Δευτέρα, 31 Ιουλίου 2017

The lymphocyte cytokinesis block micronucleus test in human populations occupationally exposed to vinyl chloride: a systematic review and meta-analysis

Publication date: Available online 31 July 2017
Source:Mutation Research/Reviews in Mutation Research
Author(s): Claudia Bolognesi, Marco Bruzzone, Marcello Ceppi, Micheline Kirsch-Volders
Vinyl chloride (VC) is widely used in industry in the production of polyvinyl chloride (PVC), which is used to manufacture a large variety of materials. VC was classified as a known (Group 1) human carcinogen by IARC on the basis of increased risk for liver angiosarcoma and hepatocellular cancer, and the carcinogenicity of VC was shown to be mediated by a genotoxic mechanism. Following inhalation, the compound is rapidly absorbed and metabolized in the liver to the electrophilic metabolites chloroethylene-oxide and chloroacetaldehyde, which form DNA adducts that can be processed into point mutations in cancer-related genes detected in humans and rats exposed to VC. A number of genotoxicity biomarkers were applied in workers exposed to VC to detect early biological responses associated with the carcinogenesis process. The present systematic review analyzed the published studies in which the cytokinesis-block micronucleus assay in peripheral lymphocytes (L-CBMN) was applied in VC-exposed subjects. Thirteen out of fifteen retrieved studies performed in China showed increased MN frequencies (FR 1.92-3.98) associated with increased cumulative exposure or employment time. Twofold and more than threefold increases were detected in PVC-exposed workers exposed to a mean of 50ppm of VC in the former Yugoslavia and in South India, respectively. The meta-analysis of MN frequency from six eligible studies confirmed this tendency (pooled MR 2.32 − 95% CI 1.64-3.27). The benchmark dose lower limit for 10% excess risk (BMDL 10) calculated from three studies resulted in an estimated exposure limit of 0.03-0.07mg/m3. Overall the results of this review showed the need for further studies, especially because PVC products from China may contain high levels of uncoupled VCM that could represent a source of exposure to workers and consumers. Moreover, the results underline the importance of re-evaluating the recommended exposure limits using new biomonitoring methods in addition to MN.



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Advancing imaging technologies for patients with spinal pain: with a focus on whiplash injury

Radiological observations of soft-tissue changes that may relate to clinical symptoms in patients with traumatic and non-traumatic spinal disorders are highly controversial. Studies are often of poor quality and findings inconsistent. A plethora of evidence suggests some pathoanatomical findings from traditional imaging applications are common in asymptomatic participants across the life span, which further questions the diagnostic, prognostic, and theranostic value of traditional imaging. While we do not dispute the limited evidence for the clinical importance of most imaging findings, we contend that the disparate findings across studies, may in part be due to limitations in the approaches used in assessment and analysis of imaging findings.

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Is There a Future for Therapists?



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Reply to “Axonal hyperexcitability due to Schwann cell involvement in chronic progressive external ophthalmoplegia”

We thank Drs. Finsterer and Zarrouk-Mahjoub (Finsterer and Zarrouk-Mahjoub, 2017) for their interest in our paper on chronic progressive external ophthalmoplegia (CPEO) (Gueguen et al., 2017).

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A double determination of central motor conduction time in the assessment of Hirayama disease

Hirayama disease (HD) is a benign neurological disease associated with unilateral or asymmetric weakness and/or amyotrophy in the muscles supplied by the C7-T1 myotomes, without significant sensory involvement and myelopathy (Hirayama, 2000; Zhou et al., 2010; Wang et al., 2012).

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Fine motor skills predict performance in the Jebsen Taylor Hand Function Test after stroke

In our daily life, we are highly dependent on the functionality of our hands. Fine motor skills are essential for holding, grasping and manipulating objects. They require an interplay between multiple sensorimotor systems. Visual, haptic, auditory and sensory information has to be integrated with sensorimotor predictions based on mechanical properties of objects being manipulated, such as weight and surface. Additionally, reactive adaptions to changing loads (Nowak et al., 2013) also play an important role.

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Prolongation of Terminal Latency of the Phrenic Nerve in Amyotrophic Lateral Sclerosis – Is it Clinically Useful, and what are the Mechanisms?

I read with interest the manuscript "The terminal latency of the phrenic nerve correlated with respiratory symptoms in amyotrophic lateral sclerosis" (this issue) by Park and Park, concluding that distal latency is the best parameter of phrenic nerve conduction to indicate early respiratory impairment in amyotrophic lateral sclerosis (ALS) patients. They investigated 23 ALS patients, split in 2 groups as defined by respiratory subscore of ALSFRS-R scale, each with a very small number of subjects (12 and 11).

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Axonal hyperexcitability due to Schwann cell involvement in chronic progressive external ophthalmoplegia

With interest we read the article by Gueguen et al. about axonal hyperexcitability depended on the degree of muscle weakness in 13 patients with chronic progressive external ophthalmoplegia (CPEO) (Gueguen et al. 2017). We have the following comments and concerns.

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Applying a pelvic corrective force induces forced use of the paretic leg and improves paretic leg EMG activities of individuals post-stroke during treadmill walking

Walking dysfunction is one of the commonly reported physical limitations after stroke (Perry et al., 1995). Individuals with post-stroke hemiparesis typically demonstrate slow gait velocity, reduced stride and step length, and both decreased period of stance and increased period of swing of the paretic leg (Balaban and Tok, 2014; Patterson et al., 2010a). As walking dysfunction can increase the risk of falls (Hausdorff et al., 2001), restrict functional mobility and negatively affect quality of life (Maclean et al., 2000; Perry et al., 1995; Schmid et al., 2007), an important goal of stroke rehabilitation is to improve symmetrical gait patterns.

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EEG-arousal regulation as predictor of treatment response in patients suffering from obsessive compulsive disorder

Obsessive Compulsive Disorder (OCD) is a neuropsychiatric disease characterized by recurrent intrusive thoughts as the obsessive part and/or repetitive ritualistic behavior as the compulsive component (American Psychiatric Association, 2013). OCD affects between 0,8 and 4% as lifetime prevalence (Angst et al, 2004; Baldwin et al, 2005; Karno et al, 1988; Robins et al, 1984) and the often chronic course is associated with high impairment in quality of life (Fontenelle et al, 2010; Hollander et al, 1996; Moritz, 2008).

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Reply to “Prolongation of Terminal Latency of the Phrenic Nerve in Amyotrophic Lateral Sclerosis – Is it Clinically Useful, and what are the Mechanisms?”

We appreciate de Carvalho's interest and constructive comments (de Carvalho, 2017) on our recent article (Park et al. 2017). He raised an important point on the possible mechanisms concerning the significantly prolonged terminal latency of the phrenic nerves in amyotrophic lateral sclerosis (ALS) in our recent study.

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Molecular Dynamics Simulations of Quinolone Resistance-Associated T86I and P104S Mutations in Campylobacter jejuni gyrA: Unraveling Structural Repercussions

Microbial Drug Resistance , Vol. 0, No. 0.


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First Report on a Randomized Investigation of Antimicrobial Resistance in Fecal Indicator Bacteria from Livestock, Poultry, and Humans in Tanzania

Microbial Drug Resistance , Vol. 0, No. 0.


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Dynamics of the EEG spectral density in the θ, α, and β bands in the visual Go / NoGo task

Abstract

The study was aimed at analyzing event-related desynchronization/synchronization (ERD/ERS) in 19-channel EEGs recorded in 329 healthy subjects in the course of a Go/NoGo task. Three methods were tested: reference, current source density (CSD), and group decomposition by independent component analysis (ICA). A comparison of the three data sets showed that the ICA method better reflects the local features of the brain responses in the θ, α, and β ranges. The functional significance of the group ICA components is discussed.



