To compare the efficacy of anaesthetic depth control using Closed Loop Anaesthesia Delivery System (CLADS) and Target Controlled Infusion (TCI) in patients with moderate to severe left ventricular dysfunction (LVSD).
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Τετάρτη 30 Αυγούστου 2017
Anaesthetic depth control using closed loop anaesthesia delivery system vs. target controlled infusion in patients with moderate to severe left ventricular systolic dysfunction
Paramedics, Full Time, Part Time, PRN - Second Alarmers Rescue Squad
Working in EMS but looking to make more money" We are going to assume you just said YES! Second Alarmers Rescue Squad is pleased to announce new stipends for PRN and permanant part tim...e career members. All hours worked by PRN staff receive a $3.00 stipend and all hours worked by PPT staff receive a $1.50 stipend. Dont forget we still have a $4 per hour stipend for any shift that is opened within ...
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EMT, Full Time, Part Time, and PRN - Second Alarmers Rescue Squad
Working in EMS but looking to make more money" We are going to assume you just said YES! Second Alarmers Rescue Squad is pleased to announce new stipends for PRN and permanant part time career members. All hours worked by PRN staff receive a $3.00 stipend and all hours worked by PPT staff receive a $1.50 stipend. Dont forget we still have a $4 per hour stipend for any shift that is opened within 48 ...
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Robot-Assisted Training of Arm and Hand Movement Shows Functional Improvements for Incomplete Cervical Spinal Cord Injury.
Objective: The aim of the study was to demonstrate the feasibility, tolerability, and effectiveness of robotic-assisted arm training in incomplete chronic tetraplegia. Design: Pretest/posttest/follow-up was conducted. Ten individuals with chronic cervical spinal cord injury were enrolled. Participants performed single degree-of-freedom exercise of upper limbs at an intensity of 3-hr per session for 3 times a week for 4 wks with MAHI Exo-II. Arm and hand function tests (Jebsen-Taylor Hand Function Test, Action Research Arm Test), strength of upper limb (upper limb motor score, grip, and pinch strength), and independence in daily living activities (Spinal Cord Independence Measure II) were performed at baseline, end of training, and 6 mos later. Results: After 12 sessions of training, improvements in arm and hand functions were observed. Jebsen-Taylor Hand Function Test (0.14 [0.04]-0.21 [0.07] items/sec, P = 0.04), Action Research Arm Test (30.7 [3.8]-34.3 [4], P = 0.02), American Spinal Injury Association upper limb motor score (31.5 [2.3]-34 [2.3], P = 0.04) grip (9.7 [3.8]-12 [4.3] lb, P = 0.02), and pinch strength (4.5 [1.1]-5.7 [1.2] lb, P = 0.01) resulted in significant increases. Some gains were maintained at 6 mos. No change in Spinal Cord Independence Measure II scores and no adverse events were observed. Conclusions: Results from this pilot study suggest that repetitive training of arm movements with MAHI Exo-II exoskeleton is safe and has potential to be an adjunct treatment modality in rehabilitation of persons with spinal cord injury with mild to moderate impaired arm functions. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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Effectiveness of a Group Physiotherapy Intervention in Nontraumatic, Inoperable Painful Shoulder: A Randomized Clinical Trial.
Purpose: The aim of the study was to assess the effectiveness of a group intervention in painful shoulder. Design: This was a two-arm controlled clinical trial with a 5-wk follow-up and 1:1 allocation ratio with pretreatment and posttreatment assessments in a Spanish hospital in 2015-2016. This study comprised 74 patients with nontraumatic, inoperable painful shoulder. Patients were randomized into two groups: (1) in intervention, patients underwent group rehabilitation exercises supervised by a physical therapist and (2) in control, patients performed the same exercises as the intervention group but in their own home. The main variables were the differences preintervention and postintervention between scores on the visual analog scale, Constant-Murley scale, and Disabilities of the Arm, Shoulder and Hand scale. The mean differences in the main variables were compared between the two interventions (t test). Registration code is NCT02541279 ( clinicaltrials.gov). Results: Differences were found in favor of the intervention group: (1) visual analog scale = -0.1 (P = 0.723), (2) Constant-Murley = 4.1 (P = 0.085), and (3) Disabilities of the Arm, Shoulder and Hand = 14.7 (P
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Genomic Analysis and Resistance Mechanisms in Shigella flexneri 2a Strain 301
Microbial Drug Resistance , Vol. 0, No. 0.
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Exploration of Parent–Provider Communication During Clinic Visits for Children With Chronic Conditions
The purpose of this study was to explore the communication behaviors demonstrated by parents of children with chronic conditions and provider team members when communicating about the child's care in outpatient clinics using concepts from the Theory of Shared Communication (TSC).
