Παρασκευή, 18 Αυγούστου 2017

Lack of association between interleukin 28B polymorphism and vertical transmission of hepatitis C.

Objectives: Single genetic nucleotide polymorphism (rs12979860) near the gene for Interleukin 28B (IL28B), is known to be of importance for frequency of spontaneous clearance and treatment outcome in interferon based therapies in patients with hepatitis C virus (HCV) infection. The aim of this study was to investigate if IL28B polymorphism in children and/or their mothers plays a role in vertical transmission of HCV (HCV-VT). Methods: Plasma samples from 59 infected women, 76 uninfected children born to infected mothers, and 47 children with known vertically transmitted HCV infection, were analysed for IL28B polymorphism and classified by the IL28B genotype (C/C, C/T and T/T) as well as by viral genotype. Results: The proportion of children with genotype C/C was the same in the vertically infected (36%, 17/47) and the exposed uninfected children (38%, 29/76). No difference was seen when stratifying for viral genotype. There was no association between mothers' IL28B genotype and the risk of vertical transmission. Conclusion: Regardless of viral genotype we found no association between IL28B genotype and the risk of HCV-VT. The IL28B genotype CC, which has been shown to be favourable in other settings, was not protective of HCV-VT. Thus, other factors possibly associated with the risk of HCV-VT need to be explored. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Physiologic Considerations in Trauma Patients Undergoing Resuscitative Endovascular Balloon Occlusion of the Aorta

Resuscitative endovascular balloon occlusion of the aorta is a new procedure for adjunctive management of critically injured patients with noncompressible torso or pelvic hemorrhage who are in refractory hemorrhagic shock, ie, bleeding to death. The anesthesiologist plays a critical role in management of these patients, from initial evaluation in the trauma bay to definitive care in the operating room and the critical care unit. A comprehensive understanding of the effects of resuscitative endovascular balloon occlusion of the aorta is essential to making it an effective component of hemostatic resuscitation.

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Resuscitative Endovascular Balloon Occlusion of the Aorta: Principles, Initial Clinical Experience, and Considerations for the Anesthesiologist

imageResuscitative endovascular balloon occlusion of the aorta (REBOA) is an endovascular technique that allows for temporary occlusion of the aorta in patients with severe, life-threatening, trauma-induced noncompressible hemorrhage arising below the diaphragm. REBOA utilizes a transfemoral balloon catheter inserted in a retrograde fashion into the aorta to provide inflow control and support blood pressure until definitive hemostasis can be achieved. Initial retrospective and registry clinical data in the trauma surgical literature demonstrate improvement in systolic blood pressure with balloon inflation and improved survival compared to open aortic cross-clamping via resuscitative thoracotomy. However, there are no significant reports of anesthetic implications and perioperative management in this challenging cohort. In this narrative, we review the principles, technique, and logistics of REBOA deployment, as well as initial clinical outcome data from our level-1 American College of Surgeons–verified trauma center. For anesthesiologists who may not yet be familiar with REBOA, we make several suggestions and recommendations for intraoperative management based on extrapolation from these initial surgical-based reports, opinions from a team with increasing experience, and translated experience from emergency aortic vascular surgical procedures. Further prospective data will be necessary to conclusively guide anesthetic management, especially as potential complications and implications for global organ function, including cerebral and renal, are recognized and described.

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Second-Order Peer Reviews of Clinically Relevant Articles for the Physiatrist: “Early Physical Therapy Vs Usual Care in Patients with Recent-Onset Low Back Pain” (Fritz JM, Magel JS, McFadden M, et al, JAMA 2015): “Physical Therapy May Not Help Acute Lower Back Pain Sufferers”

imageNo abstract available

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Physiatric Patient Care, Graduate Medical Education Training, and Graduate Medical Education Funding: A Call for Alignment

No abstract available

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Grip Strength on the Unaffected Side as an Independent Predictor of Functional Improvement After Stroke

imageObjective: The aim of this study was to investigate the association between grip strength on the unaffected side and post-stroke functional improvement. Design: A total of 127 patients with unilateral stroke were included in this study. Demographic data, clinical data on initial grip strength, initial National Institutes of Health Stroke Scale, admission and discharge Modified Barthel Index (MBI), and stroke profiles were retrospectively reviewed. Results: Univariate and multiple linear regression analyses were carried out to evaluate the predictive values of each variable. In the model for discharge MBI, age, initial National Institutes of Health Stroke Scale, grip strength on the unaffected side, lesion side, and admission MBI were shown to be independent predictors. Meanwhile, grip strength on the unaffected side, lesion side, and admission MBI had significant predictive values in the model for difference between admission and discharge MBI. Conclusion: The current study suggests for the first time that grip strength on the unaffected side is an independent predictor for short-term functional gain and outcome after stroke. This result may change post-stroke rehabilitation strategies to emphasize exercises to prevent loss of muscle strength. In addition, this implies the possibility of a relationship between sarcopenia and post-stroke function. Further research is needed to reveal the effect of sarcopenia on stroke patients and its mechanism.

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Feasibility of Restoring Walking in Multiple Sclerosis with Multichannel Implanted Electrical Stimulation

imageAbstract: A patient with multiple sclerosis–related gait dysfunction was followed over the course of his disease. Despite aggressive treatment, he developed significant weakness in ankle dorsiflexors and hip and knee flexors and was no longer capable of consistently taking a step on his own. With electrical stimulation of hip and knee flexors and ankle dorsiflexors using implanted electrodes, he was able to consistently walk short distances as far as 30 m, thus significantly improving his Expanded Disability Status Scale score. This case study supports further exploration into the potential benefits of an implanted pulse generator to ameliorate gait dysfunction and improve quality of life for people with multiple sclerosis.

