Σάββατο, 9 Σεπτεμβρίου 2017

A New Diagnostic Resource for Ceratitis capitata Strain Identification Based on QTL Mapping

The Mediterranean fruit fly Ceratitis capitata (Wiedemann) is a destructive agricultural pest and the subject of exclusion efforts in many countries. Suppression and eradication of invasive populations to prevent establishment is facilitated by the release of sterile males using the sterile insect technique (SIT). In active SIT release areas, it is critical to accurately discriminate between released sterile males and wild-caught individuals to be able to detect extremely rare invasive individuals in areas inundated with millions of sterile male flies. Current methods for discrimination exist, but are not always definitive, and a more reliable method is necessary. To address this, we took a novel approach and developed a genotyping assay that is linked to traits that facilitate male-only releases and are maintained in the SIT colonies, white pupae (wp) and temperature sensitive lethal (tsl). The development of this assay was achieved through linkage mapping and QTL mapping of wp in a mapping population derived from SIT colony flies and wild-type colony flies. This new method to discriminate released SIT flies from wild individuals was demonstrated across SIT colonies and wild individuals from across the geographic range of this species. In addition, linkage and QTL mapping of wp in C. capitata has larger impacts as it can serve as a foundational tool to identify the genetic basis of traits that facilitate the separation of male from female flies which can be used to develop SIT programs in related species.



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Caenorhabditis elegans HIF-1 Is Broadly Required for Survival in Hydrogen Sulfide

Hydrogen sulfide is common in the environment, and is also endogenously produced by animal cells. Although hydrogen sulfide is often toxic, exposure to low levels of hydrogen sulfide improves outcome in a variety of mammalian models of ischemia-reperfusion injury. In Caenorhabditis elegans, the initial transcriptional response to hydrogen sulfide depends on the hif-1 transcription factor, and hif-1 mutant animals die when exposed to hydrogen sulfide. In this study, we use rescue experiments to identify tissues in which hif-1 is required to survive exposure to hydrogen sulfide. We find that expression of hif-1 from the unc-14 promoter is sufficient to survive hydrogen sulfide. Although unc-14 is generally considered to be a pan-neuronal promoter, we show that it is active in many non-neuronal cells as well. Using other promoters, we show that pan-neuronal expression of hif-1 is not sufficient to survive exposure to hydrogen sulfide. Our data suggest that hif 1 is required in many different tissues to direct the essential response to hydrogen sulfide.



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Machine Learning Analysis Identifies Drosophila Grunge/Atrophin as an Important Learning and Memory Gene Required for Memory Retention and Social Learning

High throughput experiments are becoming increasingly common, and scientists must balance hypothesis driven experiments with genome wide data acquisition. We sought to predict novel genes involved in Drosophila learning and long-term memory from existing public high-throughput data. We performed an analysis using PILGRM, which analyzes public gene expression compendia using machine learning. We evaluated the top prediction alongside genes involved in learning and memory in IMP, an interface for functional relationship networks. We identified Grunge/Atrophin (Gug/Atro), a transcriptional repressor, histone deacetylase, as our top candidate. We find, through multiple, distinct assays, that Gug has an active role as a modulator of memory retention in the fly and its function is required in the adult mushroom body. Depletion of Gug specifically in neurons of the adult mushroom body, after cell division and neuronal development is complete, suggests that Gug function is important for memory retention through regulation of neuronal activity, and not by altering neurodevelopment. Our study provides a previously uncharacterized role for Gug as a possible regulator of neuronal plasticity at the interface of memory retention and memory extinction.



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A randomized trial of clitoral vacuum suction versus vibratory stimulation in neurogenic female orgasmic dysfunction

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Publication date: Available online 9 September 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Marcalee Alexander, Khurram Bashir, Craig Alexander, Lesley Marson, Raymond Rosen
ObjectiveTo examine safety and efficacy of use of a clitoral vacuum suction device (CVSD) versus vibratory stimulation (V) to treat orgasmic dysfunction in women with MS or SCI.DesignRandomized clinical trial.SettingTwo academic medical centers.ParticipantsThirty-one women including 20 with MS and 11 with SCI.InterventionA 12-week trial of the use of a CVSD versus VMain Outcome measuresFemale Sexual Function Inventory (FSFI) and Female Sexual Distress Scale (FSDS).Results23 women (18 MS; 5 SCI) completed the study including 13/16 randomized to CVSD and 10/15 randomized to V. There was a statistically significant increase in total FSFI score (p=.011), desire (p=. 009), arousal (p=.009), lubrication (p=.008), orgasm (p=.012), and satisfaction (p=.049) and a significant decrease in distress as measured by FSDS (p=.020) in subjects using the CVSD. In subjects who used V, there was a statistically significant increase in the orgasm subscale of the FSFI (p=.028). Subjects using the CVSD maintained improvements 4 weeks after treatment.ConclusionCVSD is safe and overall efficacious to treat female neurogenic sexual dysfunction related to MS and SCI. V is also safe and efficacious to female neurogenic orgasmic dysfunction; however, results were limited to the active treatment period. Due to ease of access and cost, clinicians can consider use of V for women with MS or SCI with orgasmic dysfunction. CVSD is recommended for women with multiple sexual dysfunctions or for whom V is ineffective.



