The 6-minute mastication test: a unique test to assess endurance of continuous chewing; normal values, reliability, reproducibility and usability in patients with mitochondrial disease

Abstract

In patients with mitochondrial disease, fatigue and muscle problems are the most common complaints. They also experience these complaints during mastication. To measure endurance in continuous mastication in patients with mitochondrial diseases the 6-minute mastication test (6MMT) was developed. This study included the collection of normal data for the 6MMT in a healthy population (children and adults). During 6 minutes of continuous mastication on a chew tube chewing cycles per minute, total amount of chewing cycles and the difference between minute 1 (M₁) and minute 6 (M₂) were collected in 271 healthy participants (5 - 80 years old). These results were compared with those of 9 pediatric and 25 adult patients with a mitochondrial disease. Visual Analogue Scale (VAS) scores were collected directly after the test and after 5 minutes. A qualitative rating was made on masticatory movements. The reproducibility of the 6MMT in the healthy population with an interval of approximately two weeks was good. The interrater reliability for the observations was excellent. The patient group demonstrated lower total amount of chewing cycles or had greater differences between M₁ and M₆. The 6MMT is a reliable and objective test to assess endurance in continuous chewing. It demonstrates the ability of healthy children and adults to chew during 6 minutes with a highly stable frequency of mastication movements. The test may give an explanation for the masticatory problems in patient groups, who are complaining of pain and fatigue during mastication.

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The role of molecular pain biomarkers in temporomandibular joint internal derangement

Summary

There is evidence that low-grade inflammation may be responsible for pain and development of degenerative changes in temporomandibular joint internal derangement. This article reviews the current knowledge of the molecular mechanisms behind TMJ internal derangements. A non-systematic search was carried out in PubMed, Embase, and the Cochrane library for studies regarding pathophysiological mechanisms behind internal derangements focusing on pain mediating inflammatory and cartilage degrading molecules. Recent data suggests that release of cytokines may be the key event for pain and cartilage destruction in TMJ internal derangements. Cytokines promote the release of matrix metalloproteinases (MMPs) and due to hypoxia, vascular endothelial growth factor (VEGF) is released. This activates chondrocytes to produce MMPs and reduce their tissue inhibitors (TIMPs) as well as the recruitment of osteoclasts, ultimately leading to cartilage and bone resorption. Also proteoglycans have an important role in this process. Several cytokines, MMPs, TIMPs, and VEGF have been identified in higher concentrations in the TMJ synovial fluid of patients with painful internal derangements and shown to be associated with the degree of degeneration. Other molecules that show elevated levels include hyaluronic acid synthase, disintegrin, and metalloproteinase with thrombospondin motifs (ADAMTs), aggrecan, fibromodulin, biglycan, and lumican. Taken together more or less pronounced inflammation of TMJ structures with release of cytokines, MMPs and other molecular markers that interact in a complex manner may be responsible for tissue degeneration in internal derangements. As internal derangements may be symptom-free, the degree of inflammation, but also other mechanisms, may be important for pain development.

This article is protected by copyright. All rights reserved.

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Identification of novel candidate genes for the inverted teat defect in sows using a genome-wide marker panel

Abstract

The number of functional teats is an important selection criterion in pig breeding. Inherited defects of the udder, such as the inverted teat, do have a considerable negative impact on the nursing ability of the sow. To investigate the genetic background of this defect and the number of functional teats in Swedish maternal lines, samples from 230 Yorkshire pigs were selected for genotyping using the PorcineSNP60K BeadChip (Illumina Inc.), each pig with at least one inverted teat was matched with one non-affected pig (fullsib or pairs with matching herd and gender). A genome-wide association study on these 230 pigs was performed using the two-step approach implemented in GenABEL using 46,652 single nucleotide polymorphisms across all autosomes and the X chromosome. A number of significant regions were identified for the inverted teat defect on chromosomes 2, 10, and 18. Many of the regions associated with the number of functional teats were located in the same or close regions, except two associated markers on the X chromosome and one on chromosome 3. We identified some of the regions on chromosomes previously reported in one linkage and one gene expression study. We conclude, despite being able to suggest new candidate genes, that further studies are needed to better understand the biologic background of the teat development. Despite the in-depth comparison of identified regions for the inverted teat defect done here, more studies are required to allow a clear identification of genetic regions relevant for this defect across many pig populations.

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Broadened population-level frequency tuning in the auditory cortex of tinnitus patients

Tinnitus is a phantom auditory perception without an external sound source and is one of the most common public health concerns that impair the quality of life of many individuals. However, its neural mechanisms remain unclear. We herein examined population-level frequency tuning in the auditory cortex of unilateral tinnitus patients with similar hearing levels in both ears using magnetoencephalography. We compared auditory evoked neural activities elicited by a stimulation to the tinnitus and non-tinnitus ears. Objective magnetoencephalographic data suggested that population-level frequency tuning corresponding to the tinnitus ear was significantly broader than that corresponding to the non-tinnitus ear in the human auditory cortex. The results obtained support the hypothesis that pathological alterations in inhibitory neural networks play an important role in the perception of subjective tinnitus.

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Orientation selectivity in the visual cortex of the nine-banded armadillo

Orientation selectivity in primary visual cortex (V1) has been proposed to reflect a canonical computation performed by the neocortical circuitry.  While orientation selectivity has been reported in all mammals examined to date, the degree of selectivity and the functional organization of selectivity varies across clades. The differences in degree of orientation selectivity are large from reports in marsupials that only a small subset of neurons are selective to studies in carnivores in which it is rare to find a neuron lacking selectivity. Further, the functional organization in cortex varies in that the primate and carnivore V1 is characterized by an organization in which nearby neurons share orientation preference while other mammals such as rodents and lagomorphs either lack or have only extremely weak clustering. To gain insight into the evolutionary emergence of orientation selectivity we examined a member of Xenarthra, an early placental clade whose members are rod monochromats. Here, for the first time, we use a combination of neuroimaging, histological, and electrophysiological methods to identify the retinofugal pathways, locate V1, and examine the functional properties of V1 neurons in the armadillo (Dasypus novemcinctus) V1. Individual neurons were strongly sensitive to the orientation and often the direction of drifting gratings. We uncovered a wide range of orientation preferences, but found a bias for horizontal gratings. The presence of strong orientation selectivity in armadillo suggests that the circuitry responsible for this computation is common to placental mammals, and may reflect a difference in the cortical circuitry of marsupial and placental cohorts.

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Nitric oxide promotes GABA release by activating a voltage-independent Ca2+ influx pathway in retinal amacrine cells

Retinal amacrine cells express nitric oxide synthase and produce nitric oxide (NO), making NO available to regulate the function of amacrine cells. Here, we test the hypothesis that NO can alter the GABAergic synaptic output of amacrine cells. We investigate this using whole-cell voltage clamp recordings and Ca²⁺ imaging of cultured chick retinal amacrine cells. When recording from amacrine cells receiving synaptic input from other amacrine cells, we find that NO increases GABAergic spontaneous postsynaptic current (sPSC) frequency. This increase in sPSC frequency does not require the canonical NO receptor, soluble guanylate cyclase, or presynaptic action potentials. However, removal of extracellular Ca²⁺ and buffering of cytosolic Ca²⁺ both inhibit the response to NO. In Ca²⁺ imaging experiments, we confirm that NO increases cytosolic Ca²⁺ in amacrine cell processes by activating a Ca²⁺ influx pathway. Neither the increase in sPSC frequency nor the cytosolic Ca²⁺ elevations are dependent upon Ca²⁺ release from stores. NO also enhances evoked GABAergic responses. Because voltage-gated Ca²⁺ channel function is not altered by NO, the increased evoked response is likely due to the combined effect of voltage-dependent Ca²⁺ influx adding to the NO-dependent, voltage independent, Ca²⁺ influx. Insight into the identity of the Ca²⁺ influx pathway is provided by the transient receptor potential canonical (TRPC) channel inhibitor clemizole which prevents the NO-dependent increase in sPSC frequency and cytosolic Ca²⁺ elevations. These data suggest that NO production in the inner retina will enhance Ca²⁺-dependent GABA release from amacrine cells by activating TRPC channel(s).

