Τρίτη, 22 Νοεμβρίου 2016

Verification of Maximal Oxygen Uptake in Obese and Nonobese Children.

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Purpose: The purpose of this study was to examine whether a supramaximal constant load verification test at 105% of the highest work rate would yield a higher V[Combining Dot Above]O2max when compared with an incremental test in 10 - 12 year old nonobese and obese children. Methods: Nine non-obese (BMI percentile: 57.5 +/- 23.2) and nine obese (BMI percentile: 97.9 +/- 1.4) children completed a two-test protocol that included an incremental test followed 15 minutes later by a supramaximal constant-load verification test. Results: The V[Combining Dot Above]O2max achieved in verification testing (Nonobese: 1.71 +/- 0.31 and Obese: 1.94 +/- 0.47 L/min) was significantly higher than that achieved during the incremental test (Nonobese: 1.57 +/- 0.27 and Obese: 1.84 +/- 0.48 L/min; P

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Accuracy and Reliability of Assessing Lateral Compartmental Leg Composition Using DXA.

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Purpose: Investigate the accuracy and reliability of a novel dual X-ray absorptiometry (DXA) scanning method in the frontal plane for total, fat, and lean mass quantification of the anterior and posterior upper leg compartments. Methods: Twenty-one (11 female; X[Combining Overline]age=20.3+/-1.3 yrs) college athletes were assessed for total and regional body composition using DXA. Segmentation of anterior/posterior thigh compartments was measured with participants lying on their right and left sides and the scanned leg elevated with two foam pads. Custom regions of interest (ROIs) were created manually with enCoreTM software for each scan using bony landmarks to quantify lean, fat, and total masses. Paired t-tests assessed this novel positioning method's accuracy against standard positioning. Intra-class correlations (ICCs) and coefficients of variation (CV) examined inter- and intra-rater reliability for lateral scan measures of total, fat, and lean masses from manually created ROIs. Results: All mean differences (+/-SD) between frontal and lateral DXA scans of right (R) and left (L) leg total mass (R: 8.42+/-195.57 g; L: 19.47+/-131.80 g), fat mass (R: 61.26+/-215.66 g; L: -5.89+/-239.97 g), and lean mass (R: -103.00+/-302.54 g; L: -27.58+/-288.14 g) were non-significant (p-value range: 0.15 to 0.91). ICCs were high for all composition measures between- and within-raters, ranging from 0.983 to 0.999 and 0.954 to 0.999, respectively, with low variation across measures (all CVs:

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Exercise Attenuates High-Fat Diet-Induced Disease Progression in 3xTg-AD Mice.

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Purpose: Little is known regarding the therapeutic role of exercise against the risk of a high-fat diet (HFD) for Alzheimer's disease (AD) and AD-like cognitive deficits. This study aimed to investigate the therapeutic effect of treadmill running against HFD-induced progression in AD neuropathology and cognitive impairments in the triple transgenic-AD (3xTg-AD) mice. Methods: The 3xTg-AD mice were assigned to a chow diet (control, n=10), a high-fat diet (HFD, n=10), or a high-fat diet combined with exercise (HFD+EX, n=10) group. Mice in the HFD were fed with a 60% fat diet for 20 weeks. The HFD+EX mice were additionally subjected to treadmill running. Results: Compared to the control mice, the HFD mice had impaired brain insulin signaling, exacerbated AD neuropathology, defects in synaptic stability/plasticity, and apoptotic neuronal cell death in conjunction with exacerbated cognitive deficits in the affected brain regions, which were all significantly alleviated in the HFD+EX mice. Conclusion: The current findings suggest that treadmill running protects against AD-like disease progression and cognitive deficits caused by a HFD in the 3xTg-AD mice. (C) 2016 American College of Sports Medicine

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Physical Activity: Absolute Intensity vs. Relative-to-Fitness-Level Volumes.

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Purpose: To investigate in a real-life setting how moderate and vigorous intensity physical activity (PA) volumes differ according to absolute intensity recommendation and relative to individual fitness level by sex, age, and body mass index (BMI). Methods: 23 224 Finnish employees (10 201 men, 13 023 women; ages 18-65 years; BMI 18.5-40.0 kg/m2) participated in heart rate recording for 2+ days. We used heart rate and its variability, respiration rate, and on/off response information from R-R interval data calibrated by participant characteristics to objectively determine daily PA volume, as follows: daily minutes of absolute moderate (3-=6 METs) PA; and minutes relative to individual aerobic fitness for moderate (40-=60%) PA. Results: According to absolute intensity categorization, the volume of both moderate and vigorous PA was higher in men compared to women (P

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A Murine Model of Robotic Training to Evaluate Skeletal Muscle Recovery after Injury.

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Purpose: In vivo studies have suggested that motor exercise can improve muscle regeneration after injury. Nevertheless, pre-clinical investigations still lack reliable tools to monitor motor performance over time and to deliver optimal training protocols to maximize force recovery. Here, we evaluated the utility of a murine robotic platform to (i) detect early impairment and longitudinal recovery after acute skeletal muscle injury and (ii) administer varying intensity training protocols to enhance forelimb motor performance. Methods: A custom-designed robotic platform was used to train mice to perform a forelimb retraction task. Following an acute injury to bilateral biceps brachii muscles, animals performed a daily training protocol in the platform at high (HL) or low (LL) loading levels over the course of three weeks. Control animals were not trained (NT). Motor performance was assessed by quantifying force, time, sub-movement count, and number of movement attempts to accomplish the task. Myofiber number and cross-sectional area at the injury site were quantified histologically. Results: Two days after injury, significant differences in the time, sub-movement count, number of movement attempts and exerted force were observed in all mice, as compared to baseline values. Interestingly, recovery time of muscle force production differed significantly between intervention groups, with HL group showing a significantly accelerated recovery. Three weeks after injury, all groups showed motor performance comparable to baseline values. Accordingly, there were no differences in the number of myofibers or average cross-sectional area among groups after 3 weeks. Conclusion: Our findings demonstrate the utility of our custom designed robotic device for quantitative assessment of skeletal muscle function in pre-clinical murine studies. Moreover, we demonstrate that this device may be used to apply varying levels of resistance longitudinally as a means manipulate physiological muscle responses. (C) 2016 American College of Sports Medicine

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Impact of Acute Dietary Manipulations on DXA and BIA Body Composition Estimates.