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Effectiveness of vertical posture recovery after external pushing impact in athletes specialized in different sports

Abstract

The ability of athletes with different training specializations to recover vertical posture after an external pushing impact was studied. Athletes engaged in cyclic exercise sports (jogging, n = 7) and complex coordinate sports (wrestling, n = 10) and nonathletes (control, n = 10) were the subjects of this study. The recovery of vertical position after a small external pushing impact on the arms extended forward was assessed using stabilography. We determined the maximum amplitude (Amp-m) of deviation from the general center of pressure, the reaction time (RT) and the velocity of reaction (V-r), as well as the variance and mean velocity of vertical posture oscillations before and after an impact. It was found that, although no differences were observed in the vertical posture stability before pushing, the Amp-m was lower in the wrestlers than in the control group (by 17.5%, p = 0.018 under the eye-open conditions; by 27.3%, p = 0.002 under the eye-closed conditions). The deprivation of visual information about the pushing moment increases the Amp-m and V-r and had no effect on the RT in all groups. Under the eye-closed conditions, an increase in Amp-m as a result of pushing was significantly lower in the wrestlers (p = 0.033) than in the control group. Under the eye-closed conditions, the accuracy of the recovery of the initial vertical position after pushing was higher in the wrestlers than in the control group (p = 0.027). The indicators of postural stability, displacement of the center of pressure, and vertical posture sway and recovery after pushing did not differ between the runners and other groups. Therefore, compared to cyclic exercises, training in complex coordinating sports more effectively improves the ability to maintain vertical posture in response to its perturbation.



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Health state, emotional intelligence, and behavior strategy: I. The development of emotional intelligence and the variability of behavior strategies in older preschool children with different levels of habitual physical activity

Abstract

On the basis of the concept of the typological variability of human physiological individuality, we have determined the systemic correlation between the indicators of cognitive activity and the parameters and development of emotional intelligence (EI) and the formation of typical behavior strategies in older preschool children of three functional types (FT-1, FT-2, and FT-3), including subjects with low (LHPA), medium (MHPA), and high (HHPA) levels of habitual physical activity. We revealed the EI features typical of each functional group of children and observed a strong negative correlation between the indicator of HPA and the total EI score. The typical manifestation of EI is closely related to other psychological parameters of cognitive and emotional–volitional activity (logical and imaginative thinking, state anxiety, and attention), which allowed us to establish the constitutional features of the behavior strategy on the basis of the integrated assessment of all the obtained data. In different conflict situations, children with HHPA (FT-3) made decisions more rapidly and by themselves; their decisions were active and aimed at achieving a specific goal on the basis of domination (individual problem solving). In contrast, children with LHPA (FT-1) solved the problems on the basis of the emotional state of other people and preferred to explain the situation to their parents or educators and ask for help (cooperative problem solving). Up to 10% of children with LHPA preferred not to solve the problem.



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Electroencephalographic dynamics of individual alpha peak frequency during the female ovarian-menstrual cycle

Abstract

Electroencephalographic brain dynamics during the menstrual, follicular, preovulatory, ovulatory, luteal and premenstrual phases of the female ovarian-menstrual cycle were analyzed. All subjects were divided into 3 groups according to individual alpha peak frequency and reaction to rhythmical photostimulation. Data obtained confirm the necessity to carry out experimental and clinical psychophysiological studies of women in the phases of the ovarian-menstrual cycle.



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Disorders of top–down cognitive control in students with learning difficulties

Abstract

The model of fixed set (for Uznadze's paradigm) was used to estimate the functional activity of the cortico-thalamic system of selective attention and cortico-hyppocampal system of emotional and volitional activity in second-year medical students with learning difficulties (n = 20). The control group (n = 30) consisted of successfully studying students of the same year. We observed a significant reduction of induced reactions of neocortical EEG α oscillations in response to the facial stimuli or conditioning Go/NoGo signals in underperforming students. This indicates a decrease in the functional activity of the corticothalamic system of selective attention, i.e., weakening of the top–down cognitive control. This disorder is the psychophysiological basis of cognitive difficulties in the learning process. The amplitude of θ-range cortical potentials in underperforming students is significantly higher than that in the control group, i.e., the level of functional activity of the cortico-hippocampal system is higher, which indicates a higher level of stress. These findings make it possible to conclude that psychophysiological laboratory studies should be used as a supporting tool for high school teachers and psychologists during their work with students with learning difficulties.



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Metabolic responses of the body to breathing with hypoxic argon–oxygen and nitrogen–oxygen mixtures

Abstract

We have studied metabolic responses of six male volunteers who were exposed to hypoxic nitrogen–oxygen and argon–oxygen respiratory mixtures under hermetic chamber conditions for a long time. We measured the values of 44 biochemical parameters of venous blood, which reflected the state of different parts of metabolism, as well as the state of organs and tissues. Under the conditions of argon–oxygen respiratory mixture with the level of oxygen of 12.8% within the first five days and 12.0% from six to ten days of the experiment, the activation of processes of anaerobic glycolysis and lipolysis with the development of metabolic acidosis was observed. Against this background, biochemical signs of unfavorable changes in the myocardium were recorded. When we used the nitrogen–oxygen respiratory mixture with the level of oxygen of 13.0% during the first five days of the experiment and 12.1% from the sixth to the tenth day, these changes were expressed much more significantly: the activation of lipolysis and a decrease in the level of serum iron were observed and the signs of damage of mitochondria, depression of the kidney function, and development of hypodynamia were recorded. Complete stabilization of metabolic processes was reached only after seven to eight days of the recovery period for both mixtures. These findings lead to the conclusion that it is physiologically more preferable to use oxygen–argon respiratory mixtures at small immersion depths.



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Lexical context affects mismatch negativity caused by pseudowords

Abstract

The aim of this study was to investigate the effect of lexical context on the latency and the amplitude of the mismatch negativity (MMN) brain potential caused by perception of pseudowords. The eventrelated potentials were recorded according to the multideviant passive odd-ball paradigm by using only pseudowords (control condition) or pseudowords with Russian words with different lexical frequencies (lexical context). It was found that different MMN patterns were generated when the same pseudoword was presented in different contexts. Pseudoword presentation in a context with other pseudowords resulted in a relatively small amplitude and large latency of MMN. If the same pseudoword was presented in a context with words, it induced significantly increased amplitude and reduced latency of MMN varying in the range of 100–200 ms. It is supposed that the pseudoword presented in a context with words is perceived as conceptually different stimulus, which leads to a significant increase in MMN. Moreover, our findings support the hypothesis that MMN is affected by lexical frequency. In particular, presentation of a high-frequency word induced a significantly more pronounced MMN response than a low-frequency one. High-frequency words also evoked earlier response, which indicates more rapid access to a frequently used lexical entry. More frequent use of certain words results in stronger internal connections in the corresponding memory circuit, which in turn is determined by the lexical context. We hypothesize that different intensities of activation depends on the strength of lexical representation.



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Age-related dynamics of the parameters of somatosensory evoked potentials in healthy children

Abstract

The purpose of this study was to evaluate the parameters of somatosensory evoked potentials (SSEPs) in healthy children of different age groups (n = 94). The amplitudes of the main cortical peaks and the central sensory conduction time (CSCT) from n. medianus and n. tibialis in children aged under 12 months, 1–12 years, and 12–17 years were estimated and compared. No significant cortical peaks were recorded from the tibial nerve in five children younger than 1 year (5 out of 23, 22%). Significant differences in CSCT were observed between the children younger than 1 year and two other groups. The amplitudes did not significantly differ between the groups. Thus, SSEPs may be used for the evaluation of somatosensory pathways in children aged one month to 17 years. CSCT differs significantly between children younger than 1 year and other age groups. Age-related reduction in CSCT and elevation of the cortical peak amplitudes may reflect the myelination of somatosensory pathways and the improvement in nervous system integration.