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Synaptic control of the shape of the motoneuron pool input-output function

Although motoneurons have often been considered to be fairly linear transducers of synaptic input, recent evidence suggests that strong persistent inward currents (PICs) in motoneurons allow neuromodulatory and inhibitory synaptic inputs to induce large nonlinearities in the relation between the level of excitatory input and motor output. To try and estimate the possible extent of this nonlinearity, we developed a pool of model motoneurons designed to replicate the characteristics of motoneuron input-output properties measured in medial gastrocnemius motoneurons in the decerebrate cat using voltage-clamp and current-clamp techniques. We drove the model pool with a range of synaptic inputs consisting of various mixtures of excitation, inhibition and neuromodulation. We then looked at the relation between excitatory drive and total pool output. Our results revealed that the PICs not only enhance gain but also induce a strong nonlinearity in the relation between the average firing rate of the motoneuron pool and the level of excitatory input. The relation between the total simulated force output and input was somewhat more linear due to higher force outputs in later recruited units. We also found that the non-linearity can be increased by increasing neuromodulatory input and/or balanced inhibitory input and minimized by a reciprocal, push-pull pattern of inhibition. We consider the possibility that a flexible input-output function may allow motor output to be tuned to match the widely varying demands of the normal motor repertoire.

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Heterogeneous effects of noradrenaline on spontaneous and stimulus-driven activity in the male accessory olfactory bulb

Noradrenaline (NA) release has been linked to experience-dependent plasticity in many model systems and brain regions. Among these is the rodent accessory olfactory system (AOS), which is crucial for detecting and processing socially relevant environmental cues. The accessory olfactory bulb (AOB), the first site of chemosensory information processing in the AOS, receives dense centrifugal innervation by noradrenergic (NAergic) fibers originating in the locus coeruleus. Though NA release has been linked to behavioral plasticity through its actions in the AOB, the impacts of NAergic modulation on AOB information processing have not been thoroughly studied. We made extracellular single-unit recordings of AOB principal neurons in ex vivo preparations of the early AOS taken from adult male mice. We analyzed the impacts of bath-applied NA (10 μM) on spontaneous and stimulus-driven activity. In the presence of NA, we observed overall suppression of stimulus-driven neuronal activity with limited impact on spontaneous activity. NA-associated response suppression in the AOB came in two forms: one that was strong and immediate (21%), and the other which involved gradual, stimulus-dependent monotonic response suppression (47%). NA-associated changes in spontaneous activity were more modest, with an overall increase in spontaneous spike frequency observed in 25% of neurons. Neurons with increased spontaneous activity demonstrated a net decrease in chemosensory discriminability. These results reveal that NAergic signaling in the AOB causes cell-specific changes in chemosensory tuning, even among similar projection neurons.

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Distinct neural circuits for control of movement vs. holding still

In generating a point to point movement, the brain does more than produce the transient commands needed to move the body part; it also produces the sustained commands that are needed to hold the body part at its destination. In the oculomotor system, these functions are mapped onto two distinct circuits: a pre-motor circuit that specializes in generating the transient activity that displaces the eyes, and a "neural integrator" that transforms that transient input into sustained activity that holds the eyes. Different parts of the cerebellum adaptively control the motor commands during these two phases: the oculomotor vermis participates in fine-tuning the transient neural signals that move the eyes, monitoring the activity of the pre-motor circuit via efference copy, whereas the floculus participates in controlling the sustained neural signals that hold the eyes, monitoring the activity of the neural integrator. Here, I review the oculomotor literature, and then ask whether this separation of control between moving and holding is a design principle that may be shared with other modalities of movement. To answer this question, I consider neurophysiological and psychophysical data in various species during control of head movements, arm movements, and locomotion, focusing on the brainstem, the motor cortex, and the hippocampus, respectively. The review of the data raises the possibility that across modalities of motor control, circuits that are responsible for producing commands that change the sensory state of a body part are distinct from those that produce commands that maintain that sensory state.

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Comparative Biology of Pain: What Invertebrates Can Tell Us about How Nociception Works

The inability to adequately treat chronic pain is a worldwide health care crisis. Pain has both an emotional and a sensory component and this latter component, nociception, refers specifically to the detection of damaging or potentially damaging stimuli. Nociception represents a critical interaction between an animal and its environment and exhibits considerable evolutionary conservation across species. Using comparative approaches to understand the basic biology of nociception could promote the development of novel therapeutic strategies to treat pain and studies of nociception in invertebrates can provide especially useful insights towards this goal. Both vertebrates and invertebrates exhibit segregated sensory pathways for nociceptive and non-nociceptive information, injury-induced sensitization to nociceptive and non-nociceptive stimuli, and even similar anti-nociceptive modulatory processes. In a number of invertebrate species, the central nervous system (CNS) is understood in considerable detail and it is often possible to record from and/or manipulate single, identifiable neurons through either molecular genetic or physiological approaches. Invertebrates also provide an opportunity to study nociception in an ethologically-relevant context that can provide novel insights into the nature of how injury-inducing stimuli produce persistent changes in behavior. Despite these advantages, invertebrates have been under-utilized in nociception research. In this review, findings from invertebrate nociception studies are summarized and proposals for how research using invertebrates can address questions about the fundamental mechanisms of nociception are presented.

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Descending antinociception induced by secondary somatosensory cortex stimulation in experimental neuropathy: role of the medullospinal serotonergic pathway

Stimulation of the secondary somatosensory cortex (S2) has attenuated pain in humans and inflammatory nociception in animals. Here we studied S2 stimulation-induced antinociception and its underlying mechanisms in an experimental animal model of neuropathy induced by spinal nerve ligation (SNL). Effect of S2 stimulation on heat-evoked limb withdrawal latency was assessed in lightly anesthetized rats that were divided into three groups based on prior surgery and monofilament testing before induction of anesthesia: i) Sham operated group, ii-iii) (mechanically) hypersensitive and non-hypersensitive SNL groups. In a group of hypersensitive SNL animals, a 5-HT_1A receptor agonist was microinjected into the rostroventromedial medulla (RVM) to assess whether autoinhibition of serotonergic cell bodies blocks antinociception. Additionally, effect of S2 stimulation on pronociceptive ON-cells and antinociceptive OFF-cells in the RVM or nociceptive spinal wide-dynamic range (WDR) neurons were assessed in anesthetized hypersensitive SNL animals. S2 stimulation induced antinociception in hypersensitive but not in non-hypersensitive SNL or sham-operated animals. Antinociception was prevented by a 5-HT_1A receptor agonist in the RVM. Antinociception was associated with decreased duration of heat-evoked response in RVM ON-cells. In spinal WDR neurons, heat-evoked discharge was delayed by S2 stimulation, and this antinociceptive effect was prevented by blocking spinal 5-HT_1A receptors. The results indicate that S2 stimulation suppresses nociception in SNL animals if SNL is associated with tactile allodynia-like hypersensitivity. In hypersensitive SNL animals, S2 stimulation induces antinociception mediated by medullospinal serotonergic pathways acting on the spinal 5-HT_1A receptor, and partly through reduction of the RVM ON-cell discharge.

