electronic databases, MEDLINE, PubMed, EMBASE using search terms relevant including pathogenesis, risk factors, diagnosis, biomarkers, classification, postoperative management, and treatment, in order to provide an exhaustive review of the different perspectives of the CSA-AKI.

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Arterialization of central venous pressure waveform

AnnCardAnaesth_2016_19_4_760_191556_f1.j

Monish S Raut, Arun Maheshwari, Manish Sharma, Sandeep Joshi, Arun Kumar, Akshay Gupta, Himanshu Goyal

Annals of Cardiac Anaesthesia 2016 19(4):760-761



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The efficacy of pre-emptive dexmedetomidine versus amiodarone in preventing postoperative junctional ectopic tachycardia in pediatric cardiac surgery

Nagat S El-Shmaa, Doaa El Amrousy, Wael El Feky

Annals of Cardiac Anaesthesia 2016 19(4):614-620

Objective: The objective of this study was to assess the effectiveness of pre-emptive dexmedetomidine versus amiodarone in preventing junctional ectopic tachycardia (JET) in pediatric cardiac surgery. Design: This is a prospective, controlled study. Setting: This study was carried out at a single university hospital. Subjects and Methods: Ninety patients of both sexes, American Society of Anesthesiologists Physical Status II and III, age range from 2 to 18 years, and scheduled for elective cardiac surgery for congenital and acquired heart diseases were selected as the study participants. Interventions: Patients were randomized into three groups (30 each). Group I received dexmedetomidine 1 mcg/kg diluted in 100 ml of normal saline intravenously (IV) over a period of 20 min, and the infusion was completed 10 min before the induction followed by a 0.5 mcg/kg/h infusion for 72 h postoperative, Group II received amiodarone 5 mg/kg diluted in 100 ml of normal saline IV over a period of 20 min, and the infusion was completed 10 min before the induction followed by a 10–15 mcg/kg/h infusion for 72 h postoperative, and Group III received 100 ml of normal saline IV. Primary outcome was the incidence of postoperative JET. Secondary outcomes included vasoactive-inotropic score, ventilation time (VT), pediatric cardiac care unit stay, hospital length of stay, and perioperative mortality. Measurements and Main Results: The incidence of JET was significantly reduced in Group I and Group II (P = 0.004) compared to Group III. Heart rate while coming off from cardiopulmonary bypass (CPB) was significantly low in Group I compared to Group II and Group III (P = 0.000). Mean VT, mean duration of Intensive Care Unit stay, and length of hospital stay (day) were significantly short (P = 0.000) in Group I and Group II compared to Group III (P = 0.000). Conclusion: Perioperative use of dexmedetomidine and amiodarone is associated with significantly decreased incidence of JET as compared to placebo without significant side effects.

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Reconstructing surface ocean circulation with 129I time series records from corals

Publication date: December 2016
Source:Journal of Environmental Radioactivity, Volume 165
Author(s): Ching-Chih Chang, George S. Burr, A.J. Timothy Jull, Joellen L. Russell, Dana Biddulph, Lara White, Nancy G. Prouty, Yue-Gau Chen, Chuan-Chou Shen, Weijian Zhou, Doan Dinh Lam
The long-lived radionuclide 129I (half-life: 15.7 × 106 yr) is well-known as a useful environmental tracer. At present, the global 129I in surface water is about 1–2 orders of magnitude higher than pre-1960 levels. Since the 1990s, anthropogenic 129I produced from industrial nuclear fuels reprocessing plants has been the primary source of 129I in marine surface waters of the Atlantic and around the globe. Here we present four coral 129I time series records from: 1) Con Dao and 2) Xisha Islands, the South China Sea, 3) Rabaul, Papua New Guinea and 4) Guam. The Con Dao coral 129I record features a sudden increase in 129I in 1959. The Xisha coral shows similar peak values for 129I as the Con Dao coral, punctuated by distinct low values, likely due to the upwelling in the central South China Sea. The Rabaul coral features much more gradual 129I increases in the 1970s, similar to a published record from the Solomon Islands. The Guam coral 129I record contains the largest measured values for any site, with two large peaks, in 1955 and 1959. Nuclear weapons testing was the primary 129I source in the Western Pacific in the latter part of the 20th Century, notably from testing in the Marshall Islands. The Guam 1955 peak and Con Dao 1959 increases are likely from the 1954 Castle Bravo test, and the Operation Hardtack I test is the most likely source of the 1959 peak observed at Guam. Radiogenic iodine found in coral was carried primarily through surface ocean currents. The coral 129I time series data provide a broad picture of the surface distribution and depth penetration of 129I in the Pacific Ocean over the past 60 years.



