EEG Activity during Realization of Manual Movements by Individuals with Different Characteristics of the Alpha Rhythm

We examined 105 19- to 21-year-old men with a high or low individual modal alpha-frequency in their background EEGs. Latencies of the sensorimotor simple and complex (choice) reactions, rate capabilities of the nervous processes in the tapping test, and spectral power and coherence of the frequency EEG components were estimated. Estimations were obtained for each examined person in the resting state and during finger movements with a force loading (bending of the fingers in the fist and their spreading). Men with relatively high background modal frequencies of the alpha rhythm were characterized by a higher level of the attention selectivity and more local modifications of EEG activity related to realization of manual movements. Somewhat less-differentiated patterns of cortical activation were typical of persons with lower modal alpha-frequencies; this may correlate with a lower plasticity of the cerebral processes under conditions of the control of manual motor activity with force loading and maintenance of the pre-set movement rate. Men with higher modal alpha-frequencies demonstrated better rate indices in the performance of sensorimotor reactions.

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Effects of Camellia Sinensis Extract on Passive Avoidance Learning and Hippocampal Neurogenesis in Rats

We investigated the effects of a concentrate of green tea (extract of Camellia sinensis) on passive avoidance learning and hippocampal neurogenesis in male Wistar rats. Twenty-one male rats were divided into control, sham, and experimental groups. Rats of the control group were left intact, sham rats received infusions of 1.0 ml of distilled water for 8 weeks, while experimental rats received 1.0 ml of brewed green tea with a concentration of 0.04 g/ml. After eight weeks and behavioral testing, brain samples were taken, and 6-μm-thick sections were prepared from the hippocampus and examined microscopically using hematoxylin+eosin staining. Results of the passive avoidance tests confirmed improved learning after green tea concentrate administration (P < 0.01). Treatment of the experimental group by the extract increased noticeably the density (number per test area) of neurons (intensity of neurogenesis) in the CA3 area and dentate gyrus of the hippocampus (P < 0.001).

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Erratum to: Computer Simulation of Molecular Interaction between Baclofen and the GABA B Receptor

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Effects of a Nociceptin Receptor Antagonist on Experimentally Induced Scratching Behavior in Mice

Itch and pain are two distressing sensations sharing a lot in common. In addition to the periphery, the central nervous system is proposed as a therapeutic target for the development of antipruritic drugs. The contribution of the most recently discovered opioid peptide, nociceptin/orphanin FQ (N/OFQ) and its receptor (NOP) in pain transmission is controversial. It seems to be pronociceptive when given supraspinally, but elicits an antinociceptive action when injected spinally. Here, we examined whether the N/OFQ system plays a role in experimentally induced pruritus. Scratching behavior was produced by intradermal administration of serotonin (50 μg/50 μl/mouse) or nociceptin (30 nmol/50 μl/mouse) to Balb/c mice. JTC-801 (1, 3 or 10 mg/kg, i.p.), a NOP receptor antagonist, attenuated both serotonin- and nociceptin-induced scratches. When given intradermally, JTC-801 (100 nmol) significantly reduced serotonin-induced but not nociceptin-induced scratches. We propose that antagonizing NOP receptors either systemically or localy may be a novel approach in the development of antipruritic agents.

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Serum osmolarity in male patients with bipolar disorder manic episode

Abstract

Imbalance of water and electrolyte homeostasis has been suggested to be associated with the acute episodes of bipolar disorder. In this study we aimed to investigate, for the first time, the serum osmolarity in bipolar disorder manic episode. A total of 68 bipolar inpatients in manic episode and 60 age-gender matched healthy controls were included in the study. Serum osmolarity was calculated from Sodium (Na⁺), glucose and blood urea nitrogen (BUN) according to formula of (2 × Na⁺) + (BUN/2.8) + (Glucose/18). Significance level was accepted as P < 0.05. Serum osmolarity of manic patients was 295.34 ± 4.90 mOsm L⁻¹ and control group was 298.46 ± 5.33 mOsm L⁻¹. Serum osmolarity of manic group was significantly lower than controls (P  <  0.001). When we compare the components of serum osmolarity; statistically significant difference was also observed between groups in terms of glucose (85.85 ± 12.25 mg dl⁻¹ for manic, 92.95 ± 20.77 mg dl⁻¹ for controls, P = 0.019) and Na⁺ (140.73 ± 2.06 mmol L⁻¹ for manic, 142.06 ± 2.48 mmol L⁻¹ for controls, P = 0.001). For BUN levels; there was no statistically significant difference between manic (25.50 ± 9.85 mg dl⁻¹) and control (26.61 ± 6.64 mg dl⁻¹) groups (P = 0.461). Our results demonstrate a diminished serum osmolarity in manic episode compared with healthy controls. This finding supports the hypothesis of a fluid and electrolyte imbalance during acute episodes. Decreased serum osmolarity may be a reflection of a relative hemodilution in mania. However, exploring the role of fluid and electrolyte homeostasis and mechanisms of related hormones may contribute to better understanding the etiology of bipolar disorder.

This article is protected by copyright. All rights reserved

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Human cerebral blood flow control during hypoxia: focus on chronic pulmonary obstructive disease (COPD) and obstructive sleep apnea (OSA)

The brain is a vital organ that relies on a constant and adequate blood flow to match oxygen and glucose delivery with the local metabolic demands of active neurons. Thus, exquisite regulation of cerebral blood flow (CBF) is particularly important under hypoxic conditions to prevent a detrimental decrease in the partial pressure of oxygen within the brain tissues. Cerebrovascular sensitivity to hypoxia, assessed as the change in CBF during a hypoxic challenge, represents the capacity of cerebral vessels to respond to, and compensate for, a reduced oxygen supply, and has been shown to be impaired or blunted in a number of conditions. For instance, this is observed with aging, and in clinical conditions such as untreated obstructive sleep apnea (OSA) and in healthy humans exposed to intermittent hypoxia. This review will 1) provide a brief overview of cerebral blood flow regulation and results of pharmacological interventions studies which we have performed to better elucidate the basic mechanisms of cerebrovascular regulation in humans; and 2) present data from studies in clinical and healthy populations, using a translational physiology approach, to investigate human CBF control during hypoxia. Results from studies in patients with chronic obstructive pulmonary disease and OSA will be presented to identify the effects of the disease processes on cerebrovascular sensitivity to hypoxia. Data emerging from experimental human models of intermittent hypoxia during wakefulness will also be reviewed to highlight the effects of intermittent hypoxia on the brain.

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Remote ischemic preconditioning does not prevent acute mountain sickness after rapid ascent to 3450 m

Remote ischemic preconditioning (RIPC) has been shown to protect remote organs, such as the brain and the lung, from damage induced by subsequent hypoxia or ischemia. Acute mountain sickness (AMS) is a syndrome of non-specific neurologic symptoms and in high altitude pulmonary edema excessive hypoxic pulmonary vasoconstriction (HPV) plays a pivotal role. We hypothesized that RIPC protects the brain from AMS and attenuates the magnitude of HPV after rapid ascent to 3450 m. Forty non-acclimatized volunteers were randomized into 2 groups. At low altitude (750 m) the RIPC group (n=20) underwent 4x5 minutes of lower limb ischemia (induced by inflation of bilateral thigh cuffs to 200 mmHg), followed by 5 minutes of reperfusion. The control group (n=20) underwent a sham protocol (4x5 minutes of bilateral thigh cuff inflation to 20 mmHg). Thereafter, participants ascended to 3450 m by train over 2 hours and stayed there for 48 hours. AMS was evaluated by the Lake Louise score (LLS) and the AMS-C score. Systolic pulmonary artery pressure (SPAP) was assessed by transthoracic Doppler echocardiography. RIPC had no effect on the overall incidence (RIPC: 35%, control: 35%, P=1.0) and severity (RIPC versus control: P=0.496 for LLS; P=0.320 for AMS-C score) of AMS. RIPC also had no significant effect on SPAP (maximum after 10 hours at high altitude; RIPC: 33 (SD 8) mmHg; controls: 37 (SD 7) mmHg; P=0.19). This study indicates that RIPC, performed immediately before passive ascent to 3450 m, does not attenuate AMS and the magnitude of high altitude pulmonary hypertension.

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Peripheral Ventilation Heterogeneity Determines the Extent of Bronchoconstriction in Asthma

In asthma, bronchoconstriction causes topographically heterogeneous airway narrowing, as measured by 3-dimensional ventilation imaging. Computation modelling suggests that peripheral airway dysfunction is a potential determinant of acute airway narrowing measured by imaging. We hypothesised that the development of low ventilation regions measured topographically by 3-dimensional imaging after bronchoconstriction is predicted by peripheral airway function. Fourteen (14) asthmatic subjects underwent ventilation Single Photon Emission Computed Tomography/CT (VSPECT/CT) before and after methacholine challenge. 1L breaths of Technegas were inhaled from FRC, in upright posture before supine scanning. The lung regions with the lowest ventilation (Vent_low) were calculated using a thresholding method, and expressed as a percentage of total ventilation (Vent_total). Multiple breath nitrogen washout was used to measure diffusion dependent and convection dependent ventilation heterogeneity (Sacin and Scond, respectively) and Lung Clearance Index (LCI), before and after challenge. FEV1 was 87.6 ±15.8 % predicted and 7 subjects had airway hyperresponsiveness. Vent_low at baseline was unrelated to spirometry or MBNW indices. Methacholine challenge decreased FEV1 by 23 ±5% of baseline while Ventlow increased from 21.5 ±2.3 %Vent_total to 26.3 ±6.7 %Vent_total (p=0.03). The change in Vent_low was predicted by baseline Sacin (r_s = 0.60, p=0.03) and by LCI (r_s = 0.70, p=0.006) but not by Scond (r_s = 0.30, p=0.30). The development of low-ventilation lung units in 3-dimensional ventilation imaging is predicted by ventilation heterogeneity in diffusion-dependent airways. This relationship suggests that acinar ventilation heterogeneity in asthma may be of mechanistic importance in terms of bronchoconstriction and airway narrowing.