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Purpose: To examine the effects of acute pre-assessment diets on body composition estimates obtained by dual-energy x-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA). Methods: In a counterbalanced design, 48 males and females were provided with two one-day diets: high-carbohydrate diet (9 g CHO/kg) and very low-carbohydrate diet (1 to 1.5 g CHO/kg). For each condition, body composition was assessed in the morning after an overnight fast, in the afternoon after feeding, and the following morning after a second overnight fast. Results: Acute food ingestion, regardless of macronutrient content, altered DXA and BIA body composition estimates, and both sexes responded similarly. DXA total and regional lean soft tissue estimates increased up to 1.7% and 3% on average in response to feeding, with individual increases of over 4.5% and 9%. DXA total and trunk fat mass estimates decreased by up to 3% on average. All DXA-derived measures of body composition returned to baseline values after the second overnight fast. Impedance measured by BIA decreased by 4.4% in response to feeding, leading to a 2% increase in total body water and fat-free mass, with individual increases up to 4.5%. BIA fat mass estimates decreased 1.4 to 2.4%, with individual decreases of up to 10%. Unlike DXA, most BIA-derived estimates did not return to baseline values after a second overnight fast. Conclusion: Acute food and fluid intake can artificially influence body composition estimates, regardless of macronutrient content. An overnight fast is likely sufficient pre-assessment dietary control for DXA and possibly sufficient for BIA. (C) 2016 American College of Sports Medicine

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Activity Levels over Four Years in a Cohort of Urban-Dwelling Adolescent Females.

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Purpose: Evidence suggests that female adolescents and those living in urban environments may have lower physical activity (PA) levels compared to their peers. Yet, few studies report PA for urban adolescent females and there is no consensus regarding potential causes for low PA in this subgroup. We examined PA levels, in a large, diverse cohort of 14-17 year old urban-dwelling females and assessed the impact of socio-economic, personal, and neighborhood/environmental factors on PA. Methods: One week of time-stamped step count data was collected on 926 girls from the Pittsburgh Girls Study (PGS) at four annual visits. Valid recordings (worn at least 10 hours on 3+ days) were examined and compared to normalized step count values from a U.S. population-representative sample. Relationships between important covariates and average steps/day were examined with regression models. Results: Adjusted mean (stdev) step counts/day at baseline were 5,614 (2,434) after controlling for important covariates with less than 6% of girls achieving at least 10,000 steps/day. PGS girls accrued ~45% of their steps during school hours. Age specific, median step counts/day for study participants were similar to the 25th percentile of U.S. population normalized values and did not significantly change over follow-up. Non-Hispanic African American race/ethnicity was associated with higher average step counts/day; obesity and a recent childbirth were associated with lower average step counts/day. Conclusions: Step counts in this cohort of urban adolescent girls were considerably lower than expected for U.S. adolescent females. Targeted efforts to improve PA levels in urban youth should consider the importance of school-based activity while increasing PA opportunities outside of school. (C) 2016 American College of Sports Medicine

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Acute Lumbar Paraspinal Myonecrosis in Football Players With Sickle Cell Trait: A Case Series.

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We report 6 cases of a novel syndrome of acute, exertional low back pain (LBP) in football players, 5 in college and one in the National Football League (NFL). All 6 are African-Americans with sickle cell trait (SCT). The acute LBP is severe and can be disabling, and the condition can be confused with muscle strain, discogenic pain, stress fracture, or other problems in athletes. Our evidence shows that this syndrome is caused by lumbar paraspinal myonecrosis (LPSMN), which likely often contributes to the lumbar paraspinal compartment syndrome. We explain why we believe SCT is a risk factor for LPSMN in football conditioning/training, even though SCT is not requisite for this syndrome, which has been reported rarely in other sports (for example, snow or water skiing) and especially in weight lifting that targets lumbar muscles. The clinical course of LPSMN in football can be mild and allow return to play in a week or two, or it can be severe and lead to long-term sequelae. Knowledge of this syndrome will enable athletic trainers and team physicians to diagnose it early, treat it properly, and lessen its impact. Further research will help us learn how better to prevent it. (C) 2016 American College of Sports Medicine

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Effects of Ibuprofen and Resistance Training on Bone and Muscle: An RCT in Older Women.

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Introduction/Purpose: Resistance training with ibuprofen supplementation may improve musculoskeletal health in postmenopausal women. The study purpose was to determine the efficacy of resistance training and ibuprofen supplementation on bone and muscle properties in postmenopausal women. Methods: Participants (n = 90, 65.3 +/- 4.9 y) were randomly assigned to: supervised resistance training or stretching (placebo-exercise) with post-exercise ibuprofen (400 mg) or placebo supplementation for 3 days/week (9 months). Baseline and post-intervention measurements included distal and shaft scans of the forearm and lower leg using peripheral Quantitative Computed Tomography (pQCT). Distal site outcomes included cross-sectional area, content, and density for total and trabecular bone, as well as estimated bone strength in compression. Shaft site outcomes included total bone area; cortical bone area, content, and density; estimated bone strength in torsion; and muscle area and density. Results: Exercise x supplement x time interactions for total bone content at the distal radius (p = 0.009) and cortical density at the radius shaft (p = 0.038) were significant. Resistance training with ibuprofen decreased total bone content (-1.5%) at the distal radius in comparison to the resistance training (0.6%; p = 0.032) and ibuprofen alone (0.5%; p = 0.050). Change in cortical density at the radius shaft differed between the stretching with placebo and ibuprofen supplementation groups (-1.8% vs. 1.1%; p = 0.050). Resistance training preserved muscle density in the lower leg more so than stretching (-3.1% vs -5.4%; p = 0.015). Conclusion: Ibuprofen consumed immediately after resistance training had a deleterious effect on bone mineral content at the distal radius while resistance training or ibuprofen supplementation individually prevented bone loss. Resistance training prevented muscle density decline in the lower leg. (C) 2016 American College of Sports Medicine

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Validation of a Simple Stool Diary used by Caregivers to Document Diarrhea Among Young Children in a Low-Income Country.

