Effect of Transcranial Direct Current Stimulation on Severely Affected Arm-Hand Motor Function in Patients After an Acute Ischemic Stroke: A Pilot Randomized Control Trial.

Objective: The aim of this article was to determine whether cathodal transcranial direct current stimulation (c-tDCS) to unaffected primary motor cortex (PMC) plus conventional occupational therapy (OT) improves functional motor recovery of the affected arm hand in patients after an acute ischemic stroke compared with sham transcranial direct current stimulation plus conventional OT. Design: In this prospective, randomized, double-blinded, sham-controlled trial of 16 severe, acute ischemic stroke patients with severe arm-hand weakness were randomly assigned to either experimental (c-tDCS plus OT; n = 8) or control (sham transcranial direct current stimulation plus OT; n = 8) groups. All patients received a standard 3-hr in-patient rehabilitation therapy, plus an additional ten 30-min sessions of tDCS. During each session, 1 mA of cathodal stimulation to the unaffected PMC is performed followed by the patient's scheduled OT. The primary outcome measure was change in Action Research Arm Test (ARAT) total and subscores on discharge. Result: Application of c-tDCS to unaffected PMC resulted in a clinically relevant 10-point improvement in the affected arm-hand function based on ARAT total score compared with a 2-point improvement in the control group. Conclusions: Application of 30-min of c-tDCS to the unaffected PMC showed a 10-point improvement in the ARAT score. This corresponds to a large effect size in improvement of affected arm-hand function in patients with severe, acute ischemic stroke. Although not statistically significant, this suggests that larger studies, enrolling at least 25 patients in each group, and with a longer follow-up are warranted. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Curcumin limits weight gain, adipose tissue growth, and glucose intolerance following the cessation of exercise and caloric restriction in rats

Weight regain, adipose tissue growth, and insulin resistance can occur within days after the cessation of regular dieting and exercise. We investigated the effect of curcumin on preserving metabolic health and limiting adipose tissue growth following the cessation of daily exercise and caloric restriction (CR). Sprague-Dawley rats (6-7 wks old) underwent a 'training' protocol of 24 hr voluntary running wheel access and CR (15-20 g/day) for 3 wks ('All Trained') or were sedentary and fed ad libitum ('Sed'). After 3 wks, 'All Trained' were randomly divided into one group which was terminated immediately ('Trained'), and two detrained groups which had their wheels locked and were reintroduced to ad libitum feeding for 1 wk. The wheel locked groups received either a daily gavage of a placebo ('Detrained + Placebo') or curcumin (200 mg/kg) ('Detrained + Curcumin'). Cessation of daily CR and exercise caused an increase in body mass, as well as a 9- 14-fold increase in epididymal, perirenal, and inguinal fat mass, all of which were attenuated by curcumin (p<0.05). Insulin area under the curve (AUC) during an oral glucose tolerance test, HOMA-IR, and C-reactive protein (CRP) were all elevated in the Detrained + Placebo group versus the Trained group (all p<0.05). Curcumin reduced insulin AUC, HOMA-IR, and CRP versus the placebo group (all p<0.05). Our results indicate that curcumin has a protective effect against weight regain and impaired metabolic control following a successful period of weight loss through diet and exercise, perhaps via inhibition of glucocorticoid action and inflammation.

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Acute hypoxia in a simulated high altitude airdrop scenario due to oxygen system failure

High Altitude High Opening (HAHO) is a military operational procedure in which parachute jumps are performed at high altitude requiring supplemental oxygen, putting personnel at risk of acute hypoxia in the event of oxygen equipment failure. This study was initiated by the Norwegian Army in order to evaluate potential outcomes during failure of oxygen supply, and to explore physiology during acute severe hypobaric hypoxia. A simulated HAHO without supplemental oxygen was carried out in a hypobaric chamber with decompression to 30 000 ft (9144 m) and then recompression to ground level with a descent rate of 1000 ft/min (305 m/min). Nine subjects were studied. Repeated arterial blood gas samples were drawn throughout the entire hypoxic exposure. Additionally, pulse oximetry, cerebral oximetry and hemodynamic variables were monitored. Desaturation evolved rapidly and the arterial oxygen tensions are amongst the lowest ever reported in volunteers during acute hypoxia. PaO₂ decreased from baseline 18.4 (17.3 - 19.1) kPa, 138.0 (133.5 - 143.3) mmHg, to a minimum value of 3.3 (2.9 - 3.7) kPa, 24.8 (21.6 - 27.8) mmHg, after 180 (60 - 210) sec, [median (range)], N=9. Hyperventilation with ensuing hypocapnia was associated with both increased arterial oxygen saturation and cerebral oximetry values, and potentially improved tolerance to severe hypoxia. One subject had a sharp drop in heart rate and cardiac index and lost consciousness 4 min into the hypoxic exposure. A simulated high altitude airdrop scenario without supplemental oxygen results in extreme hypoxemia and may result in loss of consciousness in some individuals.

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The Physiology of Oral Whistling: A Combined Radiographic and MRI Analysis

The fluid mechanics of whistling involve the instability of an air jet, resultant vortex rings, and the interaction of these rings with rigid boundaries (2,4). Experimental models support the hypothesis that the sound in human whistling is generated by a Helmholtz resonator, suggesting that the oral cavity acts as a resonant chamber bounded by two orifices, posteriorly by raising the tongue to the hard palate, and anteriorly by pursed lips 2,2,3). However, the detailed anatomical changes in the vocal tract and their relation to the frequencies generated have not been described in the literature. In this study, videofluoroscopic and simultaneous audio recordings were made of subjects whistling with the bilabial (i.e., "puckered lip") technique. One whistling subject was also recorded using magnetic resonance imaging. As predicted by theory, the frequency of sound generated decreased as the size of the resonant cavity increased; this relationship was preserved throughout various whistling tasks and was consistent across subjects. Changes in the size of the resonant cavity were primarily modulated by tongue position rather than jaw opening and closing. Additionally, when high-frequency notes were produced, lateral chambers formed in the buccal space. These results provide the first dynamic anatomical evidence concerning the acoustic production of human whistling.

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Ventilation and neurochemical changes during {micro}-opioid receptor activation or blockade of excitatory receptors in the hypoglossal motor nucleus of goats

Neuromodulator interdependence posits that changes in one or more neuromodulators are compensated by changes in other modulators to maintain stability in the respiratory control network. Herein, we studied compensatory neuromodulation in the hypoglossal motor nucleus (HMN) after chronic implantation of microtubules unilaterally (n=5) or bilaterally (n=5) into the HMN. After recovery, receptor agonists or antagonists in mock cerebrospinal fluid (mCSF) were dialyzed during the awake and NREM sleep state. During day studies, dialysis of the µ-opioid inhibitory receptor agonist DAMGO (100 µM) decreased pulmonary ventilation (V_I), breathing frequency (f), and genioglossus (GG) muscle activity, but did not alter neuromodulators measured in the effluent mCSF. However, neither unilateral dialysis of a broad spectrum muscarinic receptor antagonist (atropine; 50 mM) nor unilateral or bilateral dialysis of a mixture of excitatory receptor antagonists altered V_I or GG activity but did increase HMN serotonin (5-HT) levels. Finally, during night studies, DAMGO and excitatory antagonist decreased ventilatory variables during NREM sleep but not during wakefulness. These findings contrast to previous dialysis studies in the ventral respiratory column (VRC), where unilateral DAMGO or atropine dialysis had no effects on breathing and bilateral DAMGO or unilateral atropine increased VI and f and decreased GABA or increased 5-HT respectively. Thus, we conclude that the mechanisms of compensatory neuromodulation are less robust in the HMN than in the VRC under physiological conditions in adult goats, possibly due to site differences in the underlying mechanisms governing neuromodulator release and consequently neuronal activity, and/or responsiveness of receptors to compensatory neuromodulators.

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Drowning in a river with an average depth of three feet: interpreting athletic performance gains

This is an invited editorial on the manuscript by Foss JL, Constantini K, Mickleborough TD, and Chapman RF. Short-term arrival strategies for endurance exercise performance at moderate altitude. J Appl Physiol (1985), 2017.