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Comparative efficacy of intra-articular steroid injection and distension in patients with frozen shoulder: a systematic review and network meta-analysis

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Publication date: Available online 9 September 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Meng-Ting Lin, Ming-Yen Hsiao, Yu-Kang Tu, Tyng-Guey Wang
ObjectiveTo compare the efficacy of intra-articular (IA) steroid injection and distension in patients with frozen shoulder.Data SourcesDatabases, including MEDLINE (via PubMed), EMBASE, Scopus and Cochrane Library, were searched for studies published up to November 2016.Study SelectionWe included all published randomized controlled trials (RCTs), quasi-experimental studies and observational studies investigating the effectiveness of IA steroid injection, distension and physiotherapy in patients with frozen shoulder. Sixteen RCTs and one observational study were enrolled in meta-analysis.Data ExtractionFull-texts were independently reviewed and quality of RCTs was assessed with The Cochrane Collaboration's tool. The primary outcome was functional improvement; the secondary outcomes included pain reduction and external rotation (ER) improvement.Data SynthesisIn pair-wise meta-analysis, pooled standardized mean difference (SMD) of functional improvement and pain reduction revealed equal efficacy at three follow-up time points. With respect to ER improvement, distension has a superior effect as compared to IA steroid injection at short term [2–4 weeks; SMD: −0.36; 95% confidence interval (CI): −0.68∼ −0.04] and at medium term (6–16 weeks; SMD: −0.80; 95% CI: −1.32∼ −0.29). The network meta-analysis indicated a better efficacy for distension than for IA steroid injection in ER improvement only at medium term (6–16 weeks; SMD: −0.70; 95% CI: −1.19∼ −0.21).ConclusionIA steroid injection was as effective as distension in shoulder-function improvement, pain reduction and increasing ER of shoulder. Distension yielded better ER improvement at medium term but to a minor extent in the long term. For patients with predominant ER limitation, early distension could be considered the primary choice of treatment.



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Group- and individual-level responsiveness of the 3-point Berg Balance Scale and 3-point Postural Assessment Scale for Stroke Patients

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Publication date: Available online 9 September 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Yi-Jing Huang, Gong-Hong Lin, Shih-Chieh Lee, Yi-Miau Chen, Sheau-Ling Huang, Ching-Lin Hsieh
ObjectiveTo examine both group- and individual-level responsiveness of the 3-point Berg Balance Scale (BBS-3P) and 3-point Postural Assessment Scale for Stroke Patients (PASS-3P) in patients with stroke, and to compare the responsiveness of both 3-point measures versus their original measures (BBS and PASS) and their short forms (SFBBS and SFPASS) and between the BBS-3P and PASS-3P.DesignThe data were retrieved from a previous study wherein 212 patients were assessed at 14 and 30 days after stroke with the BBS and PASS.SettingMedical center.ParticipantsPatients with first onset of stroke within 14 days before hospitalization.Interventions.Not applicable.Main Outcome Measures.Group-level responsiveness was examined by the standardized response mean (SRM), and individual-level responsiveness was examined by the proportion of patients whose change scores exceeded the minimal detectable change of each measure. The responsiveness was compared using bootstrap approach.ResultsThe BBS-3P and PASS-3P had good group-level (SRM=0.60 and 0.56, respectively) and individual-level (48.1% and 44.8% of the patients with significant improvement, respectively) responsiveness. Bootstrap analyses showed that the BBS-3P generally had superior responsiveness to the BBS and SFBBS, and the PASS-3P had similar responsiveness to the PASS and SFPASS. The BBS-3P and PASS-3P were equally responsive to both group and individual's change.ConclusionsThe responsiveness of the BBS-3P and PASS-3P was comparable or superior to those of the original and short-form measures. We recommend the BBS-3P and PASS-3P as responsive outcome measures of balance for individuals with stroke.