Objectives: Development and validation of a simple stool diary for caretakers collecting data on stool frequency and consistency among young children in a low-income country. Methods: Focus group studies evaluated how diarrhea was understood by caregivers (content validity). The sensitivity, reliability, and correlations between dehydration and diary scores (construct validity) were tested in a clinical trial. Results: Caregivers recognized and understood the concept and severity of diarrhea. Stool frequency and liquid consistency decreased in children admitted with diarrhea (p

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Analgesic Effect and Functional Improvement Caused by Radiofrequency Treatment of Genicular Nerves in Patients With Advanced Osteoarthritis of the Knee Until 1 Year Following Treatment.

Background and Objectives: Radiofrequency ablation of genicular nerves has proved to be successful in relieving pain and incapacity caused by osteoarthritis of the knee. However, long-term efficacy of such a treatment remains to be assessed. The current study aimed to reproduce radiofrequency neurotomy of genicular nerves to manage gonarthrosis pain and disability and establish therapeutic response until 1 year after intervention. Methods: This single-center, prospective, observational, noncontrolled, longitudinal study included patients with grade 3 to 4 gonarthrosis suffering from intractable knee pain, scoring 5 or more on the visual analog scale (VAS) during >6 months. Therapy was based on ultrasound guided radiofrequency neurotomy of the superior medial, superior lateral and inferior medial genicular nerves. Visual analog scale and Western Ontario and McMaster Universities Osteoarthritis scores were assessed before therapy and at 1, 6, and 12 months following treatment. Results: Radiofrequency neurotomy of genicular nerves significantly reduced perceived pain (VAS) and disability (Western Ontario and McMaster Universities Osteoarthritis) in the majority of participants, without untoward events. The proportion of participants with improvement of 50% or greater in pretreatment VAS scores at 1, 6, and 12 months following intervention were 22/25 (88%), 16/25 (64%) and 8/25 (32%), respectively. Conclusions: Ultrasound-guided radiofrequency neurotomy of genicular nerves alleviates intractable pain and disability in the majority of patients with advanced Osteoarthritis of the knee. Such a treatment is safe and minimally invasive and can be performed in an outpatient setting. The beneficial effect of treatment started to decline after 6 months, but even 1 year after the intervention, 32% of patients reported 50% improvement or greater in pretreatment VAS scores. Copyright (C) 2016 by American Society of Regional Anesthesia and Pain Medicine.

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Maternal and fetal outcomes in HIV positive pregnant female

2016-11-22T23-05-36Z
Source: International Journal of Research in Medical Sciences
Mahim Mittal, Ashutosh Kumar Mall, Yash Gopal Sharma.
Background: Vertical Transmission is still not an uncommon mode of HIV transmission. HIV and its treatment can also affect maternal and fetal outcomes. We aimed to study incidence and factors of MTCT and maternal and fetal outcomes with the current standard of care. Methods: It was an observational study, at BRD medical college Gorakhpur. Pregnant, HIV positive females consenting for the study were enrolled. Follow up was up to 6 months post-delivery. Infant testing for transmission was done at 6 months. Results: A total 35 HIV positive pregnant female were studied. Follow up could be completed in only 29 patients. Four (13.79%) infants had HIV DNA detectable in whole blood at 6 months. Transmission was 16.6% in group taking ART for 3 months, 25% in mixed feeding group vs. 12% in exclusive breast feeding and 16.6% in NVD group vs. 9% in LSCS. Incidence of Preterm delivery was higher in group who took ART for longer duration. IUGR was present in 10/29 (27%) and growth failure in 12/29 (41%) infants. Conclusions: Longer ART duration and cesarean section delivery were more effective in preventing MTCT. Even exclusive breast feeding could result in MTCT. HIV exposure in utero may lead to IUGR. ART has no deleterious or positive effect on fetal growth but may be associated with preterm delivery. Better patient education will probably lead to earlier diagnosis and initiation of therapy to prevent transmission, and also to better fetal and infant outcomes.


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Clinical significance of presence of accessory foramen transversarium in typical cervical vertebrae

2016-11-22T23-05-36Z
Source: International Journal of Research in Medical Sciences
Esakkiammal N., Renu Chauhan.
Background: The cervical vertebrae are smallest of all the vertebrae present in the vertebral column. It is characterized by a foramen in each transverse process. The foramen transversarium (FT) of 6th to 1st cervical vertebrae transmits vertebral vessels and sympathetic nerves. Presence of another foramen apart from FT in the transverse process of cervical vertebrae is called accessory FT. Anatomical knowledge of these variations are helpful for conducting cervical spinal surgeries by the surgeons in order to prevent injury to vertebral vessels and sympathetic nerves. Methods: The present study was conducted in the department of anatomy, UCMS and GTB Hospital, Delhi, India. A total number of 241 dried cervical vertebrae were collected from the bone bank of the Department of Anatomy. Presence of any variation from the normal anatomy of the cervical vertebrae were noted and photographed. Results: Out of 241 cervical vertebrae (typical and atypical), the accessory FT was noted in typical cervical vertebrae only. Accessory FT was seen in 37 (27.6%) vertebrae, out of 134 typical cervical vertebrae. These accessory FT were either bilateral complete in 4 (2.9%) or incomplete 9 (6.7%) or unilateral complete 6 (4.5%) and unilateral incomplete 12 (8.9%) were observed. Six (4.5%) typical cervical vertebrae showed presence of complete accessory FT on one side and incomplete accessory FT on the other side in the same vertebra. Conclusions: Knowledge of variations of the presence of accessory FT in the typical cervical vertebrae is not only important to anatomist but also to radiologist in identifying the presence of duplicate vertebral artery and hence helping the neuro surgeons in preventing accidental bleeding from the vertebral artery while performing surgery on the cervical spine.