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Isometric Exercise for the Cervical Extensors Can Help Restore Physiological Lordosis and Reduce Neck Pain: A Randomized Controlled Trial

imageObjective: The aim of this study was to investigate whether isometric neck extension exercise restores physiological cervical lordosis and reduces pain. Design: Sixty-five patients with loss of cervical lordosis were randomly assigned to exercise (27 women, 7 men; mean age, 32.82 ± 8.83 yrs) and control (26 women, 5 men; mean age, 33.48 ± 9.67 yrs) groups. Both groups received nonsteroidal anti-inflammatory drugs for 10 days. The exercise group received additional therapy as a home exercise program, which consisted of isometric neck extension for 3 mos. Neck pain severity and cervical lordosis were measured at baseline and at 3 mos after baseline. Results: Compared with baseline levels, cervical lordosis angle was significantly improved in the exercise group (P

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The State of Disability Awareness in American Medical Schools

imageAbstract: This study was designed to: (1) determine how many American medical schools include disability awareness in their curriculum, (2) explore the format of disability awareness programs in existence, and (3) understand why some schools do not include disability awareness in their curriculum. An online survey was sent to deans of medical education (or equivalent positions) at accredited allopathic and osteopathic American medical schools (N = 167) in 2015. Seventy-five schools (45%) completed surveys. Fifty-two percent (39/75) reported having a disability awareness program. The most common format was people with disabilities or caregivers speaking in a large group setting. Programs were most likely to focus on adults with physical disabilities. Among schools without a program, the top barriers were no one advocating for inclusion in the curriculum and time constraints. Nearly half of schools without a program expressed interest in adopting an awareness curriculum if one was made available. Such results indicate that efforts should be made to increase the number of schools that provide disability awareness education through increased advocacy and providing additional resources to schools without a curriculum.

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Efficacy of Radial Extracorporeal Shock Wave Therapy on Lateral Epicondylosis, and Changes in the Common Extensor Tendon Stiffness With Pretherapy and Posttherapy in Real-Time Sonoelastography: Erratum

No abstract available

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Authors' Response to Letter to the Editor “Ultrasound-Guided C7 Cervical Medial Branch Block Using the In-Plane Approach”

imageNo abstract available

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Chronic Effects of Different Rest Intervals Between Sets on Dynamic and Isometric Muscle Strength and Muscle Activity in Trained Older Women

imageObjective: This study investigated the chronic effects of different rest intervals (RIs) between sets on dynamic and isometric muscle strength and muscle activity. Design: We used a repeated-measures design (pretraining and posttraining) with independent groups (different RI). Twenty-one resistance-trained older women (66.4 ± 4.4 years) were randomly assigned to either a 1-minute RI group (G-1 min; n = 10) or 3-minute RI group (G-3 min; n = 11). Both groups completed 3 supervised sessions per week during 8 weeks. In each session, participants performed 3 sets of 15 repetitions of leg press exercise, with a load that elicited muscle failure in the third set. Fifteen maximum repetitions, maximal voluntary contraction, peak rate of force development, and integrated electromyography activity of the vastus lateralis and vastus medialis muscles were assessed pretraining and posttraining. Results: There was a significant increase in load of 15 maximum repetitions posttraining for G-3 min only (3.6%; P 0.05). Conclusions: The findings suggest that different RIs between sets did not influence dynamic and isometric muscle strength and muscle activity in resistance-trained older women.

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Can Early Rehabilitation on the General Ward After an Intensive Care Unit Stay Reduce Hospital Length of Stay in Survivors of Critical Illness?: A Randomized Controlled Trial

imageObjective: The aim of this study was to evaluate if an early rehabilitation program for survivors of critical illness improves functional recovery, reduces length of stay, and reduces hospital costs. Design: This was a prospective randomized controlled trial. Fifty-three consecutive survivors of critical illness were included in the study. After discharge from the intensive care unit, the intervention group received an early rehabilitation program, and the standard-care group received physical therapy as ordered by the primary care team. Length of stay at the general ward after transfer from the intensive care unit was recorded. In addition, Early Rehabilitation Barthel Index, visual analog scale for pain, 3-minute walk test, Beck Depression Inventory, State-Trait Anxiety Inventory, and Medical Research Council scale were used. Results: In the per-protocol analysis, length of stay at the general ward was a median 14 days (interquartile range [IQR], 12–20 days) in the early rehabilitation and 21 days [IQR, 13–34 days) in the standard-care group. This significant result could not be confirmed by the intention-to-treat analysis (16 days [IQR, 13–23 days] vs. 21 days [IQR, 13–34 days]). Secondary outcomes were similar between the groups. Hospital costs were lower in the intervention group. No adverse effects were detected. Conclusions: An early rehabilitation program in survivors of critical illness led to an earlier discharge from the hospital, improved functional recovery, and was also cost-effective and safe. To Claim CME Credits: Complete the self-assessment activity and evaluation online at http://ift.tt/1l80W45 CME Objectives: Upon completion of this article, the reader should be able to (1) delineate the benefits of early rehabilitation on a general medicine ward after an intensive care unit stay, (2) recognize the safety of appropriately implemented early rehabilitation, and (3) incorporate early rehabilitation on the general medical ward as applicable. Level: Advanced Accreditation: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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The Magnitude and Time Course of Muscle Cross-section Decrease in Intensive Care Unit Patients

imageObjective: Bedriddenness and immobilization of patients at an intensive care unit may result in muscle atrophy and devaluation in quality of life. The exact effect of immobilization on intensive care unit patients is not known. The aim of this study was to investigate the magnitude and time course of muscle cross-section decrease in acute critically ill patients admitted to the intensive care unit. Design: An observational pilot study was performed in intensive care unit patients. Data of bilateral ultrasound muscle cross-section measurements of the knee extensors and the elbow flexors were collected. Thirty-four intensive care unit patients were included in this study; data are presented from 14 patients who were measured at least three times. Results: Repeated measures analysis of variance shows a significant decrease in muscle cross-section over time (F1,13 = 80.40, P ≤ 0.001).The decrease in muscle cross-section of the arms was significantly higher (F1,13 = 5.38, P = 0.037) than the decrease of the legs. Four weeks after intensive care unit admission, the muscle cross-section decrease had not reached an asymptote yet. Conclusions: The muscle cross-section decrease in bedridden intensive care unit patients is significant for a time of 2 to 4 weeks. The decrease in muscle cross-section of the arms is greater than the decrease of the legs.

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Massage Therapy for Pain and Function in Patients With Arthritis: A Systematic Review of Randomized Controlled Trials

imageBackground: Massage therapy is gaining interest as a therapeutic approach to managing osteoarthritis and rheumatoid arthritis symptoms. To date, there have been no systematic reviews investigating the effects of massage therapy on these conditions. Design: Systematic review was used. Objectives: The primary aim of this review was to critically appraise and synthesize the current evidence regarding the effects of massage therapy as a stand-alone treatment on pain and functional outcomes among those with osteoarthritis or rheumatoid arthritis. Methods: Relevant randomized controlled trials were searched using the electronic databases Google Scholar, MEDLINE, and PEDro. The PEDro scale was used to assess risk of bias, and the quality of evidence was assessed with the GRADE approach. Results: This review found seven randomized controlled trials representing 352 participants who satisfied the inclusion criteria. Risk of bias ranged from four to seven. Our results found low- to moderate-quality evidence that massage therapy is superior to nonactive therapies in reducing pain and improving certain functional outcomes. It is unclear whether massage therapy is more effective than other forms of treatment. Conclusions: There is a need for large, methodologically rigorous randomized controlled trials investigating the effectiveness of massage therapy as an intervention for individuals with arthritis.