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Long-term performance and user satisfaction with implanted neuroprostheses for upright mobility after paraplegia: Two to 14-year follow-up

Publication date: Available online 9 September 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Ronald J. Triolo, Stephanie Nogan Bailey, Kevin M. Foglyano, Rudi Kobetic, Lisa M. Lombardo, Michael E. Miller, Gilles Pinault
ObjectiveTo quantify the long-term (LT) (>2 years) effects of lower extremity (LE) neuroprostheses (NPs) for standing, transfers, stepping and seated stability after spinal cord injury.DesignSingle-subject design case series with participants acting as their own concurrent controls, including retrospective data review.SettingHospital-based clinical biomechanics laboratory with experienced (>20 years in the field) research biomedical engineers, physical therapist and medical monitoring review.ParticipantsTwenty-two (19 male, 3 female) LT (6.2 ± 2.7 years) at-home users of implanted NPs for trunk and LE function with chronic (14.4 ± 7.1 years) spinal cord injury resulting in full or partial paralysis.InterventionsTechnical and clinical performance measurements, along with user satisfaction surveys.Main Outcome MeasuresKnee extension moment, maximum standing time, body weight supported by lower extremities, three functional standing tasks, two satisfaction surveys, NP usage, and stability of implanted components.ResultsStimulated knee extension strength and functional capabilities were maintained with 94% of implant recipients reporting being "very" or "moderately" satisfied with their system. Greater than half (60%) of the participants were still using their implanted NPs for exercise and function for more than 10 minutes per day on nearly half or more of the days monitored, although maximum standing times and percentage body weight through LEs decreased slightly over the follow-up interval. Stimulus thresholds were uniformly stable. Six-year survival rates for the first-generation implanted pulse generator (IPG) and epimysial electrodes were close to 90%, while those for the second-generation IPG along with the intramuscular and nerve cuff electrodes were greater than 98%.ConclusionsObjective and subjective measures of the technical and clinical performances of implanted LE NPs generally remained consistent for 22 participants after an average of 6 years of unsupervised use at home. These findings suggest that implanted LE NPs can provide lasting benefits that recipients value.



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Premature Growth Plate Closure in a Ballet Dancer en Pointe

imageAbstract: A 13-year-old ballet dancer who had been dancing en pointe (on the tips of the toes) since 10 years presented to the clinic with a shortened right second toe. She had no previous history of pain or trauma. She was diagnosed with premature growth arrest of the second metatarsal head physes resulting in a shortened metatarsal. This is the first reported case of premature growth arrest in a ballet dancer as a result of dancing en pointe.

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Radial Extracorporeal Shock Wave Therapy Is Effective and Safe in Chronic Distal Biceps Tendinopathy

imageObjective: To assess the efficacy and safety of radial extracorporeal shock wave therapy (rESWT) for chronic distal biceps tendinopathy (cDBT). Design: Case–control study (level of evidence, 3). Setting: SUN Orthopaedics and Sports Medicine. Patients: Patients with a diagnosis of cDBT were recruited between January 2010 and February 2015. Interventions: Patients received a single session of rESWT (2000 shock waves with energy flux density of 0.18 mJ/mm2) or other forms of nonoperative therapy. Main Outcome Measures: Patients completed the visual analog scale (VAS), the modified QuickDASH (MQD) score, and the Roles and Maudsley (RM) score over a 12-month period. Results: Forty-eight patients completed the final review at 12 months and were included in the study. Subjects ranged in age from 30 to 64 years. Mean pretreatment VAS scores for the rESWT and control groups were 8.3 and 8.5, respectively. Three and 12 months after inclusion in the study, the mean VAS scores for the rESWT and control groups were 3.4 and 5.6 (P

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Incidence of Iron Deficiency and Iron Deficient Anemia in Elite Runners and Triathletes

imageObjective: To assess the incidence of iron deficiency (ID), and iron deficient anemia (IDA) within a cohort of highly trained runners and triathletes, and to examine the association of oral iron supplementation history with serum ferritin (sFe) and hemoglobin (Hb) concentrations. Methods: A retrospective analysis of routine blood test data taken from 2009 to 2015 from (n = 38) elite level runners and triathletes between the ages of 21 to 36 years. Oral iron supplement intake was assessed through a questionnaire. Results: Triathletes (female, FT; male, MT) and runners (female, FR; male, MR) had higher incidence of at least 1 episode of ID (FT 60.0%, MT 37.5%, FR 55.6%, MR 31.3%) compared with values reported in the literature for endurance athletes (20%-50% females, 0%-17% males). Male triathletes and runners had a higher incidence of IDA than their female teammates (25% MT, 20% FT, 6.3% for MR, 0% FR), a finding which has previously not been reported. Hemoglobin concentrations were low, with incidence of Hb