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HIGH-ALTITUDE CHAMPIONS: BIRDS THAT LIVE AND MIGRATE AT ALTITUDE

High altitude is physiologically challenging for vertebrate life for many reasons, including hypoxia (low environmental oxygen); yet, many birds thrive at altitude. Compared to mammals, birds have additional enhancements to their oxygen transport cascade, the conceptual series of steps responsible for acquiring oxygen from the environment and transporting it to the mitochondria. These adaptations have allowed them to inhabit a number of high-altitude regions. Waterfowl are a taxon prolific at altitude. This mini-review explores the physiological responses of high-altitude waterfowl (geese and ducks), comparing the strategies of lifelong high-altitude residents to those of transient high-altitude performers, providing insight into how birds champion high-altitude life. In particular, this review highlights and contrasts the physiological hypoxia responses of bar-headed geese (Anser indicus), birds that migrate biannually through the Himalayas (4,500-6,500 m), and Andean geese (Chloephaga melanoptera), lifelong residents of the Andes (4,000-5,500m). These two species exhibit markedly different ventilatory and cardiovascular strategies for coping with hypoxia: bar-headed geese robustly increase convective oxygen transport elements (i.e. heart rate and total ventilation) whereas Andean geese rely predominantly on enhancements that are likely morphological in origin (i.e. increases in lung oxygen diffusion and cardiac stroke volume). The mini-review compares the short- and long-term cardiovascular and ventilatory trade-offs of these different physiological strategies and offers hypotheses surrounding their origins. It also draws parallels to high-altitude human physiology and research, and identifies a number of areas of further research. The field of high-altitude avian physiology offers a unique and broadly applicable insight into physiological enhancements in hypoxia.

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Coagulopathy in Children With Liver Disease.

It was thought that a high International Normalized Ratio (INR) predicted bleeding in patients with chronic liver disease (CLD) and patients were 'autoanticoagulated'. Contrary to this belief, while patients with CLD experienced bleeding, they also developed thromboses. In the last decade, the prevailing literature challenged the idea that an elevated INR increased bleeding risk. The global assays of coagulation such as: thromboelastography (TEG)/rotational thromboelastometry (ROTEM) and thrombin generation assays (TGA) provide additional insight into coagulation processes. It has become apparent that a parallel reduction of procoagulant and anticoagulant factors leave patients in a new 'balanced' state, albeit a fragile one, where the balance can be easily disrupted. The inherent differences in coagulation between children and adults such as differences in levels of procoagulant and anticoagulant factors, underlying liver disease and the paucity of studies in children make extrapolation of these findings to the pediatric population problematic. Ultimately, this is an area that requires further investigation to avoid inappropriate use of blood products and medication. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Clinical Report: Intestinal Rehabilitation Programs in the Management of Pediatric Intestinal Failure and Short Bowel Syndrome.

Intestinal failure is a rare, debilitating condition that presents both acute and chronic medical management challenges. The condition is incompatible with life in the absence of the safe application of specialized and individualized medical therapy that includes surgery, medical equipment, nutritional products, and standard nursing care. Intestinal rehabilitation (IR) programs are best suited to provide such complex care with the goal of achieving enteral autonomy and oral feeding with or without intestinal transplantation. These programs almost all include pediatric surgeons, pediatric gastroenterologists, specialized nurses, and dietitians; many also include a variety of other medical and allied medical specialists. IR programs provide integrated interdisciplinary care, more discussion of patient management by involved specialists, continuity of care through various treatment interventions, close follow-up of outpatients, improved patient and family education, earlier treatment of complications and learning from the accumulated patient databases. Quality assurance and research collaboration among centers is also a goal of many of these programs. The combined and coordinated talents and skills of multiple types of healthcare practitioners have the potential to ameliorate the impact of intestinal failure and improve health outcomes and quality of life. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Every Other Day Dosing of Oral Viscous Budesonide is not Effective in the Management of Eosinophlic Esophagitis.

Introduction: Eosinophilic esophagitis (EoE) is a clinicopathologic disorder characterized histologically by esophageal eosinophilia. Oral viscous budesonide (OVB) is an effective treatment with remission rates reported between 55 and 87%; however, topical corticosteroids are associated with increased risk of candidal esophagitis and adrenal suppression. Attempts to decrease the daily dose of topical steroids have resulted in disease relapse. The objective of this study was to determine whether or not reducing the frequency of OVB administration would be effective in controlling esophageal eosinophilia in children and adolescents. Methods: Data were obtained by retrospective chart review of patients at Boston Children's Hospital diagnosed with EoE, based on endoscopic findings of >15 eosinophils per high power field (eos/HPF) on esophageal biopsies while on acid blockade. Patients with histologic evidence of response (

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A Rare Phenotype of Alpha-1-Antitrypsin Deficiency due to PI*IS in a Newborn With Liver Disease.

No abstract available

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Use of Fully Covered Self-Expanding Metal Biliary Stents in Pediatrics: A Case Series.

Objective: Endoscopic retrograde cholangiopancreatography (ERCP) is used to manage biliary pathology in pediatric patients. Plastic biliary stents have been utilized in this population for obstructive lesions and bile leaks, however they are sometimes not effective due to migration, occlusion, or ineffective sealing. Fully covered self-expanding metal stents (FCSEMS) have larger diameters making them more suitable for some situations. However, their use in pediatrics has not been defined. The aim of this study is to describe our experience with FCSEMS at our institution. Methods: We present a series of all patients who underwent FCSEMS placement at Children's Hospital Colorado including three adolescents and one young adult with complex medical needs. Results: Patient age range was 12-24 years and the weight ranged between 36-75 kg. All patients underwent previous ERCP and one or more rounds of plastic stenting without adequate clinical response prior to consideration of FCSEMS placement. Indications included: 1) Recalcitrant biliary anastomotic stricture post liver transplant, 2) Persistent bile leak after needle perforation, 3) Recurrent obstructive choledocholithiasis after cholecystectomy, and 4) Malignant biliary stricture. Sizes of FCSEMS depended on patient bile duct size and biliary pathology. Dwell time was 6-8 weeks. Three patients had resolution of biliary pathology after FCSEMS therapy. One patient had distal migration of FCSEMS necessitating repeat stenting. There were no adverse events from FCSEMS placement or removal. Conclusions: FCSEMS therapy should be considered in appropriate pediatric patients when plastic biliary stents are not effective. Further studies are needed to evaluate the safety and efficacy of FCSEMS in the pediatric age group. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Functional Gastrointestinal Disorders and Joint Hypermobility. A School-based Study.

Objectives: To assess the prevalence of JH among school-children with and without FGIDs. Methods: School-children completed validated Rome III questionnaires to diagnose FGID. Each child diagnosed with a FGID was matched for age and gender with a healthy control. The prevalence of JH in both groups was compared. Results: 654 school-children participated in the study. One hundred and forty-eight (22.6%) children were diagnosed with a FGID. Data from 136 FGIDs and 136 healthy controls was analyzed. Joint laxity was assessed to establish the Beighton score (>= 4 was considered JH). There was no significant difference in JH between children with and without diagnoses of FGIDs OR 1.03 (95% CI: 0.59-1.81, p = 0.89). Multivariate analysis showed that younger age OR 2.31 (95% CI: 1.30-4.10, p = 0.004) and female gender OR 2.27 (95% CI: 1.22-4.24, p = 0.009) were significantly associated with JH. Conclusions: JH is equally prevalent in school-children with and without FGIDs. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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The Management of Acute Pancreatitis in the Pediatric Population: A Clinical Report from the NASPGHAN Pancreas Committee.

Background: While the incidence of acute pancreatitis (AP) in children is increasing, management recommendations rely on adult published guidelines. Pediatric-specific recommendations are needed. Methods: The NASPGHAN Pancreas committee performed a MEDLINE review using several pre-selected key terms relating to management considerations in adult and pediatric AP. The literature was summarized, quality of evidence reviewed, and statements of recommendations developed. The authorship met to discuss the evidence, statements, and voted on recommendations. A consensus of at least 75% was required to approve a recommendation. Results: The diagnosis of pediatric AP should follow the published INSPPIRE definitions (by meeting at least two out of three criteria: (1) abdominal pain compatible with AP, (2) serum amylase and/or lipase values >=3 times upper limits of normal, (3) imaging findings consistent with AP). Adequate fluid resuscitation with crystalloid appears key especially within the first 24 h. Analgesia may include opioid medications when opioid-sparing measures are inadequate. Pulmonary, cardiovascular, and renal status should be closely monitored particularly within the first 48 hours. Enteral nutrition should be started as early as tolerated, whether through oral, gastric, or jejunal route. Little evidence supports the use of prophylactic antibiotics, anti-oxidants, probiotics, and protease inhibitors. Esophago-gastro-duodenoscopy, endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography have limited roles in diagnosis and management. Children should be carefully followed for development of early or late complications as well as recurrent attacks of AP. Conclusions: This clinical report represents the first English-language recommendations for the management of pediatric AP. Future aims should include prospective multi-center pediatric studies to further validate these recommendations and optimize care for children with AP. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Prospective Study of Gastrointestinal Symptoms in School Children of South-America.