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The evolution of the platyrrhine talus: A comparative analysis of the phenetic affinities of the Miocene platyrrhines with their modern relatives
Publication date: October 2017
Source:Journal of Human Evolution, Volume 111
Author(s): Thomas A. Püschel, Justin T. Gladman, René Bobe, William I. Sellers
Platyrrhines are a diverse group of primates that presently occupy a broad range of tropical-equatorial environments in the Americas. However, most of the fossil platyrrhine species of the early Miocene have been found at middle and high latitudes. Although the fossil record of New World monkeys has improved considerably over the past several years, it is still difficult to trace the origin of major modern clades. One of the most commonly preserved anatomical structures of early platyrrhines is the talus. This work provides an analysis of the phenetic affinities of extant platyrrhine tali and their Miocene counterparts through geometric morphometrics and a series of phylogenetic comparative analyses. Geometric morphometrics was used to quantify talar shape affinities, while locomotor mode percentages (LMPs) were used to test if talar shape is associated with locomotion. Comparative analyses were used to test if there was convergence in talar morphology, as well as different models that could explain the evolution of talar shape and size in platyrrhines. Body mass predictions for the fossil sample were also computed using the available articular surfaces. The results showed that most analyzed fossils exhibit a generalized morphology that is similar to some 'generalist' modern species. It was found that talar shape covaries with LMPs, thus allowing the inference of locomotion from talar morphology. The results further suggest that talar shape diversification can be explained by invoking a model of shifts in adaptive peak to three optima representing a phylogenetic hypothesis in which each platyrrhine family occupied a separate adaptive peak. The analyses indicate that platyrrhine talar centroid size diversification was characterized by an early differentiation related to a multidimensional niche model. Finally, the ancestral platyrrhine condition was reconstructed as a medium-sized, generalized, arboreal, quadruped.
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Postcrania of the most primitive euprimate and implications for primate origins
Source:Journal of Human Evolution, Volume 111
Author(s): Doug M. Boyer, Séverine Toussaint, Marc Godinot
The fossil record of early primates is largely comprised of dentitions. While teeth can indicate phylogenetic relationships and dietary preferences, they say little about hypotheses pertaining to the positional behavior or substrate preference of the ancestral crown primate. Here we report the discovery of a talus bone of the dentally primitive fossil euprimate Donrussellia provincialis. Our comparisons and analyses indicate that this talus is more primitive than that of other euprimates. It lacks features exclusive to strepsirrhines, like a large medial tibial facet and a sloping fibular facet. It also lacks the medially positioned flexor-fibularis groove of extant haplorhines. In these respects, the talus of D. provincialis comes surprisingly close to that of the pen-tailed treeshrew, Ptilocercus lowii, and extinct plesiadapiforms for which tali are known. However, it differs from P. lowii and is more like other early euprimates in exhibiting an expanded posterior trochlear shelf and deep talar body. In overall form, the bone approximates more leaping reliant euprimates. The phylogenetically basal signal from the new fossil is confirmed with cladistic analyses of two different character matrices, which place D. provincialis as the most basal strepsirrhine when the new tarsal data are included. Interpreting our results in the context of other recent discoveries, we conclude that the lineage leading to the ancestral euprimate had already become somewhat leaping specialized, while certain specializations for the small branch niche came after crown primates began to radiate.
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Yuneec International announces availability of Yuneec H520 Commercial UAV
The H520 Incorporates Multiple Interchangeable Payload Options, DataPilot™ Mission Planning Software and All-New YES! Commercial Service Program
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HeartRescue expands effort to reduce sudden cardiac arrest deaths
By EMS1 Staff MINNEAPOLIS — Three more states joined a project dedicated to increasing sudden cardiac arrest survival rates. The HeartRescue Project is a collaborative forum that lets partners share strategies to improve survival rates for sudden cardiac arrest victims. Recently, Maine, New Hampshire and Vermont joined the organization, bringing the total number of states to 15. "While every ...
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Weight-supported training of the upper extremity in children with cerebral palsy: a motor learning study
Novel neurorehabilitation technologies build upon treatment principles derived from motor learning studies. However, few studies have investigated motor learning with assistive devices in children and adolesce...
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Development and validation of a severity scoring system for Zellweger spectrum disorders
Abstract
The lack of a validated severity scoring system for individuals with Zellweger spectrum disorders (ZSD) hampers optimal patient care and reliable research. Here, we describe the development of such severity score and its validation in a large, well characterized cohort of ZSD individuals. We developed a severity scoring system based on the 14 organs that typically can be affected in ZSD. A standardized and validated method was used to classify additional care needs in individuals with neurodevelopmental disabilities (Capacity Profile [CAP]). Thirty ZSD patients of varying ages were scored by the severity score and the CAP. The median score was 9 (range 6–19) with a median scoring age of 16.0 years (range 2–36 years). The ZSD severity score was significantly correlated with all 5 domains of the CAP, most significantly with the sensory domain (r = 0.8971, p = <0.0001). No correlation was found between age and severity score. Multiple peroxisomal biochemical parameters were significantly correlated with the severity score. The presently reported severity score for ZSD is a suitable tool to assess phenotypic severity in a ZSD patient at any age. This severity score can be used for objective phenotype descriptions, genotype-phenotype correlation studies, the identification of prognostic features in ZSD patients and for classification and stratification of patients in clinical trials.