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Effects of Femoral Rotational Taping on Dynamic Postural Stability in Female Patients With Patellofemoral Pain

imageObjective: To investigate the effects of femoral rotational taping on task performance, dynamic postural control, and pain during the Star Excursion Balance Test (SEBT) in patients with patellofemoral pain (PFP) compared to healthy controls. Design: Case–control study, pretest–posttest. Setting: Laboratory. Participants: Twenty-four female participants (16 with PFP, 8 controls). Interventions: Participants in both the PFP and control groups performed SEBT with no taping, sham taping, and femoral rotational taping. Main Outcome Measures: The maximum anterior excursion distance, 3-dimensional hip and knee kinematics of the stance leg, and pain score (VAS) during SEBT were recorded. The coefficients of variance (CV) of kinematic data gathered from electromagnetic sensors on pelvis and femur were calculated to represent segmental stability. Results: When performing the SEBT in the anterior direction, application of femoral rotational taping increased maximum excursion distance (65.57% vs 66.15% leg length, P = 0.027), decreased hip adduction excursion (47.6 vs 32.1 degrees, P = 0.010), and pain (3.34 vs 2.38, P = 0.040) in the PFP group. Femoral rotational taping also improved the medial-lateral (7.1 vs 4.6, P = 0.015) and proximal-distal stability (7.5 vs 4.5, P = 0.020) of the pelvis, and medial-lateral stability (7.2 vs 6.1, P = 0.009) of the femur. Conclusions: The results support the use of femoral rotational taping for improving dynamic postural control and reducing pain during SEBT. Clinical Relevance: Femoral rotational taping could be used in the management of young female patients with PFP.

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Early Screening for Cardiovascular Abnormalities With Preparticipation Echocardiography: Feasibility Study

imageObjective: The traditional history and physical (H&P) is a poor screening modality to identify athletes at risk for sudden cardiac death. Although better than H&P alone, electrocardiograms (ECG) have also been found to have high false-positive rates. A limited portable echocardiogram by a frontline physician (PEFP) performed during preparticipation physical examination (PPE) allows for direct measurements of the heart to more accurately identify athletes with structural abnormalities. Therefore, it is worthwhile to assess the feasibility of incorporating limited PEFP as part of PPEs. The aim of this study was to investigate the feasibility of incorporating limited screening PEFP into routine PPEs. Methods: Thirty-five Division I male collegiate athletes were prospectively enrolled in the study after informed consent was obtained. Each athlete underwent screening with H&P, ECG, and limited PEFP. The H&P was performed based on the 2007 twelve-element preparticipation cardiovascular screening guidelines from the American Heart Association. The ECGs were interpreted using the 2013 Seattle Criteria. The limited echocardiographic (ECHO) measurements were obtained in the parasternal long axis view. End-diastolic measurements were recorded for the left ventricular diameter (LVD), left ventricular posterior wall diameter (LVPWd), interventricular septal wall diameter (IVSWd), aortic root diameter, and ascending aorta. The length of time of each screening station was recorded and reported in seconds (sec) and compared by one-way repeated-measures of analysis of variance with pairwise Bonferroni correction. A priori alpha level was set as 0.05. Results: The length of time for screening was significantly shorter with limited PEFP (137.7 ± 40.4 seconds) compared with H&P (244.2 ± 80.0 seconds) and ECG (244.9 ± 85.6 seconds, P

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Assessment of the Postural Stability of Female and Male Athletes

imageObjective: Postural stability is often affected by sport-related injuries and subsequently evaluated during postinjury examinations. Intrinsic factors, however, may also affect postural control. We sought to compare the postural control of female and male athletes as measured simultaneously by (1) the modified balance error scoring system (mBESS) and (2) a video-force plate system. Design: Cross-sectional study. Setting: Sports injury prevention center. Participants: Pediatric, adolescent, and young adult athletes who performed mBESS during an injury prevention evaluation. Independent Variables: We compared the postural control of female and male athletes. We also accounted for independent variables associated with postural stability, including age, body mass index, and history of ankle injury, concussion, and migraine headache. Main Outcome Measures: Total errors committed during the mBESS and measurements derived from integrated kinematic and kinetic data obtained by a video-force plate system. Differences between males and females were tested using analysis of covariance. Results: Participants (n = 409) ranged in age from 10 to 29 years (mean = 14.6 ± 2.8); 60% were female. No significant differences on mBESS were detected between females and males; however, female athletes demonstrated significantly better postural stability on the video-force plate analysis during double-leg (P = 0.03, d = 0.28), single-leg (P

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Concussion in Ice Hockey: Current Gaps and Future Directions in an Objective Diagnosis

imageObjective: This review provides an update on sport-related concussion (SRC) in ice hockey and makes a case for changes in clinical concussion evaluation. Standard practice should require that concussions be objectively diagnosed and provide quantitative measures of the concussion injury that will serve as a platform for future evidence-based treatment. Methods: The literature was surveyed to address several concussion-related topics: research in ice hockey-related head trauma, current subjective diagnosis, promising components of an objective diagnosis, and current and potential treatments. Main Results: Sport-related head trauma has marked physiologic, pathologic, and psychological consequences for athletes. Although animal models have been used to simulate head trauma for pharmacologic testing, the current diagnosis and subsequent treatment in athletes still rely on an athlete's motivation to report or deny symptoms. Bias-free, objective diagnostic measures are needed to guide quantification of concussion severity and assessment of treatment effects. Most of the knowledge and management guidelines of concussion in ice hockey are generalizable to other contact sports. Conclusions: There is a need for an objective diagnosis of SRC that will quantify severity, establish a prognosis, and provide effective evidence-based treatment. Potential methods to improve concussion diagnosis by health care providers include a standardized concussion survey, the King–Devick test, a quantified electroencephalogram, and blood analysis for brain cell-specific biomarkers.