Objectives: To establish the prevalence of abdominal pain (AP) in school-children in Pasto (Colombia) and determine the impact of AP on their daily activities; and compare the prevalence of AP and other gastrointestinal symptoms between school-children from Pasto and Chicago. Methods: Fourth and fifth-grade students from a public school and a private school in Colombia were invited to participate in a prospective study using the same methods and questionnaires (Spanish version) as a previous study conducted in Chicago schools. Children completed weekly confidential surveys for eight consecutive weeks. Results: A total of 332 children participated in the study (40% girls, mean age 9.97 years, median 10, range 8-12 years): public school (288), private school (44). A total of 2425 surveys were analyzed. Out of 2656 possible weekly surveys (332 children x 8 weeks), 91.3% were completed. Overall weekly prevalence of gastrointestinal symptoms: AP (39%), nausea (29.5%), constipation (14%), diarrhea (10.5%), vomiting (9%). Children with AP reported interference with activities: gym (21.9%), school (17.3%), difficulty sleeping (13.7%), and social activities (12.6%). Out of all children, 8.4% sought medical attention for AP during the study period. Conclusions: Gastrointestinal symptoms are common in school-aged children in Colombia and interfere with both daily activities and school attendance. The prevalence of AP, diarrhea and vomiting found in this study were similar to published prevalence of American children using similar methods. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Fatal Central Nervous System Post-Transplant Lymphoproliferative Disease in a Patient Who Underwent Liver Transplantation for Hepatoblastoma.

No abstract available

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Taxonomically Restricted Genes with Essential Functions Frequently Play Roles in Chromosome Segregation in Caenorhabditis elegans and Saccharomyces cerevisiae

Genes encoding essential components of core cellular processes are typically highly conserved across eukaryotes. However, a small proportion of essential genes are highly taxonomically restricted - there appear to be no similar genes outside the genomes of highly related species. What are the functions of these poorly characterized Taxonomically Restricted Genes (TRGs)? Systematic screens in S. cerevisiae and C. elegans previously identified yeast or nematode TRGs that are essential for viability and we find that these genes share many molecular features, despite having no significant sequence similarity. Specifically, we find that those TRGs with essential phenotypes have an expression profile more similar to highly conserved genes, they have more protein-protein interactions and more protein disorder. Surprisingly, many TRGs play central roles in chromosome segregation, a core eukaryotic process. We thus find that genes that appear to be highly evolutionarily restricted do not necessarily play roles in species-specific biological functions but frequently play essential roles in core eukaryotic processes.

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Neo-sex Chromosomes in the Monarch Butterfly, Danaus plexippus

We report the discovery of a neo-sex chromosome in Monarch butterfly, Danaus plexippus, and several of its close relatives. Z-linked scaffolds in the D. plexippus genome assembly were identified via sex-specific differences in Illumina sequencing coverage. Additionally, a majority of the D. plexippus genome assembly was assigned to chromosomes based on counts of 1-to-1 orthologs relative to the butterfly Melitaea cinxia (with replication using two other lepidopteran species), in which genome scaffolds have been mapped to linkage groups. Sequencing-coverage based assessments of Z-linkage combined with homology based chromosomal assignments provided strong evidence for a Z-autosome fusion in the Danaus lineage, involving the autosome homologous to chromosome 21 in M. cinxia. Coverage analysis also identified three notable assembly errors resulting in chimeric Z-autosome scaffolds. Cytogenetic analysis further revealed a large W-chromosome that is partially euchromatic, consistent with being a neo-W chromosome. The discovery of a neo-Z and the provisional assignment of chromosome linkage for >90% of D. plexippus genes lays the foundation for novel insights concerning sex chromosome evolution in this female-heterogametic model species for functional and evolutionary genomics.

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High Throughput Genetic Screening of 51 Paediatric Cataract Genes Identifies Causative Mutations in Inherited Paediatric Cataract in South Eastern Australia

Paediatric cataract is a leading cause of childhood blindness. This study aimed to determine the genetic cause of paediatric cataract in Australian families by screening known disease associated genes using massively parallel sequencing technology. We sequenced 51 previously reported paediatric cataract genes in 33 affected individuals with a family history (cases with previously known or published mutations were excluded) using the Ion Torrent Personal Genome Machine. Variants were prioritised for validation if they were predicted to alter the protein sequence and were absent or rare with minor allele frequency <1% in public databases. Confirmed mutations were assessed for segregation with the phenotype in all available family members. All identified novel or previously reported cataract causing mutations were screened in 326 unrelated Australian controls. We detected eleven novel mutations in GJA3, GJA8, CRYAA, CRYBB2, CRYGS, CRYGA, GCNT2, CRYGA and MIP, three previously reported cataract causing mutations in GJA8, CRYAA and CRYBB2. The most commonly mutated genes were those coding for gap junctions and crystallin proteins. Including previous reports of paediatric cataract associated mutations in our Australian cohort, known genes account for more than 60 % of familial paediatric cataract in Australia, indicating that still more causative genes remain to be identified.

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High-Resolution Maps of Mouse Reference Populations

Genetic reference panels are widely used to map complex, quantitative traits in model organisms. We have generated new high-resolution genetic maps of 259 mouse inbred strains from recombinant inbred strain panels (C57BL/6J x DBA/2J, ILS/IbgTejJ x ISS/IbgTejJ, C57BL/6J x A/J) and chromosome substitution strain panels (C57BL/6J-Chr#<A/J>, C57BL/6J-Chr#<PWD/Ph>, C57BL/6J-Chr#<MSM/Ms>). We genotyped all samples using the Affymetrix Mouse Diversity Array with an average inter-marker spacing of 4.3kb. The new genetic maps provide increased precision in the localization of recombination breakpoints compared to the previous maps. Although the strains were presumed to be fully inbred, we found residual heterozygosity in 40% of individual mice from five of the six panels. We also identified de novo deletions and duplications, in homozygous or heterozygous state, ranging in size from 21kb to 8.4Mb. Almost two-thirds (46 out of 76) of these deletions overlap exons of protein coding genes and may have phenotypic consequences. Twenty-nine putative gene conversions were identified in the chromosome substitution strains. We find that gene conversions are more likely to occur in regions where the homologous chromosomes are more similar. The raw genotyping data and genetic maps of these strain panels are available at http://ift.tt/2g9Qa0a.

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Genome-Scale Genetic Interactions and Cell Imaging Confirm Cytokinesis as Deleterious to Transient Topoisomerase II Deficiency in Saccharomyces cerevisiae

Topoisomerase II (Top2) is the essential protein that resolves DNA catenations. When Top2 is inactivated, mitotic catastrophe results from massive entanglement of chromosomes. Top2 is also the target of many first-line anticancer drugs, the so-called Top2 poisons. Often, tumors become resistant to these drugs by acquiring hypomorphic mutations in the genes encoding Top2. Here, we have compared the cell cycle and nuclear segregation of two coisogenic Saccharomyces cerevisiae strains carrying top2 thermosensitive alleles that differ in their resistance to Top2 poisons: the broadly-used poison-sensitive top2-4 and the poison-resistant top2-5. Furthermore, we have performed genome-scale Synthetic Genetic Array (SGA) analyses for both alleles under permissive conditions, chronic sublethal Top2 downregulation and acute, yet transient, Top2 inactivation. We find that slowing down mitotic progression, especially at the time of execution of the Mitotic Exit Network (MEN), protects against Top2 deficiency. In all conditions, genetic protection was stronger in top2-5, and this correlated with cell biology experiments in this mutant whereby we observed destabilization of both chromatin and ultrafine anaphase bridges by execution of MEN and cytokinesis. Interestingly, whereas transient inactivation of the critical MEN driver Cdc15 partly suppressed top2-5 lethality, this was not the case when earlier steps within anaphase were disrupted; i.e., top2-5 cdc14-1. We discuss the basis of this difference and suggest that accelerated progression through mitosis may be a therapeutic strategy to hypersensitize cancer cells carrying hypomorphic mutations in TOP2.