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Influence of passive tactile contact of arms on the maintenance of upright posture in humans

Abstract

The influence of light passive contact of the forearm with a pliable external object (flexible plate) on the maintenance of upright posture was studied in healthy subjects in several conditions, with the eyes closed and on immersion in a virtual visual environment (VVE). The visual environment was either stable or unstable as a result of a synphase (SP) or antiphase (AP) association between the environment and body sway. The posture maintenance analysis focused on estimating the amplitude and frequency characteristics of two elementary variables, which were calculated from the foot center of pressure (CoP) trajectories in the mediolateral and anteroposterior directions. The variables were trajectory of the vertical projection of the center of gravity (variable CG) and difference between the CoP and CG trajectories (variable CoP–CG). In both the absence and presence of passive tactile contact, the root mean square (RMS) values of the oscillation spectra of the two variables were the lowest in the stable visual environment and in the case of the antiphase association of the environment with body sways and the highest in the cases of the synphase association and standing with the eyes closed. Passive contact decreased body sways in both directions, and the RMSs of the spectra of the two variables decreased in all visual conditions. A greater decrease in RMS was observed for the CG variable. Body sways changed not only in amplitude, but also in frequency. Tactile contact increased the median frequencies (MFs) of the CG variable spectra calculated from the anteroposterior and mediolateral body sways. In contrast, a significant increase in MFs calculated for the CoP–CG variable was observed only for anteroposterior body sways. The results showed that passive contact of a forearm with a pliable external object, which does not provide a mechanical support for the subject, significantly improves the maintenance of the upright posture even in an unstable visual environment.



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Correlations between some structural and functional brain parameters in subjects with high risk of schizophrenia

Abstract

The study was aimed to the analysis of correlations between anatomic brain parameters and characteristics of neurophysiological and metabolic supportive mechanisms of cognitive functions in the patients with ultra-high risk of schizophrenia. The study comprised 30 young male patients and 30 age- and sexmatched mentally healthy subjects. We used the methods of diffusion-weighted tomography, single voxel proton MR spectroscopy, and oddball ERP recording. The statistically significant intergroup differences in the structural connectivity were confirmed in the anterior thalamic radiation of the left hemisphere. The diffusion abnormalities in this area were correlated with P300 latencies and the level of γ-aminobutyric acid (GABA).



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β 2 -adrenergic receptor maladaptations to high power resistance exercise overreaching

Abstract

The effects of a recovery drink on overreaching induced by high frequency, high power resistance exercise was assessed. Resistance trained men were assigned to a supplemented (SUP, n = 8), placebo (PL, n = 3) or control (CON, n = 6) groups. All groups completed two weeks of familiarization training using the barbell squat. In week three, SUP and PL performed ten sets of five repetitions of speed squats twice daily, for a total of 15 training sessions. CON maintained their prior training schedule. Data were collected before week three (T1), after week three (T2) and after a week of recovery by training cessation (T3). During week three, SUP consumed an amino acid, carbohydrate and creatine monohydrate containing recovery drink immediately after each training bout. PL was provided a drink of similar appearance and taste but containing minimal nutritional value. At T2, both SUP and PL decreased mean squat velocity and power at 70% 1RM. Additionally, SUP and PL decreased muscle β2-adrenergic receptor (β2-AR) expression by 61 and 83%, respectively. Increases in the ratio of nocturnal urinary epinephrine/β2-AR ratio (EPI: β2AR) for SUP and PL suggested impaired sympathetic nervous system sensitivity. SUP demonstrated a smaller decrease in β2-AR expression and a lower EPI: β2AR, suggesting the recovery drink attenuated the detrimental effects of overreaching on the sympathetic activity. In conclusion, high power resistance exercise overreaching can induce performance decrements and impair sympathetic activity, but these effects may be attenuated by supplementation.



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The precedence effect for signals moving in the horizontal plane

Abstract

The precedence effect refers to a group of auditory phenomena related to the ability to locate sound sources in reverberant environments. In the present study, this phenomenon was investigated using two moving signals. The first signal was direct (lead) and the other was delayed (lag). The motion of the sound source was created by successive switching of ten loudspeakers. The continuity of the motion was created by simultaneously attenuating the stimulus in the previous loudspeaker and enhancing it in the next one. The length of the path of the lead and lag was 34°. The lead moved from 34° to 0° (to the right) and the lag moved –52° to –86° (to the left). The duration of the lead and the lag was 1 s. Lead–lag delays ranged from 1 to 40 ms. Subjects had to indicate the location of the lag. The results indicate that the lead signal dominated in the sound localization at short delay durations (up to 18 ms). In spite of the instructions, all the subjects pointed at the lead, which suggests that they perceived the lag in this location. Two distinct sounds were perceived at the longest delays. The mean echo threshold and its standard deviation in eight subjects was 9.6 ± 4.5 ms.



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Strategies of adaptation of small arteries in diaphragm and gastrocnemius muscle to aerobic exercise training

Abstract

Aerobic exercise training is associated with adaptive changes in skeletal muscles and their vascular bed; such changes in individual muscles may vary depending on their characteristics and recruitment. This study was aimed at comparing the effects of eight-week treadmill training on the locomotor and respiratory muscles in rats. The training course increased the aerobic performance in rats, which was evidenced by an increase in maximum O2 consumption and a decrease in the blood lactate concentration in ramp test. The succinate dehydrogenase activity was increased in the red portion of the gastrocnemius muscle, but not in the diaphragm of trained rats. Arterial segments were isolated from feed arteries and studied by wire myography. The relaxation in response to acetylcholine in gastrocnemius arteries in trained animals was higher as compared with controls (due to higher NO production), while contractile responses to noradrenaline (in the presence of propranolol) were not changed. On the contrary, the endothelial function of diaphragm arteries was not affected by training, but contractile responses to activation of α-adrenoceptors were markedly increased. Thus, aerobic training may increase the blood supply rate to both locomotor and respiratory muscles, but the underlying regulatory mechanisms are different. The results obtained allow us to reveal the physiological mechanisms that determine the physical performance of the body under conditions of compromised functioning of the respiratory system.



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Differentiation of serum markers of homeostasis in highly qualified athletes engaged in various sports

Abstract

Prognostic express diagnosis of metabolic dysregulation was tested in highly qualified athletes engaged in various Olympic sports. The method is based on laser correlation spectroscopy (LCS) of biological fluids, which has widely been approved for use in medicine and evaluation of risks for natural and anthropogenic anomalies. Evaluating the risk for metabolic dysregulations with the relevant criteria will help to objectively estimate the efficiency of preventive actions in athletes.



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Changes in cardiohemodynamic parameters, cardiointervalography, and microcirculation observed in local cold test in young men born in northern regions

Abstract

The cardiohemodynamic and blood microcirculation parameters at rest and under local cold exposure in young male subjects have been estimated. It has been found that the subjects with the initially low velocity of erythrocytes (blood flow) in their nail bed capillaries have higher blood pressure, stroke volume, cardiac output, and cardiac index, which proves that these subjects have the hyperkinetic type of blood flow with the pronounced hypertensive reaction. At the same time, the shift of heart rate variability values under the cold exposure indicates that the activation of the sympathetic autonomic nervous system is more statistically significant than that in those subjects who originally had a higher velocity of erythrocytes. In the subjects of this group, no changes were observed in either heart rate autonomic regulation or index of tension under the local cold exposure, which proved that these subjects had the enhanced functional reserves of the cardiovascular system and autonomic regulation. They also had a fairly pronounced reactivity of the parameters of systemic hemodynamics, which manifested itself in changes in their blood filling parameters against the background of decrease in total peripheral vascular resistance and coefficient of integral tonicity.



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Role of hormones in regulating sodium transporters in the kidney: Modulation of phosphorylation, traffic, and expression

Abstract

The review focuses on the key sodium transporters involved in maintaining water–salt balance in the kidney. The topography of sodium transporters is discussed. Specifics of the hormone-dependent regulation, including phosphorylation, traffic, and expression, are considered for particular transporters. Special attention is paid to direct intracellular regulators of the transporter function. The role that dopamine plays as a natriuretic factor in modulating the function of various transporters is described.



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The link between exercise and titin passive stiffness

New Findings

  • What is the topic of this review?

    This review focuses on how in vivo and molecular measurements of cardiac passive stiffness can predict exercise tolerance and how exercise training can reduce cardiac passive stiffness.

  • What advances does it highlight?

    This review highlights advances in understanding the relationship between molecular (titin-based) and in vivo (left ventricular) passive stiffness, how passive stiffness modifies exercise tolerance, and how exercise training may be therapeutic for cardiac diseases with increased passive stiffness.

