Copyright-Page

Publication date: September 2017
Source:Anesthesiology Clinics, Volume 35, Issue 3





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Contributors

Publication date: September 2017
Source:Anesthesiology Clinics, Volume 35, Issue 3





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Contents

Publication date: September 2017
Source:Anesthesiology Clinics, Volume 35, Issue 3





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Forthcoming Issues

Publication date: September 2017
Source:Anesthesiology Clinics, Volume 35, Issue 3





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Transplantation

Publication date: September 2017
Source:Anesthesiology Clinics, Volume 35, Issue 3
Author(s): Aman Mahajan, Christopher Wray




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Overview of Immunosuppressive Therapy in Solid Organ Transplantation

Publication date: September 2017
Source:Anesthesiology Clinics, Volume 35, Issue 3
Author(s): Curtis D. Holt

Teaser

Mechanisms of rejection, new pharmacologic approaches, and genomic medicine are major foci for current research in transplantation. It is hoped that these new agents and personalized immunosuppression will provide for less toxic regimens that are effective in preventing both acute and chronic allograft rejection. Until new agents are available, practitioners must use various combinations of currently approved agents to find the best regimens for improved long-term outcomes.


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Percutaneous Ultrasonic Tenotomy for Refractory Common Extensor Tendinopathy Following Failed Open Surgical Release: A Report of Two Cases

Common extensor tendinopathy (CET) is a common painful overuse and degenerative condition of the lateral elbow, affecting an estimated 2 million patients per year. Although many cases resolve with conservative treatment, recalcitrant cases may progress to open surgical intervention. For patients who fail to improve with surgical management, treatment options are extremely limited. In this manuscript, we present two cases of recalcitrant surgically treated CET successfully treated with sonographically guided percutaneous ultrasonic tenotomy (UT) with 1 year follow-up.

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Idiopathic intracranial hypertension: ocular vestibular evoked myogenic potentials as a new evaluation tool

Patients with idiopathic intracranial hypertension (IIH) have an elevated intracranial pressure (ICP) in absence of any tumor or venous drain disorders. Diagnosis is based on the symptoms of elevated intracranial pressure (ICP) such as papillary edema, elevated cerebrospinal fluid (CSF) pressure in the spinal tap test of >25 cmH2O in absence of pathologic cellular or biochemical results in the spinal tap test, or structural or vascular abnormalities on cerebral MRI. For the clinical management and follow-up of patients with IIH, the possibility of non-invasively monitoring changes in ICP over time could potentially reduce the need for invasive diagnostic lumbar drainages (LD).

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New Recommendations of the IFCN: from scalp EEG to electrical brain imaging

The importance of a standardized electrode placement (1) based on specific measurements of skull landmarks, (2) labeled according to a universal designation, and (3) offering adequate coverage of all parts of the head, was proposed by Dr. Jasper a few years after the first scalp EEG recordings and readily adopted by the Second International EEG Congress (Second International EEG congress, 1950). The 10-20 electrode system was born (Klem et al., 1999)! This electrode placement system was so clinically and physiologically relevant that it has been used without any significant change ever since.

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A smoking-related background helps moderate smokers to focus: An Event-Related Potential study using a Go-NoGo Task

Smoking tobacco is known as being one of the most common health-damaging behaviors, which seems to persist, despite awareness of its negative consequences on health and intensive prevention and treatment efforts (Le Faou and Scemama, 2005). Indeed, tobacco seems to be the most addictive substance among addictive drugs (32% of users become dependent; Inserm, 2015) and a smoker dies, on average, 15 years earlier than a non-smoker (U.S. Department of Health and Human Services, 2010).