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Biallelic mutations in DYNC2LI1 are a rare cause of Ellis-van Creveld syndrome
Abstract
Ellis van Creveld syndrome (EvC) is a chondral and ectodermal dysplasia caused by biallelic mutations in the EVC, EVC2 and WDR35 genes. A proportion of cases with clinical diagnosis of EvC, however, do not carry mutations in these genes. To identify the genetic cause of EvC in a cohort of mutation-negative patients, exome sequencing was undertaken in a family with three affected members, and mutation scanning of a panel of clinically and functionally relevant genes was performed in 24 additional subjects with features fitting/overlapping EvC. Compound heterozygosity for the c.2T>C (p.Met1?) and c.662C>T (p.Thr221Ile) variants in DYNC2LI1, which encodes a component of the intraflagellar transport-related dynein-2 complex previously found mutated in other short-rib thoracic dysplasias, was identified in the three affected members of the first family. Targeted resequencing detected compound heterozygosity for the same missense variant and a frameshift change (p.Val141*) in two siblings with EvC from a second family, while a newborn with a more severe phenotype carried two DYNC2LI1 truncating variants. Our findings indicate that DYNC2LI1 mutations are associated with a wider clinical spectrum than previously appreciated, including EvC, with the severity of the phenotype likely depending on the extent of defective DYNC2LI1 function.
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Say-Barber-Biesecker-Young-Simpson syndrome and Genitopatellar syndrome: lumping or splitting?
Abstract
The Say-Barber-Biesecker-Young-Simpson variant of Ohdo syndrome (SBBYSS) and Genitopatellar syndrome (GTPTS) are two rare but clinically well-described diseases caused by de novo heterozygous sequence variants in the KAT6B gene. Both phenotypes are characterized by significant global developmental delay/intellectual disability, hypotonia, genital abnormalities, and patellar hypoplasia/agenesis. In addition, congenital heart defects, dental abnormalities, hearing loss, and thyroid anomalies are common to both phenotypes. This broad clinical overlap led some Authors to propose the concept of KAT6B spectrum disorders. On the other hand, some clinical features could help to differentiate the two disorders. Furthermore, it is possible to establish a genotype-phenotype correlation when considering the position of the sequence variant along the gene, supporting the notion of the two disorders as really distinct entities.
SBBYSS and GTPTS are two rare but clinically well-described diseases. Some Authors propose to unify them under a single denomination (KAT6B-related disorders) because they have many clinical features in common and are caused by sequence variants in the same gene. We believe that from a clinical point of view the facial phenotype of the patients with SBBYSS is striking enough to consider it appropriate to still maintain a distinction.
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Harvey victims use social media when 911 fails
"We called 911 and it rang and rang and rang and rang," a Houston resident said
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Esophagogastric junction cancer successfully treated by laparoscopic proximal gastrectomy and lower esophagectomy with intrathoracic double-flap technique: A case report
Abstract
A 66-year-old man was referred to our hospital for treatment of esophagogastric junction cancer. He was diagnosed as cT2N0M0, and the esophageal invasion was found to be 1 cm from the esophagogastric junction. He underwent laparoscopy-assisted proximal gastrectomy and lower esophagectomy with esophagogastrostomy using the intrathoracic double-flap technique through the transhiatal approach. The operative time was 662 min (suturing time was 198 min), and blood loss was 200 mL. The operative time was much longer for this procedure than for esophagogastrostomy with the conventional (intra-abdominal) double-flap technique. The postoperative course was uneventful. No abnormal gastroesophageal reflux, esophageal motility, or lower esophageal sphincter (LES) pressure was demonstrated 3 months after the operation. Laparoscopic proximal gastrectomy and lower esophagectomy with esophagogastrostomy using the double-flap technique through the transhiatal approach is safe and feasible. It may be recommended for patients with esophagogastric junction cancer with esophageal invasion of about 1 cm.
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Latif’s point: A new point for Veress needle insertion for pneumoperitoneum in difficult laparoscopy
Abstract
Introduction
Creating pneumoperitoneum is the most challenging step during laparoscopy. The periumbilical area is the classic site for Veress needle insertion. We adopted a new access point for peritoneal insufflation.
Methods
We introduced a new point for Veress needle insertion to create pneumoperitoneum during difficult laparoscopic procedures. The needle is placed between the xiphoid process and the right costal margin, and it then proceeds toward the patient's right axilla. We collected data to compare using this new method of peritoneal insufflation with using Palmer's point for pneumoperitoneum.
Results
Since 2013, we have used this new technique in 570 patients (first group) and Palmer's point in 459 patients (second group). Among these patients, 196 patients (20%) had had previous abdominal operations, 98 patients (10%) had irreducible ventral hernia, and 735 patients (70%) were morbidly obese. The two groups were comparable in terms of patient characteristics. The mean time to create pneumoperitoneum in the first group was 0.8 ± 0.002 min compared to 1.08 ± 0.007 min in the second group (P ≤ 0.5). The mean number of punctures was 1.57 ± 1.02 in the first group compared to 2.9 ± 1.5 in the second group (P≤ 0.5); in the first group, 97% were successful on the first attempt entry, whereas this figure was 91% in second group. In the first group, the liver was punctured in 13 patients without any further complications; no other viscera were punctured. In the second group, gastric puncture occurred in 5 cases, transverse colon in 2 cases, and omental injury in 12 cases.
Conclusion
This new access point may represent a safe, fast, and easy way to create pneumoperitoneum, as well as a promising alternative to Palmer's point in patients who are not candidates for classic midline entry.
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Life-threatening hemorrhage from the corona mortis after laparoscopic inguinal hernia repair: Report of a case
Abstract
Along with the increased use of other laparoscopic procedures, laparoscopic inguinal hernia repair has become widely used because of its minimally invasive nature. Here, we report a case of 66-year-old man who underwent transabdominal preperitoneal laparoscopic hernioplasty and developed hemorrhagic shock on postoperative day 1. CT showed postoperative venous hemorrhage from the retropubic space. Successful hemostasis of the massive hemorrhage was achieved laparoscopically. The origin of the hemorrhage was assumed to be the corona mortis vein, which was slightly injured during the operation. Despite the rarity of this complication, surgeons must be aware of the need to carefully dissect and fix the mesh in the retropubic space to avoid injuring the corona mortis. Laparoscopic hemostasis may be an effective alternative to the open approach.
