Cirrhosis Patients with Nonalcoholic Steatohepatitis Are Significantly Less Likely to Receive Surveillance for Hepatocellular Carcinoma

Abstract

Background

Disparities in receipt of hepatocellular carcinoma (HCC) surveillance contribute to disparities in overall survival outcomes.

Aim

We aim to evaluate disparities in receipt of routine HCC surveillance among patients with cirrhosis in a large urban safety-net hospital.

Methods

Consecutive adults (age ≥ 18) with cirrhosis from July 1, 2014, to December 31, 2015, were retrospectively evaluated to determine rates of receiving appropriate HCC surveillance within 6 months and 1 year after diagnosis of cirrhosis. Rates of HCC surveillance were stratified by sex, race/ethnicity, and liver disease etiology. Multivariate Cox proportional hazards models were utilized to evaluate for predictors of receiving appropriate HCC surveillance.

Results

Among 157 cirrhosis patients enrolled [hepatitis C virus (HCV): 29.9%, hepatitis B virus: 13.4%, alcoholic cirrhosis: 44.6%, nonalcoholic steatohepatitis (NASH): 8.9%], mean age of cirrhosis diagnosis was 53.8 ± 9.0 years. Among these patients, 49% received (n = 77) HCC surveillance within 6 months and 78% (n = 123) were surveyed within 1 year of cirrhosis diagnosis. On multivariate analyses, patients with NASH cirrhosis were significantly less likely to receive HCC surveillance compared with chronic HCV cirrhosis patients (HR 0.44, 95% CI 0.19–0.99, p < 0.05). No significant sex-specific or race/ethnicity-specific disparities in receipt of HCC surveillance were observed.

Conclusion

Among a diverse safety-net hospital population, sub-optimal HCC surveillance rates were observed: Only 49% of cirrhosis patients received HCC surveillance within 6 months, and 78% of cirrhosis patients received HCC surveillance within 1 year. Differences in rates of HCC screening by liver disease etiology were observed.

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The Gastroenterology Fellowship Match: A Decade Later

Abstract

Following a period of uncertainty and disorganization, the gastroenterology (GI) national leadership decided to reinstitute the fellowship match (the Match) under the auspices of the National Residency Matching Program (NRMP) in 2006. Although it has now been a decade since the rebirth of the Match, there have been limited data published regarding progress made. In this piece, we discuss reasons for the original collapse of the GI Match, including most notably a perceived oversupply of GI physicians and a poor job market. We discuss the negative impacts the absence of the Match had on programs and on applicants, as well as the impetus to reorganize the Match under the NRMP. We then utilize data published annually by the NRMP to demonstrate that in the decade since its rebirth, the GI Match has been remarkably successful in terms of attracting the participation of applicants and programs. We show that previous misguided concerns of an oversupply of GI physicians were not realized, and that GI fellowship positions remain highly competitive for internal medicine applicants. Finally, we discuss possible implications of recent changes in the healthcare landscape on the GI Match.

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Decompensated Liver Disease in a Patient with Neurocysticercosis

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Endoscopic Localization of Colon Cancer Is Frequently Inaccurate

Abstract

Background

Colonoscopic location of a tumor can influence both the surgical procedure choice and overall treatment strategy.

Aims

To determine the accuracy of colonoscopy in determining the location of colon cancer compared to surgical localization and to elucidate factors that predict discordant colon cancer localization.

Methods

We conducted a retrospective cross-sectional study of colon cancers diagnosed on colonoscopy at two academic tertiary-care hospitals and two affiliated community hospitals from 2012 to 2014. Colon cancer location was obtained from the endoscopic and surgical pathology reports and characterized by colon segment. We collected data on patient demographics, tumor characteristics, endoscopic procedure characteristics, surgery planned, and surgery performed. Univariate analyses using Chi-squared test and multivariate analysis using forward stepwise logistic regression were performed to determine factors that predict discordant colon cancer localization.

Results

There were 110 colon cancer cases identified during the study period. Inaccurate endoscopic colon cancer localization was found in 29% (32/110) of cases. These included 14 cases (12.7%) that were discordant by more than one colonic segment and three cases where the presurgical planned procedure was significantly changed at the time of surgery. On univariate analyses, right-sided colon lesions were associated with increased inaccuracy (43.8 vs 24.4%, p = 0.04). On multivariate analysis, right-sided colon lesions remained independently associated with inaccuracy (OR 1.74, 95% CI 1.03–2.93, p = 0.04).

Conclusions

Colon cancer location as determined by colonoscopy is often inaccurate, which can result in intraoperative changes to surgical management, particularly in the right colon.

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Gut Inflammation: More Than a Peripheral Annoyance

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Autophagy Genes of Host Responds to Disruption of Gut Microbial Community by Antibiotics

Abstract

Background

Defective autophagic machinery, such as that in Crohn's disease patients homozygous for ATG16L1 risk allele, is associated with alteration of resident gut bacterial communities. However, whether or not host autophagy responds to changes in the resident gut microbial community is not known. Here, we investigated the effect of antibiotic-induced disruption of the gut microbiome (dysbiosis) on autophagy gene expression and the expression of antimicrobial peptides/protein (AMP) over time.

Aim

To test the hypothesis that antibiotic treatment may cause time-dependent changes in gut bacterial density, autophagy genes, and antimicrobial protein/peptide gene expression.

Methods

Mice (n = 8 per group) were treated with antibiotic cocktail and sacrificed at different intervals of recovery (days 3, 7, 10, 14, 21, 28, 35, and 42) post-antibiotics. DNA and RNA were extracted from small intestinal tissues. Bacterial density, expression of host autophagy genes, and AMP genes were analyzed by relative quantitative PCR. Fold change difference in comparison with untreated control group was calculated using 2^−ΔΔCt method. Statistical analysis was performed using nonparametric Mann–Whitney test.

Results

Gut bacterial density changed in a time-dependent fashion in response to antibiotic treatment. These changes were concurrent with upregulation of autophagy genes and antimicrobial peptide/protein gene expression. We further showed that an oral gavage of a resident microbe Desulfovibrio, which bloomed in antibiotic-treated animals, induced Atg5 and lysozyme (Lyz) gene expression.

Conclusion

Autophagy genes respond to dysbiosis induced by antibiotics. This response may be a host mechanism to detect and possibly correct dysbiosis by activating antimicrobial peptides/proteins that control the microbial load in the gut.

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Gastrointestinal endoscopy in patients receiving novel direct oral anticoagulants: results from the prospective Dresden NOAC registry

Abstract

Background

Patients receiving direct-acting, non-vitamin K oral anticoagulants (NOAC) frequently undergo gastrointestinal endoscopies (GIE) but little is known on the management and outcome of these interventions.

Methods

With use of data from an ongoing, prospective, noninterventional registry of NOAC patients, the management and outcome of GIE were evaluated with use of standard event definitions. Patients undergoing GIE were categorized into two subgroups: (1) scheduled GIE (scheduled appointment, no acute bleeding) and (2) unscheduled GIE (unscheduled including management of acute gastrointestinal bleeding). The rates of major bleeding complications, cardiovascular complications, and all-cause death within 30 days after the procedure were evaluated.

Results

Between October 1, 2011, and March 31, 2015, 492 patients underwent a total of 713 GIE (44.5% gastroscopies, 53.0% colonoscopies, 2.5% endoscopic retrograde cholangiopancreatography procedures), with 70.0% being scheduled procedures and 30.0% being unscheduled procedures. Endoscopies were performed within 24 h after the last NOAC intake in 45 of 713 cases (6.3%), between 24 and 48 h after the last intake in 336 cases (47.1%), and after NOAC therapy interruption for more than 48 h in 213 cases (29.9%). Heparin bridging therapy was used in 180 of 713 procedures (25.3%) and predominantly (170/180; 94.4%) in cases of NOAC therapy interruption for longer than 72 h. Until day 30 after the procedure, the event rates were 1.4% for cardiovascular events and 0.7% for major bleeding events.

Conclusion

Continuation or short-term interruption of NOAC therapy seems to be a safe strategy for GIE. Heparin bridging therapy is predominantly used in cases of prolonged NOAC therapy interruption.

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A simple morphological classification to estimate the malignant potential of pancreatic neuroendocrine tumors

Abstract

Background

A novel morphological classification using resected specimens predicted malignant potential and prognosis in patients with pancreatic neuroendocrine tumors (P-NETs). The aim of this study was to examine the predictive ability of morphological diagnoses made using non-invasive multi-detector computed tomography (MDCT) in P-NETs.

Methods

Between 2002 and 2015, 154 patients were diagnosed with P-NETs at the Tokyo Medical and Dental University, and 82 patients who underwent surgical treatment were enrolled. The primary tumors were classified by MDCT into three types: Type I, simple nodular tumor; Type II, simple nodular tumor with extra-nodular growth; and Type III, confluent multinodular tumor. Patients were stratified by 15 clinical specialists according to classification and without any other clinical or pathological information. Clinicopathological features and patient survival were reviewed retrospectively.

Results

The mean observation time was 1004 days. Forty-six, 22, and 14 patients had Type I, II, and III tumors, respectively. Morphological classification was significantly correlated with advanced features such as tumor size, Ki-67 index, and synchronous liver metastasis (p < 0.001 for all). There were significant differences between all three tumor types as judged by ENETS TNM classification (p < 0.001), AJCC TNM classification (p = 0.046), WHO 2004 classification (p < 0.001), and WHO 2010 classification (p < 0.001). Five-year progression-free survival (PFS) rates for patients with Type I, II, and III tumors were 97, 43, and 31%, respectively (I vs. II, p < 0.001; I vs. III, p < 0.001; II vs. III, p = 0.017). Multivariate analysis revealed Type II/III tumors and synchronous liver metastasis to be independent risk factors for poor PFS.