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Responsiveness of Myofascial Trigger Points to Single and Multiple Trigger Point Release Massages: A Randomized, Placebo Controlled Trial

imageObjective: This study aimed to assess the effects of single and multiple massage treatments on pressure-pain threshold (PPT) at myofascial trigger points (MTrPs) in people with myofascial pain syndrome expressed as tension-type headache. Design: Individuals (n = 62) with episodic or chronic tension-type headache were randomized to receive 12 twice-weekly 45-min massage or sham ultrasound sessions or wait-list control. Massage focused on trigger point release (ischemic compression) of MTrPs in the bilateral upper trapezius and suboccipital muscles. PPT was measured at MTrPs with a pressure algometer pre and post the first and final (12th) treatments. Results: PPT increased across the study timeframe in all four muscle sites tested for massage, but not sham ultrasound or wait-list groups (P

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Strengthening Rehabilitation in Health Systems Worldwide by Integrating Information on Functioning in National Health Information Systems

Abstract: A complete understanding of the experience of health requires information relevant not merely to the health indicators of mortality and morbidity but also to functioning—that is, information about what it means to live in a health state, "the lived experience of health." Not only is functioning information relevant to healthcare and the overall objectives of person-centered healthcare but to the successful operation of all components of health systems. In light of population aging and major epidemiological trends, the health strategy of rehabilitation, whose aim has always been to optimize functioning and minimize disability, will become a key health strategy. The increasing prominence of the rehabilitative strategy within the health system drives the argument for the integration of functioning information as an essential component in national health information systems. Rehabilitation professionals and researchers have long recognized in WHO's International Classification of Functioning, Disability and Health the best prospect for an internationally recognized, sufficiently complete and powerful information reference for the documentation of functioning information. This paper opens the discussion of the promise of integrating the ICF as an essential component in national health systems to secure access to functioning information for rehabilitation, across health systems and countries.

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Prospective Evaluation of Postural Control and Gait in Pediatric Patients with Cancer After a 4-Week Inpatient Rehabilitation Program

imageObjective: The aim of the study was to investigate the effects of a 4-wk inpatient rehabilitation program on postural control and gait in pediatric patients with cancer. Design: Eighty-eight patients with brain tumors (n = 59) and bone/soft tissue sarcomas (n = 29) were evaluated. Postural control was assessed examining the velocity of the center of pressure and single-leg stance time on a pressure distribution platform. Walk ratio, a measure of neuromotor control, was used to evaluate intervention effects on gait. Results: Repeated measures analysis of variance showed improvements in postural control measures, indicated by a decrease in velocity of center of pressure of −0.4 cm/sec (F1,80 = 7.175, P = 0.009, ηp2 = 0.082) and increase in single-leg stance time (mean [median] = 1.1 [2.6] sec, respectively; F1,80 = 12.617, P = 0.001, ηp2 = 0.136). Walk ratio increased by 0.2 mm/steps per min (F1,82 = 3.766, P = 0.056, ηp2 = 0.044). Mean changes in dependent variables did not differ between both patient groups (P > 0.05). Conclusions: The results indicate benefits of an inpatient rehabilitation program comprising standard physical therapy as well as aquatic and hippo therapy on postural control and gait after treatment of pediatric patients with cancer.

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Ultrasound-Guided C7 Cervical Medial Branch Block Using the In-Plane Approach

imageNo abstract available

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The 1-Year Results of Lumbar Transforaminal Epidural Steroid Injection in Patients with Chronic Unilateral Radicular Pain: The Relation to MRI Findings and Clinical Features

imageObjective: In patients with chronic radicular pain, we aimed to evaluate subgroup differences in 1-yr response to transforaminal epidural steroid injection. Design: In this longitudinal cohort study of 100 subjects, 170 transforaminal epidural steroid injections were performed for 1 yr. The sample was stratified by type of disc herniation (protrusion n = 57, extrusion n = 27), by location of disc herniation (central/subarticular n = 60, foraminal n = 24), by grade of nerve root compression (low-grade compression n = 61, high-grade subarticular nerve compression n = 14, high-grade foraminal nerve compression n = 25), and by positive Slump test (n = 67). Treatment response was evaluated by visual analogue scale leg pain and self-reported disability (Oswestry Disability Index). Logistic regression was used to analyze the predictive value of baseline characteristics including the stratified subgroups. Results: High-grade subarticular nerve compression predicted the 1-yr improvement in both visual analogue scale leg pain (P = 0.046) and Oswestry Disability Index (P = 0.027). Low age (P

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A Rarely Seen Complication That Causes Increase in Morbidity in Tetraplegic Patients: Zenker Diverticula

imageAbstract: Although spinal cord injury (SCI) damages the spinal cord, physiological changes due to SCI can affect many organs and systems of the human body. While respiratory problems are common following cervical SCI, dysphagia is a relatively uncommon secondary complication that occurs after cervical SCI. We report a case of recurrent aspiration pneumonia due to Zenker diverticulum in 26-year-old tetraplegic patient with a chronic history of silent aspirations and dysphagia contributing to functional disability.

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Another Etiology of Meralgia Paresthetica-Impingement by Bone Spur from Anterior Superior Iliac Spine: A Case Report: Erratum

No abstract available

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Radiopaque Line in Front of the Lumbar Spine During a S1 Transforaminal Epidural Injection: Where Is the Contrast?

imageNo abstract available

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Using a Parent Coordinator to Support the Role of the Pediatric Nurse Practitioner in Care Coordination

The role of the pediatric nurse practitioner is becoming more complex with time. Both patients and the health care system are becoming more intricate. Effective support of the PNP can consist of a nonclinical professional who is a parent of a chronically ill child. Support including data entry, preclinic planning, self-management support, appointment scheduling, research, and between-visit follow-up can be provided from the perspective of a parent. This article will describe the role of a parent coordinator who was hired in part to provide support for a pediatric nurse practitioner in a primary care clinic for patients with asthma.