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Allergies and Exercise-Induced Bronchoconstriction in a Youth Academy and Reserve Professional Soccer Team

imageObjectives: A high prevalence of respiratory allergies and exercise-induced bronchoconstriction (EIB) has been reported among endurance athletes. This study was designed to analyze the frequency of sensitization to respiratory allergens and EIB in young soccer players. Design: Prospective cohort design. Setting: Youth academy and reserve professional soccer team during the seasons 2012 to 2013 and 2013 to 2014. Participants: Eighty-five soccer players (mean age: 20 ± 4 years) participated. Intervention: Players underwent skin prick tests (SPTs) during the seasons 2012 to 2013 and 2013 to 2014. Spirometry and a eucapnic voluntary hyperpnea test were performed on soccer players during the first season 2012 to 2013 (n = 51) to detect EIB. Two self-administered questionnaires on respiratory history and allergic symptoms (European Community Respiratory Health Survey and Allergy Questionnaire for Athletes) were also distributed during both seasons (n = 59). Main Outcome Measures: The number of positive SPTs, exercise-induced respiratory symptoms, presence of asthma, airway obstruction, and EIB. Results: Forty-nine percent of players were sensitized to at least one respiratory allergen, 33% reported an allergic disease, 1 player presented airway obstruction at rest, and 16% presented EIB. Factors predictive of EIB were self-reported exercise-induced symptoms and sensitization to at least 5 allergens. Conclusions: Questioning players about exercise-induced respiratory symptoms and allergies as well as spirometry at the time of the inclusion medical checkup would improve management of respiratory health of soccer players and would constitute inexpensive preliminary screening to select players requiring indirect bronchial provocation test or SPTs. Clinical relevance: This study showed that despite low frequencies, EIB and allergies are underdiagnosed and undertreated in young soccer players.

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In Response to: Prediction of Maximal Heart Rate in Children and Adolescents: Prediction Study in Cross-Sectional Design, Is It True?

No abstract available

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Analysis of Central and Peripheral Vision Reaction Times in Patients With Postconcussion Visual Dysfunction

imageObjective: To determine whether central and peripheral vision reaction times (PVRTs) are prolonged in patients with visual dysfunction after sustaining a concussion. Design: Comparison of Dynavision D2 central and PVRTs in patients with postconcussion visual dysfunction were compared with control data from a normative patient database. Concussion patients without visual dysfunction were not included in this study. Setting: National Collegiate Athletic Association Division 1 college training room and university based, academic health center. Participants: Patients were selected for inclusion based on diagnosis of new visual dysfunction as indicated either by physical examination of the team physician or by patient self-report of symptoms. Patients included college athletes, college students, and concussion patient's presenting to a university based, academic health center. Intervention: Measurement of central and PVRTs using a Dynavision D2 reaction time program were used as the dependent variables. Evaluations were conducted from 3 days to 11 months postconcussion, depending on the temporal development of visual symptoms after the concussion. No intervention was used. Main Outcome Measures: Average central and PVRTs for patients with postconcussion visual symptoms were compared with an asymptomatic control group with no history of concussion. Results: Both central and PVRTs were significantly prolonged in patients with postconcussion visual symptoms compared with patients with no history of concussion. Conclusions: Central and PVRTs are both prolonged in patients with postconcussion visual dysfunction with PVRT being disproportionately prolonged. The percent change from central to PVRT was also increased in patients with postconcussion visual dysfunction.

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A 12-Month Prospective Cohort Study of Symptoms of Common Mental Disorders Among European Professional Footballers