Conclusion

A novel simple morphological classification system would predict Type II and III tumors that may have higher malignant potential than Type I tumors.

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Factors associated with delayed hemorrhage after endoscopic sphincterotomy: Japanese large single-center experience

Abstract

Background

Hemorrhage is one of the serious adverse events of endoscopic sphincterotomy (EST). However, the risk factors for delayed hemorrhage after EST have not been clarified. The aim of this study was to examine the risk factors for delayed hemorrhage after EST.

Methods

Consecutive patients who underwent EST between January 2011 and December 2015 were analyzed retrospectively. The incidence, treatment outcomes, and risk factors for delayed hemorrhage were evaluated. Delayed hemorrhage was defined as symptomatic hemorrhage occurring 24 h after an endoscopic procedure.

Results

After analyzing 1113 patients who underwent EST, delayed hemorrhage was seen to occur in 30 (2.7%) patients. The median period before presentation of delayed hemorrhage was 2 days (range 1–6) after EST, and its severity was mild in four, moderate in 20, and severe in six patients. All patients with delayed hemorrhage received successful endoscopic hemostasis. Univariate analysis showed that delayed hemorrhage occurred more frequently in patients with hemodialysis (p = 0.013), heparin replacement of antithrombotic agents (p = 0.012), or early hemorrhage occurring just after EST (p < 0.001). Among these, hemodialysis (OR 6.44, 95% CI 1.67–24.8; p = 0.007), heparin replacement (OR 3.76, 95% CI 1.42–9.98; p = 0.008), and early hemorrhage (OR 4.35, 95% CI 1.90–9.96; p < 0.001) proved to be independent risk factors for delayed hemorrhage on multivariate analysis.

Conclusions

The incidence of delayed hemorrhage after EST was 2.7%. Hemodialysis, heparin replacement, and early hemorrhage were the risk factors for delayed hemorrhage.

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Wisteria floribunda agglutinin positive Mac-2-binding protein level increases in patients with acute liver injury

Abstract

Background

Wisteria floribunda agglutinin positive human Mac-2-binding protein glycosylation isomer (M2BPGi) is a novel serum glycomarker for liver fibrosis. However, it is not known whether or not M2BPGi reflects only liver fibrosis. We measured serum M2BPGi levels in patients with acute liver injury.

Methods

Fifty-one patients with acute liver injury were enrolled. M2BPGi levels were measured at the initial visit and at achievement of recovery. The relationship between M2BPGi values at the initial visit and clinical outcomes was analyzed.

Results

Serum M2BPGi levels at the initial visit were elevated in 47 of 51 acute liver injury patients (8.33 ± 7.56 cutoff index). M2BPGi values were associated with prothrombin activity (r = −0.600, P = 0.001), total bilirubin level (r = 0.588, P = 0.001), and Model for End-Stage Liver Disease score (r = 0.490, P = 0.001) but not with aspartate aminotransferase (r = −0.070) and alanine aminotransferase (r = −0.073) levels. M2BPGi values at the initial visit were significantly higher in patients with acute liver failure (diagnosed by prothrombin activity of 40% or less; P < 0.001), subsequent development of hepatic coma (P = 0.036), and subsequent requirement of liver transplant (P = 0.014), and in a patient who died (P = 0.045). M2BPGi values decreased after aminotransferase level normalization in patients who recovered from acute liver injury; however, M2BPGi level was not a predictive factor for recovery with medical therapy.

Conclusions

Serum M2BPGi values increased in patients with acute liver injury and decreased following recovery. The marker seems to reflect not only liver fibrosis but also other factors, such as liver inflammation, liver damage, and hepatocyte regeneration.

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Serum HMGB1 concentrations at 4 weeks is a useful predictor of extreme poor prognosis for advanced hepatocellular carcinoma treated with sorafenib and hepatic arterial infusion chemotherapy

Abstract

Background

Biomarkers predicting the response to the anticancer treatment and prognosis in patients with advanced hepatocellular carcinoma (HCC) are required. Recently, high mobility group box 1 (HMGB1) was reported to promote HCC progression and be associated with poor prognosis for patients with HCC. The purpose of this study was to assess serum HMGB1 concentrations before and during sorafenib treatment or hepatic arterial infusion chemotherapy (HAIC) and to explore the ability of serum HMGB1 concentrations to predict prognosis.

Methods

Serum HMGB1 concentrations were measured in 71 and 72 patients with advanced HCC treated with sorafenib and HAIC, respectively, to assess their usefulness for prediction of the response to the treatment and prognosis.

Results

Multivariate analysis identified high HMGB1 at 4 weeks (P = 0.001), high α-fetoprotein (AFP) at baseline (P = 0.025), tumor liver occupying rate (P = 0.009) and modified RECIST (mRECIST, P < 0.0001) as independent predictors of poor overall survival in sorafenib treatment. High HMGB1 at 4 weeks (P = 0.025), vascular invasion to the hepatic vein (Vv) (P < 0.0001), mRECIST (P < 0.0001) and Child-Pugh B were identified as independent predictors of poor overall survival in HAIC treatment. The concentrations of HMGB1 at baseline and 4 weeks were not correlated with conventional tumor markers and progressive disease assessed by mRECIST at 8 weeks.

Conclusions

These results suggest that serum HMGB1 at 4 weeks after the start of treatment might be a useful biomarker with added value to the conventional tumor marker and radiologic responses to predict poor overall survival in patients with advanced HCC treated with sorafenib or HAIC.

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Reflux esophagitis and its role in the pathogenesis of Barrett’s metaplasia

Abstract

Reflux esophagitis damages the squamous epithelium that normally lines the esophagus, and promotes replacement of the damaged squamous lining by the intestinal metaplasia of Barrett's esophagus, the precursor of esophageal adenocarcinoma. Therefore, to prevent the development of Barrett's metaplasia and esophageal adenocarcinoma, the pathogenesis of reflux esophagitis must be understood. We have reported that reflux esophagitis, both in a rat model and in humans, develops as a cytokine-mediated inflammatory injury (i.e., cytokine sizzle), not as a caustic chemical injury (i.e., acid burn), as traditionally has been assumed. Moreover, reflux induces activation of hypoxia inducible factor (HIF)-2α, which enhances the transcriptional activity of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) causing increases in pro-inflammatory cytokines and in migration of T lymphocytes, an underlying molecular mechanism for this cytokine-mediated injury. In some individuals, reflux esophagitis heals with Barrett's metaplasia. A number of possibilities exist for the origin of the progenitor cells that give rise to this intestinal metaplasia including those of the esophagus, the proximal stomach, or the bone marrow. However, intestinal cells are not normally found in the esophagus, the stomach, or the bone marrow. Thus, the development of Barrett's intestinal metaplasia must involve some molecular reprogramming of key developmental transcription factors within the progenitor cell, a process termed transcommitment, which may be initiated by the noxious components of the gastric refluxate. This review will highlight recent studies on the pathogenesis of reflux esophagitis and on reflux-related molecular reprogramming of esophageal squamous epithelial cells in the pathogenesis of Barrett's metaplasia.

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Erratum to: Early diagnosis of pancreatic necrosis based on perfusion CT to predict the severity of acute pancreatitis

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The use of smoothed particles approach in realistic mathematical model of intracardiac blood flow: Simulation of a self-organizing tornado-like flow

Abstract

We performed computer simulation and visualization of blood flow in the left ventricle by the method of smooth particle hydrodynamics (SPH). This visualization qualitatively describes the evolution of twisted stream and graphically demonstrates the direction of velocity field at each moment of time. The geometrical features of the left ventricle are approximated by three-dimensional segmentation of experimental clinical images obtained from multispiral computer tomography (MSCT). The model adequately describes the possible configuration of swirling flow in the left ventricle and is a part of a comprehensive study of swirling flows in different compartments of heart, which comply with a family of the exact solutions of hydrodynamic Navier–Stokes equations for the class of quasipotential¹ swirling flows. Computer visualization shows how simulated by SPH method jet of a model liquid, which is placed in limited space, remains continuity and keeps its clockwise vorticity along the direction of the flow propagation during the whole cycle. Then it turns on approximately 120° by the time of ejection into the aorta. Such structure of the flow provides more effective pumping of blood as a model liquid through the ventricle as compared to a lamellar flow mode.

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Visual and oculomotor activity of first-grade school students during reading texts of varying complexity

Abstract

We present the results of investigation of visual perception (VP) and oculomotor activity during reading texts of various difficulties from the monitor screen in children 7–8 years of age. It has been shown that, at the initial stage of the development of the reading skill, morphological and psycholinguistic parameters of the text have no significant effect on the oculomotor activity. The degree of formation of VPand its structural components more clearly manifested in the first-graders in reading plain text and is not sufficient for a successful reading of the increased complexity of the text.

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Method for noninvasive diagnosis of functional state disorders in operators with the smooth pursuit test

Abstract

The article describes a videooculographic method to detect functional state disorders in operators in the target tracking test. The method is an improved version of the smooth pursuit test and can be used to detect and to estimate the effects of various adverse factors on operators in laboratory experiments. The method is noninvasive, allows a continuous data recording for a long period of time with the subject in comfortable conditions, and may employ various videooculographic devices (including portable and low-cost models). As an example, a series of experiments was performed to detect the negative effects of alcohol intoxication. A linear relationship was observed between changes in parameters of oculomotor reactions and changes in reaction time to the target stimulus.