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Robot ZORA in rehabilitation and special education for children with severe physical disabilities: a pilot study.

The aim of this study was to explore the potential of ZORA robot-based interventions in rehabilitation and special education for children with severe physical disabilities. A two-centre explorative pilot study was carried out over a 2.5-month period involving children with severe physical disabilities with a developmental age ranging from 2 to 8 years. Children participated in six sessions with the ZORA robot in individual or in group sessions. Qualitative and quantitative methods were used to collect data on aspects of feasibility, usability, barriers and facilitators for the child as well as for the therapist and to obtain an indication of the effects on playfulness and the achievement of goals. In total, 17 children and seven professionals participated in the study. The results of this study show a positive contribution of ZORA in achieving therapy and educational goals. Moreover, sessions with ZORA were indicated as playful. Three main domains were indicated to be the most promising for the application of ZORA: movement skills, communication skills and cognitive skills. Furthermore, ZORA can contribute towards eliciting motivation, concentration, taking initiative and improving attention span of the children. On the basis of the results of the study, it can be concluded that ZORA has potential in therapy and education for children with severe physical disabilities. More research is needed to gain insight into how ZORA can be applied best in rehabilitation and special education. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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A Rare Cause of Recurrent Intestinal Obstruction

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Microscopic and telescopic pathology

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A Rare Cause of Recurrent Intestinal Obstruction

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Microscopic and telescopic pathology

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Rooted in the Community: Assessing the Reintegration Impacts of Agriculture on Rural Veterans

Publication date: Available online 24 August 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Karen Besterman-Dahan, Margeaux Chavez, Eni Njoh
ObjectiveTo assess the impact of a Veteran-oriented community agricultural initiative (CAI) on transitioning rural Veterans.DesignConvergent mixed-method program evaluation.SettingA Veteran-oriented farm-to-market CAI in rural Washington State.ParticipantsVeterans who were members of the CAI.Main Outcome MeasuresHealth, well-being, and reintegration were assessed by self-reported data from interview, demographic survey, validated health quality of life measure (Veterans RAND-12 -VR-12), validated reintegration measure (Military to Civilian Questionnaire -M2C-Q), and general satisfaction survey.ResultsVeteran participants were primarily Caucasian (88.4%, n=38) and male (74.4%, n=32) and most had a service-connected disability rating (58.2%, n=25). Qualitative and quantitative data revealed that the veterans participating in this CAI experienced health and reintegration benefits. Results on the M2C-Q, VR-12, and the satisfaction survey suggest that participating in this CAI contributed to improved mental, physical, and emotional health and vocational skills, community connectedness, and interpersonal communication. Qualitative interviews supported quantitative findings and revealed that participating in the CAI provided Veterans with a sense of satisfaction, belonging, and helped decrease the stigma surrounding their Veteran status.ConclusionsVeterans who participate in this CAI reported general improvements in physical and mental health, including improvements in sleep, nutrition, exercise, and decreases in anxiety, pain, depression and medication and substance use, all known factors which impact Veteran reintegration.



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Automated anesthesia delivery systems in cardiac surgical patients with left ventricular dysfunction: All systems go?

The interest in the use of automated drug infusion systems to deliver anesthesia has grown amongst both clinicians and researchers since their inception decades ago. Presently, two major types of automated anesthesia delivery systems exist, both of which have been used predominantly to deliver intravenous medications as part of a general anesthetic.

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Laparoscopic mesh removal for otherwise intractable inguinal pain following endoscopic hernia repair is feasible, safe and may be effective in selected patients

Abstract

Background

Laparoscopic inguinal hernia repair is preferred over an open technique because of reduced recovery time, favorable cost effectiveness, and less chronic postoperative inguinal pain. Nevertheless, some patients develop a nociceptive inguinal pain syndrome possibly related to the presence of the mesh. This is the first study describing feasibility, safety, and effectiveness of laparoscopic mesh removal in patients with chronic pain after endoscopic hernia repair.

Methods

Pre- and intraoperative data of chronic pain patients scheduled for endoscopic mesh removal were prospectively collected by a standard evaluation form. Long-term efficacy was determined using pain scores, patient satisfaction, and quality of life questionnaire. A Wilcoxon signed-rank test was used to determine significant differences between pre- and postoperative pain scores.

Results

Fourteen patients were studied (11 males, median 52 years). Median operating time was 103 min. Conversion to open surgery was not required. One intraoperatively recognized bladder laceration was laparoscopically closed. Otherwise, no intraoperative or postoperative complications occurred. Eight months postoperatively (median), pain scores had dropped from eight to four (p < 0.01). Satisfaction was good or excellent in ten patients. A recurrent hernia developed in two patients requiring an open mesh repair in one.

Conclusions

Laparoscopic mesh removal is a feasible, safe, and effective option in selected patients with chronic groin pain after endoscopic hernia repair in the hands of an experienced surgeon.

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Comparison of 8 and 5 mm robotic instruments in small cavities

Abstract

Introduction

Robotic surgery has seen increasing use in the field of pediatric surgery. Our clinical experience suggested instrument size can impact on the surgical ability. This study aimed to compare the performance of robot-assisted laparoscopic skills in confined spaces using either 5 or 8 mm instruments.

Methods

A preclinical randomized crossover study design was implemented. 24 assessors performed three different reproducible drill procedures (M1: peg transfer, M2: circle cutting, M3: intracorporeal suturing). To assess surgical proficiency in confined working spaces, these exercises were performed with 5 and 8 mm instruments of the da Vinci^® Surgical Systems Si in a cubic box with 60 mm-sized edges. Each performance was recorded and evaluated by two reviewers using both objective structured assessment of technical skills (OSATS) and global evaluative assessment of robotic skills (GEARS) scores. Parietal iatrogenic impacts and instrument collisions were specifically analyzed using a dedicated scoring system.

Results

Regardless of their experience, trainees performed significantly better when using 8 mm instruments in terms of OSATS scores (20.5 vs. 18.4; p < 0.01) and GEARS scores (23.4 vs. 21.9; p < 0.01) for most items, except for "depth perception" and "autonomy." The 8 mm performances involved significantly less parietal box damage (4.1 vs. 3.4; p < 0.01), and tool collisions (4.1 vs. 3.2; p < 0.01).

Conclusions

In light of the better performances with 8 mm tools for specific tasks and parietal sparing constraints in restricted spaces, this study indicates that 5 mm instruments can be deemed to be less effective for reconstructive procedures in small children.

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Implementation of a novel efficacy score to compare sealing and cutting devices in a porcine model

Abstract

Background

In general surgery, minimally invasive laparoscopic procedures have been steadily increasing over the last decade. The application of advanced bipolar and ultrasonic energy devices for sealing and cutting of blood vessels plays a vital role in routine clinical procedures. The advantages of energy-based instruments are enhanced sealing capability combined with both fast sealing time and minimal thermal injury. The purpose of this study was to compare the safety and efficacy profiles of nine laparoscopic sealing and cutting devices in a porcine model, with a new scoring system.

Methods

Comparative studies in a porcine model were performed to assess vessel sealing, burst pressure, thermal spread, maximum heat, sealing/cooling time, and compression strength over the full jaw. Nine different devices from five manufacturers were tested in this study. The sealing and cutting devices (SCD) score has been developed to enable standardized comparisons of various devices. For this purpose, the most important parameters were identified through a consensus approach.

Results

All sealed vessels with different devices could withstand a median pressure of more than 300 mmHg (range 112–2046 mmHg). The time for the sealing procedure was 7.705 s (range 5.305–18.38 s) for the ultrasonic and 7.860 s (range 5.08–10.17 s) for the bipolar devices. The ultrasonic instruments reached a median temperature of 218.1 °C (range 81.3–349.75 °C) and the bipolar devices a temperature of 125.5 °C (range 94.1–133.35 °C). The tissue reached a median temperature of 61.9 (range 47.1–80.6 °C) after ultrasonic sealing and 76.7 °C (range 63.1–94.2 °C) after bipolar sealing. The median SCD score was 10.47 (range 7.16–13.72).