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Imaging IGF-I uptake in growth plate cartilage using in vivo multiphoton microscopy

Bones elongate through endochondral ossification in cartilaginous growth plates located at ends of primary long bones. Linear growth ensues from a cascade of biochemical signals initiated by actions of systemic and local regulators on growth plate chondrocytes. Although cellular processes are well defined, there is a fundamental gap in understanding how growth regulators are physically transported from surrounding blood vessels into and through dense, avascular cartilage matrix. Intravital imaging using in vivo multiphoton microscopy is one promising strategy to overcome this barrier by quantitatively tracking molecular delivery to cartilage from the vasculature in real time. We previously used in vivo multiphoton imaging to show that hindlimb heating increases vascular access of large molecules to growth plates using 10-, 40-, and 70 kDa dextran tracers. In order to comparatively evaluate transport of similarly sized physiological regulators, we developed and validated methods for measuring uptake of biologically active IGF-I into proximal tibial growth plates of live 5-week old mice. We demonstrate that fluorescently labeled IGF-I (8.2 kDa) is readily taken up in the growth plate and localizes to chondrocytes. Bioactivity tests performed on cultured metatarsal bones confirmed that the labeled protein is functional, assessed by phosphorylation of its signaling kinase Akt. This methodology, which can be broadly applied to many different proteins and tissues, is relevant for understanding factors that affect delivery of biologically relevant molecules to the skeleton in real time. Results may lead to the development of drug-targeting strategies to treat a wide range of bone and cartilage pathologies.

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CORP: Measurement of Lung Function in Small Animals

The measurement of lung function in mice and rats is crucial for understanding how well small animal models of pulmonary disease recapitulate human clinical pathology, but brings with it the challenge of making accurate measurements in animals as small as a mouse. Overcoming these challenges can be achieved in a number of ways, each based on a model idealization of how the lung works as a mechanical system. Accordingly, it is important to understand the theoretical basis on which an assessment of lung function rests in order to interpret experimental measurements appropriately. It is also crucial to attend to a number of practical issues that determine the quality of the measurements. The most accurate measurements of lung function in small animals are provided by the forced oscillation technique that provides lung resistance and elastance, and their multi-frequency generalization known as impedance. Measurement quality is maximized when the greatest possible degree of control is exerted over the amplitude and frequency with which air is oscillated in and out of the lungs, the mean or end-expiratory transpulmonary pressure pertaining when the oscillations are applied, and the immediately past volume history of the lungs. It is also crucial that no spontaneous breathing efforts occur during the measurement period. Finally, there is no substitute for the skill in animal handling and surgical preparation that comes with practice; such skill should be in place before embarking on any important series of experiments.

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The Hypoxia-Adenosine Link during Inflammation

Hypoxic tissue conditions occur during a number of inflammatory diseases and are associated with the breakdown of barriers and induction of pro-inflammatory responses. At the same time, hypoxia is also known to induce several adaptive and tissue-protective pathways that dampen inflammation and protect tissue integrity. Hypoxia inducible factors (HIFs) that are stabilized during inflammatory or hypoxic conditions are at the center of mediating these responses. In the past decade, several genes regulating extracellular adenosine metabolism and signaling have been identified as being direct targets of HIFs. Here, we discuss the relationship between inflammation, hypoxia, and adenosine and that HIF-driven adenosine metabolism and signaling is essential in providing tissue protection during inflammatory conditions, including myocardial injury, inflammatory bowel disease, and acute lung injury. We also discuss how the hypoxia-adenosine link can be targeted therapeutically in patients as a future treatment approach for inflammatory diseases.

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Wearable Ballistocardiogram and Seismocardiogram Systems for Health and Performance

Cardiovascular diseases (CVDs) are prevalent in the US and many forms of CVDs primarily affect the mechanical aspects of heart function. Wearable technologies for monitoring the mechanical health of the heart and vasculature could enable proactive management of CVDs through titration of care based on physiological status, as well as preventative wellness monitoring to help promote lifestyle choices that reduce the overall risk of developing CVDs. Additionally, such wearable technologies could be used to optimize human performance in austere environments. This review describes our progress in developing wearable ballistocardiogram (BCG) and seismocardiogram (SCG) based systems for monitoring relative changes in cardiac output, contractility, and blood pressure. Our systems use miniature, low noise accelerometers to measure the movements of the body in response to the heartbeat, and novel machine learning algorithms to provide robustness against motion artifacts and sensor misplacement. Moreover, we mathematically related wearable BCG signals - representing local, cardiogenic movements of a point on the body - to better-understood whole-body BCG signals, and thereby improved estimation of key health parameters. We validated these systems using experiments with healthy subjects, studies in patients with heart failure, and measurements in austere environments such as water immersion. The systems can be used in future work as a tool for clinicians and physiologists to measure the mechanical aspects of cardiovascular function outside of clinical settings, and to thereby titrate care for patients with CVDs, provide preventative screening, and optimize performance in austere environments by providing real-time in-depth information regarding performance and risk.

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Cardiac output by pulse contour analysis does not match the increase measured by rebreathing during human spaceflight

Pulse contour analysis of the non-invasive finger arterial pressure waveform provides a convenient means to estimate cardiac output (Q ). The method has been compared to standard methods under a range of conditions but never before during spaceflight. We compared pulse contour analysis with the Modelflow algorithm to estimates of Q obtained by rebreathing during pre-flight baseline testing and during the final month of long-duration spaceflight in nine healthy male astronauts. By Modelflow analysis, stroke volume was greater in supine baseline than seated baseline or inflight. Heart rate was reduced in supine baseline so that there were no differences in Q by Modelflow estimate between the supine (7.02±1.31 L/min, mean±SD), seated (6.60±1.95 L/min) or inflight (5.91±1.15 L/min) conditions. In contrast, rebreathing estimates of Q increased from seated baseline (4.76±0.67 L/min) to inflight (7.00±1.39 L/min, significant interaction effect of Method and Spaceflight, P<0.001). Pulse contour analysis utilizes a three element Windkessel model that incorporates parameters dependent on aortic pressure - area relationships that are assumed to represent the entire circulation. We propose that a large increase in vascular compliance in the splanchnic circulation invalidates the model under conditions of spaceflight. Future spaceflight research measuring cardiac function needs to consider this important limitation for assessing absolute values of Q and stroke volume.

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Wearable Physiological Monitoring for Human Thermal-Work Strain Optimization

Safe performance limits of soldiers and athletes have typically relied on predictive work-rest models of ambient conditions, average work intensity, and characteristics of the population. Bioengineering advances in noninvasive sensor technologies including miniaturization, reduced cost, power requirements, and comfort now make it possible to produce individual predictions of safe thermal-work limits. These precision medicine assessments depend on the development of thoughtful algorithms based on physics and physiology. Both physiological telemetry and thermal-strain indices have been available for more than fifty years but greater computing power and better wearable sensors now make it possible to provide actionable information at the individual level. Core temperature can be practically estimated from time series heart rate data, and, using an adaptive physiological strain index, provides meaningful predictions of safe work limits that cannot be predicted from only core temperature or heart rate measurements. Early adopters of this technology include specialized occupations where individuals operate in complete encapsulation such as chemical protective suits. Emerging technologies that focus on heat flux measurements at the skin show even greater potential for estimating thermal-work strain using a parsimonious sensor set. Applications of these wearable technologies include many sports and military training venues where inexperienced individuals can learn effective work pacing strategies and train to safe personal limits. The same strategies can also provide a technologically-based performance edge for experienced workers and athletes faced with novel and non-intuitive physiological challenges, such as health care providers in full protective clothing treating Ebola patients in West Africa in 2014.

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Aerobic exercise elevates markers of angiogenesis and macrophage IL6 gene expression in the subcutaneous adipose tissue of overweight-to-obese adults

Alterations in the inflammatory state, metabolic function, and structure of subcutaneous adipose tissue (SAT) can impact the development of insulin resistance in obesity. Exercise can improve metabolic health in obesity, but the effects of exercise on SAT are not well known. The purpose of this study was to examine the effects of acute exercise and habitual exercise training on mRNA expression of markers of lipid metabolism, inflammation, fibrosis, and hypoxia/angiogenesis in SAT, as well as adipocyte cell size. We recruited overweight-to-obese adults who exercised regularly (ACTIVE: n=8) or were sedentary (SED: n=12). The groups were well-matched for age (27±1 vs. 24±2 y), BMI (29±1 vs. 27±1 kg/m²), and body composition (30±1 vs 29±1 % body fat), but as expected, cardiorespiratory fitness was greater in ACTIVE vs. SED (VO₂peak: 51±3 vs. 42±1 ml/kg FFM/min; p=0.01). Abdominal SAT biopsy samples were obtained before and 1 h after a single session of aerobic exercise (60 min at ~65% VO₂peak). The exercise session increased SAT mRNA expression of VEGFA, an important regulator of angiogenic processes, in both groups. In addition, SAT from ACTIVE subjects had greater mRNA expression of the endothelial cell marker CD31 compared with SED, which may be a cumulative effect of the transient increases in VEGFA with regular exercise. We also magnetically sorted CD14+ immune cells from SAT samples and found that IL6 expression was elevated in ACTIVE compared with SED. In conclusion, exercise initiates increases in factors related to angiogenic processes and may promote alterations in macrophage inflammation in SAT.