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The factor structure of the functional state of boys aged 13–14 years

Abstract

We determined the independent factors that reflect the fundamental characteristics of the functional state (FS) in adolescents aged 13–14 years (n = 162): the sympathetic regulation and parasympathetic regulation of FS, physical working capability; the efficiency of cognitive performance; the hemodynamic basis of cognitive activity; nonspecific resistance to upper respiratory tract infections. Using the systematic approach, we investigated the physiological basis of these factors and determined the indices suitable for estimating the FS of adolescents at different stages of puberty. We observed progressive dynamics of FS parameters related to factors listed above in boys of the same chronological age at different puberty stages. Beginning from stage II to stage IV, we observed a heterochronic and nonlinear decrease in the tension of system of autonomic FS regulation, an increase in the efficiency of cognitive activity and its hemodynamic supply, as well as an improvement of anaerobic working capability.

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Voluntary regulation of the functional state and its influence on the effectiveness of cognitive activity during adolescence

Abstract

We have analyzed the impact of voluntary relaxation on the functional organization and the effectiveness of the voluntary prestimulus attention in performing cognitive tasks in adolescents at the ages of 12–13 and 13–14 years. The effectiveness of cognitive task performance (audio-verbal short-term memory) was estimated on the basis of the number of correctly remembered words. We have found that both age groups are characterized by reduced capacity for voluntary relaxation and its impact on the effectiveness of cognitive task performance. The analysis of the coherence function of EEG rhythmic components in a situation of voluntary attention focused on the performance of cognitive tasks showed no significant change in the interaction of the prefrontal cortex with other cortical areas during the switch from quiet wakefulness or post-relaxation state to the preparation to perform the task, which is typical of adults and young children. Our findings can be a result of sub-optimal functioning of voluntary regulation mechanisms and organization of activities during adolescence.

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Structural rearrangements of the cerebral cortex in children and adolescents

Abstract

The cortical formations of the brain involved in visual functions (the occipital and temporo-parieto- occipital areas, the oculomotor area of the prefrontal cortex), as well as the motor cortex in the representation zone of the arm and the medial region of the frontal cortex adjacent to the limbic lobe, were studied in post-mortem material. The thickness of the cortex and cortical layer III, the sizes of pyramidal neurons, the specific volumes of neurons and intracortical vessels were studied in subjects of both sexes, from birth to the age of 20 years, at yearly intervals (103 observations) using histological techniques, computer morphometric and stereological analysis. The thickness of the cortex of the cerebral hemispheres was observed to intensively increase from birth to the age of 3 years in the occipital, temporo-parieto-occipital and prefrontal cortical areas involved in visual recognition processes. The increase in thickness of the cerebral cortex continues until the age of 6 in the occipital cortex and in the oculomotor area, until the age of 7 years in the temporo-parietooccipital area and the medial prefrontal area, and until the age of 8–9 years in the motor cortex. The sizes of pyramidal neurons increase until the age of 6 years in the motor cortex, until the age of 8 years on the medial surface of the frontal lobe, and until the age of 9–10 years in the temporo-parieto-occipital area and in the dorsolateral area of the prefrontal cortex. The specific volume of neurons and blood vessels in the cortex of the cerebral hemispheres decreases and the volume of intracortical fibers increases throughout the ascending ontogeny, which is manifested most intensively in the prefrontal cortex.

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fMRI responses of the brain during active and passive movements in left-handed subjects

Abstract

The hemodynamic (magnetic resonance imaging, fMRI, 3T) brain responses were studied in 15 left-handed healthy subjects performing active and passive movements of the dominant and non-dominant hands. Group and individual fMRI responses to the motor load were analyzed. It was found that, during the active movements of dominant and non-dominant hands, the main activation cluster appeared in the preand postcentral gyrus of the contralateral hemisphere and which topographically similar during active and passive movements. The activation cluster of greater volume was identified in these areas; the response was more diffused during the non-dominant hand movements in comparison with the dominant hand. During passive movements, the cortical activation clusters of a smaller volume in comparison with the active movements were found, which was expressed most clearly during the performance of non-dominant hand movements and could reflect the weakening of the control from the cortical structures in these conditions.

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Rheocardiography, an advanced noninvasive circulatory system test in children and adults: Progress and prospects

Abstract

This article provides an overview of theoretical studies and clinical practice of using thoracic electrical bioimpedance (TEB). TEB is a noninvasive method for the measurement of cardiac output, cardiac index, systolic time intervals, and other hemodynamic parameters. The opinions of modern authors regarding the usage of this method are still controversial. However, many studies have proved that TEB is an accurate, reliable and promising method for monitoring the relative changes in hemodynamics in many clinical situations and in physiological studies of cardiac activity.

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Evaluation of microcirculatory disturbances in patients with rheumatic diseases by the method of diffuse reflectance spectroscopy

Abstract

Immunoinflammatory reactions affecting the state of the microvasculature play the key role in the genesis of rheumatic diseases. Therefore, it is important to develop new methods for the early detection of microcirculatory disorders. The purpose of this study was to assess the possibilities of diffuse reflectance spectroscopy used to identify microcirculatory disturbances in patients with rheumatic diseases by measuring skin blood supply and oxygenation rate and their relationship with the varying degrees of inflammatory activity. A total of 36 patients with rheumatic diseases and 31 healthy volunteers took part in the study. We analyzed the skin diffuse reflectance spectra recorded on the palmar side of the distal phalange of the right middle finger using a FLAME spectrometer. The erythema index and saturation rate were calculated to quantify the content of hemoglobin and oxygen saturation of tissues in both groups. The differences in the parameters under study between the groups were found to be statistically significant. The average value of erythema index was twofold higher in patients with rheumatic diseases with the second degree of inflammatory activity and about 2.5-fold higher in patients with the third degree of inflammatory activity, compared to the control group. This fact indicates impaired blood circulation with increased blood flow caused by inflammatory processes. Thus, diffuse reflectance spectroscopy can be used as an additional non-invasive diagnostic test for assessing the severity of microcirculatory disturbances and the activity of inflammation in rheumatic diseases.

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Effect of computer work on the state of physiological functions in children aged 7 to 10 years

Abstract

We studied the age- and sex-related functional characteristics of the central nervous system (CNS), cardiovascular system (CVS), lability of the visual sensory system, and mental capacity before and after a continuous computer work for 15 min in children aged 7, 8, 9, and 10 years. The results of the research showed that the resistance of the physiological systems of the body to loads associated with computer work increases in primary school children with age. We also observed sex-related differences: many parameters of functional performance during computer work at the age of 8 years were better in girls than in boys, which was due to a higher rate of development; at the age of 10 years, girls had a larger number of adverse changes in the functional state of the body compared with boys, which is possibly due to the onset of puberty.

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Influence of cognitive load on the body functional state in children aged 9 to 12 years during early stages of puberty

Abstract

This article analyzes heart rate variability (HRV), the glucocorticoid function of adrenal glands, and brain electrical activity (EA) in children aged 9 to 12 years to study their functional state during early stages of puberty. The cognitive load (mental arithmetic) caused low-frequency waves in the heart rate spectrum in all subjects, regardless of the puberty stage and gender. With respect to the age range under study, the hormonal response to the arithmetic test, expressed in a decrease in the level of cortisol, was observed in boys only at the third stage of puberty. The visual analysis of the background electrical encephalogram showed frequent generalized bilateral and synchronous changes in the electrical activity (EA) in the form of diencephalic signs in children. The features of the relationship between the autonomic nervous system and the hypothalamic pituitary-adrenal system have been revealed in children aged 9 to 12 years during cognitive load. The closest correlations between HRV indices and cortisol levels have been found in girls at the first stage and boys at the third stage of puberty.

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Functional state of the cardiovascular system in 13-year-old adolescents with different types of autonomic nervous regulation

Abstract

The features of the functional state of cardiovascular system in 13-year-old children with different types of autonomic nervous regulation were studied. Children with normotonic and parasympathetic types of autonomic regulation were found to have the highest adaptation capacities. The autonomic nervous system influences the bioelectrical processes in myocardium, the duration of cardiac cycle phases, and cerebral blood flow. Schoolchildren aged 13 years with higher sympathetic activity have shorter duration of the cardiac cycle, the phase of isometric contraction, and diastole. They have a lower pulse blood flow rate and a higher tone of large and medium cerebral vessels. No relationship was revealed between the initial autonomic nervous regulation of heart rate and the type of adaptation of myocardium to physical dynamic loads, as well as the type of adaptation of cerebral circulation to mental stress.

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Relationships between the EEG θ- and β-parameters and heart rate variability during human cognitive performance

Abstract

We studied the dynamics of spectral coherence characteristics of the EEG θ-, β₁-, and β₂-activity and the heart rate variability (HRV) in subjects performing cognitive tests. We found an association between the HRV parameters in the process of cognitive activity and the coherence of potentials in the EEG θ-, β₁-, and β₂-bands. The heart rate parameters in the baseline state and during the test performance best correlated with the levels of the right-hemispheric coherence of potentials in the θ-, β₁-, and β₂-bands of the baseline EEG (eyes closed). The higher coherence levels corresponded to lower values of the mean time of RR intervals (RRNN), coefficient of variation (CV), total power (TP), the power of the high-frequency (HF) and low-frequency (LF) components in the HRV spectrum. During the performance of the test, higher coherence values in the EEG θ-bands with the focus in the right temporal lead corresponded to higher LF/HF values reflecting the predominance of sympathetic effects on heart rate.