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Metachronous solitary mediastinal lymph node metastases of hepatocellular carcinoma treated by video-assisted thoracic surgery twice: Report of a case
Abstract
Solitary mediastinal lymph node metastasis of hepatocellular carcinoma (HCC) is rare. We report a case of metachronically solitary mediastinal metastases of HCC treated by video-assisted thoracic surgery (VATS) twice. A 66-year-old man underwent repeated laparoscopic radiofrequency ablation or trans-arterial catheter chemo-embolization against HCC for more than 10 years. The level of alpha fetoprotein protein was elevated, and radiological modalities including FDG-PET revealed solitary mediastinal tumor metachronically. VATS was performed bilaterally twice. The postoperative course was uneventful and there had no recurrence of extra-hepatic metastases and tumor markers are within normal limits at 18 months after second VATS. VATS is a minimally invasive and useful procedure for solitary mediastinal lymph node metastasis of HCC. If primary HCC was controlled and lymph node metastasis was solitary, mediastinum lymphadenectomy using VATS might give good short and long term results.
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Pfannenstiel laparoendoscopic reduced-port bilateral radical nephrectomy for a patient with renal cell carcinoma undergoing hemodialysis
Abstract
We performed Pfannenstiel laparoendoscopic reduced-port bilateral radical nephrectomy on a patient with renal cell carcinoma undergoing hemodialysis. A 4-cm Pfannenstiel incision was made, and a GelPOINT access was inserted. Three trocars were placed through the access platform, and additional 5- and 3-mm trocars were inserted in the umbilicus and paraumbilical area, respectively. After left nephrectomy, right nephrectomy was successfully completed in 401 min, with an estimated blood loss of 70 mL. There were no intraoperative or postoperative complications, and the patient was discharged 10 days postoperatively. The umbilical scar was concealed within the umbilical fold, and the scar from the 3-mm trocar was almost invisible. The Pfannenstiel scar was minimal and concealed by the patient's underwear. Pfannenstiel laparoendoscopic reduced-port simultaneous bilateral radical nephrectomy is a safe and technically feasible procedure that offers great cosmesis for patients with bilateral renal tumors and end-stage renal disease.
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Recessive Mutations in NDUFA2 Cause Mitochondrial Leukoencephalopathy
Deficiencies of mitochondrial respiratory chain complex I frequently result in leukoencephalopathy in young patients, and different mutations in the genes encoding its subunits are still being uncovered. We report two patients with cystic leukoencephalopathy and complex I deficiency with recessive mutations in NDUFA2, an accessory subunit of complex I. The first patient was initially diagnosed with a primary systemic carnitine deficiency associated with a homozygous variant in SLC22A5, but also exhibited developmental regression and cystic leukoencephalopathy, and an additional diagnosis of complex I deficiency was suspected. Biochemical analysis confirmed a complex I deficiency, and whole exome sequencing revealed a homozygous mutation in NDUFA2 (c.134A>C, p.Lys45Thr). Review of a biorepository of patients with unsolved genetic leukoencephalopathies who underwent whole exome or genome sequencing allowed us to identify a second patient with compound heterozygous mutations in NDUFA2 (c.134A>C, p.Lys45Thr; c.225del, p.Asn76Metfs*4). Only one other patient with mutations in NDUFA2 and a different phenotype (Leigh syndrome) has previously been reported. This is the first report of cystic leukoencephalopathy caused by mutations in NDUFA2.
Graphical abstract
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Elevated resting H+ current in the R1239H type 1 Hypokalemic Periodic Paralysis mutated Ca2+ channel
Abstract
Missense mutations in the gene encoding the α1 subunit of the skeletal muscle voltage-gated Ca2+ channel induce type 1 Hypokalemic Periodic Paralysis, a poorly understood neuromuscular disease characterized by episodic attacks of paralysis associated with low serum K+. The present study aimed at identifying the changes in muscle fibre electrical properties induced by acute expression of the R1239H Hypokalemic Periodic Paralysis human mutant α1 subunit of Ca2+ channels in a mature muscle environment to better understand the pathophysiological mechanisms involved in this disorder. We transferred genes encoding wild-type and R1239H mutant human Ca2+ channels into hind limb mouse muscle by electroporation and combined voltage-clamp and intracellular pH measurements on enzymatically dissociated single muscle fibres. As compared to fibres expressing wild-type α1 subunits, R1239H mutant expressing fibres displayed Ca2+ currents of reduced amplitude and a higher resting leak inward current that was increased by external acidification. External acidification also produced intracellular acidification at a higher rate in R1239H fibres and inhibited inward rectifier K+ currents. These data indicate that the R1239H mutation induces an elevated leak H+ current at rest flowing through a gating pore created by the mutation and that external acidification favors onset of muscle paralysis by potentiating H+ depolarizing currents and inhibiting resting inward rectifier K+ currents. Our results could thus explain why paralytic attacks preferentially occur during the recovery period following intense muscle exercise.