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Impact of ABCB1, ABCG2, and CYP3A5 polymorphisms on plasma trough concentrations of apixaban in Japanese patients with atrial fibrillation

Objectives: During anticoagulant therapy, major bleeding is one of the most severe adverse effects. This study aimed to evaluate the relationships between ABCB1, ABCG2, and CYP3A5 polymorphisms and plasma trough concentrations of apixaban, a direct inhibitor of coagulation factor X. Patients and methods: A total of 70 plasma concentrations of apixaban from 44 Japanese patients with atrial fibrillation were analyzed. In these analyses, the plasma trough concentration/dose (C/D) ratio of apixaban was used as a pharmacokinetic index and all data were stratified according to the presence of ABCB1 (ABCB1 1236C>T, 2677G>T/A, and 3435C>T), ABCG2 (ABCG2 421C>A), and CYP3A5 (CYP3A5*3) polymorphisms. Influences of various clinical laboratory parameters (age, serum creatinine, estimated glomerular filtration rate, aspartate amino transferase, and alanine amino transferase) on the plasma trough C/D ratio of apixaban were included in analyses. Results: Although no ABCB1 polymorphisms affected the plasma trough C/D ratio of apixaban, the plasma trough C/D ratio of apixaban was significantly higher in patients with the ABCG2 421A/A genotype than in patients with the ABCG2 421C/C genotype (P

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The combination of CYP3A4*22 and CYP3A5*3 single-nucleotide polymorphisms determines tacrolimus dose requirement after kidney transplantation

Introduction: Tacrolimus (Tac) has a narrow therapeutic window and shows large between-patient pharmacokinetic variability. As a result, over-immunosuppression and under-immunosuppression are frequently encountered in daily clinical practice. Unraveling the impact of genetic polymorphisms on Tac pharmacokinetics may help to refine therapy. In this study, the associations of single-nucleotide polymorphisms (SNPs) in drug-metabolizing enzymes (CYP3A) with Tac pharmacokinetics were investigated in renal transplant recipients. Participants and methods: In a cohort of 272 kidney transplant recipients, associations between functional genetic variants (CYP3A4*22 and CYP3A5*3) and dose-adjusted predose Tac concentrations (C0) and daily doses of Tac at days 5–7 and 15 and 1, 3, 6 and 12 months after renal transplantation were evaluated. Patients were genotyped and clustered according to both CYP3A4*22 and CYP3A5*3 allelic status: poor (PM) (CYP3A4*22 carriers with CYP3A5*3/*3), intermediate (IM) (CYP3A4*1/*1 with CYP3A5*3/*3 or CYP3A4*22 carriers with CYP3A5*1 carriers) and extensive CYP3A-metabolizers (EM) (CYP3A4*1/*1 and CYP3A5*1 carriers). Results: EM had an 88% lower dose-adjusted C0 compared with IM. PM had a 26% higher dose-adjusted C0 compared with IM. The percentage of patients with supratherapeutic Tac exposure (C0>15 ng/ml) was significantly higher in PM (43.5%) compared with EM (0%) at days 5–7 after transplantation (P=0.01). About 30% of EM had subtherapeutic exposure (C0

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Genetic determinants of impaired awareness of hypoglycemia in type 1 diabetes

Objective: It is likely that impaired awareness of hypoglycemia (IAH) and severe hypoglycemia are in part determined by genetic factors. The aim of this study was to investigate candidate genes for associations with IAH and severe hypoglycemia in a cohort of patients with type 1 diabetes. Participants and methods: Consecutive patients with type 1 diabetes were genotyped for single-nucleotide polymorphisms in or near the genes for the β1 and β2 adrenergic receptor (ADRB1, ADRB2), SORCS1, and BNC2, and for the insertion/deletion polymorphism in the ACE gene. IAH and severe hypoglycemia were assessed using a validated questionnaire. Results: Of 486 patients, 32.5% were classified as having IAH. The Arg16Gly polymorphism of ADRB2 was associated with IAH (odds ratio: 1.49, 95% confidence interval: 1.01–2.20, P=0.046) Gly16 (GG) versus carriers of the A allele. In a haplotype analysis, the association was the highest in patients with GG at position 16 and heterozygous at position 27 (odds ratio: 2.19, 95% confidence interval: 1.33–3.61, P=0.03). There were no associations between IAH and other genes, and none of the studied genes was associated with severe hypoglycemia. Conclusion: Genotypes at two variants of ADRB2 are associated with IAH. This association is comparable with the risk of classical risk factors for IAH.

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Polymorphisms in cytochrome P450 oxidoreductase and its effect on drug metabolism and efficacy

Cytochrome P450 oxidoreductase (POR) has played a potential role in the metabolism of drugs and steroids by supplying electrons to microsomal cytochrome P450 (CYP) enzymes. More than 200 different POR mutations and polymorphisms causing more than 130 amino acid changes in the POR protein have been reported since 2004. A503V is a common amino acid sequence variant encoded by POR*28, whereas A287P and R457H are the most common disease-causing mutations in Europeans and Asians, respectively. Polymorphisms in the POR gene can affect POR activity, CYP-mediated drug metabolism activities, and the efficacy of several clinically used drugs. The effects of POR variants on CYP activities are substrate dependent. In this review, recent research on the effects of POR genetic polymorphisms on drug metabolism and therapy has been summarized and discussed, which can contribute to the rational use of drugs in clinic and the development of personalized medicine.

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Diffusion Tensor Tractography for Decompressive Operation Decisions in Patients With Intracerebral Hemorrhage.

No abstract available

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Firefighter/Paramedic - Miles City Fire Rescue

Fireifghter/Paramedic performs dual role of firefighter and paramedic. This position responds to and prerpares for emergency calls, performs station duties as assigned. Participates in training program for fire/EMS/rescue.

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Fecal immunological blood test is more appealing than the guaiac-based test for colorectal cancer screening

The reasons for participation in fecal immunological testing (FIT) of subjects who were previously non-respondents to guaiac fecal occult blood testing (g-FOBT) have not been assessed.

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RIP3 AND pMLKL PROMOTE NECROPTOSIS-INDUCED INFLAMMATION AND ALTER MEMBRANE PERMEABILITY IN INTESTINAL EPITHELIAL CELLS

Necroptosis is an inflammatory form of programmed cell death requiring receptor-interacting protein kinase 3 (RIP3) and mixed lineage kinase domain-like protein (MLKL).

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Transglutaminase 6 antibodies in gluten neuropathy

TG6 antibodies have been shown to be a marker of gluten ataxia but their presence in the context of other neurological manifestations of gluten sensitivity has not been explored.We investigated the presence of TG6 antibodies in gluten neuropathy(GN), defined as as an otherwise idiopathic peripheral neuropathy associated with serological markers of gluten sensitivity (one or more of antigliadin IgG and/or IgA, endomysial and transglutaminase-2 antibodies)

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Fecal immunological blood test is more appealing than the guaiac-based test for colorectal cancer screening

The reasons for participation in fecal immunological testing (FIT) of subjects who were previously non-respondents to guaiac fecal occult blood testing (g-FOBT) have not been assessed.

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RIP3 AND pMLKL PROMOTE NECROPTOSIS-INDUCED INFLAMMATION AND ALTER MEMBRANE PERMEABILITY IN INTESTINAL EPITHELIAL CELLS

Necroptosis is an inflammatory form of programmed cell death requiring receptor-interacting protein kinase 3 (RIP3) and mixed lineage kinase domain-like protein (MLKL).

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Transglutaminase 6 antibodies in gluten neuropathy

TG6 antibodies have been shown to be a marker of gluten ataxia but their presence in the context of other neurological manifestations of gluten sensitivity has not been explored.We investigated the presence of TG6 antibodies in gluten neuropathy(GN), defined as as an otherwise idiopathic peripheral neuropathy associated with serological markers of gluten sensitivity (one or more of antigliadin IgG and/or IgA, endomysial and transglutaminase-2 antibodies)

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Juvenile body mass estimation: A methodological evaluation

Publication date: Available online 10 August 2017
Source:Journal of Human Evolution
Author(s): Libby Cowgill
Two attempts have been made to develop body mass prediction formulae specifically for immature remains: Ruff (Ruff, C.C., 2007, Body size prediction from juvenile skeletal remains. American Journal Physical Anthropology 133, 698–716) and Robbins et al. (Robbins, G., Sciulli, P.W., Blatt, S.H., 2010. Estimating body mass in subadult human skeletons. American Journal Physical Anthropology 143, 146–150). While both were developed from the same reference population, they differ in their independent variable selection: Ruff (2008) used measures of metaphyseal and articular surface size to predict body mass in immature remains, whereas Robbins et al. (2010) relied on cross-sectional properties. Both methods perform well on independent testing samples; however, differences between the two methods exist in the predicted values. This research evaluates the differences in the body mass estimates from these two methods in seven geographically diverse skeletal samples under the age of 18 (n = 461). The purpose of this analysis is not to assess which method performs with greater accuracy or precision; instead, differences between the two methods are used as a heuristic device to focus attention on the unique challenges affecting the prediction of immature body mass estimates in particular. The two methods differ by population only in some cases, which may be a reflection of activity variation or nutritional status. In addition, cross-sectional properties almost always produce higher estimates than metaphyseal surface size across all age categories. This highlights the difficulty in teasing apart information related to body mass from that relevant to loading, particularly when the original reference population is urban/industrial.



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Body mass estimation in hominoids: Age and locomotor effects

Publication date: Available online 10 August 2017
Source:Journal of Human Evolution
Author(s): M. Loring Burgess, Shannon C. McFarlin, Antoine Mudakikwa, Michael R. Cranfield, Christopher B. Ruff
While there are a number of methods available for estimation of body mass in adult nonhuman primates, very few are available for juveniles, despite the potential utility of such estimations in both analyses of fossils and in museum collection based research. Furthermore, because of possible scaling differences, adult based body mass estimation equations may not be appropriate for non-adults. In this study, we present new body mass estimation equations for both adult and immature nonhuman hominoids based on joint and metaphyseal dimensions. Articular breadths of the proximal and distal femur, distal humerus and tibial plateau, and metaphyseal breadths of the distal femur and humerus were collected on a reference sample of 159 wild Pan, Gorilla, Pongo, Hylobates, and Symphalangus specimens of known body mass from museum and research collections. Scaling of dimensions with body weight was assessed in both the adult and the ontogenetic sample at several taxonomic levels using reduced major axis regression, followed by regression of each dimension against body mass to generate body mass estimation equations. Joint dimensions were found to be good predictors of body mass in both adult and immature hominoids, with percent prediction errors of 10–20%. However, subtle scaling differences between taxa impacted body mass estimation, suggesting that phylogeny and locomotor effects should be considered when selecting reference samples. Unlike patterns of joint growth in humans, there was little conclusive evidence for consistently larger joints relative to body mass in the non-adult sample. Metaphyseal breadths were strong predictors of body mass and, with some exceptions, gave more precise body mass estimates for non-adults than epiphyseal breadths.