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An fMRI Study of the Emotional Perception of Erotic Images in Men Aged 49–74 Years

Psychological studies have indicated that erotic images are evaluated in the context of positive emotions as the most intense, associated with the greatest degree of emotional arousal, among the whole gamut of pleasant and unpleasant stimuli. It is difficult to discriminate the cortical zones directly associated with emotional arousal from the activity of structures responsible for assessing emotional stimuli in the inducement/reward system. The aim of the present work was to identify differences in cerebral activity using functional MRI scans (fMRI) in men during assessment of the intensity of pleasant images, including erotic images, or unpleasant and neutral images. Comparison of tasks involving the assessment of pleasant images of the erotic type with tasks containing neutral or unpleasant stimuli revealed significantly more marked activation in the posterior cingulate cortex, the prefrontal cortex, and the globus pallidus on the right side. Comparison of tasks with pleasant and neural stimuli revealed an increase in the activity of the right anterior central gyrus. Thus, the process of assessment of the intensity of emotional images of erotic type was related to activation of brain areas belonging not only to the neural representation of the emotions, but also to the cognitive system controlling emotional arousal and the motivational domain, which needs to be considered when using erotic images as powerful positive emotional stimuli.

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Does Impulsivity Influence the Operation of Long-Term and Working Memory in Rats?

A "delay discounting" method – selection of food reinforcement on the basis of its value and the delay in receiving it – was used to identify animals with high and low impulsivity. Rats preferring an immediate but low-value reinforcement were assigned to the high impulsivity group and those able to restrain their behavior and receive the valuable reinforcement constituted the low-impulsivity group; some animals showed mixed-type reactions. In a Morris water maze, the three groups of animals found the platform hidden beneath the water at different times, swimming different distances and at different speeds. These differences, however, were only apparent on overall (for all trials and days) comparisons of measures and were not significant when compared on individual training days and numbers of trials. These results provide evidence that the differences between groups may be due to differences in the overall motor activity of the animals without any significant difference in the manifestations of long-term or working memory.

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Non-Verbal Behavior of Six- and 12-Month-Old Infants with Neurological Problems from Birth: A Pilot Study

An ethological approach was used to compare nonverbal behavior in infants aged six and 12 months with neurological problems from birth (ICD-10 P91.8; risk group) with the behavior of their healthy (normal group) peers. Assessment of the sequence and duration of behavioral elements displayed by the infants in the familiar home environment during day-to-day activity was performed on the basis of continuous observations using 1- and 2 min video recordings in double-blind conditions. We suggest that if there are characteristic behavioral differences, these should be regarded as prognostic markers for developmental problems in infants. Ethological analysis showed that the main behavioral differences were associated with the infants' eye and hand activity. At both ages, infants of the risk group became distracted from objects held in their hands, looking away more often than infants of the normal group. Risk group infants aged 12 months demonstrated less exploratory activity than their healthy peers. These observations lead to the suggestion that short-term observations of nonverbal behavior can be used as a supplement to diagnostic scales for the rapid assessment of cognitive status in infants.

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Delayed Copying of Unfamiliar Outline Images: Does the Decrease in Reaction Time with the Increase in the Delay Reflect a Change in the Internal Representation of the Forthcoming Movement?

A group of 24 adult subjects performed a task consisting of delayed motor reproduction (copying) of unfamiliar outline figures (trajectory templates). Templates were presented for 250 msec and were reproduced in response to an instruction given by sound signal (a brief click), delayed relative to the end of the period of presentation of the trajectory image by time T = 0, 500, 1000, 2000, or 4000 msec. Subjects performed the task in a block experiment in which the delay T was constant within each block of 32 trials. Reaction time (RT) was analyzed, along with the mean duration of movement along one segment of the trajectory (MT) and the duration of the pause between adjacent segments (DT). Reaction time RT was found to show a non-monotonic dependence on delay T, decreasing at T ≤ 1000 msec and increasing at T ≤ 2000 msec. The relationship between RT and T was adequately described by a very simple additive model – the sum of a linearly increasing component and an exponentially decreasing component. The linear increase reflected a decrease in the accuracy of predicting the moment at which the instruction signal would be presented as the delay T increased (foreperiod effect [Niemi and Näätänen, 1981; Meulenbroek and Van Galen, 1988]). The exponentially decreasing component is suggested to reflect transformation of the internal representation of the trajectory template during the period it is held in short-term memory.

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Studies of Vasopressin Secretion in Krushinskii–Molodkina Rats in Normal Conditions and during Convulsive Seizures

The aim of the present work was to study the secretory activity of vasopressinergic neurons in the hypothalamus in Krushinskii–Molodkina rats, which have a predisposition to audiogenic epilepsy, in normal conditions and during audiogenic convulsive seizures. Serum vasopressin and neurohypophyseal neurophysin II levels were compared in Wistar and Krushinskii–Molodkina rats. These studies demonstrated a decreased blood vasopressin level and an increased neurohypophyseal neurophysin II level in rats predisposed to audiogenic epilepsy, which is evidence for inhibition of the release of vasopressin into the blood. Analysis of vasopressin levels at different stages of convulsive seizures revealed a significant increase in the plasma vasopressin concentration at the clinic-tonic stage of convulsive seizures. Thus, this is the first study demonstrating that Krushinskii–Molodkina rats predisposed to audiogenic epilepsy have lower levels of vasopressinergic neuron secretory activity than sound-insensitive Wistar rats. A significant increase in plasma vasopressin at the clonic-tonic stage of convulsive seizures is evidence that the vasopressinergic neurosecretory system has a role in mediating audiogenic convulsive seizures.

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Behavior of Rats in an Open Field Test as a Prognostic Indicator of Corticosterone Levels Before and After Stress

Studies were performed to assess the role of behavioral indicators in an open field test in predicting the blood corticosterone level in stress. The most reliable indicators of behavior in the open field, reflecting a high probability of a significant increase in the corticosterone concentration after 3-h restraint, were a short latent period of first movement and a low level of motor activity. The probability of high corticosterone in normal "unstressed" conditions is reflected by a low level of motor activity and, conversely, a long latent period for the excursion to the central squares of the field.

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Methodological Characteristics of the Use of the Morris Water Maze for Assessment of Cognitive Functions in Animals

We present here a review of the use of the Morris water maze to identify impairments to the cognitive functions of the brain as part of the evaluation of the toxic actions of nanoparticles. Model experiments showed that individual variability in animals' behavior has significant influences on the results obtained in the water test. The need for preliminary selection of individuals as a measure to reduce such influences is grounded and the type of behavior displayed by the animal in the test to be used as the criterion for selection is discussed.

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The height of the cricothyroid membrane on computed tomography scans in trauma patients.

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The height of the cricothyroid membrane on computed tomography scans in trauma patients.

Anaesthesia. 2017 May 02;:

Authors: Nutbeam T, Clarke R, Luff T, Enki D, Gay D

Abstract
Emergency cricothyrotomy is a common feature in all difficult airway algorithms. It is the final step following a 'can't intubate, can't oxygenate' scenario. It is rarely performed and has a significant failure rate. There is variation in the reported size of the cricothyroid membrane, especially across population groups. Procedural failure may result from attempting to pass a device with too large an external diameter through the cricothyroid membrane. We aimed to determine the maximum height of the cricothyroid membrane in a UK trauma population. Electronic callipers were used to measure the maximum height of the cricothyroid membrane on 482 reformatted trauma computed tomography scans, 377 (78.2%) of which were in male patients. The mean (SD) height of the cricothyroid membrane, as independently measured by two radiologists, was 7.89 (2.21) mm and 7.88 (2.22) mm in male patients, and 6.00 (1.76) mm and 5.92 (1.71) mm in female patients. The presence of concurrent tracheal intubation or cervical spine immobilisation was found not to have a significant effect on cricothyroid membrane height. The cricothyroid membrane height in the study population was much smaller than that previously reported. Practitioners encountering patients who may require an emergency surgical airway should be aware of these data. Rescue airway equipment with variety of external diameters should be immediately available.

PMID: 28463474 [PubMed - as supplied by publisher]

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Airway Management of Patients Undergoing Oral Cancer Surgery: A Retrospective Analysis of 156 Patients.

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Airway Management of Patients Undergoing Oral Cancer Surgery: A Retrospective Analysis of 156 Patients.

Turk J Anaesthesiol Reanim. 2017 Apr;45(2):108-111

Authors: Nikhar SA, Sharma A, Ramdaspally M, Gopinath R

Abstract
OBJECTIVE: Oral cancer patients have a potentially difficult airway, but if managed properly during the perioperative period, morbidity and mortality can be reduced or avoided.
METHODS: The medical records of 156 patients who were operated for oral cancers were reviewed for airway management during the perioperative period.
RESULTS: The surgical procedures ranged from excisions, wide local excisions with split skin graftings, hemiglossectomies and radical neck nodes dissections to pectoralis major myocutaneous or free fibular flaps. Intubation was assessed as difficult in 14.7% of patients because of tumour- or radiation fibrosis-related trismus, restricted neck mobility and prior similar surgeries. Twenty patients had undergone surgery for oral cancer previously and were scheduled for flap reconstruction. Nasotracheal intubation was a preferred route, and 62.8% of patients could be intubated nasotracheally after neuromuscular blockade. Tracheostomy (elective or existing) was utilised for airway control in 19.2% cases. Patients who had undergone prior radiotherapy were more likely to be tracheostomised. McCoy laryngoscopes (13.4%), gum elastic bougies (23.6%), Airtraq devices (0.006%) and fibreoptic bronchoscopes (FOBs) (0.03%) were the additional airway techniques employed. In total, 64 patients (50.7%) could be extubated immediately after surgery.
CONCLUSION: Proper preoperative evaluation and planning help manage difficult airways effectively with minimal need of advanced airway gadgets. Gum elastic bougies and Magill forceps are very useful in airway management and decrease the need of elective tracheostomy in oral cancer patients.