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In Response

No abstract available

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The Need for a Global Perspective on Task-Sharing in Anesthesia

No abstract available

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Lysosomal Storage Diseases: Past, Present, and Future

imageNo abstract available

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The WFSA Global Anesthesia Workforce Survey

imageBACKGROUND: Safe anesthesia and surgical care are not available when needed for 5 billion of the world's 7 billion people. There are major deficiencies in the specialist surgical workforce in many parts of the world, and specific data on the anesthesia workforce are lacking. METHODS: The World Federation of Societies of Anaesthesiologists conducted a workforce survey during 2015 and 2016. The aim of the survey was to collect detailed information on physician anesthesia provider (PAP) and non-physician anesthesia provider (NPAP) numbers, distribution, and training. Data were categorized according to World Health Organization regional groups and World Bank income groups. RESULTS: We obtained information for 153 of 197 countries, representing 97.5% of the world's population. There were marked differences in the density of PAPs between World Health Organization regions and between World Bank income groups, ranging from 0 to over 20 PAP per 100,000 population. Seventy-seven countries reported a PAP density of

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Perioperative Hypotension in Infants: Insights From the GAS Study

No abstract available

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Quality and Safety in Anesthesia and Perioperative Care

No abstract available

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No Surprise—For Long-term Opioid Avoidance, Do We Reap What We Sow?

No abstract available

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Resuscitation Training for Schoolchildren Worldwide: Kids Save Lives: Erratum

No abstract available

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The Anesthesiologist’s Dream: “Wireless” Vital Sign Monitoring?

No abstract available

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Lack of Association Between the Use of Nerve Blockade and the Risk of Persistent Opioid Use Among Patients Undergoing Shoulder Arthroplasty: Evidence From the Marketscan Database

imageBACKGROUND: Persistent opioid use following surgery has received increasing attention from policymakers, researchers, and clinicians. Perioperative nerve blockade has been hypothesized to decrease the risk of persistent opioid use. We examined whether nerve blockade was associated with a decreased risk of persistent opioid use among patients undergoing shoulder arthroplasty, a procedure with high rates of persistent postoperative pain. METHODS: Using health care claims data, we constructed a sample of 6695 patients undergoing shoulder arthroplasty between 2002 and 2012 and used billing data to identify the utilization of nerve blockade. We then used a multivariable logistic regression to estimate the association between nerve blockade and 2 measures of opioid use: having filled at least 1 prescription for an opioid between postoperative days (PODs) 0 and 90, and between POD 91 and 365. This regression adjusted for a variety of potential confounders, such as preoperative opioid use and medical history. RESULTS: There was no association between nerve blockade and our 2 measures of persistent opioid use: adjusted odds ratio, 1.12 (97.5% confidence interval, 0.939–1.34; P = .15) for opioid use between POD 0 and 90, and adjusted odds ratio, 0.997 (97.5% confidence interval, 0.875–1.14; P = .95) for opioid use between POD 91 and 365. CONCLUSIONS: Although the use of perioperative nerve blockade may offer short-term benefits, in this study, it was not associated with a reduction in the risk of persistent opioid use for patients undergoing shoulder arthroplasty.

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Studies on Postoperative Analgesic Efficacy: Focusing the Statistical Methods and Broadening Outcome Measures and Measurement Tools

imageNo abstract available

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Fixing Medical Prices

No abstract available

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Resuscitative Endovascular Balloon Occlusion of the Aorta: A New Weapon to Combat Exsanguinating Hemorrhage

No abstract available

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Do Not Fear the Difficult IV

imageNo abstract available

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Do Institution-Level Blood Utilization and Blood Management Initiatives Meaningfully Impact Transfusion Practices in Cardiac Surgery?

imageNo abstract available

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Antibiotics and the Anesthesiologist: Is There a “Consensus?”

No abstract available

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Human Resources in Anesthesia: The Road to 2030

No abstract available

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A Graphical Guide to the REBOA: Five Life-Saving Steps

imageNo abstract available

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Surveying the Literature: Synopsis of Recent Key Publications

No abstract available

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Lack of Association Between the Use of Nerve Blockade and the Risk of Postoperative Chronic Opioid Use Among Patients Undergoing Total Knee Arthroplasty: Evidence From the Marketscan Database

imageBACKGROUND: Total knee arthroplasty (TKA) is associated with high rates of prolonged opioid use after surgery (10%–34%). By decreasing opioid use in the immediate postoperative period, perioperative nerve blockade has been hypothesized to decrease the risk of persistent opioid use. METHODS: Using health care utilization data, we constructed a sample of 120,080 patients undergoing TKA between 2002 and 2012 and used billing data to identify the utilization of peripheral or neuraxial blockade. We then used a multivariable logistic regression to estimate the association between nerve blockade and the risk of chronic opioid use, defined as having filled ≥10 prescriptions or ≥120 days' supply for an opioid in the first postsurgical year. Our analyses were adjusted for an extensive set of potential confounding variables, including medical comorbidities, previous opioid use, and previous use of other medications. RESULTS: We did not find an association between nerve blockade and the risk of postsurgical chronic opioid use across any of these 3 groups: adjusted relative risk (ARR) 0.984 for patients opioid-naïve in the year before surgery (98.3% confidence interval [CI], 0.870–1.12, P = .794), ARR 1.02 for intermittent opioid users (98.3% CI, 0.948–1.09, P = .617), and ARR 0.986 (98.3% CI, 0.963–1.01, P = .257) for chronic opioid users. Similar results held for alternative measures of postsurgical opioid use. CONCLUSIONS: Although the use of perioperative nerve blockade for TKA may improve short-term outcomes, the analyzed types of blocks do not appear to decrease the risk of persistent opioid use in the longer term.

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Relationship Between Gonadal Function and Cardiometabolic Risk in Young Men with Chronic Spinal Cord Injury

We previously reported that young men with chronic spinal cord injury (SCI) have a higher prevalence of testosterone deficiency when compared to an age-matched healthy control population. Young men with SCI are also at increased risk for developing cardiometabolic dysfunction after injury. It is unclear whether or not testosterone deficiency is associated with heightened cardiometabolic risk in men with SCI.

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Gender Dimorphism in Central Adiposity may Explain Metabolic Dysfunction after Spinal Cord injury

Increase in visceral adipose tissue (VAT) is an independent risk for mortality and other health related comorbidities.

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Plasma leptin and reduced FEV1 and FVC in Chronic Spinal Cord Injury

Adipose tissue produces leptin, which is pro-inflammatory, and adiponectin, which has anti-inflammatory properties. Participants with chronic spinal cord injury (SCI) have increased body fat and are at increased risk for respiratory illness.

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Effect of Modified Otago Exercises on Postural Balance, Fear of Falling, and Fall Risk in Older Fallers with Knee Osteoarthritis and Impaired Gait and Balance: A Secondary Analysis

Osteoarthritis (OA) is considered an established risk factor for falls. Published studies evaluating secondary falls prevention strategies among OA sufferers are limited.