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Critical Care Paramedic - Florida Hospital

Florida Hospital seeks to hire a Critical Care Paramedic who will embrace our mission to extend the healing ministry of Christ. Work Hours/Shifts: Full Time: 3 12-Hour Shifts, 6:00pm – 6:00am Job Summary: Under general supervision the Critical Care Paramedic is a professional team member who is responsible for providing direct and indirect patient care. The Critical Care Paramedic shall provide ...

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Fire department's new CPR equipment will give patients 'best possible chance'

The device goes under a person's back, while another part wraps over a person's chest and holds a device which applies the compressions

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Transrectal rigid-hybrid NOTES cholecystectomy can be performed without peritoneal contamination: a controlled porcine survival study

Abstract

Background and study aims

The risk of infectious complications due to peritoneal contamination is a major concern and inhibits the widespread use of transrectal NOTES. A standardized rectal washout with a reversible colon occlusion device in situ has previously shown potential in reducing peritoneal contamination. The aim of this study was to compare the peritoneal contamination rate and inflammatory reaction for transrectal cholecystectomy after ideal rectal preparation (trCCE) and standard laparoscopic cholecystectomy (lapCCE) in a porcine survival experiment.

Methods

Twenty pigs were randomized to trCCE (n = 10) or lapCCE (n = 10). Before trCCE, rectal washout was performed with saline solution. A colon occlusion device was then inserted and a second washout with povidone-iodine was performed. The perioperative course and the inflammatory reaction (leukocytes, C-reactive protein) were compared. At necropsy, 14 days after surgery the abdominal cavity was screened for infectious complications and peritoneal swabs were obtained for comparison of peritoneal contamination.

Results

Peritoneal contamination was lower after trCCE than after lapCCE (0/10 vs. 6/10; p = 0.003). No infectious complications were found at necropsy in either group and postoperative complications did not differ (p = 1.0). Immediately after the procedure, leukocytes were higher after lapCCE (17.0 ± 2.7 vs. 14.6 ± 2.3; p = 0.047). Leukocytes and C-reactive protein showed no difference in the further postoperative course. Intraoperative complications and total operation time (trCCE 114 ± 32 vs. 111 ± 27 min; p = 0.921) did not differ, but wound closure took longer for trCCE (31.5 ± 19 vs. 13 ± 5 min; p = 0.002).

Conclusions

After standardized rectal washout with a colon occlusion device in situ, trCCE was associated without peritoneal contamination and without access-related infectious complications. Based on the findings of this study, a randomized controlled clinical study comparing clinical outcomes of trCCE with lapCCE should be conducted.

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Remnant gastropathy due to bile reflux after Roux-en-Y gastric bypass: a unique cause of abdominal pain and successful treatment with ursodiol

Abstract

Background

Chronic abdominal pain can occur after Roux-en-Y gastric bypass (RYGB), and can remain unexplained despite extensive investigation. Bile can pool in the gastric remnant and create a bile reflux gastropathy. The aim of this study was to assess gastric remnant findings in patients with RYGB and chronic abdominal pain of unclear etiology, and to determine the effectiveness of ursodiol therapy for patients with confirmed remnant gastropathy.

Methods

All consecutive patients with RYGB and a diagnosis of chronic abdominal pain, and a negative diagnostic workup (including physical examination, routine laboratory work, cross-sectional imaging, and standard upper endoscopy), who underwent device-assisted enteroscopy for evaluation of the gastric remnant, were included. Pathology reports, treatments, and clinical follow-up were recorded.

Results

28 post-RYGB patients (all female) with chronic abdominal pain and negative evaluation were included. Pooling of bile with gastric erythema was noted in 22/28 patients. All 22 patients with endoscopic erythema had pathology consistent with bile reflux chemical gastropathy. Of these patients, 12 were started on a proton pump inhibitor (PPI) alone, and 10 were started on ursodiol. Of the ursodiol group, 8/10 (80%) patients reported substantial improvement or resolution of abdominal pain at clinical follow-up. All three ursodiol patients with repeat endoscopic examination of the gastric remnant had endoscopic and histologic resolution of gastropathy. Of the PPI patients, 1/12 reported improvement in abdominal pain at clinical follow-up (p = 0.002), and both patients with repeat endoscopic examination of the gastric remnant had persistent remnant gastropathy.

Conclusions

Roux-en-Y gastric bypass patients with unexplained chronic pain, and biopsy-confirmed chemical gastropathy, had a significantly higher rate of abdominal pain resolution with ursodiol treatment compared to PPI. Remnant gastropathy due to bile reflux is a treatable cause of chronic abdominal pain in RYGB patients, and ursodiol should be considered for empiric treatment in RYGB patients with unexplained chronic abdominal pain.

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Trauma laparoscopy: when to start and when to convert?

Abstract

Background

The use of laparoscopy for stable patients with abdominal trauma is increasing and its accuracy is nearly 100%. However, indications for laparoscopy and for conversion differ among centers. The aim of this study was to investigate indications for trauma laparoscopy and for conversion to laparotomy.

Methods

All trauma patients managed with laparoscopy over a 4-year period were retrospectively analyzed. Indications for laparoscopy, morbidity, and reasons for conversion were investigated and predictors of morbidity and conversion were sought. The management algorithm of trauma patients was reviewed and updated.

Results

Laparoscopy was used in 318 stable trauma patients. Thirty-five patients presented with blunt and 283 with penetrating abdominal injuries. The conversion rate was 11.7% for penetrating and 22.9% for blunt abdominal trauma patients. The most common reason for conversion was continuous intraabdominal bleeding that could not be controlled quickly. It was followed by multiple complex injuries, hemodynamic instability, and intraoperative visualization problems. Diagnostic laparoscopy was performed in 45%, and therapeutic laparoscopy in 55% of cases. There were no missed injuries. Complications occurred in 21.2% in the converted group and in 9.6% in the laparoscopic group. Among initial systolic blood pressure, pulse, hemoglobin, lactate, and base deficit levels, only lower pH was associated with conversion.

Conclusion

The management of all stable trauma patients with laparoscopy appears to be a safe approach. The use of sound laparoscopic equipment by a well-coordinated trauma team with adequate expertise in laparoscopy, adherence to the algorithm, and strict compliance with predetermined procedural steps are fundamental to success. Continuous intraoperative bleeding, complexity of injuries, deterioration of the patient, poor visibility, and equipment failure are indications for conversion.

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Per-oral endoscopic myotomy (POEM): mid-term efficacy and safety

Abstract

Background and aims

Per-oral endoscopic myotomy (POEM) is becoming a standard treatment for achalasia. Long-term efficacy and the rate of post-POEM reflux should be further investigated. The main aim of this study was to analyze safety and mid-term (12 and 24 months) clinical outcomes of POEM.

Methods

Data on single tertiary center procedures were collected prospectively. The primary outcome was treatment success defined as an Eckardt score < 3 at 12 and 24 months. A total of 155 consecutive patients with achalasia underwent POEM; 133 patients were included into the analysis (22 patients will be analyzed separately as part of a multicenter randomized clinical trial).

Results

POEM was successfully completed in 132 (99.2%) patients, and the mean length of the procedure was 69.8 min (range 31–136). One patient underwent a drainage for pleural effusion; no other serious adverse events occurred. Treatment success at 3, 12, and 24 months was observed in 95.5% (CI 89.6–98.1), 93.4% (86.5–96.8), and 84.0% (71.4–91.4) of patients, respectively. A total of 11 patients (8.3%) reported initial treatment failure (n = 5) or later recurrence (n = 6). The majority of relapses occurred in patients with achalasia type I (16.7 vs. 1.1% achalasia type II vs. 0% achalasia type III; p<0.05). At 12 months, post-POEM reflux symptoms were present in 29.7% of patients. At 3 months, mild reflux esophagitis was diagnosed in 37.6% of patients, and pathological gastroesophageal reflux was detected in 41.5% of patients. A total of 37.8% of patients had been treated with a proton pump inhibitor.

Conclusion

POEM resulted in greater than 90% treatment success at 12 months which tends to decrease to 84% after 2 years. More than one-third of the patients had mild reflux symptoms and/or mild esophagitis.

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Erratum to: SAGES University MASTERS Program: a structured curriculum for deliberate, lifelong learning

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Paramedic - Tri County Health Care

Summary: Under general supervision, the EMT Paramedic is responsible to provide pre-hospital emergency care. Performs activities and functions according to MN State Department of Health rules and regulations and Tri-County Hospital policy and procedure. Supports the mission of the hospital while maintaining patient confidentiality and privacy compliance. Accepts patient safety as a key area of focus ...

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Curaplex® launches Stop the Bleed Kits as licensees of the Department of Homeland Security’s Stop the Bleed® Initiative

DUBLIN, Ohio – Curaplex®, the brand carried exclusively by Sarnova's family of companies, is adding Stop the Bleed kits to their product portfolio. Curaplex Stop the Bleed kits were designed to provide their end user with immediate access to products intended to stop traumatic hemorrhaging. These kits contain basic products for emergency responders or civilians to address a traumatic bleeding situation ...

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Fire department's new CPR equipment will give patient 'best possible chance'

The device goes under a person's back, while another part wraps over a person's chest and holds a device which applies the compressions

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What's the future of EMS?