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Cross-sectional comparative study of socio-demographic and health profile of children in a NGO- run open house and street children in a metropolitan city

2016-11-22T23-05-36Z
Source: International Journal of Research in Medical Sciences
Aniruddha A. Malgaonkar, S. Kartikeyan.
Background: Street children are underprivileged urban children who suffer poverty, deprivation of education, vulnerability to various types of abuse, lack of supervision by adults, and with varying status of street-based existence and contact with their families. The study compares the socio-demographic and health profiles of children in a NGO-run Open House and street children. Methods: Respondents satisfying intake criteria were interviewed using a pre-tested questionnaire and their height and weight were measured and the data were statistically analysed. Results: 72% were aged between 12-16 years. Their occupations included rag picking, unorganised labour, street vending, cleaning vehicles, hotel work and begging. The reasons for street living were parental abuse, poverty, parental death, or peer pressure. Between the two groups of children, there were significant differences in frequencies of genital lesions (p=0.014; OR=0.465), injuries (p=0.01; OR=0.5), scabies (p=0.01; OR=0.31), and pyoderma (p=0.03; OR =0.38). A majority from both groups chewed tobacco regularly, some were addicted to more than one substance and had started using addictive substances due to peer pressure or to alleviate depression. Conclusions: Multi-pronged interventions ought to focus on improving income levels and housing of impoverished families, curbing parental abuse, and providing educational and health care facilities, establishing more number of drop-in Open Houses, providing avenues for legal income, and educating on the hazards of promiscuity and substance abuse.


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Ultrasound evaluation of carpal tunnel syndrome in patients with bifid median nerve

2016-11-22T23-05-36Z
Source: International Journal of Research in Medical Sciences
Smiti Sripathi, Anurag Ayachit, Rebin Bos.
Background: Patients with high division of the median nerve proximal to carpal tunnel, or bifid median nerve, may present with carpal tunnel syndrome (CTS). Ultrasound (US) measurements indicative of CTS in this subset of patients differ from those in patients with non-bifid median nerve. The objectives were to evaluate the parameter ∆CSA [difference between the maximum cross-sectional area of bifid median nerve within carpal tunnel (CSAc) and outside tunnel (CSAp)] in the diagnosis of CTS, to compare sensitivity and specificity of ∆CSA with nerve conduction velocity studies (NCS), and to compare the cross-sectional area (CSAc, CSAp & ∆CSA) of bifid median nerve in CTS patients with that in asymptomatic controls. Methods: 20 wrists with bifid median nerves and symptoms suggestive of CTS were included in the study group. Nerve conduction velocity studies (NCS) were performed in all cases. 4 wrists of asymptomatic age-matched subjects had bifid median nerves and normal NCS and were included in the control group. High resolution ultrasonography was performed for all wrists and findings documented. Statistical Analysis: Receiver Operating Characteristics curves were used to obtain the level of significance (p-value) and assessment of correlation between ∆CSA and NCS findings. Results: There was significant correlation between ∆CSA and NCS. A cut-off value of 2.3mm2 gave the best calculated sensitivity (76.9 %) and specificity (100%). Conclusions: CSA criteria for diagnosing CTS in patients with bifid median nerves are different from those in patients with non-bifid median nerve. ∆CSA is a sensitive and specific parameter for confirming the diagnosis of CTS in patients with bifid median nerve with sensitivity approaching that of NCS.


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Role of staging laparoscopy in upstaging CT findings and influencing treatment decisions in gastric cancers

2016-11-22T23-05-36Z
Source: International Journal of Research in Medical Sciences
Abhinay Indrakumar, Ganesh S. Mandakulutur, Keerthi R. Banavara.
Background: It is estimated that 990000 new gastric cancer (GC) cases occur in the world annually. The aim of this study was to examine the accuracy of laparoscopy in staging patients with gastric cancer in comparison with preoperative computed tomography (CT) examination and to determine the influence of staging laparoscopy on treatment decisions in gastric cancers. Methods: This was a prospective study conducted in a tertiary care hospital between August 2014 and February 2016. Thirty patients out of a series of 60 patients with gastric adenocarcinoma underwent a preoperative staging CT followed by a staging laparoscopy. The strengths of the agreement between the CT stage, the laparoscopic stage, and the final histopathological stage were determined by the weighted Kappa statistic (Kw). The number of patients with treatment decision-changes was counted. Results: The strengths of agreement between the CT stage and the final histopathological stage were Kw- 0.314 (95% confidence interval [CI]; 0.03-0.66; P≥0.0001) for T stage and 0.00 (95% CI; 0.0-0.00) for M stage, compared with 0.668 (95% CI; 0.39-0.98; P≥0.0001) and 1.00 (95% CI; 1.0-1.0; P≥0.0001) for the laparoscopic T and M stages, respectively. Unsuspected metastases that were not detected by CT, were found in 12 patients at laparoscopy, all of whom had T3 or T4 locally advanced tumors evident on CT. Conclusions: Preoperative laparoscopic staging of gastric cancer is indicated for potential surgical candidates with locally advanced disease in the absence of metastases on CT and influences treatment decision making apart from preventing unnecessary laparotomies.


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A qualitative exploration of anesthesia trainees' experiences during transition to a children's hospital

Abstract

Background

The stresses of starting a new job can make anyone feel tired and inefficient. In health care, this may impair the ability to learn at a time when there is most to learn, and increase the risk of error in a context where errors may lead to patient harm.

Aim

The aim of this study was to understand issues which influence anesthesia trainees' transition to a pediatric setting.

Methods

This qualitative study utilized in-depth semi-structured interviews to gather data from 31 anesthesia trainees who had commenced work at a tertiary children's hospital between 4 and 6 weeks previously. Data were examined using thematic analysis.

Results

Two key themes were identified: feeling ineffective, which appeared to have both a cognitive component (feeling disoriented) and an emotional component (feeling useless), and feeling anxious or afraid. Trainees found the pediatric environment highly unfamiliar, which made them feel disoriented, inefficient, and at times incompetent. Many experienced difficulty identifying a useful role in a highly specialized area of practice, leading to loss of identity as an expert clinician. Many described an ever-present fear of making an anesthetic error or being unable to manage a rapidly evolving clinical situation. Some trainees developed a negative mindset, which was reinforced by subsequent perceived failures. Overall, these experiences impeded trainees' ability to concentrate and learn.