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O204 Simultaneous bi-hemispheric repetitive transcranial magnetic stimulation for upper limb motor recovery in chronic stroke: A double blind placebo controlled study

repetitive transcranial magnetic stimulation (rTMS) is a promising intervention for the treatment of post-stroke motor deficits. Since the crucial role of non-primary motor cortices and contralesional brain areas is emerging for motor recovery in chronic stroke; we assessed safety and efficacy of bilateral rTMS over the motor areas associated to physical training (PT) on upper extremity (UE) motor function.

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O203 Neuromodulation of lower limb motor circuitry with transcutaneous lumbar spinal cord direct current stimulation

The advent of transcranial direct current stimulation (tDCS) introduced growing interest in modulating spinal circuits, altered in many neurologic conditions. Transcutaneous spinal direct current stimulation (tsDCS) of cervical and thoracic spine regions was observed to modulate sensory and motor responses. Combining clinical studies with computational modelling can be a powerful tool to establish tsDCS protocols for specific therapeutic purposes.  The aim of this study was to measure the effects of tsDCS delivered on the lumbar region on motor spinal responses and observe if these were consistent with the electric field (E-field) distribution predicted in the spinal cord using a computational model.

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P229 Peripheral nerve injury after nerve blockade

Nerve blockade is a common procedure in peripheral limb surgery. In some cases however the anesthesia is directly followed by distally paresis and/or sensory disturbance.

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P239 Muscle contraction does not always trigger the appearance of motor evoked potential polyphasia in healthy individuals

Motor evoked potentials (MEP) using magnetic stimulation are a non-invasive method that assesses the integrity of the central motor pathway. A phase is a part of the motor unit action potential that falls between two baseline crossings. Previous studies suggest that voluntary muscle contraction increases the appearance of MEP polyphasia. In this study we examined healthy individuals with the use of MEP, in order to evaluate the probability of polyphasia appearance during both muscle contraction and relaxation.

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P247 Painful laser evoked potential inhibition during high-frequency non-noxious somatosensory stimulation

The inhibition of single nociceptive inputs by single non-painful stimuli was shown to occur at supraspinal level (Testani et al., 2015). However, the neurophysiological mechanism subserving the analgesia induced by rubbing the painful part of the body or during TENS is still unknown. Our aim was to investigate the site of this inhibition.

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P230 Ulnar epineural discontinuity and electrophysiological changes in a young girl following ulnar fracture

Electrophysiologic evaluation of traumatic peripheral nerve lesions can be complicated, especially in children where the given diagnosis can have dire consequences especially if not accurate.

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P235 Localizing non-epileptic abnormal brain function in children using high density EEG (HDEEG): Electric source imaging (ESI) of focal slowing

Interictal focal slowing is an important EEG index of brain activity dysfunction, possibly representing an additional tool for presurgical evaluation in pediatric epilepsy. Here, we investigate the accuracy of electric source imaging (ESI) applied to pathological focal EEG slowing (FS) as new neurophysiological index localizing the epileptic focus in children with drug-resistant epilepsy.

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P335 Comparison of median nerve distal motor responses in patients with chronic inflammatory demyelinating polyneuropathy and carpal tunnel syndrome

Dispersion of distal compound muscle action potential (CMAP) is a useful finding for showing demyelination. In this study, we aimed to compare the duration and area of CMAP of median nerve between cases with Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) and Carpal Tunnel Syndrome (CTS).

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Fla. county losing millions of dollars in unpaid ambulance bills

Palm Beach County has $11.8 million in unpaid ambulance fees accrued from taking patients to the hospital

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The 7 SKED of SKEDCO

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The 7 Sked of SKEDCO – One for every mission! Discover more at Skedco.

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The Skedco Bleeding Simulator…Lifelike Training

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Designer Lynn King goes in-depth on this innovative approach to hemorrhage control training. Find out more at Skedco.

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Rolling and Unrolling the Sked Stretcher

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Rolling and unrolling the original Sked® Stretcher from Skedco.

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The 7 SKED of SKEDCO

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The 7 Sked of SKEDCO – One for every mission! Discover more at Skedco.

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The Skedco Bleeding Simulator…Lifelike Training

skedco-bleedingsim.jpg

Designer Lynn King goes in-depth on this innovative approach to hemorrhage control training. Find out more at Skedco.

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Rolling and Unrolling the Sked Stretcher

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Rolling and unrolling the original Sked® Stretcher from Skedco.

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Packaging a Patient in under 60 Seconds

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Learn how to package a patient in with the original Sked® Stretcher from Skedco.

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Accessing Respite Care for Persons With a Disability

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Publication date: Available online 18 August 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Sheria G. Robinson-Lane




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Measurement Characteristics and Clinical Utility of the Freezing of Gait Questionnaire in Individuals With Parkinson Disease

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Publication date: Available online 18 August 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Sydney Rozenfeld, Ana Miskovic, Kristian P. Nitsch, Linda Ehrlich-Jones




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The 7 SKED of SKEDCO

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The 7 Sked of SKEDCO – One for every mission! Discover more at Skedco.

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The Skedco Bleeding Simulator…Lifelike Training

skedco-bleedingsim.jpg

Designer Lynn King goes in-depth on this innovative approach to hemorrhage control training. Find out more at Skedco.

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Rolling and Unrolling the Sked Stretcher

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Rolling and unrolling the original Sked® Stretcher from Skedco.

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Packaging a Patient in under 60 Seconds

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Learn how to package a patient in with the original Sked® Stretcher from Skedco.

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The 7 SKED of SKEDCO

skedco-7skeds.jpg

The 7 Sked of SKEDCO – One for every mission! Discover more at Skedco.

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The Skedco Bleeding Simulator…Lifelike Training

skedco-bleedingsim.jpg

Designer Lynn King goes in-depth on this innovative approach to hemorrhage control training. Find out more at Skedco.

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Rolling and Unrolling the Sked Stretcher

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Rolling and unrolling the original Sked® Stretcher from Skedco.

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Packaging a Patient in under 60 Seconds

skedco-60secs.jpg

Learn how to package a patient in with the original Sked® Stretcher from Skedco.

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Packaging a Patient in under 60 Seconds

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Learn how to package a patient in with the original Sked Stretcher from Skedco.