BOCA RATON, Fla. — The EMS community, through a two-year process facilitated by Mike Taigman, is creating a vision for what a patient-centered, evidence-based EMS system will look like in 30 years and how to get there. Paramedic chiefs and EMS leaders at the Pinnacle EMS conference were briefed on the top developments in the first 50 years of EMS by Jon Krohmer, MD, Director, NHTSA Office of EMS ...

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Ill. fire department gets new CPR equipment to give patient 'best possible chance'

The device goes under a person's back, while another part wraps over a person's chest and holds a device which applies the compressions

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Interaction of niobium with iron-oxide colloids and the role of humic acid

Publication date: November 2017
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): Madhusudan Ghosh, K.K. Swain, Rakesh Verma
In this work, we report the sorption of Nb on iron oxides and the effect of humic acid. Iron oxides viz. goethite, hematite and magnetite were chemically synthesised and characterised by X-ray diffraction, particle size, surface area and zeta potential measurement. The sorption of Nb on all the three iron oxides was low (∼40%) at pH 1, increased to ∼ 90% at pH 8 and decreased marginally above pH 8. The effect of humic acid on the sorption was very small. Thermodynamic parameters viz. activation energy, enthalpy, entropy, free energy and sticking probability were calculated to understand the mechanism of the sorption process. Although the enthalpy was positive, the free energy change was negative i.e. the sorption was entropy driven process. The sorption followed pseudo-second-order kinetics and sticking probability model indicated that the process was chemisorption. This study is important to understand the probable migration of ⁹⁴Nb (half life 20300 y) during underground storage of radioactive waste.



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Sonim helps public safety get FirstNet-ready at APCO 2017

Field-tested, mission critical handsets and accessories available now SAN MATEO, Calif. — Sonim Technologies, the global leader in mission critical LTE-based handsets for public safety, is teaming up with more than a dozen technology leaders at the APCO Annual Conference and Expo in Denver, Aug. 13-16. Sonim has made public safety a priority and has collaborated with public safety professionals ...

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Parkinsonian rest tremor can be detected accurately based on neuronal oscillations recorded from the subthalamic nucleus

Publication date: Available online 9 August 2017
Source:Clinical Neurophysiology
Author(s): J. Hirschmann, J.M. Schoffelen, A. Schnitzler, M.A.J. van Gerven
ObjectiveTo investigate the possibility of tremor detection based on deep brain activity.MethodsWe re-analyzed recordings of local field potentials (LFPs) from the subthalamic nucleus in 10 PD patients (12 body sides) with spontaneously fluctuating rest tremor. Power in several frequency bands was estimated and used as input to Hidden Markov Models (HMMs) which classified short data segments as either tremor-free rest or rest tremor. HMMs were compared to direct threshold application to individual power features.ResultsApplying a threshold directly to band-limited power was insufficient for tremor detection (mean area under the curve [AUC] of receiver operating characteristic: 0.64, STD:0.19). Multi-feature HMMs, in contrast, allowed for accurate detection (mean AUC: 0.82, STD: 0.15), using four power features obtained from a single contact pair. Within-patient training yielded better accuracy than across-patient training (0.84 vs. 0.78, p = 0.03), yet tremor could often be detected accurately with either approach. High frequency oscillations (>200 Hz) were the best performing individual feature.ConclusionsLFP-based markers of tremor are robust enough to allow for accurate tremor detection in short data segments, provided that appropriate statistical models are used.SignificanceLFP-based markers of tremor could be useful control signals for closed-loop deep brain stimulation.



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Standardized Computer-based Organized Reporting of EEG: SCORE – second version

Publication date: Available online 9 August 2017
Source:Clinical Neurophysiology
Author(s): Sándor Beniczky, Harald Aurlien, Jan C. Brøgger, Lawrence J. Hirsch, Donald L. Schomer, Eugen Trinka, Ronit M Pressler, Richard Wennberg, Gerhard H. Visser, Monika Eisermann, Beate Diehl, Ronald P Lesser, Peter W. Kaplan, Sylvie Nguyen The Tich, Jong Woo Lee, Antonio Martins-da-Silva, Hermann Stefan, Miri Neufeld, Guido Rubboli, Martin Fabricius, Elena Gardella, Daniella Terney, Pirgit Meritam, Tom Eichele, Eishi Asano, Fieke Cox, Walter van Emde Boas, Ruta Mameniskiene, Petr Marusic, Jana Zárubová, Friedhelm C. Schmitt, Ingmar Rosén, Anders Fuglsang-Frederiksen, Akio Ikeda, David B. MacDonald, Kiyohito Terada, Yoshikazu Ugawa, Dong Zhou, Susan T. Herman
Standardized terminology for computer-based assessment and reporting of EEG has been previously developed in Europe. The International Federation of Clinical Neurophysiology established a taskforce in 2013 to develop this further, and to reach international consensus. This work resulted in the second, revised version of SCORE (Standardized Computer-based Organized Reporting of EEG), which is presented in this paper. The revised terminology was implemented in a software package (SCORE EEG), which was tested in clinical practice on 12,160 EEG recordings. Standardized terms implemented in SCORE are used to report the features of clinical relevance, extracted while assessing the EEGs. Selection of the terms is context sensitive: initial choices determine the subsequently presented sets of additional choices. This process automatically generates a report and feeds these features into a database. In the end, the diagnostic significance is scored, using a standardized list of terms. SCORE has specific modules for scoring seizures (including seizure semiology and ictal EEG patterns), neonatal recordings (including features specific for this age group), and for Critical Care EEG Terminology. SCORE is a useful clinical tool, with potential impact on clinical care, quality assurance, data-sharing, research and education.



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Comparison of Visual Evoked Potential Monitoring During Spine Surgeries under Total Intravenous Anesthesia versus Balanced General Anesthesia

Publication date: Available online 9 August 2017
Source:Clinical Neurophysiology
Author(s): Alberto A. Uribe, Ehud Mendel, Zoe A. Peters, Bassel F. Shneker, Mahmoud Abdel-Rasoul, Sergio D. Bergese
ObjectiveTo determine the comparison of its clinical utility and safety profile for visual evoked potential (VEP) monitoring during prone spine surgeries under total intravenous anesthesia (TIVA) versus balanced general anesthesia using the SightSaver™ visual stimulator.MethodsThe protocol was designed as a pilot, single center, prospective, randomized and double-arm study. Subjects were randomized to receive either TIVA or balanced general anesthesia. Following induction and intubation, 8 electrodes were placed subcutaneously to collect VEP recordings. The SightSaver™ visual stimulator was placed on the subject's scalp before prone positioning. VEP waveforms were recorded every 30 minutes and assessed by a neurophysiologist throughout the length of surgery.ResultsA total of 19 subjects were evaluated and VEP waveforms were successfully collected. TIVA group showed higher amplitude and lower latency than balanced anesthesia.ConclusionsOur data suggested that TIVA is associated with higher VEP amplitude and shorter latencies than balanced general anesthesia; therefore, TIVA could be the most efficient anesthesia regimen for VEP monitoring.SignificanceThe findings help better understand the effect of different anesthesia regimens on intra-operative visual evoked potential monitoring.



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Vitamin D levels in Smith-Lemli-Opitz syndrome

Smith–Lemli–Opitz syndrome (SLOS) is an autosomal recessive congenital malformation syndrome caused by mutations in the 7-dehydrocholesterol reductase gene. This inborn error of cholesterol synthesis leads to elevated concentrations of 7-dehydrocholesterol (7-DHC). 7-DHC also serves as the precursor for vitamin D synthesis. Limited data is available on vitamin D levels in individuals with SLOS. Due to elevated concentrations of 7-DHC, we hypothesized that vitamin D status would be abnormal and possibly reach toxic levels in patients with SLOS. Through a retrospective analysis of medical records between 1998 and 2006, we assessed markers of vitamin D and calcium metabolism from 53 pediatric SLOS patients and 867 pediatric patients who were admitted to the NIH Clinical Center (NIHCC) during the same time period. SLOS patients had significantly higher levels of 25(OH)D (48.06 ± 19.53 ng/ml, p < 0.01) across all seasons in comparison to the NIHCC pediatric patients (30.51 ± 16.14 ng/ml). Controlling for season and age of blood draw, 25(OH)D levels were, on average, 15.96 ng/ml (95%CI 13.95–17.90) higher in SLOS patients. Although, mean calcium values for both patient cohorts never exceeded the normal clinical reference range (8.6–10.2 mg/dl), the levels were higher in the SLOS cohort (9.49 ± 0.56 mg/dl, p < 0.01) compared to the NIHCC patients (9.25 ± 0.68 mg/dl). Overall, in comparison to the control cohort, individuals with SLOS have significantly higher concentrations of 25(OH)D that may be explained by elevated concentrations of serum 7-DHC. Despite the elevated vitamin D levels, there was no laboratory or clinical evidence of vitamin D toxicity.

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Effect of calf-raise training on rapid force production and balance ability in elderly men

This study examined whether home-based, high-speed calf-raise training changes the rate of torque development (RTD) during plantar flexion contractions and balance performance in elderly men. Thirty-four healthy elderly men (73 ± 5 yr) were randomly assigned to a training or control group (n = 17 in each group). The subjects in the training group completed 8 wk (3 times/wk) of home-based bilateral calf-raise training using body mass. Before and after the intervention, RTD during plantar flexion contractions and center-of-pressure (COP) displacement during single-leg standing were measured. Surface electromyographic amplitude of the triceps surae and tibialis anterior during the strength and single-leg standing was measured. Clinical magnitude-based inferences were used to interpret the training effect, with the smallest worthwhile effect assumed to be 0.2 of the baseline SD. The peak RTD increased 21% (90% confidence limits, ±19%) relative to the control group, which was accompanied by corresponding changes of the medial gastrocnemius (MG) and soleus (SOL) activations. The effect on COP displacement was possibly trivial (0%, ±13%), whereas substantial reduction in the MG (–19%, ±15%) and SOL (–25%, ±13%) activations during standing was observed. Our findings indicate that calf-raise training at home, performed without special equipment or venue, induces a substantial increase in the plantar flexors' rapid force-generating capability and triceps surae activations. Although the training effect on standing balance performance was not substantial, observed changes in the triceps surae activations during standing are expected to contribute to future balance performance improvement.