Exercise can help alleviate the negative effects of cardiovascular disease and cardiovascular co-morbidities associated with sedentary behaviour; this may be especially true in diseases that are associated with increased left ventricular passive stiffness. In this review, we discuss the inverse relationship between exercise tolerance and cardiac passive stiffness. Passive stiffness is the physical property of cardiac muscle to produce a resistive force when stretched, which, in vivo, is measured using the left ventricular end diastolic pressure–volume relationship or is estimated using echocardiography. The giant elastic protein titin is the major contributor to passive stiffness at physiological muscle (sarcomere) lengths. Passive stiffness can be modified by altering titin isoform size or by post-translational modifications. In both human and animal models, increased left ventricular passive stiffness is associated with reduced exercise tolerance due to impaired diastolic filling, suggesting that increased passive stiffness predicts reduced exercise tolerance. At the same time, exercise training itself may induce both short- and long-term changes in titin-based passive stiffness, suggesting that exercise may be a treatment for diseases associated with increased passive stiffness. Direct modification of passive stiffness to improve exercise tolerance is a potential therapeutic approach. Titin passive stiffness itself may be a treatment target based on the recent discovery of RNA binding motif 20, which modifies titin isoform size and passive stiffness. Translating these discoveries that link exercise and left ventricular passive stiffness may provide new methods to enhance exercise tolerance and treat patients with cardiovascular disease.

Thumbnail image of graphical abstract

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Braun Industries and Pierce Manufacturing team up for all-in-one apparatus

The Patriot Model is a versatile apparatus that can serve as an ambulance, rescue vehicle and fire suppression unit

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Early hominin landscape use in the Lower Omo Valley, Ethiopia: Insights from the taphonomical analysis of Oldowan occurrences in the Shungura Formation (Member F)

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Publication date: October 2017
Source:Journal of Human Evolution, Volume 111
Author(s): Tiphaine Maurin, Pascal Bertran, Anne Delagnes, Jean-Renaud Boisserie
The Oldowan archeological record of the Shungura Formation, Member F (Lower Omo valley, Ethiopia) comprises more than one hundred occurrences distributed within archeological complexes, where multiple small spots were found in association with one or two larger occurrences. Such spatial patterning could reflect hominin spatial behavior, repeated occupations within a single sedimentary unit, or taphonomic and/or collection biases. Here we test these hypotheses by way of a geoarcheological and taphonomical analysis using four criteria to assess the preservation of the lithic assemblages: (1) size composition, (2) artifact abrasion, (3) bone abrasion, and (4) orientations of lithic artifacts and bones (i.e., fabrics). We propose a new model of taphonomically induced spatial patterning where the multiple, small, well circumscribed occurrences result primarily from post-depositional processes and therefore do not reflect any underlying behavioral patterns. The large number of archeological occurrences documented in Member F, therefore, corresponds to a limited number of primary occupations (<10). The archeological occupation is mainly restricted to the lower part of Member F and may reflect a single or a small number of occupation episodes, which were located on previous levees of the paleo-Omo River, in nearby floodplain areas, or on the riverbank. This strongly suggests that most of the knapping activities originally took place close to the river. This preference of the Omo toolmakers for riverine environments could explain the scarcity of archeological material in the upper part of Member F that comprises primarily distal floodplain sedimentary facies.



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Evidence of Neanderthals in the Balkans: The infant radius from Kozarnika Cave (Bulgaria)

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Publication date: October 2017
Source:Journal of Human Evolution, Volume 111
Author(s): Anne-marie Tillier, Nikolay Sirakov, Aleta Guadelli, Philippe Fernandez, Svoboda Sirakova, Irena Dimitrova, Catherine Ferrier, Guillaume Guérin, Maryam Heidari, Ivailo Krumov, Jean-Claude Leblanc, Viviana Miteva, Vasil Popov, Stanimira Taneva, Jean-Luc Guadelli
Excavations conducted by a Bulgarian-French team at Kozarnika Cave (Balkans, Bulgaria) during several seasons yielded a long Paleolithic archaeological sequence and led to the discovery of important faunal, lithic, and human samples. This paper aims to describe the unpublished radius shaft of an infant who died approximately before the sixth month postnatal that was recovered from layer 10b, which contained East Balkan Levallois Mousterian with bifacial leaf points. The layer was dated between 130 and 200 ka (large mammals biochronology) and between 128 ± 13 ka and 183 ± 14 ka (OSL), i.e. OIS6. Here we show that, given the scarcity of Middle Pleistocene infant remains in general, and Middle Paleolithic human remains from this part of Eastern Europe in particular, the study of the Kozarnika specimen is of special interest. We discuss its place in the Middle Pleistocene European hominine record and substantiate the hypothesis of early Neanderthal presence in the eastern Balkans.



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Paleolithic subsistence strategies and changes in site use at Klissoura Cave 1 (Peloponnese, Greece)

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Publication date: October 2017
Source:Journal of Human Evolution, Volume 111
Author(s): Britt M. Starkovich
Klissoura Cave 1 in southern Greece preserves a long archaeological sequence that spans roughly 90,000 years and includes Middle Paleolithic, Uluzzian, Upper Paleolithic, and Mesolithic deposits. The site provides a unique opportunity to examine diachronic change and shifts in the intensity of site use across the Late Pleistocene. There is an overall picture of the intensified use of faunal resources at the site, evidenced by a shift from large to small game, and to small fast-moving taxa in particular. This trend is independent of climatic change and fluctuations in site use, and most likely reflects a broader, regional growth of hominin populations. At the same time, multiple lines of evidence (e.g., input of artifacts and features, sedimentation mechanisms, and intensification of faunal resources) indicate that the intensity of site use changed, with a sharp increase from the Middle Paleolithic to Aurignacian. This allows us to address a fundamental issue in the study of human evolution: differences in population size and site use between Neandertals and modern humans. At Klissoura Cave 1, the increase in occupation intensity might be related to population growth or larger group size, but it might also be due to changes in season of site use, more favorable environmental conditions at the beginning of the Upper Paleolithic, and/or changes in the composition of people occupying the site. These explanations are not necessarily mutually exclusive, and indeed the data support a combination of factors. Ascribing the increase in occupation intensity to larger Upper Paleolithic populations more broadly is difficult, particularly because there is little consensus on this topic elsewhere in Eurasia. The data are complicated and vary greatly between sites and regions. This makes Klissoura Cave 1, as the only currently available case study in southeastern Europe, a critical example in understanding the range of variation in demography and site use across the Middle to Upper Paleolithic transition.



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Landscape scale heterogeneity in the East Turkana ecosystem during the Okote Member (1.56–1.38 Ma)

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Publication date: Available online 29 July 2017
Source:Journal of Human Evolution
Author(s): D.B. Patterson, D.R. Braun, A.K. Behrensmeyer, S.B. Lehmann, S.R. Merritt, J.S. Reeves, B.A. Wood, R. Bobe
Placing the biological adaptations of Pleistocene hominins within a well-resolved ecological framework has been a longstanding goal of paleoanthropology. This effort, however, has been challenging due to the discontinuous nature of paleoecological data spanning many important periods in hominin evolution. Sediments from the Upper Burgi (1.98–1.87 Ma), KBS (1.87–1.56 Ma) and Okote (1.56–1.38 Ma) members of the Koobi Fora Formation at East Turkana in northern Kenya document an important time interval in the evolutionary history of the hominin genera Homo and Paranthropus. Although much attention has been paid to Upper Burgi and KBS member deposits, far less is known regarding the East Turkana paleoecosystem during Okote Member times. This study pairs spatially-resolved faunal abundance data with stable isotope geochemistry from mammalian enamel to investigate landscape-scale ecosystem variability during Okote Member times. We find that during this period 1) taxa within the East Turkana large mammal community were distributed heterogeneously across space, 2) the abundance of C3 and C4 vegetation varied between East Turkana subregions, and 3) the Karari subregion, an area with abundant evidence of hominin stone tool manufacture, had significantly more C3 vegetation than regions closer to the central axis of the Turkana Basin (i.e., Ileret and Koobi Fora). These findings indicate that the East Turkana paleoecosystem during the Okote Member was highly variable across space and provided a complex adaptive landscape for Pleistocene hominins.