Conclusion

All the instruments used seemed safe for use on the patient. The SCD score allows an indirect comparability of the instruments.

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Impact of visual–spatial ability on laparoscopic camera navigation training

Abstract

Background

Technical limitations of minimally invasive surgery challenge both surgeons and camera assistants. Current research indicates that visual–spatial ability (VSA) has impact on learning of laparoscopic camera navigation (LCN). However, it remains unclear if complexity of LCN tasks influences the impact of VSA. The aim of this study was to examine the influence of VSA on LCN training within tasks of different complexity levels.

Methods

The present study was conducted as a monocentric prospective trial. VSA was assessed with a cube comparison test before participants underwent LCN training. LCN training consisted of three tasks with increasing complexity. Each task was performed four times and performance was assessed each time. Correlations and multivariate regression analysis were used to assess the influence of VSA on LCN skills.

Results

Seventy-one participants were included (35 males). Significant performance improvement and faster completion times were observed from the first to fourth trial of all three LCN training tasks. Significant positive correlations between VSA and performance on LCN task 3 were found (performance: r _s = 0.47; p < 0.001, time: r _s = −0.43; p < 0.001). Multivariate regression revealed that higher VSA resulted in greater reduction of time between the first trials of LCN training task 3 (B = −1.67, p = 0.031).

Conclusion

In the present study, all trainees improved LCN performance during the training. VSA seems to have impact on LCN performance and training progress particularly for complex LCN tasks. The relation of VSA and LCN performance was stronger for less experienced participants and in the beginning of the learning phase.

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Sleeve Gastrectomy: the first 3 Years: evaluation of emergency department visits, readmissions, and reoperations for 14,080 patients in New York State

Abstract

Introduction

The purpose of our study was to evaluate the indications for and incidence of both emergency department (ED) visits and hospital readmissions within the first postoperative year. We also sought to identify the rate of reoperation within the first 3 years following a SG operation in New York State (NYS).

Methods

The SPARCS database was examined for all SGs performed between 2011 and 2013. Using a unique identifier, patients were followed for at least 1 year. Patients were followed for reoperation and/or conversion to Roux-en-Y Gastric Bypass (RYGB), as well as for any other hospital-based encounter. Using primary diagnosis codes, the top five reasons for ED visits and readmission were identified.

Results

There were 14,080 SG between 2011 and 2013. Among all patients, just over one-third of patients visited the ED (33.9%). One in every ten of these visits resulted in readmission (9.5%), with 12.5% of the total postoperative patient population undergoing readmission within their first year after SG surgery. ED visits were unrelated to surgery in just over half of the patients (n = 4977; 53.88%). However, ED visits for abdominal pain (n = 1029; 11.14%), vomiting (n = 237; 2.57%), dehydration (n = 224; 2.43%), and syncope (n = 206; 2.23%) were attributed to surgery. The top five causes for readmission within the first year after SG were unrelated to surgery (n = 1101; 41.74%), complication related to bariatric surgery (n = 211; 8%), dehydration (n = 171; 6.48%), postoperative wound complication (n = 89; 3.37%), abdominal pain (n = 78; 2.96%). Overall, there was a low reoperation rate (0.32%); specifically, rates of sleeve revision and conversion to RYBG were 0.11 and 0.21%, respectively.

Conclusion

SG has increasing popularity in NYS. Although postoperative ED visits are high, SG has a low overall reoperation rate (0.32%), and of these patients, most undergo conversion to RYGB compared to sleeve revision. Overall 1-year readmission rates after SG are 12.5%.

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Can fatigue affect acquisition of new surgical skills? A prospective trial of pre- and post-call general surgery residents using the da Vinci surgical skills simulator

Abstract

Objective

To study the effects of fatigue on general surgery residents' performance on the da Vinci Skills Simulator (dVSS).

Methods

15 General Surgery residents from various postgraduate training years (PGY2, PGY3, PGY4, and PGY5) performed 5 simulation tasks on the dVSS as recommended by the Robotic Training Network (RTN). The General Surgery residents had no prior experience with the dVSS. Participants were assigned to either the Pre-call group or Post-call group based on call schedule. As a measure of subjective fatigue, residents were given the Epworth Sleepiness Scale (ESS) prior to their dVSS testing. The dVSS MScore™ software recorded various metrics (Objective Structured Assessment of Technical Skills, OSATS) that were used to evaluate the performance of each resident to compare the robotic simulation proficiency between the Pre-call and Post-call groups.

Results

Six general surgery residents were stratified into the Pre-call group and nine into the Post-call group. These residents were also stratified into Fatigued (10) or Nonfatigued (5) groups, as determined by their reported ESS scores. A statistically significant difference was found between the Pre-call and Post-call reported sleep hours (p = 0.036). There was no statistically significant difference between the Pre-call and Post-call groups or between the Fatigued and Nonfatigued groups in time to complete exercise, number of attempts, and high MScore™ score.

Conclusion

Despite variation in fatigue levels, there was no effect on the acquisition of robotic simulator skills.

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Physiologic and psychological gender differences in bariatric surgery

Abstract

Background

Bariatric surgery is a safe and effective treatment for clinically severe obesity, but inequity in male and female utilization is well recognized. Approximately 20% of patients undergoing bariatric surgery are male. This paper aims to describe differences in outcomes by gender and to understand the physiologic and psychological differences that may explain this gender gap.

Methods

We examined 61,708 patients from the Michigan Bariatric Surgery Collaborative (MBSC) undergoing primary bariatric surgery between 2006 and 2016. Clinical data regarding demographics, comorbidities, and outcomes were compared by gender. Preoperative and 1-year postoperative surveys gathered psychological outcomes.

Results

This cohort was consistent with the national population with approximately 22% male patients. There were several significant differences between males and females at the time of surgery. Males tended to be older, have a higher BMI, be married, have lower self-reported depression scores, and have more comorbidities (all p < 0.05). Postoperatively, males suffered more serious complications than women (2.67 vs. 2.12, respectively, p < 0.05). At 1 year postoperatively, males were significantly more satisfied with their operation despite increased complications, decreased weight loss, and decreased rates of comorbidity resolution as compared to females (all p < 0.05).

Conclusions

Despite significantly lower weight loss and increased complication rates, males tend to have markedly higher satisfaction and psychological well-being scores than females. To improve outcomes in males, earlier referral to surgery may help to significantly reduce their risk. Conversely, increased attention to psychological support in the perioperative period for females may lead to improved psychological outcomes (i.e., body image, depression, psychological well-being).

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Improved immediate postoperative pain following laparoscopic inguinal herniorrhaphy using self-adhering mesh

Abstract

Background

Several synthetic meshes are available to reinforce the inguinal region following laparoscopic hernia reduction. We sought to compare postoperative pain of patients who underwent laparoscopic inguinal herniorrhaphy using self-adhering polyester mesh to those who had non-adhering, synthetic mesh implanted using absorbable tacks.

Materials and methods

This study is a retrospective review of patients who underwent primary laparoscopic inguinal herniorrhaphy at the Medical College of Wisconsin between October 2012 and July 2014. Clinical information and perioperative pain scores using the visual analog scale (VAS) were obtained to evaluate immediate pre and postoperative pain.

Results

A total of 98 patients (88 male) underwent laparoscopic inguinal herniorrhaphy during the study interval. Forty-two patients received self-adhering mesh and 56 patients received mesh secured with tacks. Patient demographics and comorbidities did not differ significantly between the two groups. There was no difference in preoperative VAS scores between groups. The self-adhering mesh patients had a lower mean VAS change score (less pain). Postoperative complications did not differ between groups apart from a higher observed incidence of seroma in the self-adhering mesh group (p = 0.04). No hernias recurred in either group during the study interval.

Conclusions

Self-adhering mesh in laparoscopic inguinal herniorrhaphy resulted in less immediate postoperative pain than tacked mesh as demonstrated by VAS score. Postoperative complications were similar between the two groups. The results of this study demonstrate that laparoscopic inguinal herniorrhaphy using self-adhering mesh is comparable to tacked mesh in regards to short-term complication rates, but show a favorable advantage in regards to immediate postoperative pain.

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Patient-specific mental rehearsal with interactive visual aids: a path worth exploring?