NEW & NOTEWORTHY Calf-raise training with the intent to move rapidly, without special equipment or venue, induces an improvement of explosive plantar flexion force, which is attributable to neuromuscular rather than musculotendinous adaptations. Although the training effect on balance performance was trivial, we found a sign of improvement (i.e., neuromuscular adaptations during standing). In conclusion, functional neuromuscular capacity can be enhanced by home-based calf-raise exercise in elderly men, which may protect against mobility loss with aging.

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Comparison of the vasodilatory effects of sodium nitroprusside vs. nitroglycerin

The vasodilatory mechanism of Nntroglycerin (NTG) is similar to sodium nitroprusside (SNP) in regard to action on guanosine 3'5'-monophosphate (cyclic GMP) via nitric oxide. However, it is unknown whether NTG can achieve the same magnitude of vasodilation in the forearm as SNP. Therefore, the purpose of the study was to evaluate the differences in forearm blood flow (FBF) and forearm vascular conductance (FVC) during escalating infusions of NTG vs. SNP at similar concentration doses and rates. We measured FBF using venous occlusion plethysmography (VOP) and Doppler ultrasound in eight young, healthy participants (mean age = 28 ± 2 yr) during four forearm volume (FAV)-specific doses (0.25, 0.5, 1, and 2 µg·100 ml FAV^–1·min^–1) of SNP and NTG infused via a brachial artery catheter. There was a significant difference in FVC of SNP vs. NTG only at the higher doses, as measured by VOP (14.9 ± 1.4 and 18.3 ± 1.5 vs. 11.6 ± 1.2 and 12.5 ± 1.2 ml/dl FAV^–1·min^–1·100 mmHg^–1). FVC as measured by Doppler ultrasound unadjusted for FAV was significantly different at the lowest and the higher two doses of SNP compared with NTG (202.1 ± 25.8, 329.4 ± 46.7, and 408 ± 63.5 vs. 142.9 ± 22.4, 217.2 ± 18.8, and 247.5 ± 18.2 ml·min^–1·100 mmHg^–1). SNP induces significantly higher vasodilatory actions compared with NTG. However, NTG is comparable in eliciting equivalent vasodilator effects to SNP during low concentration doses when measured by VOP. Importantly, for forearm pharmacology studies, NTG can elicit marked endothelium-independent forearm vasodilation.

NEW & NOTEWORTHY We compared the vasodilatory capacities of NTG vs. SNP at similar concentration doses and rates into the forearm. Based on the results of the study, it may be feasible to use intra-arterial NTG as a measure of endothelial-independent vasodilator in research studies. However, NTG dosing may need to be higher if used as an endothelial-independent vasodilator due to significant differences in the vasodilatory effects during higher doses of SNP compared with NTG.

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Experimental intermittent ischemia augments exercise-induced inflammatory cytokine production

Acute exercise-induced inflammation is implicated in mediating the beneficial adaptations to regular exercise. Evidence suggests that reduced oxygen and/or blood flow to contracting muscle alters cytokine appearance. However, the acute inflammatory responses to hypoxic/ischemic exercise have been documented with inconsistent results and may not accurately reflect the ischemia produced during exercise in patients with ischemic cardiovascular diseases. Therefore, we determined the extent to which local inflammation is involved in the response to ischemic exercise. Fourteen healthy males performed unilateral isometric forearm contractions for 30 min with and without experimental ischemia. Blood was drawn at baseline, 5 and 10 min into exercise, at the end of exercise, and 30, 60, and 120 min after exercise. Oxygen saturation levels, as measured by near-infrared spectroscopy, were reduced by 10% and 41% during nonischemic and ischemic exercise, respectively. Nonischemic exercise did not affect cytokine values. Ischemia enhanced concentrations of basic fibroblast growth factor, interleukin (IL)-6, IL-10, tumor necrosis factor-alpha, and vascular endothelial growth factor during exercise, but IL-8 was not influenced by ischemic exercise. In conclusion, the present study demonstrates that ischemic, small-muscle endurance exercise elicits local inflammatory cytokine production compared with nonischemic exercise.

NEW & NOTEWORTHY We demonstrate that ischemic, small-muscle endurance exercise elicits local inflammatory cytokine production compared with nonischemic exercise. The present study advances our knowledge of the inflammatory response to exercise in a partial ischemic state, which may be relevant for understanding the therapeutic effects of exercise training for people with ischemic cardiovascular disease-associated comorbidities.

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Ocular changes over 60 min in supine and prone postures

Some astronauts are returning from long-duration spaceflight with structural ocular and visual changes. We investigated both the transient and sustained effects of changes in the direction of the gravity vector acting on the eye using changes in body posture. Intraocular pressure (IOP; measured by Perkins tonometer), ocular geometry (axial length, corneal thickness, and aqueous depth-noncontact biometer), and the choroid (volume and subfoveal thickness optical coherence tomography) were measured in 10 subjects (5 males and 5 females). Measures were taken over the course of 60 min and analyzed with repeated-measures analysis of covariance to assess the effects of posture and time. In the supine position, choroidal volume increased significantly with time (average value at <5 min = 8.8 ± 2.3 mm³, 60 min = 9.0 ± 2.4 mm³, P = 0.03). In the prone position, IOP and axial length increased with time (IOP at <5 min 15 ± 2.7 mmHg, 60 min = 19.8 ± 4.1 mmHg, P < 0.0001; axial length at <5 min = 24.29 ± 0.77 mm, 60 min = 24.31 ± 0.76 mm, P = 0.002). Each increased exponentially, with time constants of 5.3 and 14 min, respectively. Prone corneal thickness also increased with time (<5 min = 528 ± 35 μm, 60 min = 537 ± 35 μm³, P < 0.001). Aqueous depth was shortened in the prone position (baseline = 3.22 ± 0.31 mm, 60 min = 3.18 ± 0.32 mm, P < 0.0001) but did not change with time. The data show that changes in the gravity vector have pronounced transient and sustained effects on the geometry and physiology of the eye.

NEW & NOTEWORTHY We show that gravity has pronounced transient and sustained effects on the eye by making detailed ocular measurements over 60 min in the supine and prone postures. These data inform our understanding of how gravitational forces can affect ocular structures, which is essential for hypothesizing how ocular changes could occur with microgravity exposure.

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Effect of age, diet, and tissue type on PCr response to creatine supplementation

Creatine/phosphorylcreatine (PCr) responses to creatine supplementation may be modulated by age, diet, and tissue, but studies assessing this possibility are lacking. Therefore we aimed to determine whether PCr responses vary as a function of age, diet, and tissue. Fifteen children, 17 omnivorous and 14 vegetarian adults, and 18 elderly individuals ("elderly") participated in this study. Participants were given placebo and subsequently creatine (0.3 g·kg^–1·day^–1) for 7 days in a single-blind fashion. PCr was measured through phosphorus magnetic resonance spectroscopy (³¹P-MRS) in muscle and brain. Creatine supplementation increased muscle PCr in children (P < 0.0003) and elderly (P < 0.001), whereas the increase in omnivores did not reach statistically significant difference (P = 0.3348). Elderly had greater PCr increases than children and omnivores (P < 0.0001 for both), whereas children experienced greater PCr increases than omnivores (P = 0.0022). In relation to diet, vegetarians (P < 0.0001), but not omnivores, had significant increases in muscle PCr content. Brain PCr content was not affected by creatine supplementation in any group, and delta changes in brain PCr (–0.7 to +3.9%) were inferior to those in muscle PCr content (+10.3 to +27.6%; P < 0.0001 for all comparisons). PCr responses to a standardized creatine protocol (0.3 g·kg^–1·day^–1 for 7 days) may be affected by age, diet, and tissue. Whereas creatine supplementation was able to increase muscle PCr in all groups, although to different extents, brain PCr was shown to be unresponsive overall. These findings demonstrate the need to tailor creatine protocols to optimize creatine/PCr accumulation both in muscle and in brain, enabling a better appreciation of the pleiotropic properties of creatine.

NEW & NOTEWORTHY A standardized creatine supplementation protocol (0.3 g·kg^–1·day^–1 for 7 days) effectively increased muscle, but not brain, phosphorylcreatine. Older participants responded better than younger participants whereas vegetarians responded better than omnivores. Responses to supplementation are thus dependent on age, tissue, and diet. This suggests that a single "universal" protocol, originally designed for increasing muscle creatine in young individuals, may lead to heterogeneous muscle responses in different populations or even no responses in tissues other than skeletal muscle.

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Muscle length effect on corticospinal excitability during maximal concentric, isometric and eccentric contractions of the knee extensors

Abstract

Neural control of eccentric contractions differs from that of concentric and isometric contractions, but no previous study has compared responses to motor cortex stimulations at long muscle lengths during such contraction types. This study compared the effect of muscle length on corticospinal excitability between maximal concentric, isometric and eccentric contractions of the knee extensors. Twelve males performed 12 maximal concentric, isometric and eccentric voluntary contractions (36 contractions in total), separated by a 5-min rest between contraction types. The 12 contractions for the same contraction type were performed every 10 s, and transcranial magnetic stimulations (first 8 contractions) and electrical femoral nerve stimulations (last 4 contractions) were superimposed alternatively at 75° and 100° of knee flexion. Average motor evoked potential amplitude, normalized to the maximal M wave amplitude (MEP/M), and cortical silent period (CSP) duration were calculated for each angle, and compared among the contraction types. MEP/M was lower −23% and −28%, respectively) during eccentric than both concentric and isometric contractions at 75°, but similar between contraction types at 100° (P < 0.05). CSP duration was shorter (−12% and −10%, respectively) during eccentric than both concentric and isometric contractions at 75°, but longer (+11% and +9%, respectively) during eccentric contractions at 100° (P < 0.05). These results show that corticospinal excitability during eccentric contractions is angle dependent such that cortical inhibitory processes are greater with no alteration of corticospinal excitability at 100°, while this control is reversed at 75°.