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210Pb and 137Cs as tracers of recent sedimentary processes in two water reservoirs in Cuba

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Publication date: October 2017
Source:Journal of Environmental Radioactivity, Volume 177
Author(s): Misael Díaz-Asencio, José Antonio Corcho-Alvarado, Héctor Cartas-Aguila, Anabell Pulido-Caraballé, Carmen Betancourt, Joseph M. Smoak, Elizabeth Alvarez-Padilla, Yeny Labaut-Betancourt, Carlos Alonso-Hernández, Mabel Seisdedo-Losa
Hanabanilla and Paso Bonito Reservoirs are the main fresh water sources for about half a million inhabitants in central Cuba. Prior to this investigation precise information about the losses of storage capacity was not available. Sedimentation is the dominant process leading to reduction in water storage capacity. We investigated the sedimentation process in both reservoirs by analyzing environmental radionuclides (e.g. 210Pb, 226Ra and 137Cs) in sediment cores. In the shallow Paso Bonito Reservoir (mean depth of 6.5 m; water volume of 8 × 106 m3), we estimated a mean mass accumulation rate (MAR) of 0.4 ± 0.1 g cm−2y−1 based on 210Pb chronologies. 137Cs was detected in the sediments, but due to the recent construction of this reservoir (1975), it was not possible to use it to validate the 210Pb chronologies. The estimated MAR in this reservoir is higher than the typical values reported in similar shallow fresh water reservoirs worldwide. Our results highlight a significant loss of water storage capacity during the past 30 years. In the deeper and larger Hanabanilla Reservoir (mean depth of 15.5 m; water volume of 292 × 106 m3), the MAR was investigated in three different sites of the reservoir. The mean MARs based on the 210Pb chronologies varied between 0.15 and 0.24 g cm−2y−1. The MARs calculated based on the 137Cs profiles further validated these values. We show that the sediment accumulation did not change significantly over the last 50 years. A simple empirical mixing and sedimentation model that assumes 137Cs in the water originated from both, direct atmospheric fallout and the catchment area, was applied to interpret the 137Cs depth profiles. The model consistently reproduced the measured 137Cs profiles in the three cores (R2 > 0.9). Mean residence times for 137Cs in the water and in the catchment area of 1 y and 35–50 y, respectively were estimated. The model identified areas where the catchment component was higher, zones with higher erosion in the catchment, and sites where the fallout component was quantitatively recorded in the sediments.



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Effectiveness of Resistance Circuit-Based Training for Maximum Oxygen Uptake and Upper-Body One-Repetition Maximum Improvements: A Systematic Review and Meta-Analysis

Abstract

Background

It is well known that concurrent increases in both maximal strength and aerobic capacity are associated with improvements in sports performance as well as overall health. One of the most popular training methods used for achieving these objectives is resistance circuit-based training.

Objective

The objective of the present systematic review with a meta-analysis was to evaluate published studies that have investigated the effects of resistance circuit-based training on maximum oxygen uptake and one-repetition maximum of the upper-body strength (bench press exercise) in healthy adults.

Methods

The following electronic databases were searched from January to June 2016: PubMed, Web of Science and Cochrane. Studies were included if they met the following criteria: (1) examined healthy adults aged between 18 and 65 years; (2) met the characteristics of resistance circuit-based training; and (3) analysed the outcome variables of maximum oxygen uptake using a gas analyser and/or one-repetition maximum bench press.

Results

Of the 100 articles found from the database search and after all duplicates were removed, eight articles were analysed for maximum oxygen uptake. Of 118 healthy adults who performed resistance circuit-based training, maximum oxygen uptake was evaluated before and after the training programme. Additionally, from the 308 articles found for one-repetition maximum, eight articles were analysed. The bench press one-repetition maximum load, of 237 healthy adults who performed resistance circuit-based training, was evaluated before and after the training programme. Significant increases in maximum oxygen uptake and one-repetition maximum bench press were observed following resistance circuit-based training. Additionally, significant differences in maximum oxygen uptake and one-repetition maximum bench press were found between the resistance circuit-based training and control groups.

Conclusions

The meta-analysis showed that resistance circuit-based training, independent of the protocol used in the studies, is effective in increasing maximum oxygen uptake and one-repetition maximum bench press in healthy adults. However, its effect appears to be larger depending on the population and training characteristics. For large effects in maximum oxygen uptake, the programme should include ~14–30 sessions for ~6–12 weeks, with each session lasting at least ~20–30 min, at intensities between ~60 and 90% one-repetition maximum. For large effects in one-repetition maximum bench press, the data indicate that intensity should be ~30–60% one-repetition maximum, with sessions lasting at least ~22.5–60 min. However, the lower participant's baseline fitness level may explain the lighter optimal loads used in the circuit training studies where greater strength gains were reported.



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Table of Contents



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Copyright Page



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Editorial Board



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Academy News – August PM&R

As the primary medical society for the specialty of PM&R, your Academy is focused on moving the specialty and you forward. Academy membership supports initiatives to assist our members with:

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Information for Authors



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Spanish Translated Abstracts



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Influence of aerobic fitness on vasoreactivity in young men

Abstract

Previous work has demonstrated a direct relationship between aerobic fitness and vasodilatory function (i.e., flow-mediated dilation; FMD); however, the relation between aerobic fitness and vasoconstrictor responsiveness (i.e., low flow-mediated constriction; L-FMC), and the overall vasoactive range (FMD + L-FMC) is unclear.

Purpose

To test the hypothesis that L-FMC and the overall vasoactive range (FMD + L-FMC) will be related to aerobic fitness in young, healthy men.

Methods

Twenty men (age: 23 ± 5 years) were recruited, and divided evenly into a higher (HF) vs. lower (LF) aerobic fitness group, quantified via YMCA cycle ergometry (VO2 peak extrapolation), and a 3-min step test (1-min heart rate recovery). Duplex Doppler-ultrasound was used to assess brachial artery FMD and L-FMC.

Results

Estimated VO2 peak (HF = 55 ± 10 vs. LF = 38 ± 5 mL/kg/min) and heart rate recovery (HF = 36 ± 10 vs. LF = 25 ± 8 beats) were greater in the HF group (P < 0.05). FMD and the vasoactive range were similar between groups; however, L-FMC was significantly greater in HF (HF = −2.5 ± 1.6 vs. LF = −0.7 ± 1.8%, P < 0.05; d = 1.18). A correlational analysis revealed an inverse relationship between L-FMC and both HR recovery (r = −0.665, P < 0.01) and estimated VO2 peak (r = −0.5, P < 0.05).

Conclusions

This work supports an association between L-FMC and aerobic fitness in young, healthy men. Longitudinal or interventional studies are warranted to support causality, and to distinguish whether L-FMC is more sensitive to changes in aerobic fitness than FMD.