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Association of AHSG with alopecia and mental retardation (APMR) syndrome

Abstract

Alopecia with mental retardation syndrome (APMR) is a very rare autosomal recessive condition that is associated with total or partial absence of hair from the scalp and other parts of the body as well as variable intellectual disability. Here we present whole-exome sequencing results of a large consanguineous family segregating APMR syndrome with seven affected family members. Our study revealed a novel predicted pathogenic, homozygous missense mutation in the AHSG (OMIM 138680) gene (AHSG: NM_001622:exon7:c.950G>A:p.Arg317His). The variant is predicted to affect a region of the protein required for protein processing and disrupts a phosphorylation motif. In addition, the altered protein migrates with an aberrant size relative to healthy individuals. Consistent with the phenotype, AHSG maps within APMR linkage region 1 (APMR 1) as reported before, and falls within runs of homozygosity (ROH). Previous families with APMR syndrome have been studied through linkage analyses and the linkage resolution did not allow pointing out to a single gene candidate. Our study is the first report to identify a homozygous missense mutation for APMR syndrome through whole-exome sequencing.

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Genome-wide meta-analyses of nonsyndromic orofacial clefts identify novel associations between FOXE1 and all orofacial clefts, and TP63 and cleft lip with or without cleft palate

Abstract

Nonsyndromic orofacial clefts (OFCs) are a heterogeneous group of common craniofacial birth defects with complex etiologies that include genetic and environmental risk factors. OFCs are commonly categorized as cleft lip with or without cleft palate (CL/P) and cleft palate alone (CP), which have historically been analyzed as distinct entities. Genes for both CL/P and CP have been identified via multiple genome-wide linkage and association studies (GWAS); however, altogether, known variants account for a minority of the estimated heritability in risk to these craniofacial birth defects. We performed genome-wide meta-analyses of CL/P, CP, and all OFCs across two large, multiethnic studies. We then performed population-specific meta-analyses in sub-samples of Asian and European ancestry. In addition to observing associations with known variants, we identified a novel genome-wide significant association between SNPs located in an intronic TP63 enhancer and CL/P (p = 1.16 × 10⁻⁸). Several novel loci with compelling candidate genes approached genome-wide significance on 4q21.1 (SHROOM3), 12q13.13 (KRT18), and 8p21 (NRG1). In the analysis of all OFCs combined, SNPs near FOXE1 reached genome-wide significance (p = 1.33 × 10⁻⁹). Our results support the highly heterogeneous nature of OFCs and illustrate the utility of meta-analysis for discovering new genetic risk factors.

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ANO1 in intramuscular interstitial cells of Cajal plays a key role in the generation of slow waves and tone in the internal anal sphincter

Abstract

The mechanism underlying tone generation in the internal anal sphincter (IAS) is controversial. We examined the hypothesis that tone depends upon generation of electrical slow waves (SWs) initiated in intramuscular interstitial cells of Cajal (ICC-IM) by activation of Ca²⁺-activated Cl⁻ channels (encoded by Ano1) and voltage-dependent L-type Ca²⁺ channels (encoded by Cacna1c). Phasic contractions and tone in the IAS were nearly abolished by ANO1 and Cav_L antagonists. ANO1 antagonists also abolished SWs as well as transient depolarizations that persisted after addition of Cav_L antagonists. Tone development in the IAS did not require stretch of muscles, and the sensitivity of contraction to ANO1 antagonists was the same in stretched versus un-stretched muscles. ANO1 expression was examined in wildtype and Ano1^/+egfp mice with immunohistochemical techniques. Dual labeling revealed that ANO1 expression could be resolved in ICC but not smooth muscle cells (SMCs) in the IAS and rectum. Ano1, Cacna1c and Kit gene expression were the same in extracts of IAS and rectum muscles. In IAS cells isolated with FACS, Ano1 expression was 26.5 fold greater in ICC than in SMCs while Cacna1c expression was only 2 fold greater in SMCs than in ICC. These data support a central role for ANO1 and Cav_L in the generation of SWs and tone in the IAS. ICC-IM are the probable cellular candidate for ANO1 currents and SW generation. We propose that ANO1 and Cav_L collaborate to generate SWs in ICC-IM followed by conduction to adjacent SMC where phasic calcium entry through Cav_L sums to produce tone.

This article is protected by copyright. All rights reserved

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Comparing the Costs and Acceptability of Three Fidelity Assessment Methods for Assertive Community Treatment

Abstract

Successful implementation of evidence-based practices requires valid, yet practical fidelity monitoring. This study compared the costs and acceptability of three fidelity assessment methods: on-site, phone, and expert-scored self-report. Thirty-two randomly selected VA mental health intensive case management teams completed all fidelity assessments using a standardized scale and provided feedback on each. Personnel and travel costs across the three methods were compared for statistical differences. Both phone and expert-scored self-report methods demonstrated significantly lower costs than on-site assessments, even when excluding travel costs. However, participants preferred on-site assessments. Remote fidelity assessments hold promise in monitoring large scale program fidelity with limited resources.

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Strategies for Working with Asian Americans in Mental Health: Community Members’ Policy Perspectives and Recommendations

Abstract

This qualitative study used snowball sampling of individuals known to provide informal assistance to Asian American community members with their mental health problems in a locality in the South where there has been an exponential increase of the Asian American population. The major themes found include: (1) the existence of cultural, language, knowledge, and transportation barriers and the importance of policy in addressing them; (2) the impact of the model minority myth and the need for inclusive policymaking; and (3) the unique service and policy needs of immigrants. Findings demonstrate the importance and value of including diverse Asian American individuals in mental health policymaking efforts.

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Wake County EMS Panda demonstrates hands-only CPR

Wake County EMS demonstrates how to perform hands-only CPR at a basketball game.

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Wake County EMS Panda demonstrates hands-only CPR

Wake County EMS demonstrates how to perform hands-only CPR at a basketball game.

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Aerobic fitness impacts sympathoadrenal axis responses to concurrent challenges

Abstract

The combination of mental and physical challenges can elicit exacerbated cardiorespiratory (CR) and catecholamine responses above that of a single challenge alone.

Purpose

This study examined the effects of a combination of acute mental challenges and physical stress on cardiorespiratory and catecholamine responses.

Method

Eight below-average fitness (LF VO_2max = 36.58 ± 3.36 ml⁻¹ kg⁻¹ min⁻¹) and eight above-average fitness (HF VO_2max = 51.18 ± 2.09 ml⁻¹ kg⁻¹ min⁻¹) participants completed an exercise-alone condition (EAC) session consisting of moderate-intensity cycling at 60% VO_2max for 37 min, and a dual-challenge condition (DCC) that included concurrent participation in mental challenges while cycling.

Result

The DCC resulted in increases in perceived workload, CR, epinephrine, and norepinephrine responses overall. HF participants had greater absolute CR and catecholamine responses compared to LF participants and quicker HR recovery after the dual challenge.

Conclusion

These findings demonstrate that cardiorespiratory fitness does impact the effect of concurrent stressors on CR and catecholamine responses.

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The use of ultrasound in planned cesarean delivery under spinal anesthesia for patients having nonprominent anatomic landmarks

The aim of the study was to compare conventional landmark method with ultrasound-guided spinal anesthesia in cesarean delivery cases where spinous processes and interspinous spaces were not prominent on physical examination.