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Hydration status, drug interactions, and determinants in a Spanish elderly population: a pilot study

Abstract

Proper hydration is essential to maintain optimal health and well-being at all stages of life, especially for the elderly. Side effects of certain drugs that affect hydration status may compromise the health of the ancients, who also constitute the most vulnerable group. No studies have been carried out, to our knowledge, at the intersection of drugs and hydration status. Our study aimed to evaluate the effects of chronic use of certain drugs (diuretics, corticoids and metformin) in the hydration status of the elderly. Results were obtained from a cross-sectional study with 96 volunteers (65–93 years) selected based on their pharmacological treatment. It included a validated food and drink frequency questionnaire and water removal, dehydration signs and symptoms assessment and urine analysis. All data were analysed by age and sex. Water balance decreased with advanced age, especially in men's group. Results were confirmed by means of the evaluation of dehydration signs and symptoms and colorimetric and chemical analysis of urine. Correlations between consumption of corticoids and hydration status were found, with different signs depending on the administration route (Rho = 0.522 and Rho = − 0,522 for oral and pulmonary corticoids, respectively). Furthermore, correlations between diuretics (Rho = − 0.343, p < 0.05) and metformin (Rho = − 0.802, p < 0.01) consumption and different urine markers were determined. In conclusion, the predominant dehydration state of the volunteers of the study is affected by drugs consumption and their route of administration. Hence, there is an urgent need for monitorization of hydration status based on drugs consumption.

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MtDNA genomes reveal a relaxation of selective constraints in low-BMI individuals in a Uyghur population

Abstract

Considerable attention has been focused on the effect of deleterious mutations caused by the recent relaxation of selective constraints on human health, including the prevalence of obesity, which might represent an adaptive response of energy-conserving metabolism under the conditions of modern society. Mitochondrial DNA (mtDNA) encoding 13 core subunits of oxidative phosphorylation plays an important role in metabolism. Therefore, we hypothesized that a relaxation of selection constraints on mtDNA and an increase in the proportion of deleterious mutations have played a role in obesity prevalence. In this study, we collected and sequenced the mtDNA genomes of 722 Uyghurs, a typical population with a high prevalence of obesity. We identified the variants that occurred in the Uyghur population for each sample and found that the number of nonsynonymous mutations carried by Uyghur individuals declined with elevation of their BMI (P = 0.015). We further calculated the nonsynonymous and synonymous ratio (N/S) of the high-BMI and low-BMI haplogroups, and the results showed that a significantly higher N/S occurred in the whole mtDNA genomes of the low-BMI haplogroups (0.64) than in that of the high-BMI haplogroups (0.35, P = 0.030) and ancestor haplotypes (0.41, P = 0.032); these findings indicated that low-BMI individuals showed a recent relaxation of selective constraints. In addition, we investigated six clinical characteristics and found that fasting plasma glucose might be correlated with the N/S and selective pressures. We hypothesized that a higher proportion of deleterious mutations led to mild mitochondrial dysfunction, which helps to drive glucose consumption and thereby prevents obesity. Our results provide new insights into the relationship between obesity predisposition and mitochondrial genome evolution.

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Mitophagy in maintaining skeletal muscle mitochondrial proteostasis and metabolic health with aging

Abstract

Skeletal muscle is important for overall functionality and health. Aging is associated with an accumulation of damage to mitochondria DNA and proteins. In particular, damage to mitochondrial proteins in skeletal muscle, which is a loss of mitochondrial proteostasis, contributes to tissue dysfunction and negatively impacts systemic health. Therefore, understanding the mechanisms underlying the regulation of mitochondrial proteostasis and how those mechanisms change with age is important for the development of interventions to promote healthy aging. Herein, we examine how impairment in the selective degradation of damaged/dysfunctional mitochondria through mitophagy may play a central role in the loss of mitochondrial proteostasis in skeletal muscle aging as well as its broader implications for systemic health. Further, we explore how stimulating mitophagy through exercise may promote healthy aging.

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Synaptic excitation by climbing fibre collaterals in the cerebellar nuclei of juvenile and adult mice

Abstract

The inferior olive conveys instructive signals to the cerebellum that drive sensorimotor learning. Inferior olivary neurons transmit their signals via climbing fibres, which powerfully excite Purkinje cells, evoking complex spikes and depressing parallel fibre synapses. Additionally, however, these climbing fibres send collaterals to the cerebellar nuclei (CbN). In vivo and in vitro data suggest that climbing fibre collateral excitation is weak in adult mice, raising the question of whether the primary role of this pathway may be developmental. We therefore examined climbing fibre collateral input to large premotor CbN cells over development by virally expressing channelrhodopsin in the inferior olive. In acute cerebellar slices from P12–14 mice, light-evoked EPSCs were large (>1 nA at −70 mV). The amplitude of these EPSCs decreased over development, reaching a plateau of ∼350 pA at P20–P60. Trains of EPSCs (5 Hz) depressed strongly throughout development, while convergence estimates indicated that the total number of functional afferents decreases with age. EPSC waveforms consisted of multiple peaks, likely resulting from action potential bursts in single collaterals and variable times to spike threshold in converging afferents. Activating climbing fibre collaterals evoked well-timed increases in firing probability in CbN neurons, especially in younger mice. The initially strong input, followed by the decrement in synaptic strength coinciding with the pruning of climbing fibres in the cerebellar cortex, implicates the climbing fibre collateral pathway in early postnatal development. Additionally, the persistence of substantial synaptic input at least to P60 suggests that this pathway may function in cerebellar processing into adulthood.

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Genotyping of HBV and tracking of resistance mutations in treatment-naïve patients with chronic hepatitis B

Infection and Drug Resistance

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Risky drinking habits on the rise among US adults

Reuters Health News

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Patient and physician preferences for anticancer drugs for the treatment of metastatic colorectal cancer: A discrete-choice experiment

Cancer Management and Research

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Antipsychotics’ cognitive side effects have gene-expression underpinnings

Reuters Health News

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Robot-assisted pancreaticoduodenectomy: Safety and feasibility

Robotic Surgery: Research and Reviews

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US News and World Report unveils 2017-18 Best Hospitals

Healthcare Finance News

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Elaboration and validation of Crohn’s disease anoperineal lesions consensual definitions

World Journal of Gastroenterology

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Risk stratification of patients with Crohn's disease: A retrospective analysis of clinical decision making and its impact on long-term outcome

Digestive Diseases

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Bacterial translocation and clinical progression of HCV-related cirrhosis in HIV-infected patients

Journal of Viral Hepatitis

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Clinical phenotype and outcome of hepatitis E virus-associated neuralgic amyotrophy

Neurology®

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Liver transplant-related anastomotic biliary strictures: A novel, rapid, safe, radiation-sparing, and cost-effective management approach

Gastrointestinal Endoscopy

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Open-label phase II clinical trial in 75 patients with advanced hepatocellular carcinoma receiving daily dose of tableted liver cancer vaccine, hepcortespenlisimut-L

Journal of Hepatocellular Carcinoma

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Marijuana use confers threefold risk of death from hypertension

Reuters Health News

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Utility of inflammatory marker- and nutritional status-based prognostic factors for predicting the prognosis of stage IV gastric cancer patients undergoing non-curative surgery

Anticancer Research

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Preoperative endoscopic titanium clip placement facilitates intraoperative localization of early-stage esophageal cancer or severe dysplasia

World Journal of Surgical Oncology

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Fatigue in patients with inflammatory bowel disease is associated with distinct differences in immune parameters

Clinical and Experimental Gastroenterology

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Stool cytomegalovirus polymerase chain reaction for the diagnosis of cytomegalovirus-related gastrointestinal disease

European Journal of Gastroenterology & Hepatology

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Undetectable negative tissue transglutaminase IgA antibodies predict mucosal healing in treated coeliac disease patients

Alimentary Pharmacology and Therapeutics

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Predictors of bile tree pathology in patients presenting with gallbladder disease

European Journal of Gastroenterology & Hepatology

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Association between lower air pressure and the onset of ischemic colitis: A case-control study

European Journal of Gastroenterology & Hepatology

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Effect of conjugated linoleic acids and omega-3 fatty acids with or without resistance training on muscle mass in high fat diet-fed middle-aged mice

Abstract

This study investigated the effects of 20 weeks of combined conjugated linoleic acid/omega-3 fatty acid (n-3) administration independently or combined with resistance exercise training (RET) muscle in middle-aged mice consuming a high-fat diet (HFD). Nine-month-old C57BL/6 mice were randomly assigned into four experimental groups (H: high-fat diet, HE: H + RET, HCN: H + CLA/n-3, and HECN: H + CLA/n3 + RET). Body composition and functional capacity were assessed at pre- and post-intervention. Muscle tissues were collected at 14 months of age. ANOVA was used with significance set at P ≤ 0.05. Fat mass significantly increased in H (+74%), HE (+142%), and HECN (+43%) but not HCN. Muscle wet weights were significantly lower in H and HCN than HE and HECN. Grip strength substantially declined in H (-15%) and HCN (-17%) while sensorimotor function significantly declined only in H (-11%). HECN exhibited improvement in strength (+22%) and sensorimotor coordination (+17%). Muscle tumor necrosis factor-alpha (TNF-α) mRNA expression was significantly higher in H than HE (+39%), HCN (+24%), and HECN (+21%). Mean myofiber cross-sectional areas were markedly lower in H and HCN than HE and HECN. H showed significantly lower satellite cell abundance and myonuclei number than all other groups. Our findings suggest that long-term daily CLA/n-3 intake with resistance training improved sensorimotor function, ameliorated fat gain, and prevented loss of myogenic capacity while lowering TNF-α expression under chronic HFD.