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Genetic mutations in RNA-binding proteins and their roles in ALS

Abstract

Mutations in genes that encode RNA-binding proteins (RBPs) have emerged as critical determinants of neurological diseases, especially motor neuron disorders such as amyotrophic lateral sclerosis (ALS). RBPs are involved in all aspects of RNA processing, controlling the life cycle of RNAs from synthesis to degradation. Hallmark features of RBPs in neuron dysfunction include misregulation of RNA processing, mislocalization of RBPs to the cytoplasm, and abnormal aggregation of RBPs. Much progress has been made in understanding how ALS-associated mutations in RBPs drive pathogenesis. Here, we focus on several key RBPs involved in ALS—TDP-43, HNRNP A2/B1, HNRNP A1, FUS, EWSR1, and TAF15—and review our current understanding of how mutations in these proteins cause disease.



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Sevoflurane attenuates systemic inflammation compared with propofol, but does not modulate neuro-inflammation: A laboratory rat study.

BACKGROUND: Septic encephalopathy is believed to be a result of neuro-inflammation possibly triggered by endotoxins, such as lipopolysaccharides (LPS). Modulation of the immune system is a property of volatile anaesthetics. OBJECTIVE: We aimed to investigate the systemic and cerebral inflammatory response in a LPS-induced sepsis model in rats. We compared two different sedation strategies, intravenous propofol and the volatile anaesthetic sevoflurane, with the hypothesis that the latter may attenuate neuro-inflammatory processes. DESIGN: Laboratory rat study. SETTING: Basic research laboratories at the University Hospital Zurich and University Zurich Irchel between August 2014 and June 2016. PATIENTS: A total of 32 adult male Wistar rats. INTERVENTIONS: After tracheotomy and mechanical ventilation, the anaesthetised rats were monitored before sepsis was induced by using intravenous LPS or phosphate-buffered saline as control. Rats were sedated with propofol (10 mg kg-1 h-1) or sevoflurane (2 vol%) continuously for 12 h. MAIN OUTCOME MEASURES: Systemic inflammatory markers such as cytokine-induced neutrophil chemo-attractant protein 1, monocyte chemo-tactic protein-1 and IL-6 were determined. The same cytokines were measured in brain tissue. Cellular response in the brain was assessed by defining neutrophil accumulation with myeloperoxidase and also activation of microglia with ionised calcium-binding adaptor molecule-1 and astrocytes with glial fibrillary acidic protein. Finally, brain injury was determined. RESULTS: Animals were haemodynamically stable in both sedation groups treated with LPS. Blood cytokine peak values were lower in the sevoflurane-LPS compared with propofol-LPS animals. In brain tissue of LPS animals, chemoattractant protein-1 was the only significantly increased cytokine (P = 0.003), however with no significance between propofol and sevoflurane. After LPS challenge, cerebral accumulation of neutrophils was observed. Microglia activation was pronounced in the hippocampus of animals treated with LPS (P = 0.006). LPS induced prominent astrogliosis (P

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EMT/Paramedic Program Director/Instructor - Ozarks Technical Community College

Date Position Available: September 5, 2017 Salary Scale: Salary based on experience and education. Qualifications & Experience: MANDATORY: (M1) Bachelor's degree from a regionally accredited institution of higher learning; (M2) Current certification as an EMT/Paramedic; (M3) Two years of experience in emergency medical systems; (M4) Demonstrate current knowledge in course content and effectiveness ...

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Second-Order Peer Reviews of Clinically Relevant Articles for the Physiatrist: Additional Weekend Therapy May Reduce Length of Rehabilitation Stay After Stroke: A Meta-analysis of Individual Patient Data.

No abstract available

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Aquatic Exercises in the Treatment of Low Back Pain: A Systematic Review of the Literature and Meta-Analysis of Eight Studies.

Objective: Low back pain is the most common musculoskeletal condition with a high prevalence. There was no sufficient evidence to recommend that aquatic exercise was potentially beneficial to patients with low back pain. The aim of this study was to systematically analyze all evidence available in the literature about effectiveness of the aquatic exercise. Design: A comprehensive search of PubMed, the Cochrane Library, Embase, and Cumulative Index to Nursing and Allied Health was conducted from their inceptions to November 2016 for randomized controlled trials, which concerned the therapeutic aquatic exercise for low back pain. The results were expressed in terms of standardized mean difference and the corresponding 95% confidence interval. Results: Eight trials involving 331 patients were included in the meta-analysis, and the results showed a relief of pain (standardized mean difference = -0.65, 95% confidence interval = -1.16 to -0.14) and physical function (standardized mean difference = 0.63, 95% confidence interval = 0.17 to 1.09) after aquatic exercise. However, there was no significant effectiveness with regard to general mental health in aquatic group (standardized mean difference = 0.46; 95% confidence interval = -0.22 to 1.15). Conclusions: Aquatic exercise can statistically significantly reduce pain and increase physical function in patients with low back pain. Further high-quality investigations on a larger scale are required to confirm the results. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Quadratus Lumborum Block Versus Transversus Abdominis Plane Block in Children Undergoing Low Abdominal Surgery: A Randomized Controlled Trial.

Background and Objectives: Truncal blocks have a place within multimodal analgesia techniques in abdominal surgery. The quadratus lumborum block is a new abdominal truncal block used for somatic analgesia of both the upper and lower abdomen. In this prospective, double-blind, randomized study, we aimed to compare quadratus lumborum block and transversus abdominis plane block in pediatric patients undergoing lower abdominal surgery. Methods: Fifty-three children undergoing unilateral inguinal hernia repair or orchiopexy surgery were randomized into 2 groups: transversus abdominis plane block and quadratus lumborum block. All blocks were performed under general anesthesia before surgery. Pain levels were assessed using an FLACC (Face, Legs, Activity, Cry, Consolability) scale. Results: The study included 50 patients, after excluding 3 patients who were not eligible. The number of patients who required analgesia in the first 24 hours postoperatively was significantly lower in the quadratus lumborum block group (P

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Ultrasound-Guided Regional Anesthesia Simulation Training: A Systematic Review.

Background and Objectives: Ultrasound-guided regional anesthesia (UGRA) has become the criterion standard of regional anesthesia practice. Ultrasound-guided regional anesthesia teaching programs often use simulation, and guidelines have been published to help guide URGA education. This systematic review aimed to examine the effectiveness of simulation-based education for the acquisition and maintenance of competence in UGRA. Methods: Studies identified in MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and ERIC were included if they assessed simulation-based UGRA teaching with outcomes measured at Kirkpatrick level 2 (knowledge and skills), 3 (transfer of learning to the workplace), or 4 (patient outcomes). Two authors independently reviewed all identified references for eligibility, abstracted data, and appraised quality. Results: After screening 176 citations and 45 full-text articles, 12 studies were included. Simulation-enhanced training improved knowledge acquisition (Kirkpatrick level 2) when compared with nonsimulation training. Seven studies measuring skill acquisition (Kirkpatrick level 2) found that simulation-enhanced UGRA training was significantly more effective than alternative teaching methods or no intervention. One study measuring transfer of learning into the clinical setting (Kirkpatrick level 3) found no difference between simulation-enhanced UGRA training and non-simulation-based training. However, this study was discontinued early because of technical challenges. Two studies examined patient outcomes (Kirkpatrick level 4), and one of these found that simulation-based UGRA training improved patient outcomes compared with didactic teaching. Conclusions: Ultrasound-guided regional anesthesia knowledge and skills significantly improved with simulation training. The acquired UGRA skills may be transferred to the clinical setting; however, further studies are required to confirm these changes translate to improved patient outcomes. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

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Impact of Different Ventilation Strategies on Driving Pressure, Mechanical Power, and Biological Markers During Open Abdominal Surgery in Rats.