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Body size, brain size, and sexual dimorphism in Homo naledi from the Dinaledi Chamber

Publication date: October 2017
Source:Journal of Human Evolution, Volume 111
Author(s): Heather M. Garvin, Marina C. Elliott, Lucas K. Delezene, John Hawks, Steven E. Churchill, Lee R. Berger, Trenton W. Holliday
Homo erectus and later humans have enlarged body sizes, reduced sexual dimorphism, elongated lower limbs, and increased encephalization compared to Australopithecus, together suggesting a distinct ecological pattern. The mosaic expression of such features in early Homo, including Homo habilis, Homo rudolfensis, and some early H. erectus, suggests that these traits do not constitute an integrated package. We examined the evidence for body mass, stature, limb proportions, body size and dental size dimorphism, and absolute and relative brain size in Homo naledi as represented in the Dinaledi Chamber sample. H. naledi stature and body mass are low compared to reported values for H. erectus, with the exception of some of the smaller bodied Dmanisi H. erectus specimens, and overlap with larger Australopithecus and early Homo estimates. H. naledi endocranial volumes (465–560 cc) and estimates of encephalization quotient are also similar to Australopithecus and low compared to all Homo specimens, with the exception of Homo floresiensis (LB1) and the smallest Dmanisi H. erectus specimen (D4500). Unlike Australopithecus, but similar to derived members of genus Homo, the Dinaledi assemblage of H. naledi exhibits both low levels of body mass and dental size variation, with an estimated body mass index of sexual dimorphism less than 20%, and appears to have an elongated lower limb. Thus, the H. naledi bauplan combines features not typically seen in Homo species (e.g., small brains and bodies) with those characteristic of H. erectus and more recent Homo species (e.g., reduced mass dimorphism, elongated lower limb).



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Cardiovascular Responses to Skeletal Muscle Stretching: “Stretching” the Truth or a New Exercise Paradigm for Cardiovascular Medicine?

Abstract

Stretching is commonly prescribed with the intended purpose of increasing range of motion, enhancing muscular coordination, and preventing prolonged immobilization induced by aging or a sedentary lifestyle. Emerging evidence suggests that acute or long-term stretching exercise may modulate a variety of cardiovascular responses. Specifically, at the onset of stretch, the mechanical deformation of the vascular bed coupled with stimulation of group III muscle afferent fibers initiates a cascade of events resulting in both peripheral vasodilation and a heart rate-driven increase in cardiac output, blood pressure, and muscle blood flow. This potential to increase shear stress and blood flow without the use of excessive muscle energy expenditure may hold important implications for future therapeutic vascular medicine and cardiac health. However, the idea that a cardiovascular component may be involved in human skeletal muscle stretching is relatively new. Therefore, the primary intent of this review is to highlight topics related to skeletal muscle stretching and cardiovascular regulation and function. The current evidence suggests that acute stretching causes a significant macro- and microcirculatory event that alters blood flow and the relationship between oxygen availability and oxygen utilization. These acute vascular changes if performed chronically may result in improved endothelial function, improved arterial blood vessel stiffness, and/or reduced blood pressure. Although several mechanisms have been postulated, an increased nitric oxide bioavailability has been highlighted as one promising candidate for the improvement in vessel function with stretching. Collectively, the evidence provided in this review suggests that stretching acutely or long term may serve as a novel and alternative low intensity therapeutic intervention capable of improving several parameters of vascular function.

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Supported Employment for Veterans with Traumatic Brain Injury: Provider Perspectives

Publication date: Available online 5 August 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Terri K. Pogoda, Kathleen F. Carlson, Katelyn E. Gormley, Sandra G. Resnick
ObjectiveIn 2006, 13 sites were provided with one-time pilot funding to provide supported employment (SE) to Veterans with traumatic brain injury (TBI) history. In 2014, we surveyed SE providers at pilot and non-pilot sites that did not receive this funding. Our objectives were to identify any pilot and non-pilot site differences regarding current: (1) provision of SE to Veterans with TBI; (2) staffing and communication between the SE and polytrauma/TBI teams; and (3) provider perceptions on facilitators and barriers to providing, and suggestions for improving, SE.SettingVeterans Health Administration (VHA) SE programs.DesignMixed methods cross-sectional survey study.ParticipantsProviders included a total of 54 SE supervisors and 90 vocational rehabilitation specialists (VRSs).InterventionsNot applicable.Main Outcome MeasuresWeb-based surveys of forced-choice and open-ended items included questions on SE team characteristics, communication with polytrauma/TBI teams, and experiences with providing SE to Veterans with TBI history.ResultsSE was provided to Veterans with TBI at 100% of pilot and 59.2% of non-pilot sites (p = .09). However, VRSs at pilot sites reported that communication with the polytrauma/TBI team about SE referrals was more frequent than at non-pilot sites (p = .003). In open-ended items, suggestions for improving SE were similar across pilot and non-pilot sites, and included increasing staffing for VRSs and case management, enhancing communication and education between SE and polytrauma/TBI teams, and expanding the scope of the SE program so that eligibility is based on employment support need, rather than diagnosis.ConclusionsThese findings may contribute to an evidence base that informs SE research and clinical directions on service provision, resource allocation, team integration efforts, and outreach to Veterans with TBI who have employment support needs.