Abstract

Background

Surgeons of today are faced with unprecedented challenges; necessitating a novel approach to pre-operative preparation which takes into account the specific tests each case poses. In this study, we examine patient-specific mental rehearsal for pre-surgical practice and assess whether this method has an additional effect when compared to generic mental rehearsal.

Methods

Sixteen medical students were trained how to perform a simulated laparoscopic cholecystectomy (SLC). After baseline assessments, they were randomised to two equal groups and asked to complete three SLCs involving different anatomical variants. Prior to each procedure, Group A practiced mental rehearsal with the use of a pre-prepared checklist and Group B mental rehearsal with the checklist combined with virtual models matching the anatomical variations of the SLCs. The performance of the two groups was compared using simulator provided metrics and competency assessment tool (CAT) scoring by two blinded assessors.

Results

The participants performed equally well when presented with a "straight-forward" anatomy [Group A vs. Group B—time sec: 445.5 vs. 496 p = 0.64—NOM: 437 vs. 413 p = 0.88—PL cm: 1317 vs. 1059 p = 0.32—per: 0.5 vs. 0 p = 0.22—NCB: 0 vs. 0 p = 0.71—DVS: 0 vs. 0 p = 0.2]; however, Group B performed significantly better [Group A vs. B Total CAT score—Short Cystic Duct (SCD): 20.5 vs. 26.31 p = 0.02 η ² = 0.32—Double cystic Artery (DA): 24.75 vs. 30.5 p = 0.03 η ² = 0.28] and committed less errors (Damage to Vital Structures—DVS, SCD: 4 vs. 0 p = 0.03 η ²=0.34, DA: 0 vs. 1 p = 0.02 η ² = 0.22). in the cases with more challenging anatomies.

Conclusion

These results suggest that patient-specific preparation with the combination of anatomical models and mental rehearsal may increase operative quality of complex procedures.

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Barriers to laparoscopic colon resection for cancer: a national analysis

Abstract

Background

Level one evidence has shown that minimally invasive surgery (MIS) for colon cancer improves short-term outcomes with equivalent long-term oncologic results when compared to open surgery. However, the adoption of MIS for patients with colon cancer has not been universal. The goal of this study is to identify barriers to the use of MIS surgery in colon cancer resection across the United States.

Methods

The National Cancer Database was queried for all cases of colonic adenocarcinoma resection from 2010 to 2012. Patients undergoing an MIS approach were compared with those undergoing open surgery (OS). MIS was defined as either robotic or laparoscopic surgery. Patients with metastatic disease, surgery for palliation, or tumors >8 cm were excluded. Multivariable modeling was used to identify variables associated with the use of open surgery.

Results

After applying exclusion criteria, 124,205 cases were identified. An MIS approach was used in only 54,621 (44%) patients. In a multivariable model adjusting for stage and tumor size, a number of important factors were associated with decreased odds of a MIS approach including black race (OR .91; p < .0001), lack of insurance (OR .51; p < .0001), lower education (OR .88; p < .0001), lower income (OR .83; p < .0001), treatment at a community program (OR .86; p < .0001), and treatment at a low-volume center (OR .79; p < .0001). Utilization of MIS increased over the study period (2010: 38.7%, 2011: 44.0%, 2012: 49.1%; p < .0001).

Conclusions

MIS approach is utilized in less than half of all colon resections in this national database, which accounts for over 70% of all diagnosed cancers in the US. Significant variability exists among age, race, insurance status, socioeconomic status, region, and facility type. In light of the recognized benefits of the MIS approach, local and national policy should focus on narrowing these disparities and continuing the upward trend of MIS utilization.

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Long-term outcomes of patients with early gastric cancer found to have lesions for which endoscopic treatment is not indicated on histopathological evaluation after endoscopic submucosal dissection

Abstract

Background

Gastric cancer treatment guidelines recommend additional surgery as the standard treatment for lesions for which endoscopic submucosal dissection (ESD) is not indicated. However, the incidence of lymph-node metastasis is low in most patients.

Methods and materials

The study comprised 231 patients (231 lesions) who underwent ESD for early gastric cancer (EGC) in our hospital from September 2002 through March 2015 and were found to have lesions for which endoscopic treatment is not indicated on histopathological evaluation after ESD. The patients were divided into the additional operation group and the follow-up group, and long-term outcomes were studied retrospectively. Risk factors for metastasis and recurrence were also studied (capture rate, 98.7%).

Results

The median follow-up was 48 months. There were 174 men and 57 women with a median age of 72 years. The additional operation group comprised 118 patients, and the follow-up group comprised 113 patients. The rates of 5-year cause-specific survival and 5-year overall survival were significantly higher in the additional operation group (100 and 96.0%, respectively) than in the follow-up group (92.6 and 73.3%, respectively; p = 0.010, p < 0.001). In the follow-up group, 5 patients (4.4%) died of gastric cancer (p = 0.021). Among elderly patients 75 years or older, long-term outcomes did not differ significantly between the groups. Sixteen patients had metastasis or recurrence, and the presence of lymphatic involvement was an independent risk factor for metastasis, recurrence, or both (p = 0.003; odds ratio 10.594; 95% confidence interval 2.294–48.927).

Conclusions

In patients with EGC who are confirmed to have lesions for which endoscopic treatment is not indicated on histopathological evaluation after ESD, additional surgery should be aggressively performed if the patient can tolerate such treatment. In elderly patients aged 75 years or older and patients with serious underlying diseases, follow-up observation was suggested to be one option in patients who give informed consent after receiving an explanation of the risk of recurrence.

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Characterization of common bile duct injury after laparoscopic cholecystectomy in a high-volume hospital system

Abstract

Background

Despite the popularity of laparoscopic cholecystectomy, rates of common bile duct injury remain higher than previously observed in open cholecystectomy. This retrospective chart review sought to determine the prevalence of, and risk factors for, biliary injury during laparoscopic cholecystectomy within a high-volume healthcare system.

Methods

800 of approximately 3000 cases between 2009 and 2015 were randomly selected and retrospectively reviewed. A single reviewer examined all operative notes, thereby including all cases of BDI regardless of ICD code or need for a second procedure. Biliary injuries were classified per Strasberg et al. (J Am Coll Surg 180:101–125, 1995). Logistic regression models were utilized to identify univariable and multivariable predictors of biliary injuries.

Results

31.0% of charts stated that the Critical View of Safety was obtained, and 12.4% of charts correctly described the critical view in detail. Three patients (0.4%) had a cystic duct leak, and 4 (0.5%) had a common bile duct injury. Of the four CBDI, three patients had a partial transection of the CBD and one had a partial stricture. Patients who suffered BDI were more likely to have had lower hemoglobin, urgent surgery, choledocholithiasis, or acutely inflamed gallbladder. Multivariable analysis of BDI risk factors showed higher preoperative hemoglobin to be independently protective against CBDI. Acutely inflamed gallbladder and choledocholithiasis were independently predictive of CBDI.

Conclusions

The rate of CBDI in this study was 0.5%. Acutely inflamed conditions were risk factors for biliary injury. Multivariable analysis suggests a protective effect of higher preoperative hemoglobin. There was no correlation of CVS with prevention of biliary injury, although only 12.4% of charts could be verified as following the technique correctly. Better implementation of CVS, and increased caution in patients with perioperative inflammatory signs, may be important for preventing bile duct injury. Additionally, counseling patients with acute inflammation on increased risk is important.

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Inside EMS Podcast: Giving volunteer EMTs meaningful incentives

Download this podcast on iTunes, SoundCloud or via RSS feed ​​In this Inside EMS Podcast episode, co-hosts Chris Cebollero and Kelly Grayson discuss two recent news articles. The first is out of Pennsylvania, where they are looking to give a tax credit to volunteers to increase recruitment and retention. The second is out of Florida, where an ambulance service was forced to write off $11.8 million ...

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App boosts communications for emergency medical services

Responders can transmit information more efficiently while en route to hospital, crucial when a person's life could be on the line

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ESO announces addition of SafetyPAD to its product portfolio

Leading Healthcare Software and Data Company for EMS, Fire, and Hospitals Expands Through Transaction to Acquire Assets of oPEN Inc.