BACKGROUND: Intraoperative mechanical ventilation may yield lung injury. To date, there is no consensus regarding the best ventilator strategy for abdominal surgery. We aimed to investigate the impact of the mechanical ventilation strategies used in 2 recent trials (Intraoperative Protective Ventilation [IMPROVE] trial and Protective Ventilation using High versus Low PEEP [PROVHILO] trial) on driving pressure ([DELTA]PRS), mechanical power, and lung damage in a model of open abdominal surgery. METHODS: Thirty-five Wistar rats were used, of which 28 were anesthetized, and a laparotomy was performed with standardized bowel manipulation. Postoperatively, animals (n = 7/group) were randomly assigned to 4 hours of ventilation with: (1) tidal volume (VT) = 7 mL/kg and positive end-expiratory pressure (PEEP) = 1 cm H2O without recruitment maneuvers (RMs) (low VT/low PEEP/RM-), mimicking the low-VT/low-PEEP strategy of PROVHILO; (2) VT = 7 mL/kg and PEEP = 3 cm H2O with RMs before laparotomy and hourly thereafter (low VT/moderate PEEP/4 RM+), mimicking the protective ventilation strategy of IMPROVE; (3) VT = 7 mL/kg and PEEP = 6 cm H2O with RMs only before laparotomy (low VT/high PEEP/1 RM+), mimicking the strategy used after intubation and before extubation in PROVHILO; or (4) VT = 14 mL/kg and PEEP = 1 cm H2O without RMs (high VT/low PEEP/RM-), mimicking conventional ventilation used in IMPROVE. Seven rats were not tracheotomized, operated, or mechanically ventilated, and constituted the healthy nonoperated and nonventilated controls. RESULTS: Low VT/moderate PEEP/4 RM+ and low VT/high PEEP/1 RM+, compared to low VT/low PEEP/RM- and high VT/low PEEP/RM-, resulted in lower [DELTA]PRS (7.1 +/- 0.8 and 10.2 +/- 2.1 cm H2O vs 13.9 +/- 0.9 and 16.9 +/- 0.8 cm H2O, respectively; P

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Targeting Hypoxia Signaling for Perioperative Organ Injury.

Perioperative organ injury has a significant impact on surgical outcomes and presents a leading cause of death in the United States. Recent research has pointed out an important role of hypoxia signaling in the protection from organ injury, including for example myocardial infarction, acute respiratory distress syndrome, acute kidney, or gut injury. Hypoxia induces the stabilization of hypoxia-inducible factors (HIFs), thereby leading to the induction of HIF target genes, which facilitates adaptive responses to low oxygen. In this review, we focus on current therapeutic strategies targeting hypoxia signaling in various organ injury models and emphasize potential clinical approaches to integrate these findings into the care of surgical patients. Conceptually, there are 2 options to target the HIF pathway for organ protection. First, drugs became recently available that promote the stabilization of HIFs, most prominently via inhibition of prolyl hydroxylase. These compounds are currently trialed in patients, for example, for anemia treatment or prevention of ischemia and reperfusion injury. Second, HIF target genes (such as adenosine receptors) could be activated directly. We hope that some of these approaches may lead to novel pharmacologic strategies to prevent or treat organ injury in surgical patients. (C) 2017 International Anesthesia Research Society

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Avoiding Complications From Patient Positioning for Intraocular Surgery.

Collaboration of the surgical and anesthesia teams for patient positioning is essential to assure patient comfort and safety, preventing systemic and ophthalmic complications. The goals and rationales of positioning for intraocular surgery are discussed including placing the head above the heart, elevating the chin, using a head rest that is sufficiently firm, maximizing anesthesia care team access and minimizing fire risk, and taping the patient's head to the operating table to reduce unexpected movement with intraocular injury. (C) 2017 International Anesthesia Research Society

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Aortocaval Compression Syndrome: Time to Revisit Certain Dogmas.

More than 70 years ago, the phenomenon of "postural shock" in the supine position was described in healthy women in late pregnancy. Since then, avoidance of the supine position has become a key component of clinical practice. Indeed, performing pelvic tilt in mothers at term to avoid aortocaval compression is a universally adopted measure, particularly during cesarean delivery. The studies on which this practice is based are largely nonrandomized, utilized a mix of anesthetic techniques, and were conducted decades ago in the setting of avoidance of vasopressors. Recent evidence is beginning to refine our understanding of the physiologic consequences of aortocaval compression in the context of contemporary clinical practice. For example, magnetic resonance imaging of women at term in the supine and tilted positions has challenged the dogma that 15[degrees] of left tilt is sufficient to relieve inferior vena cava compression. A clinical investigation of healthy term women undergoing elective cesarean delivery with spinal anesthesia found no difference in neonatal acid-base status between women randomized to be either tilted to the left by 15[degrees] or to be in the supine position, if maternal systolic blood pressure is maintained at baseline with a crystalloid coload and prophylactic phenylephrine infusion. This review presents a fresh look at the decades of evidence surrounding this topic and proposes a reevaluation and appraisal of current guidelines regarding entrenched practices. (C) 2017 International Anesthesia Research Society

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Current Approach to Heart Failure.

No abstract available

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Whiplash Injury: Perspectives on the Development of Chronic Pain.

No abstract available

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The Expected Role of the Anesthesiologist in Delivering Bad News.

No abstract available

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The Evaluation of a Noninvasive Respiratory Volume Monitor in Pediatric Patients Undergoing General Anesthesia.

BACKGROUND: Pediatric patients following surgery are at risk for respiratory compromise such as hypoventilation and hypoxemia depending on their age, comorbidities, and type of surgery. Quantitative measurement of ventilation in nonintubated infants/children is a difficult and inexact undertaking. Current respiratory assessment in nonintubated patients relies on oximetry data, respiratory rate (RR) monitors, and subjective clinical assessment, but there is no objective measure of respiratory parameters that could be utilized to predict early respiratory compromise. New advances in technology and digital signal processing have led to the development of an impedance-based respiratory volume monitor (RVM, ExSpiron, Respiratory Motion, Inc, Waltham, MA). The RVM has been shown to provide accurate real-time, continuous, noninvasive measurements of tidal volume (TV), minute ventilation (MV), and RR in adult patients. In this prospective observational study, our primary aim was to determine whether the RVM accurately measures TV, RR, and MV in pediatric patients. METHODS: A total of 72 pediatric patients (27 females, 45 males), ASA I to III, undergoing general anesthesia with endotracheal intubation were enrolled. After endotracheal intubation, continuous data of MV, TV, and RR were recorded from the RVM and an in-line monitoring spirometer (NM3 monitor, Phillips Healthcare). RVM and NM3 measurements of MV, TV, and RR were compared during a 10-minute period prior to the incision ("Presurgery") and a 10-minute period after the end of surgery ("Postsurgery"). Relative errors were calculated over 1-minute segment within each 10-minute period. Bias, precision, and accuracy were calculated using Bland-Altman analyses and paired-difference equivalence tests were performed. RESULTS: Combined across the Presurgery and Postsurgery periods, the RVM's mean measurement bias (RVM - NM3 measurement) for MV was -3.8% (95% limits of agreement) (+/-1.96 SD): (-19.9% to 12.2%), for TV it was -4.9 (-21.0% to 11.3%), and for RR it was 1.1% (-4.1% to 6.2%). The mean measurement accuracies for MV, TV, and RR were 11.9%, 12.0%, and 4.2% (0.6 breaths/min), respectively. Note that lower accuracy numbers correspond to more accurate RVM measurements. The equivalence tests rejected the null hypothesis that the RVM and NM3 have different mean values and conclude with 90% power that the measurements of MV, TV, and RR from the RVM and NM3 are equivalent within +/-10%. CONCLUSIONS: Our data indicate acceptable agreement between RVM and NM3 measurements in pediatric mechanically-ventilated patients. Future studies assessing the capability of the RVM to detect respiratory compromise in other clinical settings are needed. (C) 2017 International Anesthesia Research Society

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Chronic Hiccups: An Underestimated Problem.