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Cardiovascular Health in St. Louis Bosnian-Americans

Abstract

In Bosnia and Herzegovina, cardiovascular disease accounts for nearly 50% of deaths. Cardiovascular health of resettled Bosnian-Americans has not been well-characterized. Our study aimed to quantify cardiovascular risk in Bosnian-Americans in St. Louis, the largest non-European center of resettlement. Seven community screenings focused on Bosnian-Americans were held. Cardiovascular risk was calculated to stratify individuals into low (<10%), moderate (10–20%), and high (>20%) risk. Those with self-reported coronary heart disease (CHD) or risk equivalent were considered high-risk. Two-hundred fifty Bosnian-Americans were screened; 51% (n = 128) consented to the IRB-approved study. Twenty-one percent were smokers, 33% obese, and 33% had hypertension. Excluding risk equivalent individuals, 5.7% of subjects were high-risk, increasing to 26.6% when including high-risk equivalents. Lipid abnormalities include elevated triglycerides (29.0%) and low HDL (50.0%). Compared to general American population studies, Bosnian-Americans have greater ten-year hard CHD risk. A community-based approach identified potential culturally-based lifestyle interventions including diet, exercise, and smoking.



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Maternal voluntary physical activity attenuates delayed neurodevelopment in malnourished rats

Abstract

This study evaluated the effects of maternal voluntary physical activity (VPA) during pregnancy and lactation on somatic growth (SG), reflex ontogeny (RO) and locomotor activity (LA) of rats whose mothers were protein-restricted. Virgin female Wistar rats were divided into six groups: Control Normal Protein (C-NP, n = 4); Control Low Protein (C-LP, n = 4), Inactive Normal Protein (I-NP, n = 8), Inactive Low Protein (I-LP, n = 7), Very Active Normal Protein (VA-NP, n = 8) and Very Active Low Protein (VA-LP, n = 6). VPA was recorded daily in dams. LP groups were fed an 8% casein diet, and controls were fed 17% casein diet during pregnancy and lactation. Offspring were evaluated in terms of SG (body weight and length, latero-lateral skull axis and anteroposterior head axis) and RO (palmar grasp, righting, free-fall righting, negative-geotaxis, cliff-avoidance, auditory-startle response and vibrissa-placing). LA was evaluated at 23, 45 and 60 days old in the open field. VPA was reduced during pregnancy and lactation independent of the maternal diet. Pups from LP dams showed delayed SG, reflex maturation and patterns of LA when compared with controls. C-LP and I-LP pups showed a delayed SG, RO and LA. Pups from VA-LP mothers showed no delay in SG and RO and presented a faster development of patterns of LA. Maternal VPA attenuated the effects of LP diet on indicators of neurodevelopment and patterns of LA of offspring.

This article is protected by copyright. All rights reserved



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Thermal softening of polyvinyl chloride nasotracheal tubes: effect of temperature on tube navigability.

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Thermal softening of polyvinyl chloride nasotracheal tubes: effect of temperature on tube navigability.

Can J Anaesth. 2017 Mar;64(3):331-332

Authors: Shanahan E, Yu CV, Tang R, Sawka A, Vaghadia H

PMID: 27822785 [PubMed - indexed for MEDLINE]



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Temporal dissociation of salience and prediction error responses to appetitive and aversive taste

Abstract

The feedback-related negativity (FRN), a frontocentral ERP occurring 200–350 ms after emotionally valued outcomes, has been posited as the neural correlate of reward prediction error, a key component of associative learning. Recent evidence challenged this interpretation and has led to the suggestion that this ERP expresses salience instead. Here, we distinguish between utility prediction error and salience by delivering or withholding hedonistically matched appetitive and aversive tastes, and measure ERPs to cues signaling each taste. We observed a typical FRN (computed as the loss-minus-gain difference wave) to appetitive taste, but a reverse FRN to aversive taste. When tested axiomatically, frontocentral ERPs showed a salience response across tastes, with a particularly early response to outcome delivery, supporting recent propositions of a fast, unsigned, and unspecific response to salient stimuli. ERPs also expressed aversive prediction error peaking at 285 ms, which conformed to the logic of an axiomatic model of prediction error. With stimuli that most resemble those used in animal models, we did not detect any frontocentral ERP signal for utility prediction error, in contrast with dominant views of the functional role of the FRN ERP. We link the animal and human literature and present a challenge for current perspectives on associative learning research using ERPs.



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Frontal alpha asymmetry and callous-unemotional traits in imprisoned violent offenders: A pilot study

Abstract

Based on the approach-withdrawal model of hemispheric asymmetry, anger and aggression have been linked to an approach-related pattern, characterized by stronger relative left-hemispheric anterior cortical activity. Recent work suggests that also in individuals with extremely violent tendencies, such as imprisoned offenders, approach-related asymmetry may be associated with self-reported trait anger and aggression. A putative association between alpha asymmetry and further characteristics relevant for aggression, such as callous-unemotional (CU) traits, remains to be explored. CU traits may increase the probability of aggressive behavior; nevertheless, they may also enable individuals to inhibit and postpone the overt display of aggression until circumstances grant its strongest impact. In the current exploratory study, we measured trait aggression, CU traits, and resting-state EEG asymmetry in the alpha band (8–13 Hz) in imprisoned violent offenders in a German high security prison. Results revealed that particularly trait callousness was associated with stronger relative right-hemispheric anterior cortical activity (i.e., a withdrawal-related pattern). An association between alpha asymmetry and aggression was not replicated. These preliminary findings suggest that, due to the involved emotional and interpersonal detachment, callousness might be withdrawal related, despite its potential to bring about aggressive behavior. They also imply that the identification of putative clinical subtypes in prisoners is required, as varying psychopathology might undermine an association between alpha asymmetry and aggression.



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The effects of supramaximal versus submaximal intensity eccentric training when performed until volitional fatigue

Abstract

Purpose

Our purpose was to compare supramaximal versus submaximal intensity eccentric training performed until volitional fatigue.

Methods

Thirty-two young adults (19 males) were randomized into one of three groups: (1) ECC110 performed eccentric (ECC) only contractions at 110% of concentric (CON) 1-repetition maximum (1RM); (2) ECC80 performed ECC only contractions at 80% of CON 1RM; (3) a control group. Training progressed from 3 to 6 sets of unilateral ECC training of the elbow flexors over 8 weeks, with each set performed until volitional fatigue. Elbow flexors muscle thickness (via ultrasound) and 1RM were assessed pre- and post-training. Rating of perceived exertion (RPE) and muscle soreness was self-reported.