Conclusions

The impact of disorientation and anxiety on anesthesia trainees as they adapt to a highly specialized clinical environment such as a children's hospital should not be underestimated. Study findings illustrate the importance of helping new trainees to feel less afraid, more useful, and more realistic in assessing their own performance during the transition period.

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A retrospective comparison of intrathecal morphine and epidural hydromorphone for analgesia following posterior spinal fusion in adolescents with idiopathic scoliosis

Summary

Background

Posterior spinal fusion to correct idiopathic scoliosis is associated with severe postoperative pain. Intrathecal morphine is commonly used for analgesia after adolescent posterior spinal fusion; however, anticipating and managing the increase in pain scores after resolution of analgesic effect of intrathecal morphine analgesia is challenging. In 2014, we developed a clinical protocol detailing both the administration of intrathecal morphine intraoperatively and the transition to routine, scheduled oral analgesics at 18 h postoperatively. The goal of our study was to examine the efficacy of our intrathecal morphine protocol vs epidural hydromorphone for postoperative analgesia after posterior spinal fusion.

Methods

Following IRB approval, we retrospectively identified developmentally intact children of ages 10–20 years in our electronic database with a diagnosis of idiopathic scoliosis who had undergone elective posterior spinal fusion surgery from June 2014 to April 2015. For the intrathecal morphine group, intrathecal morphine was administered in a dose of 12 μg·kg−1 (max 1000 μg) prior to incision. Postoperatively, all children in the intrathecal morphine group had an order to receive oral oxycodone (0.1 mg·kg−1, max 5 mg) starting at 18 h postintrathecal morphine injection. For the epidural hydromorphone group, catheters were placed by the surgeon and bolused with 5 μg·kg−1 hydromorphone (max 200 μg) and 1 μg·kg−1 fentanyl (max 50 μg), followed by a continuous infusion of 40–60 μg·h−1, and patient-controlled bolus doses of 5 μg with a lockout interval of 30 min. All patients in both groups had postoperative orders for acetaminophen, diazepam, and ketorolac.

Results

During the study time period, 20 patients received intrathecal morphine and were successfully matched with 20 patients who received epidural hydromorphone. All patients in the intrathecal morphine group were transitioned to oral analgesics on the first postoperative day, without need for intravenous opioids after discharge from the postanesthesia care unit. Compared to the epidural hydromorphone group, the intrathecal morphine group reported lower pain scores in the postanesthesia care unit (difference in means −4.26 [95% CI −6.56, −1.96], P = 0.001) and first 8 h after surgery (difference in means −1.88 [95% CI −3.84, 0.082, P = 0.060) and higher pain scores on the 2nd postoperative day (difference in means 1.60 [95% CI 0.10, 3.10], P = 0.037). The documented time to ambulation and time of Foley catheter removal were statistically earlier in the intrathecal morphine group, and the hospital length of stay was significantly shorter (3.0 ± 0.5 days vs 3.5 ± 0.7 days; P = 0.03). Adverse events did not significantly differ between the groups.

Conclusion

The efficacy of intraoperative intrathecal morphine for postoperative analgesia in the posterior spinal fusion patient population has been shown previously; however, the pain and analgesic trajectory, including transition to other analgesics, has not previously been studied. Our findings suggest that for many patients, use of intrathecal morphine in addition to routine administration of nonopioid medications facilitates direct transition to oral analgesics in the early postoperative period and earlier routine ambulation and discharge of posterior spinal fusion patients.

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Retraction



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Dynamic compensation mechanism gives rise to period and duty-cycle level sets in oscillatory neuronal models

Rhythmic oscillation in neurons can be characterized by various attributes, such as the oscillation period and duty cycle. The values of these features depend on the amplitudes of the participating ionic currents, which can be characterized by their maximum conductance values. Recent experimental and theoretical work has shown that the values of these attributes can be maintained constant for different combinations of two or more ionic currents of varying conductances, defining what is known as level sets in conductance space. In two-dimensional conductance spaces, a level set is a curve, often a line, along which a particular oscillation attribute value is conserved. In this work, we use modeling, dynamical systems tools (phase-space analysis), and numerical simulations to investigate the possible dynamic mechanisms responsible for the generation of period and duty-cycle levels sets in simplified (linearized and FitzHugh-Nagumo) and conductance-based (Morris-Lecar) models of neuronal oscillations. A simplistic hypothesis would be that the tonic balance between ionic currents with the same or opposite effective signs is sufficient to create level sets. According to this hypothesis, the dynamics of each ionic current during a given cycle are well captured by some constant quantity (e.g., maximal conductances), and the phase-plane diagrams are identical or are almost identical (e.g., cubic-like nullclines with the same maxima and minima) for different combinations of these maximal conductances. In contrast, we show that these mechanisms are dynamic and involve the complex interaction between the nonlinear voltage dependencies and the effective time scales at which the ionic current's dynamical variables operate.



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Effects of reward on oculomotor control

The present study examines the extent to which distractors that signal the availability of monetary reward on a given trial affect eye movements. We used a novel eye movement task in which observers had to follow a target around the screen while ignoring distractors presented at varying locations. We examined the effects of reward magnitude and distractor location on a host of oculomotor properties, including saccade latency, amplitude, landing position, curvature, and erroneous saccades toward the distractor. We found consistent effects of reward magnitude on classic oculomotor phenomena such as the remote distractor effect, the global effect, and oculomotor capture by the distractor. We also show that a distractor in the visual hemifield opposite to the target had a larger effect on oculomotor control than an equidistant distractor in the same hemifield as the target. Bayesian hierarchical drift diffusion modeling revealed large differences in drift rate depending on the reward value, location, and visual hemifield of the distractor stimulus. Our findings suggest that high reward distractors not only capture the eyes but also affect a multitude of oculomotor properties associated with oculomotor inhibition and control.