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Wake County EMS Panda demonstrates hands-only CPR

Wake County EMS demonstrates how to perform hands-only CPR at a basketball game.

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Hemosuccus pancreaticus caused by a mucinous cystic neoplasm of the pancreas

Abstract

Hemosuccus pancreaticus is a gastrointestinal hemorrhage through the main pancreatic duct. Here, we report a rare case of hemosuccus pancreaticus due to a mucinous cystic neoplasm of the pancreas. A 62-year-old woman who had been followed for a branch duct intraductal papillary mucinous neoplasm visited our emergency room due to severe abdominal pain and bloody discharge. Computed tomography revealed that the pancreatic cyst increased the tension of the wall and a high-density area indicative of bleeding into the cyst was observed. Endoscopy showed opening of and hemorrhaging from the papilla of Vater. The patient was diagnosed with hemosuccus pancreaticus caused by hemorrhaging into the cyst from the branch duct intraductal papillary mucinous neoplasm. Based on this diagnosis, elective distal pancreatectomy was performed. The histopathological diagnosis was a mucinous cystic neoplasm with intermediate-grade dysplasia based upon the pathological findings that fibrous ovarian-type stroma existed abundantly and the stroma cells were positive for progesterone receptor and inhibin. Hemosuccus pancreaticus caused by a mucinous cystic neoplasm is extremely rare and there has been only one case reported to date. In conclusion, it should be recognized that pancreatic cystic neoplasms including mucinous cystic neoplasms may cause hemosuccus pancreaticus.

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Wake County EMS Panda demonstrates hands-only CPR

Wake County EMS demonstrates how to perform hands-only CPR at a basketball game.

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The Social and Spatial Patterning of Life Stress Among Immigrants in Canada

Abstract

While much literature has examined immigrants' health in Canada, less attention has focused specifically on the life stress, an important yet understudied post-migration challenge which may lead to poor coping strategies and negative health consequences. For this study, the pooled 2009–2014 Canadian Community Health Survey (CCHS) was analyzed, using multilevel logistic regression to examine the compositional effects (at an individual level) and areal effects (at a CMA/CA level) on reported high life stress. Separate models have been run for immigrants and non-immigrants for comparative purposes. The results reveal different ways in which select individual socioeconomic and lifestyle factors affect life stress. A statistically significant yet small areal effect at the CMA/CA level on life stress was identified for both immigrants and non-immigrants. When comparing immigrants to non-immigrants, factors such as smoking, length of residency in Canada, and mental health status were found to be particularly informative for predicting high life stress among immigrants. A Healthy Immigrant Effect (HIE) is partially evident, as immigrants with a longer stay in Canada are more likely to be highly stressed than recent arrivals. The areal effect on variances in high life stress is minimal, suggesting the importance of focusing on individual-level effects as stress predictors.

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Kan. dispatcher shares joy in helping deliver baby

By EMS1 Staff

MCPHERSON COUNTY, Kan. — A local dispatcher aided a couple in delivering their son Monday.

Dispatcher Chanda Jumet said she receives many calls regarding animals escaping or on the loose, but baby deliveries are far and few between. 

"My first thought was OK, stay calm, don't let him know you are a tiny-little bit nervous," Jumet said.

Jumet first asked for the location of the home before instructing the woman's husband on how to deliver the baby, reported KSN. 

EMS arrived just before the baby was delivered; Jumet said she could hear the baby's first cry over the phone. 

"It makes you remember why you do the job you do," Jumet said. "You hear all of the bad stuff that happens and then you hear the one good and it makes everything worth it."

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Ill. paramedic placed on leave after ambulance crash

Officials said surveillance video shows the ambulance running a red light prior to the incident

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DiaMedical USA Announces Loaded Emergency Packs for EMS Training

West Bloomfield, MI – DiaMedical USA and SimLabSolutions are proud to introduce their newest line of exclusive EMS simulation products with the launch of Loaded Emergency Packs™ for EMS education and training. These packs will help EMS instructors successfully integrate simulation scenarios into National Registry of Emergency Medical Technicians (NREMT) Portfolio Project psychomotor skills ...

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Patients’ Age Rather Than Model of End-Stage Liver Disease Score Predicts Survival After Liver Transplantation

Abstract

Background

The model of end-stage liver disease (MELD) score is the standard tool for prioritizing patients awaiting liver transplantation. There is currently no definite high cutoff score reflecting disease severity that might exclude patients from transplantation. Furthermore, the age limit that used to disqualify patients from eligibility to transplantation was recently withdrawn in several countries.

Aims

The aims of this study were to assess the effects of MELD score and age at time of transplantation on patients' short- and long-term survival.

Methods

We conducted a retrospective single-center study on a cohort of patients transplanted for the first time due to non-fulminant liver failure.

Results

Four hundred and seventeen patients (mean age 50.2 years, 63% males) who underwent liver transplantation for the first time were included. Both higher patients' and donors' age were significantly associated with increased long-term mortality (p = 0.007, 95% CI 1.006–1.038 for patient age, p = 0.02, 95% CI 1.002–1.023 for donor age). Patients' age remained significantly associated with survival at 1 year post-transplantation, as well. We found no association between higher MELD score at transplantation and long-term mortality (p = 0.189, 95% CI 0.99–1.051) irrespective of patients' age. Specifically, when patients were divided according to their MELD score at transplantation (MELD < 15, MELD 15–25 and MELD > 25), no significant differences in long-term survival were detected between these three subgroups. Results did not differ significantly in a subgroup analysis of patients without hepatocellular carcinoma at the time of transplantation.

Conclusions

Patients' and donors' age rather than patients' MELD score at transplantation determine survival following liver transplantation.

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What information should you give dispatchers when calling 911?

When a caller dials 911, it's most likely their first time doing so. Considering the circumstances, tensions are high and thoughts become muddled. A user on Quora recently asked, "When calling an emergency number, what information should I give the operator first"" A few answers stood out to us, especially one by founder and executive director of Allied Medical Training named Sean Ewen. You can read his reply below:

In the United States when calling 911, the emergency dispatcher will usually start the question by saying something like "What's your emergency""

To expedite help, it's best to be prepared with the following information and use a clear, calm voice. Take a deep breath while calling to focus and calm yourself.

The dispatcher will ask questions to solicit the information needed to send an appropriate response team and keep them informed.

• Nature of emergency: Such as vehicle collision, fire, medical or trauma emergency, behavioral emergency, situation requiring law enforcement, or special situation (such as hazardous materials spill or other issue requiring containment or special rescue).
• Location of emergency: Be as specific as possible. Examples: The specific area of the building or property, which side of the road or intersection and any instructions for accessing the site including the direction of approach or gate/security codes
• A call back number: In case the call is disconnected or responders have trouble finding the site.
• Number of people affected and their conditions: This is important so appropriate number of resources can be sent. Helpful basic information to provide include whether the victims are breathing, pulse present and any significant bleeding or other life-threatening injuries.

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Cardiac arrest in accidental hypothermia: Work the patient or don't start resuscitation?

A wrongful death lawsuit for failing to initiate resuscitative efforts was filed against EMS providers by the family of Jake Anderson in late 2016. According to publicly available news sources, Anderson, 19, was found unconscious with no apparent signs of life in freezing temperatures and declared dead with no interventions or transport to a hospital.