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Mobility device quality impacts participation outcomes among people with disabilities: A structural equation modeling analysis

Publication date: Available online 5 August 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Susan Magasi, Alex W.K. Wong, Ana Miskovic, David Tulsky, Allen W. Heinemann
ObjectiveTo test the effect that indicators of mobility device quality have on participation outcomes among community dwelling adults with spinal cord injuries (SCI), traumatic brain injuries (TBI) and stroke using structural equation modeling.DesignSurvey, cross-sectional study, and model testing.SettingClinical research space at 2 academic medical centers and one free-standing rehabilitation hospital in the Midwestern United States (St. Louis, Ann Arbor, Chicago).ParticipantsCommunity-dwelling adults (mean age= 48 years(SD 14.3)) with SCI, TBI and Stroke (n=250).InterventionsNot applicableMain Outcomes MeasuresThe Mobility Device Impact Scale, PROMIS Social Health (v2.0) questionnaires, including Ability to Participate in Social Roles and Activities and Satisfaction with Social Roles and Activities questionnaires and the 2 Community Participation Indicators' Enfranchisement Scales. Details about device quality (reparability, reliability, ease of maintenance) and device type were also collected.ResultsRespondents used ambulation aids (30%), manual (34%), and power wheelchairs (30%). Indicators of device quality had a moderating association with participation outcomes, with three device quality variables, ease of repairs and maintenance, and device reliability accounting for 20% of the variance in participation. Wheelchair users reported lower participation enfranchisement than persons using ambulation aids.ConclusionMobility device quality plays an important role in participation outcomes. It is critical that people have access to mobility devices and that these devices be reliable.



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Early detection of exercise-induced muscle damage using elastography

Abstract

Purpose

This study aimed to determine whether an increase in muscle shear modulus measured 30 min after eccentric exercise (30 min) reflects the magnitude of force deficit measured 48-h post-exercise (48 H).

Methods

A total of 53 healthy participants were distributed in five groups. Four groups performed either repeated eccentric elbow flexions or knee extensions at either a low or high load. A fifth group performed repeated concentric elbow flexions (control load).

Results

A significant decreased peak torque was found for elbow flexors and knee extensors 48 h after the eccentric exercises (all P values < 0.001). A significant increase in shear modulus was found at 30 min for the elbow flexors for low (+70.5 ± 44.3%, P < 0.001) and high load (+153.9 ± 192.4%, P < 0.001). Similarly, the shear modulus of knee extensors increased for low (+26.7 ± 19.1%, P < 0.001) and high load (+79.4 ± 67.1%, P < 0.001). The relative increase in shear modulus measured at 30 min was significantly correlated to the relative decrease in peak torque measured at 48 H for both elbow flexors (r = −0.80) and knee extensors (r = −0.82). A further analysis suggested that biceps brachii and rectus femoris were more affected by muscle damage than their synergists.

Conclusion

This study shows that an increase in muscle shear modulus measured 30 min after a damaging exercise reflects the decrease in peak torque measured at 48 H. Shear modulus may therefore, provide a useful tool for coaches and clinicians to non-invasively estimate the amount of muscle damage induced by a damaging exercise.