PMID: 28439444 [PubMed - in process]

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CONSORT the effect of intraoperative dexmedetomidine on hemodynamic responses during emergence from nasotracheal intubation after oral surgery.

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CONSORT the effect of intraoperative dexmedetomidine on hemodynamic responses during emergence from nasotracheal intubation after oral surgery.

Medicine (Baltimore). 2017 Apr;96(16):e6661

Authors: Jo YY, Kim HS, Lee KC, Chang YJ, Shin Y, Kwak HJ

Abstract
BACKGROUND: Dexmedetomidine provides smooth emergence with reduced agitation. The authors hypothesized low-dose dexmedetomidine infusion might contribute to hemodynamic stability during and after nasotracheal tube extubation.
METHODS: Ninety-three adult patients scheduled for oral and maxillofacial surgery were enrolled in this prospective study. Patients were randomly assigned to receive normal saline (control group, n = 31), dexmedetomidine at 0.2 μg/kg/h (DEX0.2 group, n = 31), or dexmedetomidine at 0.4 μg/kg/h (DEX0.4 group, n = 31). Mean arterial pressure (MAP), heart rate (HR), and response entropy (RE) and state entropy (SE) were recorded during emergence from anesthesia.
RESULTS: Extubation times were similar in the 3 groups. Mean MAP was significantly lower at eye opening (T3) and immediately after extubation (T4) in the DEX0.2 (P = .013 and .003, respectively) and DEX0.4 group (P = .003 and .027, respectively) than in the control group. At T3 and T4, mean HR was significantly higher in the control group than in the DEX0.2 (P = .014 and .022, respectively) or DEX0.4 groups (P = .003 and <.001, respectively). In the postanesthetic care unit, mean MAP and HR were significantly lower in the DEX0.2 (P = .03 and .022, respectively) and DEX0.4 groups (P = .027 and <.001, respectively) than in the control group.
CONCLUSION: Intraoperative dexmedetomidine infusion at rates of 0.2 or 0.4 μg/kg/h during oral and maxillofacial surgery could provide stable hemodynamic profiles during anesthetic emergence from nasotracheal intubation without delaying extubation times.

PMID: 28422874 [PubMed - indexed for MEDLINE]

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Abdominal Retraction Pad Used in Orthognathic Surgery: A Novel Technique for Nasotracheal Tube Stabilization During Le Fort I Osteotomy.

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Abdominal Retraction Pad Used in Orthognathic Surgery: A Novel Technique for Nasotracheal Tube Stabilization During Le Fort I Osteotomy.

J Craniofac Surg. 2016 Oct;27(7):1842-1844

Authors: Nelke KH, Pawlak W, Łuczak K

Abstract
Many types of surgical osteotomies of the cranio-facial skeleton relay on adequate surgical field preparation. Placement and stabilization of nasotracheal tube during orthognathic surgery is very important. In most cases, long-lasting surgery includes various surgical maneuvers around patient's skull, which depend on accurate nasotracheal tube stabilization. Usage of adhesive plasters for heavy anesthetic tube connector placement and stability might result in tube instability and local disfigurement of nasal projection and visibility in the nasal and infraorbital areas. We present a novel technique for nasotracheal tube stabilization allowing each surgeon controlling tube position, visual evaluation of nasal projection, and its tip during various surgical movements of maxillary bone, such as extrusion, intrusion, rotation or others, during Le Fort I osteotomy. Despite additional time necessary for preparation of surgical field, attachment of the tube and suturing, presented method allows achieving very satisfactory final outcomes with visible access to key nasal structures important in Le Fort I osteotomy. Presented method could be also used in any other facial surgery procedure.

PMID: 27557467 [PubMed - indexed for MEDLINE]

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Nutritional implications for ultra-endurance walking and running events

This paper examines the various nutritional challenges which athletes encounter in preparing for and participating in ultra-endurance walking and running events. Special attention is paid to energy level, perf...

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In conversation with…Thomas Frederic Hornbein

Whilst attending a conference in the not too distant past, I was fortunate enough to be seated at lunch next to a very eminent octogenarian academic. Conversation ensued, and I was instantly captivated by his ...

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Keratinocytes at the uppermost layer of epidermis might act as sensors of atmospheric pressure change

It has long been suggested that climate, especially atmospheric pressure change, can cause health problems ranging from migraine to myocardial infarction. Here, I hypothesize that the sensory system of epiderm...

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High altitude-related hypertensive crisis and acute kidney injury in an asymptomatic healthy individual

High-altitude exposure causes a mild to moderate rise in systolic and diastolic blood pressure. This case report describes the first documented case of a hypertensive crisis at altitude, as well as the first r...

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Exercise in space: the European Space Agency approach to in-flight exercise countermeasures for long-duration missions on ISS

To counteract microgravity (µG)-induced adaptation, European Space Agency (ESA) astronauts on long-duration missions (LDMs) to the International Space Station (ISS) perform a daily physical exercise countermea...

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Erratum to: Critical Congenital Heart Disease Newborn Screening Implementation: Lessons Learned

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Acknowledgment of Reviewers

<span class="paragraphSection">Scientific progress depends on the generosity of reviewers who assist editors by sharing their time and expertise in the peer review process. Deborah S. Carr, PhD, editor of the Journal of Gerontology: Social Sciences, wishes to thank the following persons for their assistance in reviewing two or more manuscripts during 2015.</span>

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Acknowledgment of Reviewers

<span class="paragraphSection">Scientific progress depends on the generosity of reviewers who assist editors by sharing their time and expertise in the peer review process. Bob G. Knight, PhD, editor of the Journal of Gerontology: Psychological Sciences, wishes to thank the following persons for their assistance in reviewing two or more manuscripts during 2015.</span>

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Remembering Robert Kane

<span class="paragraphSection"></span>

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Acknowledgment of Reviewers

<span class="paragraphSection">Scientific progress depends on the generosity of reviewers who assist editors by sharing their time and expertise in the peer review process. Bob G. Knight, PhD, editor of the Journal of Gerontology: Psychological Sciences, wishes to thank the following persons for their assistance in reviewing two or more manuscripts during 2016.</span>

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Acknowledgment of Reviewers

<span class="paragraphSection"><strong>Decision Editor:</strong></span>

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Health Equity and Aging of Bisexual Older Adults: Pathways of Risk and Resilience

<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objectives:</div>Bisexual older adults are a growing yet largely invisible, underserved, and understudied population. Utilizing the Health Equity Promotion Model, we examined hypothesized mechanisms accounting for health disparities between bisexual older adults and lesbian and gay older adults.<div class="boxTitle">Method:</div>Based on data from Caring and Aging with Pride, the largest national survey of LGBT older adults, this study (<span style="font-style:italic;">N</span> = 2,463) utilized structural equation modeling to investigate direct and indirect associations between sexual identity (bisexual vs. lesbian and gay) and health via sexual identity factors (identity disclosure and internalized stigma), social resources, and socioeconomic status (SES).<div class="boxTitle">Results:</div>Bisexual older adults reported significantly poorer health compared with lesbian and gay older adults. Indirect effects involving sexual identity factors, social resources, and SES explained the association between bisexual identity and poorer health. A potentially protective pathway was also identified wherein bisexuals had larger social networks after adjusting for other factors.<div class="boxTitle">Discussion:</div>Bisexual older adults face distinct challenges and health risks relative to other older adults, likely because of the accumulation of socioeconomic and psychosocial disadvantages across the life course. Interventions taking into account older bisexuals' unique risk and protective factors may be helpful in reducing health inequities.</span>

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Instrumental- and Emotion-Focused Care Work During Physical Health Events: Comparing Gay, Lesbian, and Heterosexual Marriages

<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objectives:</div>We consider emotion- and instrumental-focused care work and marital stress during significant physical health events in midlife gay, lesbian, and heterosexual marriages.<div class="boxTitle">Method:</div>We employ the factorial method, an extension of the actor–partner interdependence model, to analyze survey data from 808 midlife gay, lesbian, and heterosexual spouses in 404 unions.<div class="boxTitle">Results:</div>The amount of emotion- and instrumental-focused care work provided during physical health events, and the associations between care work and marital stress, depends on the gender of the respondent, gender of the spouse, and whether spouses are in a same-sex or different-sex union. For example, in both same- and different-sex marriages, women report providing more emotion-focused care work during their own health event than do men, and respondents report more health-related marital stress when the patient is a woman.<div class="boxTitle">Discussion:</div>Investigating how midlife same-sex and different-sex spouses care for each other during a spouse's health event expands understandings of gendered aging experiences within marriage. Findings can elucidate health policies and clinical strategies that best support the health of men and women in same- and different-sex marriages.</span>

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Agency and Social Forces in the Life Course: The Case of Gender Transitions in Later Life

<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objectives:</div>In order to bolster gerontology's knowledge base about transgender issues and advance conceptualizations of agency and social forces in life course scholarship, this study explores the conditions under which people contemplate or pursue a gender transition in later life.<div class="boxTitle">Methods:</div>In-depth interviews were conducted with male-to-female identified persons (<span style="font-style:italic;">N</span> = 22) who have seriously contemplated or pursued a gender transition after the age of 50 years. Participant observation was also carried out at three national transgender conferences (<span style="font-style:italic;">N</span> = 170 hours). Interpretive analyses utilized open and focused coding, analytical memo writing, and an iterative process of theory development.<div class="boxTitle">Results:</div>Participants in this study faced unrelenting social pressures to conform to normative gender expectations throughout their lives, which were often internalized and experienced as part of themselves. Confronting these internalized forces often took the form of a "dam bursting," an intense emotional process through which participants asserted agency in the face of constraining social forces in order to pursue a gender transition in later life.<div class="boxTitle">Discussion:</div>The findings in this paper are used to extend the life course concept of agency within structure, which has implications for future life course research in aging, especially with respect to socially marginalized and oppressed minority groups.</span>