This article is protected by copyright. All rights reserved
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Do right-ventricular trabeculae gain energetic advantage from having a greater velocity of shortening?
Abstract
Our study aimed to ascertain whether the interventricular difference of shortening velocity, reported for isolated cardiac tissues in vitro, affects interventricular mechano-energetic performance when tested under physiological conditions using a shortening protocol designed to mimic those in vivo. We isolated trabeculae from both ventricles of the rat, mounted them in a calorimeter, and performed experiments at 37°C and 5 Hz stimulus frequency to emulate conditions of the rat heart in vivo. Each trabecula was subjected to two experimental protocols: (i) isotonic work-loop contractions at a variety of afterloads, and (ii) isometric contractions at a variety of preloads. Velocity of shortening was calculated from the former protocol during the isotonic shortening phase of the contraction. Simultaneous measurements of force-length work and heat output allowed calculation of mechanical efficiency. The shortening-dependent thermal component was quantified from the difference in heat output between the two protocols. Our results show that both extent of shortening and velocity of shortening were higher in trabeculae from the right ventricle. Despite these differences, trabeculae from both ventricles developed the same stress, performed the same work, liberated the same amount of heat, and hence operated at the same mechanical efficiency. Shortening heat was also ventricle independent. The interventricular differences in velocity of shortening and extent of shortening of isolated trabeculae were not manifested in any index of energetics. These collective results underscore the absence of any mechano-energetic advantage or disadvantage conferred on right-ventricular trabeculae arising from their superior velocity of shortening.
This article is protected by copyright. All rights reserved
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A national survey of natural radionuclides in soils and terrestrial radiation exposure in Iran
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): M.R. Kardan, N. Fathabdi, A. Attarilar, M.T. Esmaeili-Gheshlaghi, M. Karimi, A. Najafi, S.S. Hosseini
In the past, some efforts have been made for measuring natural radioactivity and evaluating public exposure to natural radiation in certain areas of Iran especially in well-known High Level Natural Radiation Areas (HLNRA) in Ramsar and Mahallat. However, the information on radionuclide concentrations, and, consequently, terrestrial radiation exposure for many other areas are not available. There was therefore a need for a systematic and nation-wide survey. For this purpose, 979 soil samples from 31 provinces were collected. The activity concentrations of 40K, 226Ra and 232Th were measured by HPGe detector. The average activity concentrations for Iran were found to be 457.7 Bq/kg for 40K, 24.3 Bq/kg for 226Ra and 25.8 Bq/kg for 232Th. Results were compared with previous regional or provincial surveys. The population-weighted average outdoor and indoor annual effective dose due to external exposure to terrestrial sources of radiation are 0.06 mSv and 0.33 mSv, respectively. It was shown that there is a significant correlation between the activity concentrations of 232Th and 40K in soil. In addition, the results of chi square tests show normal and lognormal distributions cannot be considered for the frequency distributions of activity concentration of 232Th and 226 Ra while 40K has a normal distribution.
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Environmental gamma radiation analysis for Ulsan city with the highest nuclear power plant density in Korea
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): UkJae Lee, Jun Woo Bae, Hee Reyoung Kim
This study presents a real-time measurement-based rapid radiation distribution visualization system for radionuclide recognition, which can quickly scan a contaminated environment. The system combines a portable detector with a digital map and a program for quick data treatment. Radiation information at the measurement location is transferred between a detector and a laptop. It includes environmental and artificial components, specific radionuclides, and total radionuclides. After scanning the area, the radiation distributions are comprehensively displayed in 2D and 3D maps corresponding to the measured area, all in a few tens of seconds. The proposed method was verified using the standard 137Cs and 60Co sources. The gamma radiation distribution of the areas measured in Ulsan city, which included non-destructive testing and radioisotope treatment facilities, hospitals, transportation spots, and residential and commercial areas, showed that Ulsan city has maintained safe levels of radiation. The system performed well. In addition, it was found that this system could detect unexpected hot spots quickly in affected environments.
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Local infiltration analgesia: a 2-year follow-up of patients undergoing total hip arthroplasty
Abstract
Purpose
Local infiltration analgesia (LIA) is commonly used for postoperative pain management following total hip arthroplasty (THA). However, the long-term effects of the component drugs are unclear. The aim of our study was to investigate functional outcome, quality of life, chronic post-surgical pain, and adverse events in patients within 2 years of undergoing THA.
Methods
The study was a secondary analysis of data from a previous larger study. Eighty patients were randomized to receive either intrathecal morphine (Group ITM) or local infiltration analgesia (Group LIA) for pain management in a double-blind study. The parameters measured were patient-assessed functional outcome [using the Hip dysfunction and Osteo-arthritis Outcome Score (HOOS) questionnaire], health-related quality of life [using the European Quality of Life–5 dimensions (EQ-5D) questionnaire and the 36-Item Short Form Health Survey (SF-36) score], and pain using the numeric rating score (NRS), with persistent post-surgical pain having a NRS of > 3 or a HOOS pain sub-score of > 30. All complications and adverse events were investigated during the first 2 years after primary surgery.
Results
Pain intensity and rescue analgesic consumption were similar between the groups after hospital discharge. No differences were found in HOOS or SF-36 score between the groups up to 6 months after surgery. A significant group × time interaction was seen in the EQ 5D form in favor of the LIA group. No between-group difference in persistent post-surgical pain was found at 3 or 6 months, or in adverse events up to 2 years after surgery.