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Production and release rate of 37Ar from the UT TRIGA Mark-II research reactor

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Publication date: Available online 22 November 2016
Source:Journal of Environmental Radioactivity
Author(s): Christine Johnson, Steven R. Biegalski, Edward J. Artnak, Ethan Moll, Derek A. Haas, Justin D. Lowrey, Craig E. Aalseth, Allen Seifert, Emily K. Mace, Vincent T. Woods, Paul Humble
Air samples were taken at various locations around The University of Texas at Austin's TRIGA Mark II research reactor and analyzed to determine the concentrations of 37Ar, 41Ar, and 133Xe present. The measured ratio of 37Ar/41Ar and historical records of 41Ar releases were then utilized to estimate an annual average release rate of 37Ar from the reactor facility. Using the calculated release rate, atmospheric transport modeling was performed in order to determine the potential impact of research reactor operations on nearby treaty verification activities. Results suggest that small research reactors (∼1 MWt) do not release 37Ar in concentrations measurable by currently proposed OSI detection equipment.



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Radon as a natural tracer for underwater cave exploration

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Publication date: Available online 22 November 2016
Source:Journal of Environmental Radioactivity
Author(s): Katalin Csondor, Anita Erőss, Ákos Horváth, Dénes Szieberth
The Molnár János cave is one of the largest hypogenic caves of the Buda Thermal Karst (Budapest, Hungary) and mainly characterized by water-filled passages. The major outflow point of the waters of the cave system is the Boltív spring, which feeds the artificial Malom Lake. Previous radon measurements in the cave system and in the spring established the highest radon concentration (71 BqL−1) in the springwater. According to previous studies, the origin of radon was identified as iron-hydroxide containing biofilms, which form where there is mixing of cold and thermal waters, and these biofilms efficiently adsorb radium from the thermal water component. Since mixing of waters is responsible for the formation of the cave as well, these iron-hydroxide containing biofilms and the consequent high radon concentrations mark the active cave forming zones. Based on previous radon measurements, it is supposed that the active mixing and cave forming zone has to be close to the spring, since the highest radon concentration was measured there. Therefore radon mapping was carried out with the help of divers in order to get a spatial distribution of radon in the cave passages closest to the spring. Based on our measurements, the highest radon activity concentration (84 BqL−1) was found in the springwater. Based on the distribution of radon activity concentrations, direct connection was established between the spring and the István-room of the cave, which was verified by an artificial tracer. However, the distribution of radon in the cave passages shows lower concentrations (18–46 BqL−1) compared to the spring, therefore an additional deep inflow from hitherto unknown cave passages is assumed, from which waters with high radon content arrive to the spring. These passages are assumed to be in the active cave formation zone. This study proved that radon activity concentration distribution is a useful tool in underwater cave exploration.



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Thoron, radon and air ions spatial distribution in indoor air

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Publication date: Available online 22 November 2016
Source:Journal of Environmental Radioactivity
Author(s): Predrag Kolarž, Janja Vaupotič, Ivan Kobal, Predrag Ujić, Zdenka Stojanovska, Zora S. Žunić
Spatial distribution of radioactive gasses thoron (Tn) and radon (Rn) in indoor air of 9 houses mostly during winter period of 2013 has been studied. According to properties of alpha decay of both elements, air ionization was also measured. Simultaneous continual measurements using three Rn/Tn and three air-ion active instruments deployed on to three different distances from the wall surface have shown various outcomes. It has turned out that Tn and air ions concentrations decrease with the distance increase, while Rn remained uniformly distributed. Exponential fittings function for Tn variation with distance was used for the diffusion length and constant as well as the exhalation rate determination. The obtained values were similar with experimental data reported in the literature. Concentrations of air ions were found to be in relation with Rn and obvious, but to a lesser extent, with Tn.



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Decommissioning strategy for liquid low-level radioactive waste surface storage water reservoir

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Publication date: Available online 22 November 2016
Source:Journal of Environmental Radioactivity
Author(s): S.S. Utkin, I.I. Linge
The Techa Cascade of water reservoirs (TCR) is one of the most environmentally challenging facilities resulted from FSUE "PA "Mayak" operations. Its reservoirs hold over 360 mln m3 of liquid radioactive waste with a total activity of some 5 × 1015 Bq.A set of actions implemented under a special State program involving the development of a strategic plan aimed at complete elimination of TCR challenges (Strategic Master-Plan for the Techa Cascade of water reservoirs) resulted in considerable reduction of potential hazards associated with this facility.The paper summarizes the key elements of this master-plan: defining TCR final state, feasibility study of the main strategies aimed at its attainment, evaluation of relevant long-term decommissioning strategy, development of computational tools enabling the long-term forecast of TCR behavior depending on various engineering solutions and different weather conditions.



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Effects of caffeine ingestion on endurance performance in mentally fatigued individuals

Abstract

Purpose

To examine the effects of caffeine ingestion on physiological and perceptual responses in mentally fatigued individuals.

Methods

Eight male physically active subjects completed four cycling constant-workload tests in four experimental conditions at 80 % of maximal power output: control (C), mental fatigue (MF), mental fatigue plus caffeine ingestion (5 mg/kg) (MF-CAF), and mental fatigue plus placebo (MF-PLA). The mental fatigue was induced by a continuous performance task A-X version (AX-CPT). Before and after the AX-CPT, the profile of mood state (POMS) and blood samples for lactate measurement were collected. Oxygen consumption ( \( \dot{V}{\text{O}}_{2} \) ), rating of perceived exertion (RPE), and electromyography (EMG) activity were measured during the cycling test.

Results

The time to exhaustion in C, MF, MF-PLA, and MF-CAF were 251 ± 30, 222 ± 23, 248 ± 28, and 285 ± 42 s, respectively. Delta values (corrected by C condition) were higher in MF-CAF than MF (P = 0.031). MF-CAF reported higher Vigor scores when compared with C (P = 0.046) and MF (P = 0.020). RPE at the first minute was significantly higher in MF-PLA than in C (P = 0.050); at the second minute, RPE was higher in MF-PLA than in C (P = 0.049) and MF-CAF (P = 0.048). EMG activity was not different between the conditions.

Conclusions

Caffeine ingestion increased approximately 14 % endurance performance after the induction of mental fatigue. This effect was accompanied by a tendency to improvement in mood state (i.e., vigor). Therefore, caffeine ingestion can promote a beneficial effect on endurance performance in mentally fatigued individuals.