The plaintiff is alleging that the responders failed to perform an assessment, failed to follow their own policy and procedures for hypothermia victims in cardiac arrest and essentially abandoned the patient contributing to his death. We will never be able to say with any certainty that resuscitative efforts would have revived Anderson nor do we know all the facts surrounding the case, but for discussion's sake, would you have initiated treatment and transport"

From a medical standpoint, the long-held mantra that one isn't dead until they're warm and dead was recently supported in the journal Resuscitation by Hilmo and colleagues. In this review, "Nobody is dead until warm and dead": Prolonged resuscitation is warranted in arrested hypothermic victims also in remote areas — A retrospective study from northern Norway, Hilmo et al describe their experience successfully resuscitating victims who were down for almost seven hours and one patient who had a core body temperature of 13.7 C (56.6 F). Other interesting results include:

• Although overall mortality remains high, survivors had surprisingly good neurologic outcomes with favorable overall quality of life.
• There are no great prehospital predictors of survival, so boldly initiating resuscitation in the absence of contraindications is still warranted.
• Contraindications to resuscitation include:
  - Avalanche burial >35 minutes with airway packed with snow and initial rhythm of asystole
  - Asphyxiation
  - Hyperkalemia (>12 mmol/L)
  - Hypothermia that occurred after cardiac arrest
  - Obvious mortality such as body decomposition, decapitation, truncal transection, frozen solid chest wall
• Manner of hypothermia (water, wind/air, snow) had no impact on survival rates.
• Survival was associated with transport to hospitals with extracorporeal rewarming capabilities

In EMS systems where hospitals with extracorporeal rewarming capabilities are distant, stopping at a smaller hospital en route to check the patient's serum potassium level is also something to consider.

Extracorporeal life support or ECMO has truly changed the survivability curve in victims of accidental hypothermia. Because determining patient viability in the field is next to impossible in the absence of obvious mortality described above, current science supports the initiation of treatment and transport for patients in cardiac arrest due to accidental hypothermia.

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Parental Refusal of Vitamin K and Neonatal Preventive Services: A Need for Surveillance

Abstract

Objectives Vitamin K deficiency bleeding (VKDB) in infants is a coagulopathy preventable with a single dose of injectable vitamin K at birth. The Tennessee Department of Health (TDH) and Centers for Disease Control and Prevention (CDC) investigated vitamin K refusal among parents in 2013 after learning of four cases of VKDB associated with prophylaxis refusal. Methods Chart reviews were conducted at Nashville-area hospitals for 2011–2013 and Tennessee birthing centers for 2013 to identify parents who had refused injectable vitamin K for their infants. Contact information was obtained for parents, and they were surveyed regarding their reasons for refusing. Results At hospitals, 3.0% of infants did not receive injectable vitamin K due to parental refusal in 2013, a frequency higher than in 2011 and 2012. This percentage was much higher at birthing centers, where 31% of infants did not receive injectable vitamin K. The most common responses for refusal were a belief that the injection was unnecessary (53%) and a desire for a natural birthing process (36%). Refusal of other preventive services was common, with 66% of families refusing vitamin K, newborn eye care with erythromycin, and the neonatal dose of hepatitis B vaccine. Conclusions for Practice Refusal of injectable vitamin K was more common among families choosing to give birth at birthing centers than at hospitals, and was related to refusal of other preventive services in our study. Surveillance of vitamin K refusal rates could assist in further understanding this occurrence and tailoring effective strategies for mitigation.

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Impact of Prosocial Behavioral Involvement on School Violence Perpetration Among African American Middle School and High School Students

Abstract

The purpose of this study was to examine factors associated with school violence perpetration among African American youth. African American students in 7th through 12th grade (n = 7488) in schools within one Metropolitan area completed the Pride National Drug Survey. Chi square analyses revealed school violence perpetration significantly differed based on grade and prosocial behavioral involvement. Students in 7th–8th grade (54.7%) were more likely to engage in school violence in comparison to 9th–12th grade students (48.8%). Students with low prosocial behavior (52.8%) involvement were more likely than their counterparts (48.9%) to engage in school violence perpetration. Logistic regression also indicated females and 9th–12th students with low prosocial behavior involvement were significantly less likely than their counterparts to engage in school violence. Findings should be considered by health educators and prevention specialists when developing programs and efforts to prevent in school violence perpetration among African American students.

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EDA mutation by exome sequencing in non-syndromic X-linked oligodontia

Graphical Abstract

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Does prophylactic ligation of the thoracic duct reduce chylothorax rates in patients undergoing oesophagectomy? A systematic review and meta-analysis

European Journal of Cardio-Thoracic Surgery

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Omega-3 fatty acids as a treatment for non-alcoholic fatty liver disease in children: A systematic review and meta-analysis of randomized controlled trials

Clinical Nutrition

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Disparity in neural and subjective responses to food images in women with obesity and normal-weight women

Obesity

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Lamivudine therapy during the second vs the third trimester for preventing transmission of chronic hepatitis B

Journal of Viral Hepatitis

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Percutaneous image-guided irreversible electroporation for the treatment of unresectable, locally advanced pancreatic adenocarcinoma

Journal of Vascular and Interventional Radiology

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Gastrointestinal safety of direct oral anticoagulants: A large population-based study

Gastroenterology

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Long-term experience of magnetic anal sphincter augmentation in patients with fecal incontinence

Diseases of the Colon and Rectum

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Rapid alanine aminotransferase normalization with entecavir and hepatocellular carcinoma in hepatitis B virus-associated cirrhosis

Digestive Diseases and Sciences

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All-cause and acute pancreatitis health care costs in patients with severe hypertriglyceridemia

Pancreas

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Quality of life, patient satisfaction, and disease burden in patients with gastroesophageal reflux disease with or without laryngopharyngeal reflux symptoms

Journal of Gastroenterology and Hepatology

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Natural orifice specimen extraction with single stapling colorectal anastomosis for laparoscopic anterior resection: Feasibility, outcomes, and technical considerations

Diseases of the Colon and Rectum

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HCV reinfection incidence among individuals treated for recent infection

Journal of Viral Hepatitis

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The management of chronic refractory pouchitis with an evidence-based treatment algorithm

Alimentary Pharmacology and Therapeutics

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Role of combined 68Ga-DOTATOC and 18F-FDG positron emission tomography/computed tomography in the diagnostic workup of pancreas neuroendocrine tumors: Implications for managing surgical decisions

Pancreas

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Thromboelastometry hypercoagulable profiles and portal vein thrombosis in cirrhotic patients with hepatocellular carcinoma

Digestive and Liver Diseases

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Characteristics of gastric cancer in negative test of serum anti- Helicobacter pylori antibody and pepsinogen test: A multicenter study

Gastric Cancer

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Improving prognosis for patients with hepatocellular carcinoma in Ireland 1994–2008

European Journal of Gastroenterology & Hepatology

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Can response to locoregional therapy help predict long-term survival after liver transplantation for hepatocellular carcinoma? A systematic review

Liver Transplantation

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Effects of premedication with Pronase for endoscopic ultrasound of the stomach: A randomized controlled trial

World Journal of Gastroenterology

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Prediabetes in pediatric recipients of liver transplant: mechanism and risk factors

The Journal of Pediatrics

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Nonsurgical Treatment Choices by Individuals with Lumbar Intervertebral Disc Herniation in the United States: Associations with Long-term Outcomes.