Persistent singultus, hiccupping that lasts for longer than 48 hours, can have a tremendous impact on a patient's quality of life. Although involved neurologic structures have been identified, the function of hiccups remains unclear-they have been controversially interpreted as a primitive reflex preventing extent swallowing of amniotic fluid in utero, an archaic gill ventilation pattern, or a fetus' preparation for independent breathing. Persistent singultus often presents as a symptom for various diseases, most commonly illnesses of the central nervous system or gastrointestinal tract; they can also be evoked by a variety of pharmacological agents. It is often impossible to define a singular cause. A wide range of treatment attempts, pharmacological and nonpharmacological, have been concerted to this date; however, chlorpromazine remains the only Food and Drug Administration-approved drug in this context. Large-scale studies on efficacy and tolerance of other therapeutic strategies are lacking. Gabapentin, baclofen, and metoclopramide have been reported to accomplish promising results in reports on the therapy of persistent singultus; they may also be effective when given in combination with other drugs, eg, proton pump inhibitors, or as conjoined therapy. As another approach of note, acupuncture treatment was able to abolish hiccups in a number of studies. When managing hiccup patients within the clinical routine, it is of importance to conduct a comprehensive and effective diagnostic workup; a well-functioning interdisciplinary team is needed to address possible causes for the symptom. Persistent singultus is a medical problem not to be underestimated; more research on options for effective treatment would be greatly needed. (C) 2017 International Anesthesia Research Society

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Degenerative Severe Aortic Stenosis in Tetralogy of Fallot: Multimodality Echocardiographic Hemodynamic Assessment.

No abstract available

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Limits of Agreement With Confidence Intervals Are Necessary to Assess Comparability of Measurement Devices.

No abstract available

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Trauma Anesthesiology as Part of the Core Anesthesiology Residency Program Training: Expert Opinion of the American Society of Anesthesiologists Committee on Trauma and Emergency Preparedness (ASA COTEP).

No abstract available

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Addition of Nasal Cannula Can Either Impair or Enhance Preoxygenation With a Bag Valve Mask: A Randomized Crossover Design Study Comparing Oxygen Flow Rates.

BACKGROUND: A critical safety component of emergency anesthesia is the avoidance of hypoxemia during the apneic phase of a rapid sequence intubation. Preoxygenation with a bag valve mask (BVM) or anesthetic circuit may be improved with supplemental oxygen by nasal cannula (NC) if there is a mask leak. In addition, NC is recommended for apneic oxygenation after induction and may be placed before preoxygenation. However, the optimum NC flow rate for preoxygenation or whether the presence of NC alone creates a mask leak remains unclear. METHODS: We performed a randomized crossover study on healthy volunteers comparing BVM alone and BVM with NC flow rates of 0 (NC-0), 5 (NC-5), 10 (NC-10), and 15 (NC-15) liters per minute (lpm). Our primary outcome was end-tidal oxygen (ETO2) after 3-minute preoxygenation. RESULTS: There was no difference in ETO2 between NC-15, NC-10, or BVM-only at 3 minutes. NC-0 and NC-5 recorded significantly lower ETO2 at all times compared with NC-15, NC-10, or BVM-only (least difference NC-5, -7% [95% confidence interval {CI}, -4% to -10%), NC-0, 16% [95% CI, 13%-19%]). There was a difference in ETO2 between NC-15 and BVM-only at 1 minute (7%; 95% CI, 5%-9%), but not at 2 or 3 minutes. There was no difference in ETO2 between NC-10 and NC-15. CONCLUSIONS: Our study found that NC at 0 and 5 lpm with a BVM is deleterious to preoxygenation and should be avoided. In addition, a lack of difference between NC-10 and BVM-only demonstrates that NC at flows of at least 10 lpm should not impair the preoxygenation process. While NC-15 may offer a benefit by reaching maximal ETO2 at 1 minute, this would need to be balanced against patient comfort. (C) 2017 International Anesthesia Research Society

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Questionable Design to Validate the ProAQT/Pulsioflex Device.

No abstract available

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Managing Obstetric Emergencies and Trauma, Revised 3rd ed.

No abstract available

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Alarm Limits for Intraoperative Drug Infusions: A Report From the Multicenter Perioperative Outcomes Group.

BACKGROUND: Continuous medication infusions are commonly used during surgical procedures. Alarm settings for infusion pumps are considered important for patient safety, but limits are not created in a standardized manner from actual usage data. We estimated 90th and 95th percentile infusion rates from a national database for potential use as upper limit alarm settings. METHODS: We extracted infusion rate data from 17 major hospitals using intraoperative records provided by Multicenter Perioperative Outcomes Group for adult surgery between 2008 and 2014. Seven infusions were selected for study: propofol, remifentanil, dexmedetomidine, norepinephrine, phenylephrine, nitroglycerin, and esmolol. Each dosage entry for an infusion during a procedure was included. We estimated the 50th, 90th, and 95th percentile levels for each infusion across institutions, and performed quantile regression to examine factors that might affect the percentiles rates, such as use in general anesthesia versus sedation. RESULTS: The median 90th and 95th percentile infusion rates (with interquartile range) for propofol were 150 (140-150) and 170 (150-200) [mu]g/kg/min. Quantile regression demonstrated higher 90th and 95th percentile rates during sedation for gastrointestinal endoscopy than for all surgical procedures performed under general anesthesia. For selected vasoactive medications, the corresponding median 90th and 95th percentile rates (with interquartile range) were norepinephrine 14.0 (9.8-18.1) and 18.3 (12.6-23.9) [mu]g/min, and phenylephrine 60 (55-80) and 80 (75-100) [mu]g/min. CONCLUSIONS: Alarm settings based on infusion rate percentile limits would be triggered at predictable rates; ie, the 95th percentile would be exceeded and an alarm sounded during 1 in 20 infusion rate entries. As a result, institutions could establish pump alarm settings consistent with desired alarm frequency using their own or externally validated usage data. Further study will be needed to determine the optimal percentile for infusion alarm settings. (C) 2017 International Anesthesia Research Society

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XFIRE® Collection from TRU-SPEC® Now Available

TRU-SPEC® to release line of fire-resistant station wear MARIETTA, Ga. — TRU-SPEC®, a leading supplier of uniforms and personal equipment to the military, law enforcement, public safety and shooting sports markets, introduces the XFIRE™ collection, a line of fire resistant station wear built with the Fire, EMS and Industrial professional in mind.

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Braun Industries & Pierce Manufacturing team up for all-in-one apparatus

The Patriot Model is a a versatile apparatus that can serve as an ambulance, rescue vehicle, and fire suppression unit

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Video: Ambulance erupts in flames behind fire station

The fire department said the fire was not suspicious and was probably caused by an electrical issue

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Diet-induced hypercholesterolemia alters liver glycosaminoglycans and associated-lipoprotein receptors in rats

Abstract

Glycosaminoglycans (GAGs) play an important role in lipoprotein metabolism. In liver, it facilitates the uptake of remnants through receptor-independent endocytosis. However, changes in liver GAGs during diet-induced hypercholesterolemia with normal levels of fat feeding are unknown. Present paper highlights the effect of diet-induced hypercholesterolemia with normal levels (5%) of fat on liver GAGs and other associated lipoprotein receptors. Hypercholesterolemia was induced in rats by feeding diet supplemented with 0.5% cholesterol and 0.125% bile salts. Hypercholesterolemia showed significantly decreased GAGs of both heparan sulfate (HS) and chondroitin sulfate/dermatan sulfate (CS/DS) classes of molecules. Quantitative real-time polymerase chain reaction analysis of GAG biosynthetic enzymes and other genes revealed significant changes in expression profile. The decrease in GAGs was prevented by simvastatin treatment; a drug that inhibits endogenous cholesterol synthesis that was used as a positive control in our study. Furthermore, there was a comparatively decreased binding of GAGs from hypercholesterolemic rats to lipoprotein lipase. LRP1 which plays a major role in lipoprotein uptake was also significantly decreased, and it was attenuated in simvastatin-treated hypercholesterolemic rats. Furthermore, LDLR and ApoE were also decreased significantly in liver of hypercholesterolemic rats. Thus, diet-induced hypercholesterolemia results in dysregulation of cholesterol homeostasis apparently through changes in GAGs in conjunction with other associated players.