Results

Both ECC110 (+0.25 cm) and ECC80 (+0.21 cm) showed a greater post-training increase in muscle thickness compared to control (−0.01 cm) (p < 0.05), with no differences between ECC110 and ECC80. ECC80 (+1.23 kg) showed a greater post-training increase in strength compared to control (p < 0.05), while ECC110 (+0.76 kg) had no significant difference post-training vs. control (−0.01 kg). ECC80 had significantly lower average RPE scores than ECC110 (p < 0.05).

Conclusions

Both supramaximal intensity eccentric training and submaximal intensity eccentric training are effective for increasing muscle size, but submaximal eccentric training is perceived to require less exertion than supramaximal training. These findings suggest that submaximal eccentric training may be an ideal strategy to increase muscle size and strength in individuals whose needs warrant training at a lower level of exertion.



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Modifiable factors and esophageal cancer: a systematic review of published meta-analyses

Abstract

There are marked differences in the etiology of the major histological types of esophageal cancer (EC)—squamous cell carcinomas (ESCC) and adenocarcinomas (EAC). This study aimed to summarize the current scientific knowledge on modifiable risk factors for EC, by histological type, through a systematic review of meta-analyses referenced in PubMed and ISI Web of Knowledge. We identified 100 meta-analyses on risk factors for ESCC (n = 54), EAC (n = 43), or EC (n = 51). ESCC risk significantly increased with alcohol and maté drinking, smoking, red and processed meat consumption and human papillomavirus infection, while it was negatively associated with body mass index and consumption of fruit, vegetables, white meat, folate, and some carotenoids. Cessation of drinking and smoking significantly reduced ESCC risk. For EAC, an increased risk was reported for smoking, body mass index, and red and processed meat consumption, while risk decreased with Helicobacter pylori infection, low/moderate alcohol drinking, physical activity, and consumption of fruit, vegetables, folate, fiber, beta-carotene, and vitamin C. Differences in results between meta-analyses and mechanisms underlying some of the associations found are discussed. This work reinforces the importance of a separate assessment of EC subtypes to allow for a proper evaluation of incidence trends and planning of prevention/control interventions.



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Issue Information - Editorial Board



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Corrigendum



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Sodium butyrate ameliorates S100/FCA-induced autoimmune hepatitis through regulation of intestinal tight junction and toll-like receptor signaling pathway

Immunology Letters

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Mylan, US finalize $465 million EpiPen settlement

Reuters Health News

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Colonoscopic full-thickness resection using an over-the-scope device: A prospective multicentre study in various indications

Gut

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Long-term gum disease linked to Alzheimer's disease

Reuters Health News

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Steatosis severity affects the diagnostic performances of noninvasive fibrosis tests in nonalcoholic fatty liver disease

Liver International

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Real world efficacy and safety of ombitasvir, Paritaprevir/r+Dasabuvir+Ribavirin in genotype 1B patients with HCV liver cirrhosis

Liver International

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Hepatitis C virus-related complications are increasing in women veterans: A national cohort study

Journal of Viral Hepatitis

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APF530 versus ondansetron, each in a guideline-recommended three-drug regimen, for the prevention of chemotherapy-induced nausea and vomiting due to anthracycline plus cyclophosphamide–based highly emetogenic chemotherapy regimens: a post hoc subgroup analysis of the Phase III randomized MAGIC trial

Cancer Management and Research

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Fecal concentrations of bacterially derived vitamin K forms are associated with gut microbiota composition but not plasma or fecal cytokine concentrations in healthy adults

American Journal of Clinical Nutrition

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Moderate alcohol use is not associated with fibrosis progression in HIV/HCV co-infected women: A prospective cohort study

Clinical Infectious Diseases

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Association between irritable bowel syndrome and overactive bladder: A research survey

Urology

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Obesity, metabolic syndrome, and cardiovascular risk in gluten-free followers without celiac disease in the United States: Results from the National Health and Nutrition Examination Survey 2009–2014

Digestive Diseases and Sciences

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Novo Nordisk's diabetes drug succeeds in key trial

Reuters Health News

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Inflammatory bowel disease with primary sclerosing cholangitis: A Danish population-based cohort study 1977-2011

Liver International

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Prospective evaluation of associations between cancer-related pain and perineural invasion in patients with resectable pancreatic adenocarcinoma

Journal of Gastrointestinal Surgery

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Health-related quality of life associated with regorafenib treatment in refractory advanced gastric adenocarcinoma

Gastric Cancer

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Trends in the Mortality of Hepatocellular Carcinoma in the United States

Journal of Gastrointestinal Surgery

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Alimentary Pharmacology and Therapeutics

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World Journal of Gastroenterology

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Ultrashort bowel is an independent risk factor for liver fibrosis in adults with home parenteral nutrition

Liver International

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Interactions Between Energy Drink Consumption and Sleep Problems: Associations with Alcohol Use Among Young Adolescents

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Application of transcutaneous ultrasonography for the diagnosis of muscle mass loss in patients with liver cirrhosis

Abstract

Background

To propose an ultrasound-based parameter for the diagnosis of muscle mass loss (MML) in cirrhosis.

Methods

This is an IRB-approved cross-sectional study (October 2013 to January 2017) with written informed consent including 357 subjects—234 cirrhosis and 123 controls. MML was diagnosed using the skeletal muscle index at the L3 level (L3-SMI) on computed tomography (CT). Transcutaneous ultrasound was used to demonstrate a cross section of the right iliopsoas muscle, and the iliopsoas muscle index (IP index) was defined by the iliopsoas muscle area/height2 (mm2/m2). Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic ability of IP index for MML.

Results

The iliopsoas muscle was detected in all subjects. The IP index was lower in cirrhosis than in controls: males (211.2 ± 73.8 vs. 295.5 ± 139.4, P < 0.0001) and females (200.2 ± 72.5 vs. 284.4 ± 112.4, P < 0.0001). L3-SMI and IP index showed correlations in males (r = 0.699, P < 0.0001) and in females (r = 0.707, P < 0.0001). Independent factors for MML by multivariate analysis were body mass index and IP index in both males and females. Sensitivity, specificity, and area under the ROC curve by IP index to detect MML were 79.5%, 73.1%, and 0.835, respectively, with the best cut-off value of 189.2 for males, and 84.6%, 78.8%, and 0.874, respectively, with the best cut-off value of 180.6 for females.

Conclusions

Using transcutaneous ultrasound, the IP index may be a valuable diagnostic parameter for MML in cirrhosis.



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