imageObjective: To determine the 12-month incidence and comorbidity of symptoms of common mental disorders (CMD) among European professional footballers and to explore the association of potential stressors with the health conditions under study among those European professional footballers. Design: Observational prospective cohort study with a follow-up period of 12 months. Participants: Male professional footballers from 5 European countries (n = 384 at baseline). Assessment of Risk Factors: Adverse life events, conflicts with trainer/coach, and career dissatisfaction were explored by using validated questionnaires. Main Outcome Measures: Symptoms of distress, anxiety/depression, sleep disturbance, and adverse alcohol use were assessed using validated questionnaires. Results: A total of 384 players (mean age of 27 years old; mean career duration of 8 years) were enrolled, of which 262 completed the follow-up period. The incidence of symptoms of CMD were 12% for distress, 37% for anxiety/depression, 19% for sleep disturbance, and 14% for adverse alcohol use. Over the follow-up period of 12 months, approximately 13% of the participants reported 2 symptoms, 5% three symptoms, and 3% four symptoms. Professional footballers reporting recent adverse life events, a conflict with trainer/coach, or career dissatisfaction were more likely to report symptoms of CMD, but statistically significant associations were not found. Conclusions: The 12-month incidence of symptoms of CMD among European professional footballers ranged from 12% for symptoms of distress to 37% for symptoms of anxiety/depression. A professional football team typically drawn from a squad of 25 players can expect symptoms of CMD to occur among at least 3 players in one season.

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Normative Values of the Sport Concussion Assessment Tool 3 (SCAT3) in High School Athletes

imageObjective: Establish sex, age, and concussion history–specific normative baseline sport concussion assessment tool 3 (SCAT3) values in adolescent athletes. Design: Prospective cohort. Setting: Seven Wisconsin high schools. Participants: Seven hundred fifty-eight high school athletes participating in 19 sports. Independent Variables: Sex, age, and concussion history. Main Outcome Measures: Sport Concussion Assessment Tool 3 (SCAT3): total number of symptoms; symptom severity; total Standardized Assessment of Concussion (SAC); and each SAC component (orientation, immediate memory, concentration, delayed recall); Balance Error Scoring System (BESS) total errors (BESS, floor and foam pad). Results: Males reported a higher total number of symptoms [median (interquartile range): 0 (0-2) vs 0 (0-1), P = 0.001] and severity of symptoms [0 (0-3) vs 0 (0-2), P = 0.001] and a lower mean (SD) total SAC [26.0 (2.3) vs 26.4 (2.0), P = 0.026], and orientation [5 (4-5) vs 5 (5-5), P = 0.021]. There was no difference in baseline scores between sex for immediate memory, concentration, delayed recall or BESS total errors. No differences were found for any test domain based on age. Previously, concussed athletes reported a higher total number of symptoms [1 (0-4) vs 0 (0-2), P = 0.001] and symptom severity [2 (0-5) vs 0 (0-2), P = 0.001]. BESS total scores did not differ by concussion history. Conclusion: This study represents the first published normative baseline SCAT3 values in high school athletes. Results varied by sex and history of previous concussion but not by age. The normative baseline values generated from this study will help clinicians better evaluate and interpret SCAT3 results of concussed adolescent athletes.

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Epidemiology of Snow Skiing– Versus Snowboarding-Related Concussions Presenting to the Emergency Department in the United States from 2010 to 2014

imageObjectives: To examine the trend of concussions in skiers and snowboarders from 2010 to 2014; and to quantify and compare the incidence of concussions injuries in skiers and snowboarders who presented to emergency departments in the United States in 2014. Design: Cross-sectional study of concussions in skiers and snowboarders who were evaluated in emergency departments in the United States. Main Outcomes Measure: Incidence of concussions. Results: The trend of the annual incidence of concussions for skiers and snowboarders remained stable from 2010 to 2014. An estimated total of 5388 skiing-related concussions and 5558 snowboarding-related concussions presented to emergency departments in the United States between January 1st, 2014, and December 31st, 2014. This represented an incidence of 16.9 concussions per 1 000 000 person-years for skiers and 17.4 concussions per 1 000 000 person-years for snowboarders. The incidence of concussions in the pediatric and young adult population of skiers was significantly higher than the incidence in the adult population. Similarly, the incidence of concussions in the pediatric and young adult population of snowboarders was significantly higher than the incidence in the adult population. The incidence of concussions was significantly higher in males compared with females in both skiing and snowboarding. Conclusions: The incidence of concussions from 2010 to 2014 plateaued in both skiers and snowboarders. Pediatric and young adult skiers and snowboarders had significantly higher incidences of concussion than the adult population. In contrast to the higher incidence of concussions in females in several sports including ice hockey, soccer, and basketball, the incidence of concussions was higher in males compared with females in both skiing and snowboarding.