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Associated lumbar scoliosis does not affect outcomes in patients undergoing focal minimally invasive transforaminal lumbar interbody fusion (MISTLIF) for neurogenic symptoms – a minimum 2-year follow-up study

There is no current literature comparing outcomes of patients with and without lumbar scoliosis having neurological symptoms undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS TLIF) technique.

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Differences in the time of onset of postoperative upper limb palsy among surgical procedures: a meta-analysis

The time of onset of postoperative upper limb palsy (ULP), also referred to as C5 palsy, varies among patients. Although some studies addressed the relationship between the time of onset of ULP and potential etiologies, no meta-analysis has been conducted regarding the association between the time of onset of ULP and other factors such as surgical procedure type and treated diseases.

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Learning to use a body-powered prosthesis: changes in functionality and kinematics

Little is known about action-perception learning processes underlying prosthetic skills in body-powered prosthesis users. Body-powered prostheses are controlled through a harness connected by a cable that migh...

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The Rising Zebrafish Research in China: Meeting Report of the 3rd Chinese Zebrafish Principal Investigator Meeting & the Inaugural Meeting of China Zebrafish Society

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Publication date: Available online 6 October 2016
Source:Journal of Genetics and Genomics
Author(s): Dongyuan Ma, Yuanyuan Xue, Yifan Zhang, Yonghua Sun, Anming Meng, Feng Liu




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The effect of iron dextran on the transcriptome of pig hippocampus

Abstract

The chain of events resulting from oxidative stress is still barely understood. The hippocampus is particularly vulnerable to oxidative stress. With the emergence of high-throughput sequencing, many different biological components can be discovered simultaneously. Using RNA-seq technology, we conducted a whole-transcriptome analysis of the hippocampi of piglets exposed to iron dextran (FeDex), a potent inducer of oxidation stress. The total hippocampal RNA from the piglets was sequenced, and 11.5 Gb of sequencing data were obtained. Regulatory molecules involved in oxidative stress were determined through the identification of 362 differentially expressed genes (DEGs). The functional analysis revealed that these DEGs were primarily involved in the defense response and responses to external stimuli. Furthermore, 76 neuropeptide gene transcripts and 60 neuropeptide receptor gene transcripts were identified in the hippocampus. Of these transcripts, the mRNA levels of six neuropeptide genes were significantly changed. Overall, this study describes the first use of RNA-seq to elucidate the transcriptomic changes in the piglet hippocampus caused directly by the injection of iron dextran, which enabled the characterization of the transcriptional response triggered by oxidative stress.



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Prediction of in-hospital mortality and morbidity using high-sensitivity C-reactive protein after burr hole craniostomy

Abstract

Background

The purpose of this study was to assess whether preanesthetic laboratory values can predict in-hospital mortality and morbidity in patients who have undergone burr hole craniostomy due to chronic subdural hematoma.

Methods

From January 2007 to February 2016, the records of 502 consecutive patients who underwent burr hole craniotomy were analyzed. All cases of burr hole craniostomy were fitted with a drain, as required by our institutional protocol.

Results

Patients' demographic data and preoperative laboratory values were subjected to logistic regression analysis to predict in-hospital mortality and morbidity after burr hole craniostomy. Hemoglobin, prothrombin time, activated partial thromboplastin time, serum glucose, and high-sensitivity C-reactive protein (hsCRP) were found to be significantly associated with in-hospital mortality and morbidity by univariate regression analysis, but of these, only hsCRP (hazard ratio 1.210, 95 % confidence interval 1.089–1.345, P < 0.001) was found to significantly predict in-hospital mortality and morbidity by multivariate regression analysis. Areas under the curve for predicting in-hospital mortality and morbidity were 0.765 (95 % confidence interval 0.624–0.906, P = 0.002) and 0.646 (0.559–0.733, P = 0.001), respectively.

Conclusions

Preoperative hsCRP was found to be an independent predictor of in-hospital mortality and morbidity after burr hole craniostomy due to chronic subdural hematoma.



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How body-worn cameras improve EMS documentation

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NEW ORLEANS — Body-worn cameras, though widely used in law enforcement, are infrequently used in EMS. Jeffrey Ho, MD, the chief medical director for Hennepin EMS, who also works as a deputy sheriff, described a simulation study conducted to assess the accuracy of patient care documentation at the EMS World Expo.

EMS documentation usually occurs from memory, a process that can introduce error. Body-worn camera videos can improve event recall during the ePCR process.

Ho has been advocating for body-worn cameras in EMS for six years. Hennepin EMS recently conducted a simulated patient encounter study (read the abstract for Effect of Body-Worn Cameras on EMS Documentation Accuracy: A Pilot Study) to evaluate the effect on documentation accuracy when a body-worn camera was used. Ho, who is the medical director for TASER International, Inc., received TASER Flex body-worn cameras at no cost for the study.