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Resistance exercise increases intramuscular NF-κb signaling in untrained males

Abstract

Purpose

The NF-κB signaling pathway regulates multiple cellular processes following exercise stress. This study aims to examine the effects of an acute lower-body resistance exercise protocol and subsequent recovery on intramuscular NF-κB signaling.

Methods

Twenty-eight untrained males were assigned to either a control (CON; n = 11) or exercise group (EX; n = 17) and completed a lower-body resistance exercise protocol consisting of the back squat, leg press, and leg extension exercises. Skeletal muscle microbiopsies were obtained from the vastus lateralis pre-exercise (PRE), 1-hour (1H), 5-hours (5H), and 48-hours (48H) post-resistance exercise. Multiplex signaling assay kits (EMD Millipore, Billerica, MA, USA) were used to quantify the total protein (TNFR1, c-Myc) or phosphorylation status of proteins belonging to the NF-κB signaling pathway (IKKa/b, IkBα, NF-κB) using multiplex protein assay. Repeated measures ANOVA analysis was used to determine the effects of the exercise bout on intramuscular signaling at each time point. Additionally, change scores were analyzed by magnitude based inferences to determine a mechanistic interpretation.

Results

Repeated measures ANOVA indicated a trend for a two-way interaction between the EX and CON Group (p = 0.064) for c-Myc post resistance exercise. Magnitude based inference analysis suggest a "Very Likely" increase in total c-Myc from PRE-5H and a "Likely" increase in IkBα phosphorylation from PRE-5H post-resistance exercise.

Conclusion

Results indicated that c-Myc transcription factor is elevated following acute intense resistance exercise in untrained males. Future studies should examine the role that post-resistance exercise NF-κβ signaling plays in c-Myc induction, ribosome biogenesis and skeletal muscle regeneration.



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Bilateral deficit in maximal force production

Abstract

The bilateral deficit phenomenon, characterized by a reduction in the amount of force from a single limb during maximal bilateral actions, has been shown in various movement tasks, contraction types and different populations. However, bilateral deficit appears to be an inconsistent phenomenon, with high variability in magnitude and existence, and seems to be plastic, as bilateral facilitation has also been shown to occur. Furthermore, many mechanisms underlying this phenomenon have been proposed over the years, but still remain largely unknown. The purpose of this review was to clarify and critically discuss some of the important issues relevant to bilateral deficit. The main findings of this review were: (1) bilateral deficit does not seem to be contraction-type dependent; however, it is more consistent in dynamic compared to isometric contractions; (2) postural stabilization requirements and/or ability to use counterbalances during unilateral actions seem to influence the expression of bilateral deficit to a great extent; strong evidence has been provided for higher-order neural inhibition as a possible mechanism, but requires further exploration using a lower limb model; biomechanical mechanisms, such as differences in shortening velocity between contraction modes and displacement of the force–velocity curve, seem to underlie bilateral deficit in ballistic and explosive contractions; (3) task familiarity has a large influence on bilateral deficit and thus adequate testing specificity is warranted in training/cross-sectional experiments; (4) the literature investigating the relationship between bilateral deficit and athletic performance and injury remains scarce; hence, further research in this area is required.



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The quality of placebos used in randomized, controlled trials of lumbar and pelvic joint thrust manipulation – a systematic review.

Spinal manipulative therapy (SMT) has been attributed with substantial non-specific effects. Accurate assessment of the non-specific effects of SMT relies on high-quality studies with low risk of bias that compare to appropriate placebos.

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Mich. EMT student saves father’s life after heart attack

By EMS1 Staff

TECH, Mich. — During a family mountain biking trip, an EMT had one of the most difficult calls unfold right in front of him.

Mario Calabria was biking with his family when his father fell off his bike, hit a tree and was knocked unconscious, reported Up Matters

Calabria began to perform CPR after he was unable to find a pulse. He told his brother's girlfriend to call 911 and gave her a map so she could show their location to first responders. 

Although Calabria managed to get a pulse, his father stopped breathing a second time. Soon after, EMTs and police officers arrived on scene and used an AED. Calabria's father was also intubated to avoid swelling in his airway. After five shocks, first responders were able to get a pulse. 

"At first, it was just me versus a massive heart attack," Calabria said. "Then I was surrounded with people who knew what they were doing … it was a team effort."

Calabria's father was loaded into an ambulance and later airlifted to a medical center. He was put into an induced coma; he was released from the hospital six days later.



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Comparing the effects of sustained and transient spatial attention on the orienting towards and the processing of electrical nociceptive stimuli

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Publication date: Available online 22 November 2016
Source:International Journal of Psychophysiology
Author(s): Rob H.J. Van der Lubbe, Jorian H.G. Blom, Elian De Kleine, Ernst T. Bohlmeijer
We examined whether sustained vs. transient spatial attention differentially affect the processing of electrical nociceptive stimuli. Cued nociceptive stimuli of a relevant intensity (low or high) on the left or right forearm required a foot pedal press. The cued side varied trial wise in the transient attention condition, while it remained constant during a series of trials in the sustained attention condition. The orienting phase preceding the nociceptive stimuli was examined by focusing on lateralized EEG activity. ERPs were computed to examine the influence of spatial attention on the processing of the nociceptive stimuli. Results for the orienting phase showed increased ipsilateral alpha and beta power above somatosensory areas in both the transient and the sustained attention conditions, which may reflect inhibition of ipsilateral and/or disinhibition of contralateral somatosensory areas. Cued nociceptive stimuli evoked a larger N130 than uncued stimuli, both in the transient and the sustained attention conditions. Support for increased efficiency of spatial attention in the sustained attention condition was obtained for the N180 and the P540 component. We concluded that spatial attention is more efficient in the case of sustained than in the case of transient spatial attention.



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Mich. EMT student saves father’s life after heart attack

Mario Calabria was biking with his family when his father fell off his bike, hit a tree and was knocked unconscious.