Objectives: The objectives of this study were to (1) evaluate differences between patients with lumbar intervertebral disc herniation who received physical therapy (PT) and those who did not; (2) identify factors associated with receiving PT; and (3) examine the influence of PT on clinical outcomes over the course of 1 yr. Design: An observational cohort study using data from the Spine Patient Outcomes Research Trial was conducted. This study included 363 patients with intervertebral disc herniation who received nonsurgical management within 6 wks of enrollment. Baseline characteristics were compared between patients who received PT and those who did not. Multivariate logistic regression examined factors predictive of patients receiving PT. Mixed effects models were used to compare primary outcomes (Short-Form Survey 36 bodily pain and physical function and modified Oswestry Index) at 3 and 6 mos and 1 yr after enrollment. Results: Forty percent of the nonsurgical cohort received PT. Higher disability scores, neurological deficit, and patient preference predicted PT use. Compared with other nonsurgical management strategies, standard care PT was not associated with a significant difference in pain, disability, or surgery over 1 yr. Conclusions: Many patients with intervertebral disc herniation seek secondary care for persisting symptoms and pursue nonsurgical management. The best management strategy is unclear and further research is needed to examine appropriate sequencing and selection of treatment. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Improved Functional Performance in Geriatric Patients During Hospital Stay.

Objective: The aim of this work was to evaluate the time course of changes in strength and functional performance in elderly hospitalized medical patients. Design: This was a prospective observational study in elderly medical patients of age 65 years or older at a geriatric department. Measurements were obtained on days 2 to 4, day 5 to 8, and days 9 to 13. Functional performance was measured with De Morton Mobility Index (DEMMI) test and a 30-second chair stand test (30-s CST). Muscular strength was measured with handgrip strength. Activity level was determined with accelerometry (ActivPAL). Results: Results in DEMMI and 30-s CST gradually improved (P 0.05). Larger functional improvements were observed in patients with "high" compared to "low" and "moderate" activity level (P

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CELSR2, encoding a planar cell polarity protein, is a putative gene in Joubert syndrome with cortical heterotopia, microophthalmia, and growth hormone deficiency

Joubert syndrome is a ciliopathy characterized by a specific constellation of central nervous system malformations that result in the pathognomonic "molar tooth sign" on imaging. More than 27 genes are associated with Joubert syndrome, but some patients do not have mutations in any of these genes. Celsr1, Celsr2, and Celsr3 are the mammalian orthologues of the drosophila planar cell polarity protein, flamingo; they play important roles in neural development, including axon guidance, neuronal migration, and cilium polarity. Here, we report bi-allelic mutations in CELSR2 in a Joubert patient with cortical heterotopia, microophthalmia, and growth hormone deficiency. © 2017 Wiley Periodicals, Inc.

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Reply to: posterior wall puncture during ultrasound-guided arterial cannulation suggests inadequate operator skills

No abstract available

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Reply to: the small details that influence postoperative pain

No abstract available

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Minimally invasive analgesia after cardiac surgery

No abstract available

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Reply to: association of increased N terminal B-type natriuretic propeptide levels with short-term adverse outcomes after noncardiac surgery

No abstract available

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Bilateral sternal infusion of ropivacaine and length of stay in ICU after cardiac surgery with increased respiratory risk: A randomised controlled trial

BACKGROUND: The continuous bilateral infusion of a local anaesthetic solution around the sternotomy wound (bilateral sternal) is an innovative technique for reducing pain after sternotomy. OBJECTIVE: To assess the effects of the technique on the need for intensive care in cardiac patients at increased risk of respiratory complications. DESIGN: Randomised, observer-blind controlled trial. SETTING: Single centre, French University Hospital. PATIENTS: In total, 120 adults scheduled for open-heart surgery, with one of the following conditions: age more than 75 years, BMI >30 kg m−2, chronic obstructive pulmonary disease, active smoking habit. INTERVENTION: Either a bilateral sternal infusion of 0.2% ropivacaine (3 ml h−1 through each catheter; 'intervention' group), or standardised care only ('control' group). Analgesia was provided with paracetamol and self-administered intravenous morphine. MAIN OUTCOME MEASURES: The length of time to readiness for discharge from ICU, blindly assessed by a committee of experts. RESULTS: No effect was found between groups for the primary outcome (P = 0.680, intention to treat); the median values were 42.4 and 37.7 h, respectively for the control and intervention groups (P = 0.873). Similar nonsignificant trends were noted for other postoperative delays. Significant effects favouring the intervention were noted for dynamic pain, patient satisfaction, occurrence of nausea and vomiting, occurrence of delirium or mental confusion and occurrence of pulmonary complications. In 12 patients, although no symptoms actually occurred, the total ropivacaine plasma level exceeded the lowest value for which neurological symptoms have been observed in healthy volunteers. CONCLUSION: Because of a small size effect, and despite significant analgesic effects, this strategy failed to reduce the time spent in ICU. TRIAL REGISTRATION: EudraCT (N°: 2012-005225-69); ClinicalTrials.gov (NCT01828788).

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Does permissive hypoxaemia during extracorporeal membrane oxygenation cause long-term neurological impairment?: A study in patients with H1N1-induced severe respiratory failure

BACKGROUND: The Extracorporeal Life Support Organisation accepts permissive hypoxaemia in adult patients during extracorporeal membrane oxygenation (ECMO). The neurological long-term outcome of this approach has not yet been studied. OBJECTIVES: We investigated the prevalence of brain lesions and cognitive dysfunction in survivors from the Influenza A/H1N1 2009 pandemic treated with permissive hypoxaemia during ECMO for severe acute respiratory distress syndrome (ARDS). Our hypothesis was that this method is reasonable if tissue hypoxia is avoided. DESIGN: Long-term follow-up study after ECMO. SETTING: Karolinska University Hospital, Sweden, from October 2012 to July 2013. PATIENTS: Seven patients treated with ECMO for severe influenza A/H1N1-induced ARDS were studied 3.2 years after treatment. Blood lactate concentrations were used as a surrogate for tissue oxygenation. INTERVENTIONS: Neurocognitive outcome was studied with standardised cognitive tests and MRI of the brain. MAIN OUTCOME MEASURES: Cognitive functioning and hypoxic brain lesions after permissive hypoxaemia during ECMO. The observation period was the first 10 days of ECMO or the entire treatment period if shorter than 10 days. RESULTS: Eleven of 13 patients were still alive 3 years after ECMO. We were able to contact seven of these patients (mean age 31 years), who all agreed to participate in this study. Mean ± SD peripherally measured arterial saturation during the observation period was 79 ± 10%. Full-scale Intelligence Quotient was within one standard deviation or above from the mean of a healthy population in five patients, and was 1.5 SD below the mean in one patient. In one other patient, it could not be determined because of a lack of formal education. Memory functioning was normal in all patients. MRI showed no changes related to cerebral hypoxia. CONCLUSIONS: Permissive hypoxaemia during ECMO might not negatively affect long-term cognitive outcome if adequate organ perfusion is maintained. TRIAL REGISTRATION: at Clinicaltrials.gov NCT01763060

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Lung recruitment improves right ventricular performance after cardiopulmonary bypass: A randomised controlled trial