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Understanding Sexual Freedom and Autonomy in Assisted Living: Discourse of Residents’ Rights Among Staff and Administrators

<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objectives:</div>In contrast to nursing homes, assisted living (AL) facilities emphasize independence and autonomy as part of their mission. However, we do not know to what extent this extends to sexual freedom and autonomy.<div class="boxTitle">Method:</div>Using grounded theory methodology and symbolic interactionism, we examine how staff and administrators in AL facilities discuss residents' rights to sexual freedom and how this influences the environment of AL.<div class="boxTitle">Results:</div>Staff and administrators engage in a contradictory discourse of residents' rights that simultaneously affirms the philosophy of AL while behaving in ways that create an environment of surveillance and undermine those rights.<div class="boxTitle">Discussion:</div>A discourse of residents' rights masks a significant conflict between autonomy and protection in regards to sexual freedom in AL.</span>

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Older Gay Men and Their Support Convoys

<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objective:</div>We used the convoy model and the network type construct to identify the relationship quality profiles found among older gay men and to examine how they define a satisfactory network.<div class="boxTitle">Method:</div>We used a network mapping strategy and in-depth qualitative interviews with 20 participants in Atlanta. During the interviews, all network members were discussed, regardless of relationship or map position.<div class="boxTitle">Results:</div>For participants, having people in their lives with whom they could fully be "out" as gay men (authenticity) was at the root of a quality network. This allowed them to develop emotional closeness (intimacy), which, in part, provided a foundation of social support. Participants' discussion of network quality, which reflected authenticity, intimacy, and social support, revealed high, moderate, and low quality network types.<div class="boxTitle">Discussion:</div>Our findings diversify knowledge of the network type construct, provide a deeper understanding of its qualitative features, and give voice to this often-invisible group, situating meaning within their social-historical context. The findings suggest that the meaning of a quality network is contextual and culturally specific, varying across groups of older adults.</span>

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Work Impact and Emotional Stress Among Informal Caregivers for Older Adults

<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objectives:</div>With the growing aging population and reliance on informal caregivers in the United States, many individuals will take on the role of caregiver as an adult. We examined whether informal caregivers experience work interference or a change in work status (i.e., retiring/quitting) due to caregiving. We also explored whether experiencing work interference or a change in work status was associated with greater emotional stress.<div class="boxTitle">Method:</div>This secondary analysis is drawn from the Fifth National Survey of Older Americans Act (OAA) program participants, which included 1,793 family caregivers. The present analysis is on caregivers of working age (18–64 years) providing care to another adult, which included 922 caregivers. Ordinal logit models were used to assess associations between experiencing work interference or a change in work status and emotional stress. Study weights were applied for all analyses.<div class="boxTitle">Results:</div>At the time of the survey, more than half (52.9%) of caregivers were employed full- or part-time. Among nonworking caregivers (i.e., not working or retired) at the time of the survey, 39.8% responded that they had quit or retired early due to caregiving demands. Among employed caregivers, 52.4% reported that informal caregiving had interfered with their employment. Importantly, those respondents who reported work interference or a change in work status were more likely to report higher levels of emotional stress associated with caregiving demands.<div class="boxTitle">Discussion:</div>These findings suggest the need to further explore work among informal caregivers and associations with emotional stress, as well as consider work-based policy approaches, organizational and/or societal, to support informal caregivers.</span>

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What Drives National Differences in Intensive Grandparental Childcare in Europe?

<span class="paragraphSection"><div class="boxedTextSection"><div class="boxTitle">Research Problem</div>Grandparents play an active role in the lives of their grandchildren, with around half of grandparents across 10 European countries having looked after at least one of their grandchildren in the preceding year without the presence of their parents. Nevertheless, there are striking national differences in the frequency of grandparental childcare with grandparents in Southern European countries more likely to provide childcare almost daily (see <a href="#F1" class="reflinks">Figure 1</a>). This study asks whether cross-national variation in patterns of intensive grandparental care in Europe can be explained by national demographic and socioeconomic differences between individuals, or whether structural and cultural factors are more important.Figure 1.Percentage of grandparents looking after grandchildren by frequency and country. <span style="font-style:italic;">Source:</span> SHARE, 2004/2005. Weighted Data. For those grandparents who provided care for more than one grandchild, the highest frequency of care is considered. Own calculations.<div class="boxTitle">Data and Methods</div>This study used cross-national data from 10 European countries using the 2004/2005 Survey of Health, Ageing and Retirement in Europe. We analyzed grandparents aged 50 and older with adult children living in a separate, private household, and with at least one grandchild younger than 16. Using multilevel logistic regression modeling, we examined the extent to which variation in intensive grandparental childcare (defined as looking after grandchildren almost daily or at least 15hr each week) can be attributed to country-level variations in individual-level demographic and socioeconomic characteristics, or national-level female labor force participation, childcare provision, and cultural attitudes.</div></span>

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Race/Ethnic Differentials in the Health Consequences of Caring for Grandchildren for Grandparents

<span class="paragraphSection"><div class="boxedTextSection"><div class="boxTitle">RESEARCH PROBLEM AND DATA</div>African American and Hispanic grandparents are more likely to care for grandchildren than White grandparents. However, research has not fully investigated race/ethnic differentials in the health consequences of such caregiving for grandparents. Results from a limited number of studies are inconsistent and inconclusive, partly due to the use of small, nonrepresentative samples, but also due to the complex nature of the topic, with different mechanisms operating in opposing directions. For example, do the benefits of grandparenting (e.g., emotional reward and social support) outweigh the negative effects (e.g., stress, physical demand, and financial difficulty) or vice versa? Do minority grandparents' poorer health outcomes reflect their initial socioeconomic disadvantage or does a lack of financial resources compound the stress of caregiving? Finally, do minority grandparents' stronger emphasis on family ties and greater support from family act as a buffer that increases resilience to strain? Analyzing nationally representative, longitudinal data on grandparents older than 50 years from the Health and Retirement Study (1998–2010) (<a href="#F1" class="reflinks">Figure 1</a>), we examine the effects of living arrangements and caregiving intensity on older adults' health trajectories, measured by changing health (an index of frailty that includes self-reports of chronic illness, disabilities, depression, overall health, and obesity) in race/ethnic subsamples.Figure 1.Predicted frailty index for race/ethnic subgroups.</div></span>

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What’s good for the goose is not good for the gander: Age and gender differences in scanning emotion faces

<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objectives:</div>Research indicates that older adults' (≥60 years) emotion recognition is worse than that of young adults, young and older men's emotion recognition is worse than that of young and older women (respectively), older adults' looking at mouths compared with eyes is greater than that of young adults. Nevertheless, previous research has not compared older men's and women's looking at emotion faces so the present study had two aims: (a) to examine whether the tendency to look at mouths is stronger amongst older men compared with older women and (b) to examine whether men's mouth looking correlates with better emotion recognition.<div class="boxTitle">Method:</div>We examined the emotion recognition abilities and spontaneous gaze patterns of young (<span style="font-style:italic;">n</span> = 60) and older (<span style="font-style:italic;">n</span> = 58) males and females as they labelled emotion faces.<div class="boxTitle">Results:</div>Older men spontaneously looked more to mouths than older women, and older men's looking at mouths correlated with their emotion recognition, whereas women's looking at eyes correlated with their emotion recognition.<div class="boxTitle">Discussion:</div>The findings are discussed in relation to a growing body of research suggesting both age and gender differences in response to emotional stimuli and the differential efficacy of mouth and eyes looking for men and women.</span>

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Back to Work? Not Everyone. Examining the Longitudinal Relationships Between Informal Caregiving and Paid Work After Formal Retirement

<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objectives:</div>Research on unretirement (retirees who re-enter the workforce) is burgeoning. However, no longitudinal study has examined how informal care relates to unretirement. Utilizing role theory, this study aims to explore the heterogeneity of informal care responsibilities in retirement and to examine how informal care informs re-entering the workforce in later life.<div class="boxTitle">Method:</div>Data were drawn from the Health and Retirement Study of fully retired individuals aged 62 years and older in 1998 (<span style="font-style:italic;">n</span> = 8,334) and followed to 2008. Informal care responsibilities included helping a spouse/partner with activities of daily living (ADLs) or instrumental activities of daily living (IADLs); helping parent(s) or parent-in-law(s) with ADLs or IADLs; and single or co-occurrence of care roles. Covariates included economic and social factors. Cox proportional hazard models were utilized.<div class="boxTitle">Results:</div>When compared with noncaregivers, helping a spouse with ADLs or IADLs reduced the odds of returning-to-work in the subsequent wave by 78% and 55%, respectively (hazard ratio [HR]: 0.22, confidence interval [CI]: 0.06–0.87; HR: 0.45, CI: 0.21–0.97). There was no statistical difference to returning-to-work between noncaregivers and helping parents with ADLs/IADLs or multiple caregiving responsibilities.<div class="boxTitle">Discussion:</div>Role theory provided a useful framework to understand the relationships of informal care and unretirement. Aspects of role strain emerged, where, spousal caregivers were less likely to come out of retirement. Spousal caregivers may face challenges to working longer, and subsequently, opportunities to bolster their retirement security are diminished. Research and policy implications are discussed.</span>

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Anticipatory Motor Planning in Older Adults