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Discharges with surgical procedures performed less often than once per month per hospital account for two-thirds of hospital costs of inpatient surgery

Most surgical discharges (54%) at the average hospital are for procedures performed no more often than once per month at that hospital. We hypothesized that such uncommon procedures would be associated with an even greater percentage of the total cost of performing all surgical procedures at that hospital.

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Submental intubation — Practical alternative airway in maxillofacial surgeries

Airway management of maxillofacial patients is very crucial for both anesthetists and maxillofacial surgeons, as the former need to maintain a patent airway for adequate ventilation while the latter require adequate room for surgical procedures. In most maxillofacial surgeries where dental occlusion needs to be assessed intra operatively, nasotracheal intubation is always the preferred route. However, this route of intubation is not always possible and orotracheal intubation is not practical as it hinders the achievement of dental occlusion.

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Is gabapentin effective and safe in open hysterectomy? A PRISMA compliant meta-analysis of randomized controlled trials

Pain management after open hysterectomy has been investigated for years. Owing to the effect of significant analgesic, gabapentin was often administrated for pre-emptive analgesia. However, the relationship between gabapentin and postoperative pain after open hysterectomy is still controversial. This meta-analysis was applied to assess the efficacy of pre-emptive use of gabapentin in open hysterectomy.

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Sugammadex efficacy for reversal of rocuronium- and vecuronium-induced neuromuscular blockade: A pooled analysis of 26 studies

To summarize and compare efficacy of sugammadex with neostigmine or placebo for reversal of rocuronium- or vecuronium-induced neuromuscular blockade (NMB), and to demonstrate consistency of sugammadex results across various patient populations.

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Modified open-access scheduling for new patient evaluations at an academic chronic pain clinic increased patient access to care, but did not materially reduce their mean cancellation rate: A retrospective, observational study

To determine if open-access scheduling would reduce the cancellation rate for new patient evaluations in a chronic pain clinic by at least 50%.

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Clinical efficacy of a supraglottic airway device with a pressure gauge for robot-assisted surgery

The number of robot-assisted surgeries has increased in the recent years. During a robot-assisted surgery, it is difficult to manage a change in airway pressure due to a pneumoperitoneum and a change of the position in the perioperative position. Inadequate airway pressure management may increase the incidence of sore throats [1,2]. The LMAR Protector™ Airway (Teleflex Medical Japan, Tokyo, Protector) is the newest type of most second-generation airway. The Protector has an integrated cuff pressure indicator that allows for continuous cuff pressure monitoring at-a-glance (Fig.

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The combination of sugammadex and desflurane may increase the risk of bronchospasm during general anesthesia

Since our hospital began carrying sugammadex, a period of three months, our Anesthesiology department had three cases of bronchospasm. All three occurred immediately after sugammadex administration during general anesthesia with desflurane maintenance. Two of these cases occurred during routine orthopedic surgery and the other during an uncomplicated hernia repair at a southern VA hospital in the United States.

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Lumbar vertebra surgery performed with a bilateral posterior quadratus lumborum block

The methods for perioperative pain management have remained limited for lumbar vertebrae surgery. Several type of quadratus lumborum (QL) block has been reported to be an effective analgesic in not only trunk surgery but also lower limbs surgery [1,2,3]. Of these QL block, a posterior QL block, injects local anesthetic at the posterior aspect of the QL, may be effective analgesic in lumbar vertebrae surgery because local anesthetic may flow to the transverse process and block posterior branched of lumbar spinal nerve (Fig.

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Ultrasound-guided transversus thoracic muscle plane block: Complication in 299 consecutive cases

It has been reported that a transversus thoracic muscle plane (TTP) block can block multiple anterior branches of the intercostal nerves (Th2 to 6), which dominate the internal mammary region [1,2,3,4,5]. Some complications such as hematoma, infection, and pneumothorax may occur after a TTP block. In the present study, we reported the incidence of these complications in patients who received an ultrasound-guided TTP block. This study was approved by the Showa University Hospital Institutional Review Board (approval number 2234) and was registered at the University Hospital Medical Information Network (UMIN ID number UMIN000026296).

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Nebulized ketamine for successful management of difficult airway

Awake fiberoptic intubation (FOI) is the gold standard of airway management when a difficult airway is expected. It is essential to sufficiently anaesthetize the upper airway and suppress the gag, swallow and cough reflexes prior to awake FOI and thus ensure patient comfort [1]. Topical application of local anaesthetics by nebulization is one of the techniques used to anaesthetize the airway. To the best of our knowledge, this is the first report on the advantage of a nebulized administration route of ketamine in securing the airway.

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Biological evidence of the impact of burnout on the health of anesthesiologists

Our group presented a study on burnout many years ago and the initial reaction by other researchers in the anesthesia community was to dismiss the importance of our findings [1]. I remember that a prominent anesthesiologist in particular said "In my time, we just told people to toughen up." It was not until surgeons started to present and support national studies regarding burnout that we decided to pay closer attention and greater value to the issue [2].

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Uncommon combinations of ICD10-PCS or ICD-9-CM operative procedure codes account for most inpatient surgery at half of Texas hospitals

Recently, there has been interest in activity-based cost accounting for inpatient surgical procedures to facilitate "value based" analyses. Research 10–20years ago, performed using data from 3 large teaching hospitals, found that activity-based cost accounting was practical and useful for modeling surgeons and subspecialties, but inaccurate for individual procedures. We hypothesized that these older results would apply to hundreds of hospitals, currently evaluable using administrative databases.

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Perioperative use of 5% dextrose to decrease postoperative nausea and vomiting

In a randomized clinical trial comparing the incidence of postoperative nausea and vomiting (PONV) during perioperative administration of 5% dextrose and normal saline in patients undergoing laparoscopic cholecystectomy, Mishra et al. [1] show that perioperative administration of 5% dextrose can reduce PONV significantly and even if PONV occurs, the quantity of rescue antiemetics to combat PONV is also reduced significantly. Many things of this study were well done. The authors used a consistent operation (elective laparoscopic cholecystectomy) and had tried to control most of known factors affecting PONV, such as age, female gender, non-smoking status, Apfel score, durations of anesthesia and operation, intraoperative fluid volumes, etc.

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Laparoscopic cholecystectomy under neuraxial anesthesia compared with general anesthesia: Systematic review and meta-analyses

Pneumoperitoneum during laparoscopic cholecystectomy (LC) can cause hypercapnia, hypoxemia, hemodynamic changes and shoulder pain. General anesthesia (GA) enables the control of intraoperative pain and ventilation. The need for GA has been questioned by studies suggesting that neuraxial anesthesia (NA) is adequate for LC.

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Application of a skin traction method to facilitate ultrasound-guided brachial plexus block in obese patient with short neck

Ultrasound-guided brachial plexus block is difficult to perform in patients who are obese and have a short neck, as a thick subdermal adipose layer makes stable ultrasound probe placement impossible [1]. A skin traction method is reportedly helpful for central venous catheter placement in pediatric cases [2]. Here, we propose the use of the skin traction method to perform brachial plexus block in obese patients.

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Another quest for the holy grail of abolishing post operative nausea and vomiting

Postoperative nausea and vomiting (PONV) continues to have an incidence of approximately 30% in the general population, up to 70% in high-risk individuals, and also consistently ranks amongst the most undesirable side-effects of anesthesia that patients encounter post-operatively [1,2]. PONV remains one of the most common causes of prolonged post-operative care unit (PACU) stay as well as unexpected hospital admission for same-day surgery patients, both of which can have profound significance and implications that reach well beyond the PACU as well as potentially have a negative impact on the patient's satisfaction and increase overall health care costs.

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Cervical interfascial plane (CIP) block and multifidus cervicis plane (MCP) block: Similarities and tips

We read with interest the Correspondence by Drs. Ueshima and Otake regarding cervical interfascial plane (CIP) block [1]. They described that CIP block was administered with local anesthetic injection between the multifidus and longissimus muscles at the level of C5, achieving C2-6 analgesic effect observed by pinprick test. We would like to express our concerns about this technique.

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PECS2 blocks for breast surgery: A case for multimodal anesthesia

Breast surgery is associated with moderate to severe postoperative pain, and high incidence of postoperative nausea and vomiting (PONV). If left untreated, it can lead to increased patients' suffering, a prolongation of hospital stay and related costs [1]. Failure to provide good postoperative analgesia is also associated with poor recovery and increased risk of developing chronic post-surgical pain (CPSP) [2]. The incidence of CPSP after breast surgery can be as high as 60% in some cases and acute postoperative pain is, in itself, an independent predictor of CPSP after breast surgery at 4 and 9months [2,3].

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A novel treatment for herpes zoster pain using an electrical stimulating catheter with a steering guidewire

Herpes zoster is caused by reactivation of latent varicella-zoster virus in the trigeminal or dorsal root ganglion. Reactivation of the virus results in inflammation, a local immune response, and destruction of affected central and peripheral nerves [1]. Severe zoster pain can cause physical disability and emotional distress. The severity of acute zoster pain is a risk factor for postherpetic neuralgia [2]. Therefore, effective treatment of zoster pain is important to prevent negative sequelae. By delivering therapeutic agents directly into targeted spinal segment, accurate epidural drug delivery can maximize the desired effects while minimizing adverse systemic effects.

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Labor analgesia: We need to better understand and educate our obstetric patients

Nitrous oxide has long been an option for labor analgesia in the United Kingdom. It has only been over the last few years, however, that it has become available on some Labor and Delivery units in the United States with many others now considering whether to offer it as another analgesic choice for laboring women. Limited data are available regarding the efficacy of nitrous oxide labor analgesia. In this issue of the Journal of Clinical Anesthesia, Sutton, et al. provide useful information that may assist anesthesiologists and obstetricians who are adopting its use on their units.

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