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Tanzania to use drone network to deliver critical medicines

In 2018, they will begin using drones to make up to 2,000 deliveries per day to more than 1,000 health facilities

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6-year-old pulls drowning toddler twin cousins from pool

The twins' father, a first responder, said they were limp and "blue as a pair of blue jeans" when he began CPR

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Concrete and cement composites used for radioactive waste deposition

Publication date: November 2017
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): Jaroslava Koťátková, Jan Zatloukal, Pavel Reiterman, Karel Kolář
This review article presents the current state-of-knowledge of the use of cementitious materials for radioactive waste disposal. An overview of radwaste management processes with respect to the classification of the waste type is given. The application of cementitious materials for waste disposal is divided into two main lines: i) as a matrix for direct immobilization of treated waste form; and ii) as an engineered barrier of secondary protection in the form of concrete or grout. In the first part the immobilization mechanisms of the waste by cement hydration products is briefly described and an up-to date knowledge about the performance of different cementitious materials is given, including both traditional cements and alternative binder systems. The advantages, disadvantages as well as gaps in the base of information in relation to individual materials are stated. The following part of the article is aimed at description of multi-barrier systems for intermediate level waste repositories. It provides examples of proposed concepts by countries with advanced waste management programmes. In the paper summary, the good knowledge of the material durability due to its vast experience from civil engineering is highlighted however with the urge for specific approach during design and construction of a repository in terms of stringent safety requirements.



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Calculations of individual doses for Techa River Cohort members exposed to atmospheric radioiodine from Mayak releases

Publication date: November 2017
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): Bruce A. Napier, Paul W. Eslinger, Evgenia I. Tolstykh, Marina I. Vorobiova, Elena E. Tokareva, Boris N. Akhramenko, Victor A. Krivoschapov, Marina O. Degteva
Time-dependent thyroid doses were reconstructed for over 29,000 Techa River Cohort members living near the Mayak production facilities from ¹³¹I released to the atmosphere for all relevant exposure pathways. The calculational approach uses four general steps: 1) construct estimates of releases of ¹³¹I to the air from production facilities; 2) model the transport of ¹³¹I in the air and subsequent deposition on the ground and vegetation; 3) model the accumulation of ¹³¹I in environmental media; and 4) calculate individualized doses. The dose calculations are implemented in a Monte Carlo framework that produces best estimates and confidence intervals of dose time-histories. Other radionuclide contributors to thyroid dose were evaluated. The ¹³¹I contribution was 75–99% of the thyroid dose. The mean total thyroid dose for cohort members was 193 mGy and the median was 53 mGy. Thyroid doses for about 3% of cohort members were larger than 1 Gy. About 7% of children born in 1940–1950 had doses larger than 1 Gy. The uncertainty in the ¹³¹I dose estimates is low enough for this approach to be used in regional epidemiological studies.



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Determining an optimal clinical dose of elobixibat, a novel inhibitor of the ileal bile acid transporter, in Japanese patients with chronic constipation: a phase II, multicenter, double-blind, placebo-controlled randomized clinical trial

Abstract

Background

Elobixibat is an oral treatment candidate for chronic constipation with a novel mechanism of action via inhibition of the ileal bile acid transporter. We performed this randomized, double-blind, placebo-controlled, dose-finding phase IIb study in Japanese patients with chronic constipation to determine the optimal clinical dose of elobixibat.

Methods

Japanese patients with chronic constipation were randomized to receive elobixibat (5, 10, or 15 mg) or placebo once daily for 2 weeks. The primary efficacy endpoint was the change from baseline in frequency of spontaneous bowel movements at Week 1 of treatment. Secondary endpoints and adverse events were also examined.

Results

Among 226 patients who provided informed consent, 163 patients were randomized and included in the full analysis set. In the 10- and 15-mg groups, frequency of spontaneous bowel movements (±standard deviation) were significantly higher than baseline (5.7 ± 4.2 and 5.6 ± 3.5 times per week, respectively, compared with 2.6 ± 2.9 times per week in the placebo group [P = 0.0005, P = 0.0001, respectively]). Subgroup analysis indicated that elobixibat was equally effective in patients with or without constipation-predominant irritable bowel syndrome. Common adverse events included mild abdominal pain and diarrhea in the elobixibat groups; no serious or severe adverse events occurred. Elobixibat was well tolerated at once-daily oral doses up to 15 mg for 2 weeks.

Conclusions

Our study results suggest that 10 mg of elobixibat is a clinically optimal dose for Japanese patients with chronic constipation.

Clinical trial registration number

JapicCTI-142608.

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New fossils of Australopithecus anamensis from Kanapoi, West Turkana, Kenya (2012–2015)

Publication date: Available online 23 August 2017
Source:Journal of Human Evolution
Author(s): C.V. Ward, J.M. Plavcan, F.K. Manthi
Kanapoi, Kenya, has yielded the earliest evidence of the genus Australopithecus, Australopithecus anamensis. Renewed fieldwork from 2012 through 2015 yielded 18 new fossils attributable to this species. The new specimens include the second maxillary fragment known from a Kanapoi hominin and the first from a relatively young adult. The new maxilla has the distinctive rounded nasal aperture margin characteristic of A. anamensis. A second partial proximal tibia from the site is the first postcranial element from a small A. anamensis individual. A new partial mandible and complete mandibular dentition display distinctive Kanapoi hominin morphology, but the mandible displays a larger trigonid on its fourth premolar than any known so far. Two new complete sets of mandibular incisors are also notably large, especially the lateral ones, a distinctive feature of A. anamensis compared with Australopithecus afarensis. The new fossils also highlight the distinctive morphology of Kanapoi A. anamensis compared to later hominins.



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Transferring an Analytical Technique from Ecology to the Sport Sciences

Abstract

Background

Learning transfer is defined as an individual's capability to apply prior learnt perceptual, motor, or conceptual skills to a novel task or performance environment. In the sport sciences, learning transfers have been investigated from an athlete-specific perspective. However, sport scientists should also consider the benefits of cross-disciplinary learning to aid critical thinking and metacognitive skill gained through the interaction with similar quantitative scientific disciplines.

Objective

Using team sports performance analysis as an example, this study aimed to demonstrate the utility of a common analytical technique in ecology in the sports sciences, namely, nonmetric multidimensional scaling.

Methods

To achieve this aim, three novel research examples using this technique are presented, each of which enables the analysis and visualization of athlete (organism), team (aggregation of organisms), and competition (ecosystem) behaviors.

Results

The first example reveals the technical behaviors of Australian Football League Brownlow medalists from the 2001 to 2016 seasons. The second example delineates dissimilarity in higher and lower ranked National Rugby League teams within the 2016 season. Lastly, the third example shows the evolution of game play in the basketball tournaments between the 2004 and 2016 Olympic Games.

Conclusions

In addition to the novel findings of each example, the collective results demonstrate that, by embracing cross-disciplinary learning and drawing upon an analytical technique common to ecology, novel solutions to pertinent research questions within sports performance analysis could be addressed in a practically meaningful way. Cross-disciplinary learning may subsequently assist sport scientists in the analysis and visualization of multivariate datasets.

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Functional significance of extent and timing of muscle activation during double poling on-snow with increasing speed

Abstract

Purpose

To evaluate the level of activation and timing of upper- and lower-body muscles during double poling at different speeds on snow.

Methods

Nineteen well-trained cross-country skiers volunteered to double pole on a flat snowy track at different speeds (15, 18, 21 km h⁻¹). The target speeds could be maintained by the skiers thanks to the use of an audio-pace system in combination with cones spaced equally alongside the track. Only 11 subjects were finally included in the analysis, since their actual speeds, calculated through a photocell system, were within ±0.5 km h⁻¹ from those requested. Cycle and poling durations were measured from the recordings of an accelerometer attached to a wrist, while the pattern and the level of muscle activation were evaluated from electromyographyc signals.

Results

Double poling speed did not alter the sequence of muscle activation that started with hip flexors, continued with trunk flexors, shoulder, elbow and trunk extensors and ended with ankle plantar-flexors. However, higher speeds required an increasing involvement of thigh, trunk and shoulder muscles (P < 0.05) as well as an anticipation of their activation before pole plant (P < 0.05).

Conclusions

A progressively earlier activation of trunk and lower limb muscles is a coordinative strategy that allows rapid achievement of optimal body posture prior to the exertion of poling phase. Moreover, earlier activation of these muscles as the speed increases provides adequate muscle stiffness in the shoulder and core regions for the acceptance of the poling load.