<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objectives:</div>The end-state comfort (ESC) effect represents an efficiency constraint in anticipatory motor planning. Although young adults usually avoid uncomfortable postures at the end of goal-directed movements, newer studies revealed that children's sensitivity for ESC is not fully in place before the age of 10 years. In this matter, it is surprising that nothing is known about the development of the ESC effect at older ages. Therefore, the aim of the present study was to examine the development of anticipatory motor planning in older adults.<div class="boxTitle">Method:</div>In 2 experiments, a total of 119 older adults (from 60 to 80 years old) performed in an unimanual (Experiment 1) and a bimanual version (Experiment 2) of the bar-transport-task.<div class="boxTitle">Results:</div>Across both experiments, the propensity of the ESC effect was significantly lower in the old-old (71–80 years old) as compared with the young-old (60–70 years old) participants.<div class="boxTitle">Discussion:</div>Although the performance of the young-old participants in the unimanual and bimanual task was comparable to what has been reported for young adults, the performance of the old-old participants was rather similar to the behavior of children younger than 10 years. Thus, for the first time, evidence is provided for the decrease of the ESC effect in older adults.</span>

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What Do We Need at the End of Life? Competence, but not Autonomy, Predicts Intraindividual Fluctuations in Subjective Well-Being in Very Old Age

<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objectives:</div>Self-determination theory (SDT) suggests that fulfillment of the universal psychological needs for autonomy, competence, and relatedness is essential for well-being of all humans. However, it is not clear whether this prediction also holds in advanced old age. The present study aims to test SDT for the two less researched needs in advanced old age: the needs for competence and autonomy.<div class="boxTitle">Method:</div>A total of 111 very old adults (age range at first measurement occasion 87–97 years) were assessed up to 6 times over the course of about 4 years.<div class="boxTitle">Results:</div>Competence, but not autonomy, predicted subjective well-being at the within-person level of analysis. At the between-person level, only negative affect was predicted by autonomy and competence, whereas positive affect and life satisfaction were predicted by competence only.<div class="boxTitle">Discussion:</div>Results challenge the life-span universality of the needs for competence and autonomy postulated by SDT in very old adults and suggest that the high vulnerability in this life phase may change the importance of these needs for well-being.</span>

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The Relation of Ego Integrity and Despair to Personality Traits and Mental Health

<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objectives:</div>Existing studies in the Eriksonian tradition found that ego integrity and despair are important indicators of life-span development. The present study relates ego integrity and despair to contemporary theories of personality and mental health.<div class="boxTitle">Method:</div>A cross-sectional study of Dutch adults aged between 50 and 95 years (<span style="font-style:italic;">N</span> = 218) was carried out, using the Northwestern Ego Integrity Scale, the subscales for neuroticism, extraversion, and openness to experience of the NEO-FFI, the Mental Health Continuum-Short Form, and the Center for Epidemiological Studies Depression Scale-Short Form.<div class="boxTitle">Results:</div>Extraversion and openness to experience have an indirect relation to ego integrity that is mediated by well-being. Neuroticism was related to despair and explained the relationship of depressive symptoms to despair. Chronological age did not moderate these findings.<div class="boxTitle">Discussion:</div>Ego integrity appears to be related to fluctuating states of mental health, whereas despair is more an expression of a general trait-like disposition of neuroticism. Implications for further research are discussed.</span>

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Short-Term Buffers, but Long-Term Suffers? Differential Effects of Negative Self-Perceptions of Aging Following Serious Health Events

<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objectives:</div>Large longitudinal studies show that negative self-perceptions of aging can be detrimental for health outcomes. However, negative self-perceptions of aging (i.e., associating aging with physical losses) might be adaptive because they prepare individuals for serious health events (SHEs), resulting in short-term positive effects as opposed to long-term negative effects on well-being and health.<div class="boxTitle">Method:</div>Longitudinal data from 309 older adults (aged 65 and older) were analyzed. Short-term (6 months) and long-term (2.5 years) effects after a SHE of negative self-perceptions of aging on functional limitations (FLs) and negative affect (NA) were investigated.<div class="boxTitle">Results:</div>Results show that in the case of a SHE, individuals with more negative self-perceptions of aging reported less NA after 6 months but more FLs after 2.5 years. In contrast, individuals with less negative self-perceptions of aging reported more NA in the short-run but less FLs later on.<div class="boxTitle">Discussion:</div>People with more negative self-perceptions of aging may be mentally prepared for health events or may have habituated to health declines. Individuals with more positive self-perceptions, in contrast, may invest a lot in coping efforts immediately after the health event. Similarities to research on unrealistic optimism are discussed.</span>

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Which Women are Highly Active Over a 12-Year Period? A Prospective Analysis of Data from the Australian Longitudinal Study on Women’s Health

Abstract

Introduction

Current Australian physical activity (PA) guidelines encourage adults to accumulate 150–300 min of moderate to vigorous PA each week. Some critics assert that 300 min is unachievable.

Objectives

The aims of this study were to identify the proportion of younger and mid-aged women who met the 300-min recommendation over a 12-year period, examine how the "highly active" women achieved this level of activity (in terms of walking, moderate activity, and vigorous activity), and to identify the sociodemographic, biological, lifestyle, and work-related determinants of being "highly active".

Methods

Younger (n = 7843) and mid-aged (n = 8043) participants in the Australian Longitudinal Study on Women's Health completed triennial surveys between 2000 and 2013, when their ages were 24.6–36.3 and 52.5–64.5 years, respectively. Self-reported PA was assessed as time spent in walking, moderate activity, and vigorous activity in the previous week; an index of MET.min/week was derived and dichotomized as <1000 MET.min/week (<300 min; not highly active) or ≥1000 MET.min/week (≥300 min; highly active). Generalized estimating equations were used to examine univariable and multivariable associations between a number of sociodemographic, lifestyle, and health variables with PA status (measured at every survey).

Results

In the younger cohort, the proportion who were highly active decreased from 40% in 2000 to 31% in 2012. High levels of activity were achieved through a combination of walking (39.1–45.1% of total activity) and vigorous PA (41.8–47.7%). In the mid-age cohort, the proportion of women who were highly active increased from 32% in 2001 to 47% in 2013; this was achieved predominantly through walking (55.8–59.7%). In multi-variable models, the highest odds for being in the high PA category (odds ratios [ORs] ≥ 1.20; p < 0.001) were for younger women who were single, those who worked long full-time hours, those who drank any quantity of alcohol, and those who sat for less than 8 h/day. In the mid-age cohort, the highest odds for being in the high PA category (ORs ≥1.20; p < 0.001) were for women with post-school education, those who were retired, those who were low-risk drinkers (compared with non-drinkers), those who sat for less than 8 h/day, and those with lower levels of stress.

Discussion

Our findings clearly indicate that the upper limit of the Australian PA guidelines is achievable for large numbers of women. Factors associated with being highly active were different for younger and mid-age women, but healthy weight, high education, and paid work (full-time in the younger women, part-time in mid-age) were common characteristics of highly active women in both cohorts.

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Effects of Altitude/Hypoxia on Single- and Multiple-Sprint Performance: A Comprehensive Review

Abstract

Many sport competitions, typically involving the completion of single- (e.g. track-and-field or track cycling events) and multiple-sprint exercises (e.g. team and racquet sports, cycling races), are staged at terrestrial altitudes ranging from 1000 to 2500 m. Our aim was to comprehensively review the current knowledge on the responses to either acute or chronic altitude exposure relevant to single and multiple sprints. Performance of a single sprint is generally not negatively affected by acute exposure to simulated altitude (i.e. normobaric hypoxia) because an enhanced anaerobic energy release compensates for the reduced aerobic adenosine triphosphate production. Conversely, the reduction in air density in terrestrial altitude (i.e. hypobaric hypoxia) leads to an improved sprinting performance when aerodynamic drag is a limiting factor. With the repetition of maximal efforts, however, repeated-sprint ability is more altered (i.e. with earlier and larger performance decrements) at high altitudes (>3000–3600 m or inspired fraction of oxygen <14.4–13.3%) compared with either normoxia or low-to-moderate altitudes (<3000 m or inspired fraction of oxygen >14.4%). Traditionally, altitude training camps involve chronic exposure to low-to-moderate terrestrial altitudes (<3000 m or inspired fraction of oxygen >14.4%) for inducing haematological adaptations. However, beneficial effects on sprint performance after such altitude interventions are still debated. Recently, innovative 'live low-train high' methods, in isolation or in combination with hypoxic residence, have emerged with the belief that up-regulated non-haematological peripheral adaptations may further improve performance of multiple sprints compared with similar normoxic interventions.

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Comment on: “Determining Strength: A Case for Multiple Methods of Measurement”

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Advances in ligase chain reaction and ligation based amplifications for genotyping assays; detection and applications

Publication date: Available online 2 May 2017
Source:Mutation Research/Reviews in Mutation Research
Author(s): Abdullah A. Gibriel, Ola Adel
Single nucleotide polymorphisms (SNPs) are common genetic variants that have been reported to cause several genetic diseases. Various SNP genotyping screening assays were developed and implemented for diagnostic purposes but with certain limitations in sensitivity, specificity, cost effectiveness and/or time savings. Since the discovery of ligase chain reaction (LCR) in the last decade of the 20th century, it became one of the most favored platforms for SNP genotyping. Recent and powerful modifications have been introduced to both LCR and ligation based amplifications to enable high-throughput and inexpensive multiplex genotyping with improved robustness, simplicity, sensitivity and specificity. In this article, classical and up to date modifications in LCR and ligation based amplifications are evaluated with particular emphases on the recently integrated detection strategies such as electrochemical and magnetic biosensors, nanoparticles, quantum dots, quartz crystal and leaky surface acoustic surface biosensors, DNAzyme, rolling circle amplification, strand displacement amplification, surface enhanced raman scattering, chemiluminescence and fluorescence resonance energy transfer. Sensitivity and limitation parameters for modified technologies are also discussed. Applications of these platforms in various fields such as genetic diseases detection, bacterial and viral pathogens detection, epigenetic mapping, nucleic acids assembly and miRNA detection are highlighted along with the successfully integrated technologies that have been commercialized for genotyping assays.