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Patellar Tendinopathy and Potential Risk Factors: An International Database of Cases and Controls

imageObjectives: Numerous risk factors have been identified for patellar tendinopathy (PT), often in small population studies. The aim was to use an international online questionnaire to generate a large database and identify significant risk factors. Design: Case–control study. Setting: Private practice and sporting teams recruited from England, Spain, and Italy with the questionnaire available in all 3 languages (equivalence between online and self-administration shown previously). All data were anonymized and password protected. Participants: Eight hundred twenty-five data sets collected between January 2012 and May 2014. Assessment of Risk Factors: A total of 23.4% of participants had clinically diagnosed PT. A comparison between these participants and participants without PT was made. Main Outcome Measure: Association between the presence of PT and risk factors. Results: Eight risk factors were included in the analysis based on a purposeful selection procedure: sex, hours of training, hamstring flexibility, previous patellar tendon rupture, previous knee injury, current/previous back pain, family history, and age. Four were found to have statistically significant odds ratios: female sex [0.70, 95% confidence interval (CI), 0.49-1.00, P = 0.05], hours of training (>20 hours 8.94, 95% CI, 4.68-17.08, P

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Abdominal Aortic Dissection and Cold-Intolerance After Whole-Body Cryotherapy: A Case Report

imageAbstract: Whole-body cryotherapy (WBC) involves short exposures to air temperatures below −100°C and is purported to enhance recovery after exercise and accelerate rehabilitation after injury. It is generally considered a procedure with few side effects, but there are no large studies that have established its safety profile. We present the case of a 56-year-old patient who developed an abdominal aortic dissection after receiving 15 sessions of WBC. The patient had no other strong risk factors for aortic dissection. Exposure to cold temperatures, including WBC, has multiple hemodynamic effects, including increases in blood pressure, heart rate, and an adrenergic response. We suggest that these changes could act as a trigger for the onset of aortic dissections. This could be the first reported cardiovascular complication associated with WBC.

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Trunk Muscle Function Deficit in Youth Baseball Pitchers With Excessive Contralateral Trunk Tilt During Pitching

imageObjective: Pitching technique is one of many factors that affect injury risk. Exhibiting excessive contralateral trunk tilt (CLT) during pitching has been linked to higher ball speed but also to increased joint loading. Deficit in trunk muscle strength has been suggested as an underlying cause of this movement pattern. The purpose of the study was to compare trunk muscle strength between youth baseball pitchers with varying degree of CLT during pitching. Design: Cross-sectional study. Setting: Baseball practice fields. Participants: Twenty-eight youth baseball pitchers. Independent Variables: Pitching technique was captured using a video camera. Based on the 2-dimensional trunk contralateral flexion angle, pitchers were categorized into low (30 degrees) CLT groups. Main Outcome Measures: Maximum isometric strength tests for trunk flexion, extension, and bilateral rotation, measured using a dynamometer. Results: The pitchers with high CLT (n = 10) had longer pitching experience (P = 0.014), produced higher ball speed (P = 0.003) compared with the pitchers with moderate (n = 10) and low (n = 8) CLT, but demonstrated greater asymmetry in trunk rotation strength (relative weakness in rotation strength toward dominant side) compared with the pitchers with low CLT (P = 0.015). Conclusions: Excessive CLT may be a strategy that young pitchers learn to achieve higher ball velocity but also may be associated with imbalance between the oblique muscles on dominant and nondominant side, which may be acquired from repetitive pitching. Strengthening and emphasizing the use of dominant side oblique muscles may keep pitchers from leaning excessively during pitching and thus decrease joint loading.

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Bilateral Anterior Knee Pain in a High School Cross-Country Runner: An Atypical Etiology

imageAbstract: Anterior knee pain is a common complaint found in distance runners, and can be the end result of a variety of benign processes. A 17-year-old female cross-country runner presented to a sports medicine clinic with insidious onset of bilateral patellofemoral pain (PFP). In the workup of the significant quadriceps weakness discovered on her initial examination, a principal contributing cause of her PFP, she was found to have a form of spinal muscular atrophy, an uncommon neurodegenerative disease that typically requires multidisciplinary medical care. Her case provides a good example for clinicians to consider, at times, an in-depth assessment of the root causes of benign conditions.

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Return to Sports After Multiple Trauma: Which Factors Are Responsible?—Results From a 17-Year Follow-up

imageObjective: We hypothesize that the majority of polytraumatised patients are unable to maintain their preinjury level of sporting activity, and that musculoskeletal injuries are a major contributing factor. We assessed the impact of such injuries on sporting prowess, with a focus on isolating, particularly debilitating musculoskeletal trauma. Methods: We conducted a cohort study of 637 patients at a level 1 trauma centre, to assess the long-term outcome of severe trauma on return to sporting activities (RTS). Data collated on the multiply injured patient included preinjury physical activity, standardized outcome scores (SF-12, GOS, HASPOC), and clinical follow-up of at least 10 years duration. The return to preinjury sports participation was defined as a primary outcome parameter. Regression analyses were performed to identify specific injuries interfering with the RTS. Study Design: Prognostic study; Level of evidence, II. Results: Mean follow-up was 17 ± 5 years. We included 465 patients, including 207 athletic and 258 nonathletic individuals. Mean age at the time of injury was 26 ± 11.5 years and injury severity was comparable between the 2 cohorts. The deleterious effects on quality of life and the total duration of the rehabilitation process were also similar in athletes and nonathletes. Athletes were more likely to be unable to return to preinjury activities, or to return to a lower level of sporting prowess posttrauma. We identified knee injuries as the type of musculoskeletal trauma most likely to be career ending for the athlete (odds ratio 3.4, 95% confidence interval, 1.4-8.3; P = 0.008). Conclusion: Our results demonstrate an enforced shift from high-impact and team sports to low-impact activities after multiple trauma. Injuries of the lower extremities, especially around the knee joint, seem to have the highest lifechanging potential, preventing individuals from returning to their previous sporting activities.