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Modelling of the dissolution and reprecipitation of uranium under oxidising conditions in the zone of shallow groundwater circulation

Publication date: November 2017
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): Ekaterina M. Dutova, Aleksei N. Nikitenkov, Vitaly D. Pokrovskiy, David Banks, Bjørn S. Frengstad, Valerii P. Parnachev
Generic hydrochemical modelling of a grantoid-groundwater system, using the Russian software "HydroGeo", has been carried out with an emphasis on simulating the accumulation of uranium in the aqueous phase. The baseline model run simulates shallow granitoid aquifers (U content 5 ppm) under conditions broadly representative of southern Norway and southwestern Siberia: i.e. temperature 10 °C, equilibrated with a soil gas partial CO2 pressure (PCO2, open system) of 10^−2.5 atm. and a mildly oxidising redox environment (Eh = +50 mV). Modelling indicates that aqueous uranium accumulates in parallel with total dissolved solids (or groundwater mineralisation M – regarded as an indicator of degree of hydrochemical evolution), accumulating most rapidly when M = 550–1000 mg L⁻¹. Accumulation slows at the onset of saturation and precipitation of secondary uranium minerals at M = c. 1000 mg L⁻¹ (which, under baseline modelling conditions, also corresponds approximately to calcite saturation and transition to Na-HCO3 hydrofacies). The secondary minerals are typically "black" uranium oxides of mixed oxidation state (e.g. U3O7 and U4O9). For rock U content of 5–50 ppm, it is possible to generate a wide variety of aqueous uranium concentrations, up to a maximum of just over 1 mg L⁻¹, but with typical concentrations of up to 10 μg L⁻¹ for modest degrees of hydrochemical maturity (as indicated by M). These observations correspond extremely well with real groundwater analyses from the Altai-Sayan region of Russia and Norwegian crystalline bedrock aquifers. The timing (with respect to M) and degree of aqueous uranium accumulation are also sensitive to Eh (greater mobilisation at higher Eh), uranium content of rocks (aqueous concentration increases as rock content increases) and PCO2 (low PCO2 favours higher pH, rapid accumulation of aqueous U and earlier saturation with respect to uranium minerals).



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Travel Time to Hospital for Childbirth: Comparing Calculated Versus Reported Travel Times in France

Abstract

Objectives Timely access to health care is critical in obstetrics. Yet obtaining reliable estimates of travel times to hospital for childbirth poses methodological challenges. We compared two measures of travel time, self-reported and calculated, to assess concordance and to identify determinants of long travel time to hospital for childbirth. Methods Data came from the 2010 French National Perinatal Survey, a national representative sample of births (N = 14 681). We compared both travel time measures by maternal, maternity unit and geographic characteristics in rural, peri-urban and urban areas. Logistic regression models were used to study factors associated with reported and calculated times ≥30 min. Cohen's kappa coefficients were also calculated to estimate the agreement between reported and calculated times according to women's characteristics. Results In urban areas, the proportion of women with travel times ≥30 min was higher when reported rather than calculated times were used (11.0 vs. 3.6%). Longer reported times were associated with non-French nationality [adjusted odds ratio (aOR) 1.3 (95% CI 1.0–1.7)] and inadequate prenatal care [aOR 1.5 (95% CI 1.2–2.0)], but not for calculated times. Concordance between the two measures was higher in peri-urban and rural areas (52.4 vs. 52.3% for rural areas). Delivery in a specialised level 2 or 3 maternity unit was a principal determinant of long reported and measured times in peri-urban and rural areas. Conclusions for Practice The level of agreement between reported and calculated times varies according to geographic context. Poor measurement of travel time in urban areas may mask problems in accessibility.

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Title V Workforce Development in the Era of Health Transformation

Abstract

Purpose The National Maternal and Child Health Workforce Development Center at UNC Chapel Hill (the Center), funded by the Maternal and Child Health Bureau, provides Title V state/jurisdiction leaders and staff and partners from other sectors with opportunities to develop skills in quality improvement, systems mapping and analysis, change management, and strategies to enhance access to care to leverage and implement health transformation opportunities to improve the health of women and children. Description Since 2013, the Center has utilized a variety of learning platforms to reach state and jurisdiction Title V leaders. In the intensive training program, new skills and knowledge are applied to a state-driven health transformation project and include distance-based learning opportunities, multi-day, in-person training and/or onsite consultation, as well as individualized coaching to develop workforce skills. Assessment The first intensive cohort of eight states reported enhanced skills in the core areas of quality improvement, systems mapping and analysis, change management, and strategies to enhance access to care which guided changes at state system and policy levels. In addition, teams reported new and/or enhanced partnerships with many sectors, thereby leveraging Title V resources to increase its impact. Conclusion The Center's provision of core workforce skills and application to state-defined goals has enabled states to undertake projects and challenges that not only have a positive impact on population health, but also encourage collaborative, productive partnerships that were once found to be challenging—creating a workforce capable of advancing the health and wellbeing of women and children.