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Molecular authentication of two medicinal plants Ligularia fischeri and Ligularia stenocephala using allele-specific PCR (AS-PCR) strategy

Abstract

Ligularia fischeri (Gom-chi) and Ligularia stenocephala (Gon-dal-bi) are popular edible herbs in Korea. L. fischeri is used to treat jaundice, hepatitis, rheumatoid arthritis, and scarlet fever, while L. stenocephala is used to treat anxiety, weakness, and menstrual disorders. The herbal medicinal activities of these two herbs differ, but they are very difficult to distinguish based on their morphologies, especially in their dried forms. In an effort to distinguish these two plant species, we sequenced three barcoding genes in plastids, matK, rbcL, and trnH-psbA. From the analysis of sequence variations, we detected five single nucleotide polymorphisms (SNPs) between two the species. Allele specific (AS)-primers in the SNPs were employed in discrimination of the two species. Of the five AS-primer sets, one primer pair in matK gene showed reproducibly distinguishable PCR amplification between plants of L. fischeri and L. stenocephala. The method is reproducible and efficient, and is the first reported molecular method to discriminate between L. fischeri and L. stenocephala.

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A conserved repetitive DNA element located in the centromeres of chromosomes in Medicago genus

Abstract

In most eukaryotic species, centromeres harbor large arrays of tandem repeated satellite DNA sequences. In this study, we report on the genomic distribution of a centromere satellite repeat "MtR3" in Medicago genus and three distantly related genera. Fluorescence in situ hybridization (FISH) results showed MtR3 repeats were detected in the centromere regions in M. truncatula, M. minima, M. edgeworthii, M. ruthenica, M. caerulea, M. sativa, and M. falcata (4×), but no signals were discovered in M. lupulina, M. polymorpha, and M. falcata (2×), Melilotus officinalis, Crotalaria medicaginea, and Trifolium repens. However, sequence analysis showed this MtR3 DNA had genomic distribution in all species and was highly conserved across the entire Medicago genus and three other genera. The conservation and widespread presence suggested MtR3 repeats may play important roles in centromeric function.

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Genome based quantification of Streptococcus parauberis in multiple organs of infected olive flounder ( Paralichthys olivaceus )

Abstract

Although Streptococcus parauberis is the major bacterial pathogen affecting olive flounder, the translocation and dissemination of this pathogen in infected fish are not well understood. Therefore, we conducted real-time PCR and histopathologic examination to monitor the intensity of infection in multiple organs of the olive flounder after challenge with S. parauberis through subcutaneous injection. The bacterial burden in the fish kidney, when sampled at 0, 3, and 7 dpc, was 0, 6.2 ± 4.5 × 10⁵, and 6.7 ± 5.5 × 10⁶ CFU/100 mg of tissue, respectively, indicating that the infection progressed rapidly over time. Of the ten different tissues sampled, the heart and the brain were the major target organs of S. parauberis based on highest copy number as detected by our modified real-time PCR method. Histopathologic examination also showed that S. parauberis caused severe inflammation accompanied by leucocyte infiltration, connective tissue expansion, and a loss of cardiomyocytes in the brain and heart of fish sampled at dpc 7. However, the number of S. parauberis-positive fish at 3 dpc was much higher in the spleen (6/8 fish) than in the remaining organs, suggesting that the spleen is targeted in the early stages of infection relative to the heart (2/8 fish) or brain (3/8 fish). This study provides essential information for studies to find treatments for the effective elimination of S. parauberis in target organs (i.e., the brain and heart) of olive flounder.

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Whole genome sequencing and functional features of UMX-103: a new Bacillus strain with biosurfactant producing capability

Abstract

The genus Bacillus is a Gram-positive, aerobic, endospore-forming, rod-shaped bacterium commonly found in the environment that have important industrial, medical, agriculture and environmental values. Here, we report the whole genome sequence analysis of UMX-103 which was isolated from a hydrocarbon contaminated site in Terengganu, Malaysia. An integration of both genomics and chemical approaches were conducted to analyse the biosurfactant production by the strain UMX-103. The genome was assembled using a combination of both de novo and reference-guided assembly methods. The genome size of UMX-103 is 4,234,627 bp with 4399 genes comprising of 4301 protein-coding genes and 98 RNA genes. The mapping results showed 93.44% of genome similarity with B. subtilis strain 168. We have identified 25 genes involved in biosurfactants production. Among the 25 identified genes, 14 genes were involved in surfactin biosynthesis and 11 genes were implicated in surfactin regulation. Fifteen genomic islands were identified which are different from other closely related Bacillus species. In addition, our study also revealed the genetic contents of this bacterium and genes which are involved in biosurfactant production.

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Proteomic profiles of Daphnia magna exposed to lead (II) acetate trihydrate and atrazine

Abstract

In this study, acute toxicity tests were performed to evaluate the impacts of lead (II) acetate trihydrate and atrazine on aquatic organism using a typical freshwater flea, Daphnia magna. Besides, the proteomic profile of the treated D. magna (LC20) was investigated in the pH range from 3 to 10 using 2-dimensional gel electrophoresis method and then analyzed by the Progenesis software to explore the differentially expressed proteins (DEPs) compared to the control organisms. The results showed that there were 179 DEPs caused by these two toxic compounds. More interestingly, the identified DEPs have been found to be involved in energy metabolism, oxidative stress response, dynamic structure of cytoskeleton filaments and effected by two chemicals in opposite ways: up- and down-regulation. A significant difference of protein expression between the control and the stress-exposed D. magna which confirmed the effect of toxic chemicals has been observed. In summary, the proteomic approach as well as the detailed analysis results were proved to be useful for understanding the novel molecular mechanisms for lead or atrazine induced pathological changes. Moreover, specific DEPs can be used as novel biomarker candidates to detect these heavy metal and pesticide.

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Codon usage bias and evolutionary analyses of Zika virus genomes

Abstract

Zika virus (ZIKV) is a member of the family Flaviviridae and contains a single-stranded RNA genome with positive-polarity. Like Dengue, Zika virus uses Aedes aegypti mosquito as a vector to infect human with a wide range of clinical signs, from asymptomatic to influenza-like syndrome. Despite significant progress in genomic analyses, how a viral relationship with two different hosts affect the overall fitness, constancy, and dodging of hosts immune system are elusive. Here we analyzed Zika virus codon-based evolution using eleven strains from different geographical locations. The overall codon usage was similar and slightly bias among all strains. An occurrence of A-ending in highly-preferred codons and analysis by various approaches strongly suggests that mutational bias is the main force shaping codon usage in this virus. However, natural selection and geographical realities cannot be ignored in marginal influence on codon usage. The viral genomes naturally favor Aedes aegypti over human host for tRNA pool in translation. Such findings will assist researchers in understanding elements contribute to viral adaptation and evolutionary setup with hosts.

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Serum level of C-reactive protein on postoperative day 3 is a predictive indicator of postoperative pancreatic fistula after laparoscopic gastrectomy for gastric cancer

Abstract

Introduction

Postoperative pancreatic fistula (POPF) is a serious complication after gastrectomy for gastric cancer. It is vitally important to detect signs of POPF in the early postoperative period and perform adequate management to avoid patient death. The aim of this study was to investigate the predictive indicators of POPF after laparoscopic gastrectomy for gastric cancer.

Methods

The current study included 197 patients who were pathologically diagnosed with adenocarcinoma and underwent laparoscopic gastrectomy between January 2010 and December 2014 in our hospital.

Result

Nine patients (5.6%) developed POPF of grade III or higher according to the Clavien–Dindo classification. There was no statistical difference between POPF and various clinicopathological indicators, including age, gender, BMI, extent of lymph node dissection, and operative procedure. With respect to postoperative laboratory data, however, the serum level of C-reactive protein on postoperative day 3 was significantly related to the development of POPF. Receiver–operating characteristic analysis indicated that optimal cut-off value of the serum level of C-reactive protein on postoperative day 3 was 17.0 mg/dL, with a sensitivity of 74.0, specificity of 88.0, positive predictive value of 0.14, and negative predictive value of 0.99.

Conclusion

An elevated C-reactive protein level on postoperative day 3 can help physicians predict the likelihood of POPF and facilitate decision making regarding prompt clinical evaluation and therapeutic approaches for POPF.

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Bilateral inguinal hernia after axillary-femoral artery bypass effectively treated with laparoscopic repair: A case report

Abstract

We report herein our experience with bilateral inguinal hernia surgery for a patient who had previously undergone a Y-shaped vascular graft for an abdominal aortic aneurysm and then right axillary-bilateral femoral artery bypass surgery. Preoperative physical examination and imaging revealed a subcutaneous vascular graft passing from the right axilla through the right flank region and branching at the lower abdomen to reach the femoral areas on both sides. As repair surgery by inguinal incision was considered difficult, we performed laparoscopic surgery. Bilateral direct hernia was observed on intraperitoneal observation. Essentially no intraperitoneal organ adhesion to the abdominal wall was present, and the previous surgery was also confirmed not to have reached the inguinal preperitoneal space. Transabdominal preperitoneal repair was therefore performed, yielding favorable results.

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