Conclusion
Analysis of functional outcome, quality of life, and post-discharge surgical pain did not reveal significant differences between patients receiving LIA and those receiving ITM. LIA was found to be a safe technique for THA during the long-term follow-up. However, it should be noted that these conclusions are based on a limited number of patients.
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Mechanisms of curcumin-induced gastroprotection against ethanol-induced gastric mucosal lesions
Abstract
Background
Curcumin, a pleiotropic substance used for centuries in traditional medicine, exhibits antioxidant, anti-inflammatory and antiproliferative efficacy against various tumours, but the role of curcumin in gastroprotection is little studied. We determined the effect of curcumin against gastric haemorrhagic lesions induced by 75% ethanol and alterations in gastric blood flow (GBF) in rats with cyclooxygenase-1 (COX-1) and COX-2 activity inhibited by indomethacin, SC-560 or rofecoxib, inhibited NO-synthase activity, capsaicin denervation and blockade of TRPV1 receptors by capsazepine.
Methods
One hour after ethanol administration, the gastric mucosal lesions were assessed by planimetry, the GBF was examined by H2 gas clearance, plasma gastrin was determined by radioimmunoassay, and the gastric mucosal mRNA expression of Cdx-2, HIF-1α, HO-1 and SOD 2 was analysed by RT-PCR.
Results
Curcumin, in a dose-dependent manner, reduced ethanol-induced gastric lesions and significantly increased GBF and plasma gastrin levels. Curcumin-induced protection was completely reversed by indomethacin and SC-560, and significantly attenuated by rofecoxib, L-NNA, capsaicin denervation and capsazepine. Curcumin downregulated Cdx-2 and Hif-1α mRNA expression and upregulated HO-1 and SOD 2, and these effects were reversed by L-NNA and further restored by co-treatment of L-NNA with l-arginine.
Conclusions
Curcumin-induced protection against ethanol damage involves endogenous PG, NO, gastrin and CGRP released from sensory nerves due to activation of the vanilloid TRPV1 receptor. This protective effect can be attributed to the inhibition of HIF-1α and Cdx-2 expression and the activation of HO-1 and SOD 2 expression.
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Synergic effects of the ApoC3 and ApoA4 polymorphisms on the risk of hypertension
Abstract
The apolipoprotein (Apo) C3 and A4 genes, which are members of the ApoA1/C3/A4/A5 gene cluster, play important roles in lipid metabolism. Despite their importance, studies on the association between these polymorphisms in patients with hypertension are rare. In this study, we examined the associations of ApoC3 (−482C>T rs2854117, −455T>C rs2854116 and 3238G>C rs5128) and ApoA4 1687A>G rs5104 polymorphisms in Korean hypertensive patients. Three hundred and forty patients with hypertension and 515 healthy normotensive subjects were studied. ApoC3 and ApoA4 polymorphisms in the subjects were analyzed by polymerase chain reaction and restriction fragment length polymorphism. The four polymorphisms were not associated with susceptibility to hypertension. However, several haplotypes constructed from four polymorphisms of the ApoC3 and ApoA4 genes were associated with susceptibility to hypertension. With respect to the clinical parameters of hypertension, the −482C>T and −455T>C polymorphisms of the ApoC3 gene were associated with abnormal body mass index (P = 0.024) and triglyceride levels (P = 0.033) in the hypertensive group, respectively. Based on these results, the ApoC3 and ApoA4 polymorphisms might affect synergically susceptibility to hypertension in Koreans.
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Changes with aging in gastric biomarkers levels and in biochemical factors associated with Helicobacter pylori infection in asymptomatic Chinese population
World Journal of Gastroenterology
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Report reveals high level of drug use in athletics
Reuters Health News
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Laparoscopic versus open 1-stage resection of synchronous liver metastases and primary colorectal cancer
Gland Surgery
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New ransomware strain targeting healthcare
Healthcare Finance News
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Remnant liver tumor growth activity during treatment associating liver partition and portal vein occlusion for staged hepatectomy (ALPPS)
Journal of Gastrointestinal Surgery
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Evaluation of gastrointestinal patient reported outcomes Measurement Information System (GI-PROMIS) symptom scales in subjects with inflammatory bowel diseases
The American Journal of Gastroenterology
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An updated meta-analysis of controlled observational studies: Proton-pump inhibitors and risk of Clostridium difficile infection
Journal of Hospital Infection
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Intake of dietary fibre and lifetime non-steroidal anti-inflammatory drug (NSAID) use and the incidence of colorectal polyps in a population screened for colorectal cancer
Journal of Epidemiology and Community Health
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Modified Helicobacter test using a new test meal and a 13C-urea breath test in Helicobacter pylori positive and negative dyspepsia patients on proton pump inhibitors
World Journal of Gastroenterology
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Interaction effects among IFN-{gamma}+874, IL-2-330, IL-10-1082, IL-10-592 and IL-4-589 polymorphisms on the clinical progression of subjects infected with hepatitis B virus and/or hepatitis C virus: A retrospective nested case-control study
BMJ Open
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Drug development for breast, colorectal, and non-small cell lung cancers from 1979 to 2014
Cancer
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Fibrosis-4 index helps identify HBV carriers with the lowest risk of hepatocellular carcinoma
The American Journal of Gastroenterology
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Might statin use lower the risk of death from prostate cancer?