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5 EMS safety tips to prevent carfentanil exposure

Old timers may remember the heroin epidemic of the mid 1980s, the crack epidemic of the early 1990s and the rise of meth labs around 2000. More recently, synthetic drugs such as MDMA, bath salts and spice have received media coverage as ways for humans to drive themselves crazy.

But the current opioid crisis has really gotten everyone's attention. The depth and breadth of patients impacted by narcotic overdoses has been incredible. According to the U.S. Department of Health and Human Services, 78 Americans die each day from opioid-related overdoses. The effect is widespread, with the greatest numbers of deaths occurring in diverse states such as Massachusetts, Pennsylvania, Oklahoma and Colorado.

The supply of opioids on the black market has never been more plentiful. More than 650,000 opioid prescriptions are dispensed daily. Small "stamp bags" of heroin can cost as little as $10. Access to opioids is easy and recovery is difficult, because narcotic addiction has physiologic and psychological roots.

What is especially dangerous now to both users and first responders is the use of fillers that drug makers cut into or batch with heroin to increase sales. Everything from corn starch to rat poison has been used. Yet EMS and other public safety providers stand the risk of becoming ill when contacting substances such as carfentanil, which can be absorbed readily through air and skin contact. Carfentanil, which is intended for large animal sedation, is 10,000 times more potent than morphine and 100 times stronger than fentanyl, one microgram of carfentanil is enough to cause significant effects on humans and one milligram is enough to be lethal.

In September 2016, the U.S. Drug Enforcement Agency issued a critical statement to the public and law enforcement personnel warning of potentially disastrous effects after casual or unintended contact with carfentanil. There have been instances where police officers, firefighters and EMS personnel have been affected while operating at a scene where the drug was present.

Safety tips for EMS
Remember and follow these tips when operating on a scene where carfentanil, fentanyl and other such substances may be present:

1. Be aware of your surroundings
This may be obvious while on the scene of an overdose patient; in other situations, not so much. Unusual odors like vinegar may be present. Interior doors with padlocks and other security measures may be a sign of clandestine activity.

2. Think hazmat
If more than one person is experiencing signs and symptoms of an opioid overdose, it might be intentional. Or it might be an inadvertent exposure. Similar to a carbon monoxide situation, evacuate everyone out of a scene immediately. If powder is present on clothing, you may need a hazmat specialist to decontaminate the patient in order to avoid aerosolizing the product. NIOSH categorizes fentanyl as an incapacitating agent and describes the necessary PPE to prevent exposure.

3. Act as if you were operating within a crime scene
That means not disturbing or touching anything other than the patient. Do not stay within the scene any longer than you have to. Prevent others from entering the scene unless absolutely necessary.

4. If you or another responder begins to feel ill, STOP and seek care immediately
Carfentanil and fentanyl require large doses of naloxone as a reversal agent. There may not be enough naloxone on scene to administer to more than one patient, necessitating a multi-unit response or transport to an emergency department.

5. Scene safety is paramount for EMS providers
Knowing the potential lethality of these powerful drugs will help keep you safe form their effects the next time you're at work.



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The benefits of ultrasound-guided continuous sensory nerve blockade in the setting of burn injury: a case report of bilateral continuous superficial peroneal nerve blockade in a patient with severe sleep apnea

The management of pain after burn injuries is a clinical challenge magnified in patients with significant comorbidities. Presently, burn pain is treated via a wide variety of modalities, including systemic pharmacotherapy and regional analgesia. Although the latter can provide effective pain control in patients with burn injuries, it is relatively underused. Furthermore, the development of ultrasound guidance has allowed for novel approaches and sparing of motor nerve blockade with preference toward sensory-specific analgesia that has not been possible previously.

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Predictors of primary care provider adoption of CT colonography for colorectal cancer screening

Abdominal Imaging

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The porirua protocol in the treatment of clozapine-induced gastrointestinal hypomotility and constipation: a pre- and post-treatment study

CNS Drugs

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Comparison of knowledge-based iterative model reconstruction and hybrid reconstruction techniques for liver CT evaluation of hypervascular hepatocellular carcinoma

Journal of Computer Assisted Tomography

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Dietary trace element intake and liver cancer risk: Results from two population-based cohorts in China

International Journal of Cancer

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Evidence-based guidelines for the management of exocrine pancreatic insufficiency after pancreatic surgery

Annals of Surgery

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Pan-genotypic treatment regimens for hepatitis C virus: Advantages and disadvantages in high- and low-income regions

Journal of Viral Hepatitis

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Metabolic phenotypes of obesity: Frequency, correlates and change over time in a cohort of postmenopausal women

International Journal of Obesity

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Laparoscopic cholecystectomy for acute calculous cholecystitis: A retrospective study assessing risk factors for conversion and complications

World Journal of Emergency Surgery

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Analysis of Physiological Respiratory Variable Alarm Alerts Among Laboring Women Receiving Remifentanil.

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BACKGROUND: Remifentanil may be used by laboring women for analgesia, despite controversy because of potential apneas. We evaluated candidate variables as early warning alerts for apnea, based on prevalence, positive predictive rate, sensitivity for apnea event detection, and early warning alert time intervals (lead time) for apnea. METHODS: We performed a secondary analysis of respiratory physiological data that had been collected during a prospective IRB-approved study of laboring women receiving IV patient-controlled boluses of remifentanil 20 to 60 [mu]g every 1 to 2 minutes. Analyzed data included the respiratory rate (RR), end-tidal CO2 (EtCO2), pulse oximetry (SpO2), heart rate (HR), and the Integrated Pulmonary Index (IPI; Capnostream 20; Medtronic, Boulder, CO) that had been recorded continuously throughout labor. We defined immediate early warning alerts as any drop in a variable value below a prespecified threshold for 15 seconds: RR = 10 further seconds. The IPI value (1 to 10; 10 = healthy patient, =10 seconds. The positive predictive value of alerts for apnea was 35.8% (99% confidence interval [CI]: 27.1-45.6), 28.9% (99% CI: 20.8-38.7), 4.3% (99% CI: 1.9-9.6), and 24.6% (99% CI: 18.3-32.2) for RR, EtCO2, SpO2, and IPI, respectively. The sensitivity for apnea event detection was 100% (99% CI: 90.3-100) for RR (

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