The simulation had multiple complexities and stressful stimuli, such as several firearms, drug paraphernalia, a distraught family member, an ambulance transport, a bystander recording the paramedic and delivering a report to an emergency department nurse. After completing the scenario, the paramedic documented the incident from memory on an ePCR. Next, the paramedics were allowed to view their own body-worn camera video without any limitations on playback. After video review of the simulation, 71 documentation changes were made by the 10 paramedics who participated in the study.

Memorable quotes on memory and documentation
Here are memorable quotes from Ho's presentation on improving EMS documentation with body-worn cameras.

"I believe body-worn cameras would really be phenomenal in health care when you think about the things we see, need to document and the teaching opportunity."

"Memory is an adaptive process and subject to errors."

"This study was completed four years ago, but was not published because no one was interested. Now there is finally some interest."

Key takeaways on use of body-worn cameras in EMS
Here are the key takeaways from Ho's presentation on body-worn cameras to improve EMS documentation.

Memory and recall of events
Emotional and physical stress make forming memories more difficult. Stressors, such as fatigue and exertion, are common in EMS incidents. Documentation by memory perception is highly inaccurate.

After reviewing the video, the paramedics in the study, who had an average of seven years of field experience, made minor (7 changes), moderate (51) and major (13) documentation changes. Older, more experienced paramedics made less documentation changes after video review.

Uses of video in EMS
Ho described many uses of video in EMS including documentation of the mechanism of injury, identifying concerning or dangerous items on the scene, capturing the patient's behavior and statements, point-of-view recording of the methods used to secure, assess and treat the patient.

Video recording may reduce risk of liability from poor or inadequate documentation. All actions performed on scene are captured and can be reviewed later.

Body cameras change behavior
From law enforcement research, we know that body-worn cameras change officer behavior and suspect behavior. EMS leaders can expect body-worn cameras to make a similar impact on the behavior of patients and EMS providers.

Learn more about use of video in EMS:



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How body-worn cameras improve EMS documentation

A study on EMS documentation accuracy using EMS body-worn cameras discussed at EMS World Expo.

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How EMS ultrasound will transform prehospital care

Prehospital ultrasound, the latest patient assessment technology to transition from the hospital to EMS, discussed at EMS World Expo.

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Genetics of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome

Abstract

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, also referred to as Müllerian agenesis, is the second most common cause of primary amenorrhea. It is characterized by congenital absence of the uterus, cervix, and the upper part of the vagina in otherwise phenotypically normal 46,XX females. MRKH syndrome has an incidence of about 1 in 4,500-5,000 newborn females and it is generally divided into two subtypes: MRKH type 1, in which only the upper vagina, cervix and the uterus are affected, and MRKH type 2, which is associated with additional malformations generally affecting the renal and skeletal systems, and also includes MURCS (MÜllerian Renal Cervical Somite) characterized by cervico-thoracic defects.

MRKH syndrome is mainly sporadic; however, familial cases have been described indicating that, at least in a subset of patients, MRKH may be an inherited disorder. The syndrome appears to demonstrate an autosomal dominant inheritance pattern, with incomplete penetrance and variable expressivity.

The etiology of MRKH syndrome is still largely unknown, probably because of its intrinsic heterogeneity. Several candidate causative genes have been investigated, but to date only WNT4 has been associated with MRKH with hyperandrogenism. This review summarizes and discusses the clinical features and details progress to date in understanding the genetics of MRKH syndrome.

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The biology of germ cell tumors in Disorders of Sex Development

Abstract

Development of a malignant germ cell tumor, i.e., germ cell cancer (GCC) in individuals with disorders of sex development (DSD) depends on a number of (epi-)genetic factors related to early gonadal- and germ cell development, possibly related to genetic susceptibility. Fetal development of germ cells is orchestrated by strict processes involving specification, migration and the development of a proper gonadal niche. In this review we will discuss the early (epi-)genetic events in normal and aberrant germ cell and gonadal development. Focus will be on the formation of the precursor lesions of GCC in individuals who have DSD. In our view, expression of the different embryonic markers in, and epigenetic profile of the precursor lesions reflects the developmental stage in which these cells are blocked in their maturation. Therefore, these are not a primary pathogenetic driving force. Progression later in life towards a full blown cancer likely depends on additional factors such as a changed endocrine environment in a susceptible individual. Genetic susceptibility is, as evidenced by the presence of specific risk genetic variants (SNPs) in patients with a testicular GCC, related to genes involved in early germ cell and gonadal development.

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