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Assessing the Risk of Having Small for Gestational Age Newborns Among Lebanese Underweight and Normal Pre-pregnancy Weight Women

Abstract

Introduction It has been established that underweight women with low gestational weight gain (GWG) are at a higher risk of having Small for Gestational Age (SGA) newborns. However, the association remains poorly studied in Middle Eastern societies exhibiting different ethnic groups, genetic predisposing factors along with differences in nutritional food intake during pregnancy. The aim of this study is to assess the risk of having a SGA newborn among underweight and normal weight BMI women while studying the role of GWG in this association. Methods This is a retrospective cross-sectional study of 62,351 singleton pregnancies from the National Collaborative Perinatal Neonatal Network between 2001 and 2009 from 27 hospitals across Lebanon. Women who had underweight and normal pre-pregnancy BMI were included. Results A total of 8.6% newborns were SGA and 6.6% of women were underweight. Among women with normal and underweight pre-pregnancy BMI, 8.6 and 12.4% had SGA births respectively. Overall, the adjusted OR of having SGA newborns was significantly higher among underweight women (OR = 1.448; 95%CI = 1.287–1.630) compared to normal pre-pregnancy BMI. Below normal weight gain significantly increased the odds of SGA for both normal and underweight pre-pregnancy BMI women, with adjusted ORs of 1.535 (95% CI = 1.418–1.661) and 1.970 (95%CI = 1.515–2.560) respectively. Discussion Higher risks of SGA newborns in underweight and normal BMI women with low GWG were observed. In addition, normal weight gain couldn't protect underweight women of having risk for SGA newborns. Hence, all pregnant women should be encouraged to maintain healthy BMI before pregnancy and attain adequate GWG.

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Executive function after exhaustive exercise

Abstract

Purpose

Findings concerning the effects of exhaustive exercise on cognitive function are somewhat equivocal. The purpose of this study was to identify physiological factors that determine executive function after exhaustive exercise.

Methods

Thirty-two participants completed the cognitive tasks before and after an incremental exercise until exhaustion (exercise group: N = 18) or resting period (control group N = 14). The cognitive task was a combination of a Spatial Delayed-Response (Spatial DR) task and a Go/No-Go task, which requires executive function. Cerebral oxygenation and skin blood flow were monitored during the cognitive task over the prefrontal cortex. Venous blood samples were collected before and after the exercise or resting period, and blood catecholamines, serum brain-derived neurotrophic factor, insulin-like growth hormone factor 1, and blood lactate concentrations were analyzed.

Results

In the exercise group, exhaustive exercise did not alter reaction time (RT) in the Go/No-Go task (pre: 861 ± 299 ms vs. post: 775 ± 168 ms) and the number of error trials in the Go/No-Go task (pre: 0.9 ± 0.7 vs. post: 1.8 ± 1.8) and the Spatial DR task (pre: 0.3 ± 0.5 vs. post: 0.8 ± 1.2). However, ΔRT was negatively correlated with Δcerebral oxygenation (r = −0.64, P = 0.004). Other physiological parameters were not correlated with cognitive performance. Venous blood samples were not directly associated with cognitive function after exhaustive exercise.

Conclusion

The present results suggest that recovery of regional cerebral oxygenation affects executive function after exhaustive exercise.