BACKGROUND: Atelectasis after cardiopulmonary bypass (CPB) can affect right ventricular (RV) performance by increasing its outflow impedance. OBJECTIVE: The aim of this study was to determine whether a lung recruitment manoeuvre improves RV function by re-aerating the lung after CPB. DESIGN: Randomised controlled study. SETTING: Single-institution study, community hospital, Córdoba, Argentina. PATIENTS: Forty anaesthetised patients with New York Heart Association class I or II, preoperative left ventricular ejection fraction at least 50% and Euroscore 6 or less scheduled for cardiac surgery with CPB. INTERVENTIONS: Patients were assigned to receive either standard ventilation with 6 cmH2O of positive end-expiratory pressure (PEEP; group C, n = 20) or standard ventilation with a recruitment manoeuvre and 10 cmH2O of PEEP after surgery (group RM, n = 20). RV function, left ventricular cardiac index (CI) and lung aeration were assessed by transoesophageal echocardiography (TOE) before, at the end of surgery and 30 min after surgery. MAIN OUTCOME MEASURES: RV function parameters and atelectasis assessed by TOE. RESULTS: Haemodynamic data and atelectasis were similar between groups before surgery. At the end of surgery, CI had decreased from 2.9 ± 1.1 to 2.6 ± 0.9 l min−1 m−2 in group C (P = 0.24) and from 2.8 ± 1.0 to 2.6 ± 0.8 l min−1 m−2 in group RM (P = 0.32). TOE-derived RV function parameters confirmed a mild decrease in RV performance in 95% of patients, without significant differences between groups (multivariate Hotelling t-test P = 0.16). Atelectasis was present in 18 patients in group C and 19 patients in group RM (P = 0.88). After surgery, CI decreased further from 2.6 to 2.4 l min−1 m−2 in group C (P = 0.17) but increased from 2.6 to 3.7 l min−1 m−2 in group RM (P 

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Reply to: volume therapy in obstetrics

No abstract available

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Assessment of a smartphone app (Capstesia) for measuring pulse pressure variation: agreement between two methods: A Cross-sectional study

BACKGROUND: Less invasive and noninvasive methods are emerging for haemodynamic monitoring. Among them is Capstesia, a smartphone app that, from photographs of a patient monitor showing invasive arterial pressure, estimates advanced haemodynamic variables after digitising and analysing the pressure curves. OBJECTIVE: The aim of this study was to compare the level of agreement between the analysis of the signals obtained from the patient monitor and a photograph of the same images using the Capstesia app. DESIGN: Cross-sectional study. SETTING: Araba University hospital (Txagorritxu), Vitoria-Gasteiz, Alava, Spain, from January to February 2015. PATIENTS: Twenty patients (229 images) who had an arterial catheter (radial or femoral artery) inserted for haemodynamic monitoring. INTERVENTION: Snapshots obtained from the patient monitor and a photograph of these same snapshots using the Capstesia application were assessed with the same software (MATLAB, Mathworks, Natick, Massachusetats, USA) for evaluating the level of concordance of the following variables: pulse pressure variation (PPV), cardiac output (CO) and maximum slope of the pressure curve (dP/dt). Comparison was made using interclass correlation coefficients with corresponding 95% confidence intervals, and Bland–Altman plots with the corresponding percentages of error. MAIN OUTCOME MEASURES: (PPV). Secondary outcome: CO and maximum slope of the pressure curve [dP/dt]. RESULTS: The interclass correlation coefficients for PPV, CO and max dP/dt were 0.991 (95% confidence interval 0.988 to 0.993), 0.966 (95% confidence interval 0.956 to 0.974) and 0.962 (95% confidence interval 0.950 to 0.970), respectively. In the Bland–Altman analysis, bias and limits of agreement of PPV were (0.50% ± 1.42) resulting in a percentage of error of 20% for PPV. For CO they were 0.19 ± 0.341, with a 13.8% of error. Finally bias and limits of agreement for max dP/dt were 1.33 ± 77.71, resulting in an error of 14.20% CONCLUSIONS: Photograph of the screenshots obtained with the Capstesia app show a good concordance with analysis of the original screenshots. Either approach could be used to monitor the haemodynamic variables assessed.

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Developing standardised advanced training in neuroanaesthesia: Results of a Europe-wide survey

No abstract available

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External validation of predictive models for acute kidney injury following cardiac surgery: A prospective multicentre cohort study

BACKGROUND: Four predictive models for acute kidney injury associated with cardiac surgery were developed by Demirjian in the United States in 2012. However, the usefulness of these models in clinical practice needs to be established in different populations independent of that used to develop the models. OBJECTIVES: Our aim was to evaluate the predictive performance of these models in a Spanish population. DESIGN: A multicentre, prospective observational study. DATA SOURCES: Twenty-three Spanish hospitals in 2012 and 2013. ELIGIBILITY CRITERIA: Of 1067 consecutive cardiac patients recruited for the study, 1014 patients remained suitable for the final analysis. MAIN OUTCOME MEASURES: Dialysis therapy, and a composite outcome of either a doubling of the serum creatinine level or dialysis therapy, in the 2 weeks (or until discharge, if sooner) after cardiac surgery. RESULTS: Of the 1014 patients analysed, 34 (3.4%) required dialysis and 95 (9.4%) had either dialysis or doubled their serum creatinine level. The areas under the receiver operating characteristic curves of the two predictive models for dialysis therapy, which include either presurgical variables only, or combined presurgical and intrasurgical variables, were 0.79 and 0.80, respectively. The model for the composite endpoint that combined presurgical and intrasurgical variables showed better discriminatory ability than the model that included only presurgical variables: the areas under the receiver operating characteristic curves were 0.76 and 0.70, respectively. All four models lacked calibration for their respective outcomes in our Spanish population. CONCLUSION: Overall, the lack of calibration of these models and the difficulty in using the models clinically because of the large number of variables limit their applicability.

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Association of increased N terminal B-type natriuretic propeptide levels with short-term adverse outcomes after noncardiac surgery

No abstract available

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Comparative analysis of resuscitation using human serum albumin and crystalloids or 130/0.4 hydroxyethyl starch and crystalloids on skeletal muscle metabolic profile during experimental haemorrhagic shock in swine: A randomised experimental study

BACKGROUND: Protection against acute skeletal muscle metabolic dysfunction and oxidative stress could be a therapeutic target in volume expansion for severely bleeding patients. OBJECTIVES: This experimental pilot study in swine aims at comparing 130/0.4 hydroxyethyl starch (HES) with 4% albumin along with crystalloid perfusion for first-line volume expansion in haemorrhagic shock with a particular emphasis on oxidative stress and muscular mitochondrial function. DESIGN: Randomised experimental study. SETTING: Digestive Cancer Research Institute Preclinical Laboratory, Strasbourg University Hospital, France, from February 2012 to June 2013. ANIMALS: Twenty large white pigs. INTERVENTION: Pressure-controlled haemorrhagic shock and volume resuscitation using either 4% human serum albumin or 130/0.4 HES along with crystalloid perfusion were performed in 20 large white pigs. MAIN OUTCOME MEASURES: Muscular biopsy of gastrocnemius muscle was performed for metabolomics screening, mitochondrial respiratory chain assessment and electron spin resonance reactive oxygen species production along with arterial and venous reactive oxygen species production at baseline, at the completion of shock, at 90 min and at 180 min after volume expansion. RESULTS: There was no difference between the two groups in measurements of skeletal muscle superoxide production. In a pooled analysis, there was a statistically significant decrease in gastrocnemius muscle creatine content from baseline to 90 min (P 

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Volume therapy in obstetrics

No abstract available

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The small details that influence postoperative pain

No abstract available

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Posterior wall puncture during ultrasound-guided arterial cannulation suggests inadequate operator skills

No abstract available

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Complications in Neuroanesthesia

No abstract available

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CASE REPORT OF SPINDLE CELL CARCINOMA OF THE CONJUNCTIVA- A RARE TUMOUR