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Comprehensive analysis on the homology, interaction, and miRNA regulators of human deleted in azoospermia proteins: updated evolutionary relationships with primates

Abstract

In humans, at least four copies of deleted in azoospermia (DAZ) proteins are encoded in close proximity along the euchromatic long arm of the Y chromosome, specifically at azoospermia factor region c. DAZ proteins and their ancestors deleted in azoospermia like (DAZL) and boule homolog, RNA binding protein (BOLL) are RNA-binding proteins that regulate the post-transcriptional functions of genes. The homology of human/primate DAZ family, and conserved phosphorylation sites, interaction with autosomal proteins and potential microRNAs that could target post-transcriptional regulation of human DAZ may needs to be study-updated. In this paper, we performed a comprehensive bioinformatics analyses to uncover the above theme. Our analyses revealed that all the human DAZ proteins share over 93% of sequence identity. When compared to the human DAZ2 and DAZ3, DAZ1 and DAZ4 are very close in terms of evolutionary conservation, and interaction with the autosomal proteins including DAZL and BOLL. Additionally, we report a total of 51 DAZ family proteins from primate species that shows evolutionarily close relationships with human proteins. This article provides an overview to assist reproductive biologists and geneticists in understanding the similarities and/or dissimilarities between human DAZ family proteins that play critical role during spermatogenesis.



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Differential effects of late gestation maternal overnutrition on the regulation of surfactant maturation in fetal and postnatal life

Abstract

With the increasing incidence of obesity worldwide, the proportion of women entering pregnancy overweight or obese has increased dramatically. The fetus of an overnourished mother experiences numerous metabolic changes that may modulate lung development and hence successful transition to air-breathing at birth. We used a sheep model of maternal late gestation overnutrition (LGON; from 115 d gestation, term 147 ± 3 d) to determine the effect of exposure to an increased plane of nutrition in late gestation on lung development in the fetus (at 141 d gestation) and the lamb (30 d after birth). We found a decrease in the numerical density of surfactant protein positive cells, as well as a reduction in mRNA expression of surfactant proteins (SFTP-A, -B and -C), a rate limiting enzyme in surfactant phospholipid synthesis (phosphate cytidylyltransferase 1, choline, alpha; PCYT1A) and glucose transporters (SLC2A1 and SLC2A4) in the fetal lung. In lambs at 30 d after birth, there were no differences between Control and LGON groups in the surfactant components that were downregulated in the LGON fetuses. However, mRNA expression of SFTP-A, PCYT1A, peroxisome proliferator activated receptor-γ (PPARG), fatty acid synthase (FASN) and fatty acid transport protein (FATP1) were increased in LGON lambs compared to controls. These results indicate a reduced capacity for surfactant production in late gestation. While these deficits are normalised by 30 d after birth, the lungs of LGON lambs exhibited altered glucose transport and fatty acid metabolism, which is consistent with an enhanced capacity for surfactant synthesis and restoration of surfactant maturity in these animals.

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Rearing-environment-dependent hippocampal local field potential differences in wildtype and inositol trisphosphate receptor type 2 knockout mice

Abstract

Rearing in an enriched environment (ENR) is known to enhance cognitive and memory abilities in rodents, whereas social isolation (ISO) induces depression-like behaviour. The hippocampus has been documented to undergo morphological and functional changes depending on these rearing environments. For instance, rearing condition during juvenility alters CA1 stratum radiatum gamma oscillation power in rats. In this study, hippocampal CA1 local field potentials (LFP) were recorded from bilateral CA1 in urethane-anesthetized mice that were reared in either ENR or ISO condition. Similar to previous findings in rats, gamma oscillation power during theta states was higher in ENR group. Ripple events that occur during non-theta periods in the CA1 stratum pyramidale also had longer intervals in ISO mice. Since astrocytic Ca2+ elevations play a key role in synaptic plasticity, we next tested if these changes in LFP are also expressed in IP3R2-knockout (KO) mice, in which astrocytic Ca2+ elevations are largely diminished. We found that the gamma power was also higher in IP3R2-KO-ENR mice compared to IP3R2-KO-ISO mice, suggesting that the rearing-environment-dependent gamma power alteration does not necessarily require the astrocytic IP3/Ca2+ pathway. By contrast, ripple events showed genotype-dependent changes as well as rearing condition-dependent changes: ISO housing and IP3R2 deficiency both lead to longer inter-ripple intervals. Moreover, we found that ripple magnitude in the right CA1 tended to be smaller in IP3R2-KO. Since IP3R2-KO mice have been reported to have depression phenotypes, our results suggest that ripple events and animals' mood may be broadly correlated.

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The HLF/IL-6/STAT3 feedforward circuit drives hepatic stellate cell activation to promote liver fibrosis

Gut

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Slug slime inspires new kind of surgical glue

Reuters Health News

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Safety of cold polypectomy for small colorectal neoplastic lesions: A prospective cohort study in Japan

International Journal of Colorectal Disease

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Merck cyber attack halted manufacturing, will hurt profits

Reuters Health News

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Delayed postoperative diet is associated with a greater incidence of prolonged postoperative ileus and longer stay in hospital for patients undergoing gastrointestinal surgery

Nutrition & Dietetics

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Serial combination of non-invasive tools improves the diagnostic accuracy of severe liver fibrosis in patients with NAFLD

Alimentary Pharmacology and Therapeutics

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Acute appendicitis in children: Can surgery be postponed? Short-term results in a cohort of 225 children?

Langenbeck's Archives of Surgery

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Sofosbuvir/Velpatasvir in Patients With Hepatitis C Virus Genotypes 1-6 and Compensated Cirrhosis or Advanced Fibrosis

Liver International

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Patterns of care for locally advanced pancreatic adenocarcinoma using the national cancer database

Pancreas

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Sociodemographic determinants of waitlist and post-transplant survival among end-stage liver disease patients

American Journal of Transplantation

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Circulating epithelial cells in intraductal papillary mucinous neoplasms and cystic pancreatic lesions

Pancreas

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Exposure to oral contraceptives increases the risk for development of inflammatory bowel disease: A meta-analysis of case-controlled and cohort studies

European Journal of Gastroenterology & Hepatology

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US House panel spotlights use of FDA rules to slow generic drugs

Reuters Health News

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Do we need to screen for de-novo diabetes mellitus in chronic hepatitis C patients after a sustained virological response?

European Journal of Gastroenterology & Hepatology

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Hepatocyte-derived exosomes promote T follicular regulatory cell expansion during HCV infection

Hepatology

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Prevalence and significance of HMGA2 expression in esophageal adenocarcinoma

Histopathology

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Cancer risk and survival in path_MMR carriers by gene and gender up to 75 years of age: A report from the Prospective Lynch Syndrome Database

Gut

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Retrospective study of patients on etanercept therapy for rheumatic diseases in patients with chronic hepatitis C virus

JCR: Journal of Clinical Rheumatology

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Metabolic effects of sleeve gastrectomy and laparoscopic greater curvature plication: An 18-month prospective, observational, open-label study

Obesity Surgery

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Postoperative complications in individuals aged 70 and over undergoing elective surgery for colorectal cancer

Colorectal Disease

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Length of Involuntary Hospitalization Related to the Referring Physician’s Psychiatric Emergency Experience

Abstract

Although involuntary commitment (IC) is a serious intervention in psychiatry and must always be regarded as an emergency measure, the knowledge about influencing factors is limited. Aims were to test the hypothesis that duration of involuntary hospitalization and associated parameters differ for IC's mandated by physicians with or with less routine experience in psychiatric emergency situations. Duration of involuntary hospitalization and duration until day-passes of 508 patients with IC at the University Hospital of Psychiatry Zurich were analyzed using a generalized linear model. Durations of involuntary hospitalization and time until day-passes were significantly shorter in patients referred by physicians with less routine experience in psychiatric emergency situations than compared to experienced physicians. Shorter hospitalizations following IC by less-experienced physicians suggest that some IC's might be unnecessary. A specific training or restriction to physicians being capable of conducting IC could decrease the rate of IC.



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