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Defective splicing of the RB1 transcript is the dominant cause of retinoblastomas

Abstract

Defective splicing is a common cause of genetic diseases. On average, 13.4% of all hereditary disease alleles are classified as splicing mutations with most mapping to the critical GT or AG nucleotides within the 5′ and 3′ splice sites. However, splicing mutations are underreported and the fraction of splicing mutations that compose all disease alleles varies greatly across disease gene. For example, there is a great excess (46%; ~threefold) of hereditary disease alleles that map to splice sites in RB1 that cause retinoblastoma. Furthermore, mutations in the exons and deeper intronic position may also affect splicing. We recently developed a high-throughput method that assays reported disease mutations for their ability to disrupt pre-mRNA splicing. Surprisingly, 27% of RB1-coding mutations tested also disrupt splicing. High-throughput in vitro spliceosomal assembly assay reveals heterogeneity in which stage of spliceosomal assembly is affected by splicing mutations. 58% of exonic splicing mutations were primarily blocked at the A complex in transition to the B complex and 33% were blocked at the B complex. Several mutants appear to reduce more than one step in the assembly. As RB1 splicing mutants are enriched in retinoblastoma disease alleles, additional priority should be allocated to this class of allele while interpreting clinical sequencing experiments. Analysis of the spectrum of RB1 variants observed in 60,706 exomes identifies 197 variants that have enough potential to disrupt splicing to warrant further consideration.

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Investigating the genetic relationship between Alzheimer’s disease and cancer using GWAS summary statistics

Abstract

Growing evidence from both epidemiology and basic science suggest an inverse association between Alzheimer's disease (AD) and cancer. We examined the genetic relationship between AD and various cancer types using GWAS summary statistics from the IGAP and GAME-ON consortia. Sample size ranged from 9931 to 54,162; SNPs were imputed to the 1000 Genomes European panel. Our results based on cross-trait LD Score regression showed a significant positive genetic correlation between AD and five cancers combined (colon, breast, prostate, ovarian, lung; r _g = 0.17, P = 0.04), and specifically with breast cancer (ER-negative and overall; r _g = 0.21 and 0.18, P = 0.035 and 0.034) and lung cancer (adenocarcinoma, squamous cell carcinoma and overall; r _g = 0.31, 0.38 and 0.30, P = 0.029, 0.016, and 0.006). Estimating the genetic correlation in specific functional categories revealed mixed positive and negative signals, notably stronger at annotations associated with increased enhancer activity. This suggests a role of gene expression regulators in the shared genetic etiology between AD and cancer, and that some shared variants modulate disease risk concordantly while others have effects in opposite directions. Due to power issues, we did not detect cross-phenotype associations at individual SNPs. This genetic overlap is not likely driven by a handful of major loci. Our study is the first to examine the co-heritability of AD and cancer leveraging large-scale GWAS results. The functional categories highlighted in this study need further investigation to illustrate the details of the genetic sharing and to bridge between different levels of associations.

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Proton Pump Inhibitors in Gastroesophageal Reflux Disease: Friend or Foe

Abstract

Purpose of Review

Proton pump inhibitor (PPI) use in gastroesophageal reflux disease (GERD) has been redefined, in light of recent advances highlighting GERD phenotypes that respond to PPIs, and fresh revelations of potential risks of long-term PPI therapy.

Recent Findings

Erosive esophagitis predicts excellent response to PPI therapy, but non-erosive reflux disease (NERD) with abnormal reflux parameters on ambulatory reflux monitoring also demonstrates a similar response. In contrast, response is suboptimal in the absence of abnormal reflux parameters. In this setting, if an alternate appropriate indication for PPI therapy does not coexist, risks may outweigh benefits of PPI therapy. Adverse events from long-term PPI therapy continue to be reported, most based on association rather than cause-and-effect.

Summary

Appropriate indications need to be established before embarking on long-term PPI therapy. Future research will define true risks of long-term PPI therapy, and develop alternate management options for acid peptic diseases.

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The European society of regional anesthesia and pain therapy and the American society of regional anesthesia and pain medicine joint committee practice advisory on controversial topics in pediatric regional anesthesia I and II: what do they tell us?.