2017-01-03T23-58-32Z
Source: International Journal of Current Research and Review
Mehulkumar K. Patel, Sanjay V. Dhotre, Mahesh B. Patel, Hansa M. Goswami, Hitendra P. Barot, Monika S. Nanavati.
Aim: To present a case of spindle cell carcinoma of the conjunctiva to emphasize the importance of detailed pathological examination to differentiate the cell type for the prognosis and the decision of proper treatment. Case Report: A 55 year old male patient presented at civil hospital, Ahmedabad with complain of decreased vision in the left eye. There was no history of trauma and pain. On examination, a pedunculated lesion over the conjunctiva with no ulceration, which grew slowly over 4 months. Histopathological examination showshistology of poorly differentiated squamous cell carcinoma of the conjunctiva with sarcomatoid differentiation (spindle cell variant of squamous cell carcinoma) which was confirmed on subsequent immunohistochemical examination. Discussion: Squamous cell carcinoma is the most common malignant tumor of the ocular surface8. Spindle cell carcinoma is a poorly differentiated variant of squamous cell carcinoma that rarely occurs in the conjunctiva 3,4,5,6,7. Cervantes et al. reported a total 287 cases of squamous cell carcinoma of conjunctiva, in which only two cases were documented as spindle cell carcinoma11. Surgical excision with or without cryotherapy and radiotherapy remains widely accepted treatment for squamous cell carcinoma of the conjunctiva9,10. Conclusion: Because of their possible aggressive behaviour, spindle cell carcinoma of the conjunctiva is known to be sight- and life threatening. It is important to differentiate this variety of squamous cell carcinoma from mimics specially sarcomas with spindle cell morphology and spindle cell predominant malignant melanoma. Hence detailed pathological examination is very important to differentiate the cell type for the prognosis and the decision of proper treatment.


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EPIDEMIOLOGICAL STUDY OF THE ASSOCIATION OF HYPOTHYROIDISM WITH ANAEMIA IN NON-PREGNANT WOMEN OF REPRODUCTIVE AGE GROUP IN A TERTIARY CARE HOSPITAL IN KOLKATA

2017-01-03T23-58-32Z
Source: International Journal of Current Research and Review
Joya Ghosh, Mriganka Baruah.
Objectives: Many studies suggest that hypothyroidism should be suspected in patients who have anaemia with an unknown aetiology. Thus the study was conducted to find out the proportion of hypothyroidism in both anaemic and non-anaemic women of reproductive age group and to determine the association between anaemia and hypothyroidism, if any. Methods: A cross sectional study with case control design was carried out in 100 non-pregnant women of reproductive age group in a hospital in eastern India for a period of one year. The proportion of hypothyroidism in both the groups was estimated by measuring TSH. The association between anaemia and hypothyroidism were ascertained in both the groups by Pearsons Chi-Square test. Data analysis was also done using logistic regression. Results: The mean haemoglobin was 12.85 gm/dl in the non-anaemic population and 10.57 gm/dl in the anaemic population. The mean TSH was 2.81μIU/ml in the non-anaemic population and 2.61μIU/ml in the anaemic population. But there was no significant association between anaemia and hypothyroidism, which was one of the objectives. Logistic regression analysis showed that with increasing number of living issues, the risk of anaemia increases and the mode of delivery had a hazard ratio of 2.6. Conclusion: In our study, hypothyroidism did not show any significant association with anaemia thus, thyroid profile test may not be made mandatory in all anaemic women of reproductive age group to rule out hypothyroidism as its cause. In our study, risk factors for anaemia were found to be younger age group, caesarean mode of delivery and parity.


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STUDIES ON EFFECT OF CERTAIN ANTIBIOTICS ON CALLUS GROWTH IN TERMINALIA CHEBULA

2017-01-03T23-58-32Z
Source: International Journal of Current Research and Review
P. Ramanjaneyulu, A. Vijaya Bhaskara Rao.
The study was undertaken to identify suitable antibiotic and their required concentrations for enhancement of callus production and for further transformation studies. The effect of antibiotics such as carbenicillin, cefotaxime and streptomycin were studied on the callus growth of Terminalia chebula. Different antibiotics were added at different concentrations to the callus culture media and maintained up to 45 days. The experiments exhibited varied growth stimulation over controls. Cefotaxime and carbenicillin exhibited higher growth index when compared to control at different concentrations whereas streptomycin showed insignificant effect on growth index of Terminalia chebula callus culture. The results could be attributed to the plant hormone like chemical nature of cefotaxime and carbenicillin. However streptomycin did not exhibited higher callus production. Hence, it is concluded that the addition of antibiotics at optimum concentrations to the culture media could increase the growth of callus and the higher yield of callus.


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A COMPARATIVE STUDY OF MIGLITOL AND ACARBOSE ADD ON THERAPY INTENDED FOR BETTER GLYCAEMIC CONTROL IN TYPE 2 DIABETES MELLITUS

2017-01-03T23-58-32Z
Source: International Journal of Current Research and Review
Lopamudra Dhar Choudhury, Ranjan Basu, Tanmay Biswas, Apurba Mukherjee, Anup Kumar Das.
Objectives: This study was done to find out the comparative efficacy of Miglitol and Acarbose as add on therapy in patients of type 2 Diabetes Mellitus. Methods: This is a prospective, randomized, patient controlled, open label comparative study involving Type 2 diabetes patients, aged between 35-70 years of either sex of hyperglycaemic with PPBS >180mg%, FBS 0.05 signifying Miglitol to be better than Acarbose in terms of glycaemic controlin type 2 D.M. Conclusions: Type 2 Diabetes forms a significant share of the Diabetic load in India where cereals in the form of carbohydrates form the staple diet of most Indians. Thus α glucosidase inhibitors like Miglitol and acarbose are sure to play an important role as an add on therapy when first line drugs like sulphonylurea and biguanides fail to control the hyperglycaemia and they have minimum adverse effects, with more or less similar efficacy with Miglitol being better than Acarbose..


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Myoelectric activation pattern changes in the involved limb of individuals with transtibial amputation during locomotor state transitions

Publication date: Available online 3 January 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Bryson H. Nakamura, Michael E. Hahn
ObjectiveTo investigate whether lower extremity muscle activation patterns differ in the strides leading to locomotive state transitions in the involved limb of individuals with transtibial amputation. It was hypothesized that all transitions would elicit activation differences between strides as the subjects moved toward the transition event.DesignA single sample, observational study.SettingThe study was conducted in the hallways, ramps and stairs of a university building.ParticipantsA volunteer sample of nine persons with unilateral transtibial amputation (48.8±12.1years; 1.74±0.09m; 86.1±24.7kg) were recruited by posting flyers in local prosthetics clinics.InterventionsNot applicable.Main Outcome MeasuresSurface electromyography was used to measure muscle activation from seven muscles of the involved limb. Subjects walked across eight different terrain conditions transitioning from level-ground to ramp/stair locomotion and vice versa. Statistical Parametric Mapping Analysis of Variance (α<0.05) was used to assess muscle activation differences in the three pre-transition gait cycles as subjects moved toward the terrain change.ResultsNo muscle activation changes were observed in ramp transitions. All stair transitions elicited a myoelectric difference in at least two muscles. The transition from stair descent to level ground elicited change in the greatest number of muscles. Tibialis anterior activation was unchanged in all transitions.ConclusionsMuscle activation differences were observed in the involved limb of individuals with transtibial amputation during stair transitions, suggesting that those patterns may be successfully used in transition detection algorithms. It remains unknown whether ramp transitions can be successfully identified pre-transition using electromyography.



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