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Self-cleaving ribozymes enable the production of guide RNAs from unlimited choices of promoters for CRISPR/Cas9 mediated genome editing

Publication date: Available online 24 August 2017
Source:Journal of Genetics and Genomics
Author(s): Yubing He, Tao Zhang, Ning Yang, Meilian Xu, Lang Yan, Lihao Wang, Rongchen Wang, Yunde Zhao




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Endoscopic Management of Benign Esophageal Strictures

Abstract

Purpose of Review

This paper presents the author's approach to esophageal dilation. It offers a tailored approach to the application of dilation to specific types of esophageal stenotic lesions.

Recent Findings

In patients with inflammatory stricture, recent studies confirm the importance of treating the underlying inflammatory condition in order to decrease the rate of recurrence. The paper reviews some of the novel techniques that have been suggested for the treatment of refractory benign esophageal strictures, including incisional therapy, stenting, or the injection steroids or antifibrotic agents.

Summary

The endoscopist who treats esophageal strictures must be familiar with the tools of the dilation and how they are best applied to specific types of stenotic lesions. If inflammation is present, effective management requires treatment of the inflammatory process in addition to mechanical dilation of the stenotic lesion. Controlled trials of novel approaches to treatment of refractory benign esophageal strictures are limited and will be necessary to determine efficacy.

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Endoscopic Evaluation of Post-Fundoplication Anatomy

Abstract

Purpose of Review

We aim to review the endoscopic evaluation of post-fundoplication anatomy and its role in assessment of fundoplication outcomes and in pre-operative planning for reoperation in failed procedures.

Recent Findings

There is no universally accepted system for evaluating post-fundoplication anatomy endoscopically. However, multiple reports described the usefulness of post-operative endoscopy as a quality control measure and in the evaluation of complex cases such as repeat procedures and paraesophageal hernias (PEH).

Summary

Endoscopic evaluation of post-fundoplication anatomy has an important role in assessing the outcomes of operative repair and pre-operative planning for failed fundoplications. Attempts have been made to characterize the appearance of the newly formed gastroesophageal valve after successful repairs and to standardize endoscopic reporting and classification of anatomic descriptions of failed fundoplications. However, there is no consensus. More studies are needed to evaluate the applicability and reproducibility of proposed endoscopic evaluation systems in order for such tools to become widely accepted.

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Meta-analysis of chromosomal aberrations as a biomarker of exposure in healthcare workers occupationally exposed to antineoplastic drugs

Publication date: Available online 24 August 2017
Source:Mutation Research/Reviews in Mutation Research
Author(s): Christine Roussel, Kristine L. Witt, Peter B. Shaw, Thomas H. Connor
Many antineoplastic drugs used to treat cancer, particularly alkylating agents and topoisomerase inhibitors, are known to induce genetic damage in patients. Elevated levels of chromosomal aberrations, micronuclei, and DNA damage have been documented in cancer patients. Elevations in these same biomarkers of genetic damage have been reported in numerous studies of healthcare workers, such as nurses and pharmacists, who routinely handle these drugs, but results vary across studies. To obtain an overall assessment of the exposure effect, we performed a meta-analysis on data obtained from peer-reviewed publications reporting chromosomal aberration levels in healthcare workers exposed to antineoplastic drugs. A literature search identified 39 studies reporting on occupational exposure to antineoplastic drugs and measurement of chromosomal aberrations in healthcare workers. After applying strict inclusion criteria for data quality and presentation, data from 17 studies included in 16 publications underwent meta-analysis using Hedges' bias-corrected g and a random-effects model. Results showed the level of chromosomal aberrations in healthcare workers exposed to antineoplastic drugs was significantly higher than in controls. The standardized mean differences (difference of means divided by within sd) from all studies were pooled, yielding a value 1.006 (unitless) with p <0.001. Thus, in addition to the documented genotoxic effects of antineoplastic drugs in cancer patients, this meta-analysis confirmed a significant association between occupational exposure to antineoplastics during the course of a normal work day and increases in chromosomal aberrations in healthcare workers. Based on the studies reviewed, we were unable to accurately assess whether appropriate use of protective measures might reduce the incidence of genetic damage in healthcare workers. However, given the potential for increased cancer risk linked to increases in chromosomal aberrations, the results of this study support the need to limit occupational exposure of healthcare workers to antineoplastic drugs as much as possible.



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Irritable bowel symptoms and the development of common mental disorders and functional somatic syndromes identified in secondary care: A long-term, population-based study

Clinical Epidemiology

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After solar eclipse, Americans' eyes seem mostly none the worse

Reuters Health News

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Usefulness of shear wave elastography as a quantitative diagnosis of chronic pancreatitis

Journal of Gastroenterology and Hepatology

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CMS targets providers that have high error rates in new claims processing, fraud reviews

Healthcare Finance News

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Prospective observational study to assess the need for postoperative antibiotics following surgical incision and drainage of skin and soft tissue abscess in pediatric patients

Journal of Pediatric Surgery

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Symptoms of anxiety and depression are independently associated with inflammatory bowel disease-related disability

Digestive and Liver Diseases

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Gliptin therapy reduces hepatic and myocardial fat in type 2 diabetic patients Gliptins and cardiometabolic risk

European Journal of Clinical Investigation

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Low-dose linaclotide (72 μg) for chronic idiopathic constipation: a 12-week, randomized, double-blind, placebo-controlled trial

The American Journal of Gastroenterology

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The association of early combined lactate and glucose levels with subsequent renal and liver dysfunction and hospital mortality in critically ill patients

Critical Care

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What are the dietary treatment research priorities for inflammatory bowel disease? A short report based on a priority setting partnership with the James Lind Alliance

Journal of Human Nutrition and Dietetics

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Elevated expression of neuropilin-2 associated with unfavorable prognosis in hepatocellular carcinoma

OncoTargets and Therapy

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BiClamp vessel-sealing device for open hepatic resection of malignant and benign liver tumours: A single-institution experience

BMC Cancer

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Using unproven methods to tackle cancer could be deadly

Reuters Health News

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Efficacy of three-in-one capsule bismuth quadruple therapy for Helicobacter pylori eradication in clinical practice in a multinational patient population

Helicobacter

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The effect of oligofructose-enriched inulin supplementation on gut microbiota, nutritional status and gastrointestinal symptoms in paediatric coeliac disease patients on a gluten-free diet: Study protocol for a pilot randomized controlled trial

Nutrition Journal

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Citius Altius Fortius: The new paradigm in the treatment of chronic hepatitis C disease

Clinical Infectious Diseases

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The safety and efficacy of an alcohol-free pancreatic cyst ablation protocol

Gastroenterology

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Routine pouchoscopy prior to ileostomy takedown may not be necessary in patients with chronic ulcerative colitis

Digestive Diseases

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Significant decrease of saturation index in erythrocytes membrane from subjects with non-alcoholic fatty liver disease (NAFLD)

Lipids in Health and Disease

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High serum pepsinogen I and beta Helicobacter pylori infection are risk factors for aspirin-induced gastroduodenal injury

Digestive Diseases

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Modulation of gene expression by nutritional state and hormones in Bombyx larvae in relation to its growth period

Publication date: Available online 23 August 2017
Source:Gene Expression Patterns
Author(s): Bembem Thounaojam, Bela Keshan
Insect growth and development are mainly regulated via synchronization of many extrinsic and intrinsic factors such as nutrition and hormones. Previously we have demonstrated that larval growth period influences the effect of insulin on the accumulation of glycogen in the fat body of Bombyx larvae. In the present study we demonstrate that Bombyx larvae at the terminal growth period (TGP, after critical weight) had a significantly greater increase in the expression level of Akt in the fat body than at the active growth period (AGP, before critical weight). The larvae at TGP also showed an increase in the expression level of ecdysone receptors (EcRB1 and USP1) and ecdysone-induced early genes (E75A and broad). The treatment of bovine insulin and methoprene to larvae at AGP induced the transcript levels of Akt, irrespective of the nutritional status of the larvae. However, in larvae at TGP, insulin repressed the transcript level of Akt. On contrary, 20-hydroxyecdysone induced the expression level of Akt in TGP larvae, but at feeding only. Insulin and 20E thus showed an antagonistic action on the Akt expression level in TGP larvae under feeding. The studies thus showed that larval growth period influences the expression level of Akt and ecdysone receptors in Bombyx. Further, the growth period and nutrition modulate the effect of exogenous hormones on Akt expression.



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