Purpose of review: To summarize the two recent sets of European and American Societies of Regional Anesthesia (ESRA-ASRA) Practice Advisory Guidelines for the performance of pediatric regional anesthesia (PRA). Recent findings: Owing to the still ongoing debate regarding crucial issues concerning the effective and safe conduct of PRA and because of the lack of any generally accepted guidelines regarding PRA the (ESRA-ASRA) have addressed these in two topical publications. Summary: Following an extensive literature search and an evidence-based approach the ESRA-ASRA task force have now provided a practice advisory on the following hot topics in PRA: the safety and appropriateness of placing block during general anesthesia or deep sedation, the use of test dosing, whether to use air or saline when performing loss-of-resistance, the risk of masking an acute compartment syndrome by use of PRA, dosing of local anesthetics for neuroaxial nerve blocks as well as peripheral nerve blocks, and finally the use of various drugs as adjuncts to local anesthetics. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Reducing Circumduction and Hip Hiking During Hemiparetic Walking Through Targeted Assistance of the Paretic Limb Using a Soft Robotic Exosuit.

Objective: The aim of the study was to evaluate the effects on common poststroke gait compensations of a soft wearable robot (exosuit) designed to assist the paretic limb during hemiparetic walking. Design: A single-session study of eight individuals in the chronic phase of stroke recovery was conducted. Two testing conditions were compared: walking with the exosuit powered versus walking with the exosuit unpowered. Each condition was 8 minutes in duration. Results: Compared with walking with the exosuit unpowered, walking with the exosuit powered resulted in reductions in hip hiking (27 [6%], P = 0.004) and circumduction (20 [5%], P = 0.004). A relationship between changes in knee flexion and changes in hip hiking was observed (Pearson r = -0.913, P

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The Role of Polyethylene Glycol in the Treatment of Functional Constipation in Children.

According to international guidelines, polyethylene glycol (PEG) is the laxative of first choice in the treatment of functional constipation in children, both for disimpaction and for maintenance treatment. PEG acts as an osmotic laxative and its efficacy is dose dependent. PEG is highly effective, has a good safety profile and is well tolerated by children. Only minor adverse events have been reported. Overall the use of PEG in children has been reported to be safe, although in patients predisposed to water and electrolyte imbalances monitoring of serum electrolytes should be considered. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Preventive effect of a vapocoolant spray on propofol-induced pain: a prospective, double-blind, randomized study

Abstract

Purpose

Propofol causes injection pain. Although lidocaine pre-treatment via venous occlusion is known to be the most effective way, it still has some inconvenience. We implemented this study to compare the effect of a vapocoolant spray with lidocaine pre-treatment.

Methods

Participants (n = 90) were randomized to one of three groups. Group V: after placebo injection and tourniquet, the vapocoolant spray was applied; group L: after lidocaine injection and tourniquet, the placebo spray was applied; group C: after placebo injection and tourniquet, the placebo spray was applied. The intensity of propofol-induced pain, the incidence of metallic taste, and the satisfaction were assessed.

Results

Propofol-induced pain was significantly lower in groups V and L than in group C [0.5 (0–2.25), 0.5 (0–1), and 5 (1–7), median (interquartile range), respectively, p < 0.001]. There was no significant difference in pain intensity between groups V and L. Group L showed a significantly higher incidence of metallic taste than groups V and C (23, 0, and 0%, respectively; p = 0.001). Groups V and L showed higher satisfaction scores than group C [5 (4–5), 4 (3.75–5), and 2 (2–3), respectively; p < 0.001], and there was a significant difference between groups V and L (p = 0.012).

Conclusion

Vapocoolant spray showed a similar effect to lidocaine in analgesia and lowered the incidence of a metallic taste. These resulted in greater satisfaction with the vapocoolant spray compared with lidocaine. Vapocoolant spray is an effective and convenient way to prevent propofol-induced pain.

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Pre-eclampsia and acute pulmonary embolism—the importance of making a differential diagnosis: a case report

Abstract

We describe the case of a 41-year-old pregnant patient who presented at 38 weeks of gestation for an urgent cesarean section, with new onset of pre-eclampsia as the initial diagnosis. The intraoperative course was complicated by seizures and hemodynamic collapse. Initially, the presentation of seizure pointed to pre-eclampsia/eclampsia; however, with careful consideration of each event as it occurred, the correct diagnosis was later determined to be pulmonary embolism and stroke. This case illustrates the importance of considering multiple possible etiologies, even when a particular diagnosis seems obvious.

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