Reuters Health News
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Bacterial and fungal infections in acute-on-chronic liver failure: Prevalence, characteristics and impact on prognosis
Gut
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An investigation into the nutritional composition and cost of gluten-free versus regular food products in the UK
Journal of Human Nutrition and Dietetics
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Health-related quality of life after gastrectomy, esophagectomy, and combined esophagogastrectomy for gastroesophageal junction adenocarcinoma
Gastric Cancer
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Up-regulation of transient receptor potential vanilloid (TRPV) and down-regulation of brain-derived neurotrophic factor (BDNF) expression in patients with functional dyspepsia (FD)
Neurogastroenterology & Motility
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Predictors of early readmission in patients with cirrhosis after the resolution of bacterial infections
The American Journal of Gastroenterology
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Initial radiofrequency ablation failure for hepatocellular carcinoma: Repeated radiofrequency ablation versus transarterial chemoembolisation
Clinical Radiology
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HLA-DQ:gluten tetramer test in blood gives better detection of coeliac patients than biopsy after 14-day gluten challenge
Gut
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Maxillary implant-supported Overdentures Opposed by (Partial) Natural Dentitions: A 5-Year Prospective Case Series Study
Abstract
Purpose
To assess the 5-year treatment outcome of maxillary implant-retained overdentures opposed by natural antagonistic teeth.
Methods
50 consecutive patients received maxillary overdentures supported by six dental implants. Implants were placed in the anterior region, if enough bone was present (n=25 patients) Implant were placed in the posterior region if implant placement in in the anterior region was not possible (n=25 patients). Variables assessed included survival of implants, condition of hard and soft peri-implant tissues, and patients' satisfaction.
Results
Five-year implant survival rate was 97.0% and 99.3% and mean radiographic bone loss was 0.23 mm and 0.69 mm in the anterior and posterior group, respectively. Median scores for plaque, calculus, gingiva, bleeding, and mean scores for pocket probing depth were low and stayed low. Patients' satisfaction after treatment was high in both groups.
Conclusions
Within the limits of this 5-year study, it is concluded that six dental implants (placed in the anterior or posterior region) connected with a bar and opposed to natural antagonistic teeth result in acceptable results for clinical parameters; and good outcomes for marginal bone level changes and patient satisfaction.
This article is protected by copyright. All rights reserved.
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DIFFERENT PATTERNS OF WALKING AND POSTPRANDIAL TRIGLYCERIDES IN OLDER WOMEN.
Purpose: Although a single bout of continuous exercise (>=30 min) reduces postprandial triglyceride (TG), little evidence is available regarding the effect of multiple short (= 1.70 mmol/L) completed three, one-day laboratory-based trials in a random order: 1) control, 2) continuous walking, and 3) multiple short bouts of walking. On the control trial, participants sat in a chair for 8 hours. For the walking trials, participants walked briskly in either one 30-min bout in the morning (0900-0930) or twenty 90-sec bouts over 8 hours. Except for walking both exercise trials mimicked the control trial. In each trial, participants consumed a standardized breakfast (0800) and lunch (1100). Venous blood samples were collected in the fasted state and at 2, 4, 6 and 8 h after breakfast. Results: The serum TG incremental area under the curve was 35% and 33% lower on the continuous and multiple short bouts of walking trials than the control trial (8.2 +/- 3.1 vs 8.5 +/- 5.4 vs 12.7 +/- 5.8 mmol[BULLET OPERATOR]8h/L respectively, main effect of trial: ES = 0.459, P = 0.001). Conclusions: Accumulating walking in short bouts limits postprandial TG in at-risk, inactive older women with fasting hypertriglyceridemia. (C) 2017 American College of Sports Medicine
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A New Condition in McArdle Disease: Poor Bone Health-Benefits of an Active Lifestyle.
Introduction-Purpose: McArdle disease (muscle glycogen phosphorylase deficiency) is a genetic condition associated with exercise intolerance, but how it affects lean mass (LM) and bone mineral content (BMC) and density (BMD) in patients is unknown. We compared these variables between McArdle patients and age/sex-matched healthy controls and assessed their potential association with physical activity (PA) levels in patients. Methods: A case-control, cross-sectional design was used to examine LM, BMC and BMD by dual-energy X-ray absorptiometry in 136 young adults of both sexes [36 McArdle patients (33+/-15y) and 103 controls (34+/-11y)]. PA was assessed with the International Physical Activity Questionnaire (IPAQ). Results: McArdle patients had significantly lower LM values in whole-body and regional sites than their corresponding controls, whereas no differences were found (except for the trunk) when physically active patients (n=23) were compared with controls. All bone-related variables were significantly lower in patients than in controls (average difference of 13% for BMC and 7.6% for BMD). By contrast, no significant differences at the lumbar spine, pelvis and femur sites were found between physically active patients and controls. Conclusion: We report on a previously undescribed condition in McArdle patients, poor bone health, which warrants further attention as it can occur in relatively young adults. An active lifestyle can at least partly alleviate this disorder presumably because of its beneficial effect on LM. (C) 2017 American College of Sports Medicine
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Isoflurane Preconditioning Alleviated Murine Liver Ischemia and Reperfusion Injury by Restoring AMPK/mTOR-Mediated Autophagy.
BACKGROUND: Isoflurane has a pharmacological preconditioning effect against ischemia injury in the heart, kidney, and brain, but whether and how isoflurane preconditioning protects livers against ischemia and reperfusion (IR) injury is unclear. METHODS: Mice were randomly divided into an isoflurane preconditioning (ISO) group and control group, receiving 1.5% isoflurane or carrier gas for 40 minutes, respectively (n = 8/group). A partial warm liver IR model was used, and liver injury was evaluated. Primary hepatocytes were pretreated with 1.5% isoflurane for 2 hours before the induction of cell death by hydrogen peroxide. Cell death and survival were evaluated with the lactate dehydrogenase and cell counting kit-8 assay. Autophagy and regulatory molecules in stressed livers and hepatocytes were analyzed by Western blot (n = 6/group). An autophagy inhibitor (3-methyladenine [3-MA]) and 5' adenosine monophosphate-activated protein kinase (AMPK) inhibitor (dorsomorphin) were administered in vivo (n = 8/group) and in vitro (n = 6/group). RESULTS: Compared to that observed in the control group, mice in the ISO group showed reduced liver injury (alanine aminotransferase [ALT] levels, control versus ISO group, 8285 +/- 769 vs 4896 +/- 917 U/L, P
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Theoretical Modeling of Coagulation Management With Therapeutic Plasma or Prothrombin Complex Concentrate.
Prothrombin complex concentrates (PCCs) have been associated with a possible risk of thromboembolic complications, potentially attributable to an increased ratio of the plasma concentration of factor II (FII) to antithrombin (AT). We developed a mathematical model to examine the relationship between amounts of PCC or therapeutic plasma administered, and plasma levels of FII and AT. The model showed that PCC produces substantial increases in plasma levels of FII but only small changes in AT, increasing the FII:AT ratio. Therapeutic plasma was shown to have only modest effects on levels of FII or AT, unless high doses are used. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. (C) 2017 International Anesthesia Research Society
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Two Unique Cases of Ciprofloxacin-Associated Avulsion of Ligament and Tendon.
Ciprofloxacin is recognized to have a deleterious relationship with tendons, particularly Achilles tendinopathy, which makes up most case reports. Tendinopathy seems to occur because of induction of collagen-degrading enzymes causing damage and ischemia of the poorly vascularized regions preventing repair. The focus on the relationship of ciprofloxacin and the Achilles tendon leaves patients on fluoroquinolones with non-Achilles tendinopathy symptoms at risk of misdiagnosis. There have not been any documented instances of ligament damage with ciprofloxacin administration in the literature, although ligament and tendon compositions are similar and should have similar susceptibility. This report includes two cases, one presenting with right lateral thumb pain and a medical history of gastroenteritis treated with ciprofloxacin. Physical examination showed swelling of the right metacarpophalangeal joint and ultrasound confirmed disruption of the radial collateral ligament at insertion on first metacarpal; the second case is of a woman presenting with right hip pain in setting of chronic recurrent diverticulitis treated with ciprofloxacin. She received work-up for lumbar disc disease and spondylosis. After standard therapy with pharmacotherapy and physical therapy for radiculopathy failed, magnetic resonance imaging was performed showing near complete avulsion of the right hamstring tendons from the ischial tuberosity. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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Beyond editing to writing large genomes
Advances in genome sequencing, editing and synthetic biology have enhanced the feasibility of large-scale genome engineering, termed genome writing. In this Opinion article, Chari and Church discuss the strengths and limitations of diverse strategies for genome writing, including extensively modifying existing genomes versus synthesizing genomes de novo, and they provide future visions for writing large genomes.
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Comparison of the laryngeal mask airway supreme and the i-gel in paralysed elderly patients: A randomised controlled trial.
BACKGROUND: The laryngeal mask airway supreme (LMA-S) and i-gel are both popular second-generation supraglottic airway devices that have been widely studied in surgical patients, but their differences in clinical performance in the elderly are not clear. OBJECTIVE: We compared the efficacy and safety of the LMA-S and i-gel in anaesthetised and paralysed elderly patients. DESIGN: A prospective, randomised and parallel study. SETTING: Single-centre trial, study period January 2014 from to October 2016. PATIENTS: One hundred and six elderly patients who underwent urological or orthopaedic surgery with an expected duration less than 2 h. INTERVENTION: Patients were allocated to either the LMA-S (n = 53) or i-gel (n = 53) group. All insertions were performed in a standardised manner according to the manufacturers' instructions. MAIN OUTCOME MEASURES: Our primary endpoint was the rate of successful insertion at the first attempt. The adequacy of positive pressure ventilation and airway sealing, fibreoptic laryngoscopy grades and stability of airway maintenance during anaesthesia were also assessed. RESULTS: Although the rate of successful insertion at the first attempt was similar between the two groups (94.3 vs. 82.7%, P = 0.072), more patients required device manipulation during insertion with the LMA-S than the i-gel (42.3 vs. 18.9%, P = 0.011). Good fibreoptic laryngoscopy grades were significantly more common with the i-gel than the LMA-S (79.3 vs. 55.8%, P = 0.042), and peak inspiratory pressures were lower in the i-gel group both immediately after insertion and at the end of surgery. Leak pressures were significantly higher in the i-gel group than the LMA-S group, both immediately after insertion and at the end of surgery (25.8 vs. 23.0, P = 0.036; and 28.1 vs. 23.7, P
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