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Reply

No abstract available

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Does fear extinction in the laboratory predict outcomes of exposure therapy? A treatment analog study

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Publication date: Available online 8 September 2017
Source:International Journal of Psychophysiology
Author(s): Eduard Forcadell, David Torrents-Rodas, Bram Vervliet, David Leiva, Miquel Tortella-Feliu, Miquel A. Fullana
Fear extinction models have a key role in our understanding of anxiety disorders and their treatment with exposure therapy. Here, we tested whether individual differences in fear extinction learning and fear extinction recall in the laboratory were associated with the outcomes of an exposure therapy analog (ETA). Fifty adults with fear of spiders participated in a two-day fear-learning paradigm assessing fear extinction learning and fear extinction recall, and then underwent a brief ETA. Correlational analyses indicated that enhanced extinction learning was associated with better ETA outcome. Our results partially support the idea that individual differences in fear extinction learning may be associated with exposure therapy outcome, but suggest that further research in this area is needed.



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A review of the effects of physical activity and sports concussion on brain function and anatomy

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Publication date: Available online 8 September 2017
Source:International Journal of Psychophysiology
Author(s): Sara Tremblay, Alvaro Pascual-Leone, Hugo Théoret
Physical activity has been associated with widespread anatomical and functional brain changes that occur following acute exercise or, in the case of athletes, throughout life. High levels of physical activity through the practice of sports also lead to better general health and increased cognitive function. Athletes are at risk, however, of suffering a concussion, the effects of which have been extensively described for brain function and anatomy. The level to which these effects are modulated by increased levels of fitness is not known. Here, we review literature describing the effects of physical activity and sports concussions on white matter, grey matter, neurochemistry and cortical excitability. We suggest that the effects of sports concussion can be coufounded by the effects of exercise. Indeed, available data show that the brain of athletes is different from that of healthy individuals with a non-active lifestyle. As a result, sports concussions take place in a context where structural/functional plasticity has occurred prior to the concussive event. The sports concussion literature does not permit, at present, to separate the effects of intense and repeated physical activity, and the abrupt removal from such activities, from those of concussion on brain structure and function.



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P 16 The implementation of Near-Infrared-Spectroscopy (NIRS) in sports science – a verification of suitability using the compound movement squat

Near - Infrared Spectroscopy (NIRS) serves as a promising tool to examine cortical activity in a sports-scientific context. The associated feasibility of said method remains to be validated as exercise - induced confounders such as increases in extracerebral blood flow have been postulated (Tachtsidis and Scholkmann, 2016). Additionally, the relationship between force and cortical activity is yet to be investigated in compound movements. Both parameters show a linear relationship in isolated movements (Shibuya et al., 2014) yet it remains unclear whether this relationship applies to compound movements.

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P 18 Prefrontal and motor cortex transcranially evoked potentials (TEP) in children and adolescents

Potentials evoked by transcranial magnetic stimulation (TEP) differ depending on the cortical areas where TMS has been applied. Moreover, TEP underly a marked development during childhood and adolescence.

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P 15 Voice-identity processing deficits are induced by lesions in the temporal and inferior parietal lobe

Human voice recognition is an essential skill for social interactions. The mechanisms that the human brain uses for voice recognition are to-date unknown. According to studies in patients with brain lesions, voice recognition critically involves the bilateral temporal lobe and the right inferior parietal lobe. In contrast, functional magnetic resonance imaging (fMRI) studies suggest that primarily the right temporal lobe contributes to voice recognition. In order to systematically investigate brain regions required for voice recognition, we conducted a voxel-based lesion symptom mapping (VLSM) study.

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P 17 Neural signatures of post-perceptual attention and selective working memory encoding

Post-perceptual cues can enhance visual short term memory encoding even after the offset of the visual stimulus. However, both the mechanisms by which the sensory stimulus characteristics are buffered as well as the mechanisms by which post-perceptual selective attention enhances short term memory encoding remain unclear.We analyzed late post-perceptual event-related potentials (ERP) in visual change detection tasks (100ms stimulus duration) by high-resolution ERP analysis to elucidate these mechanisms.

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In this issue: October 2017



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In This Issue: August 2017



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Issue Information



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An antero-lateral approach to ultrasound-guided lumbar plexus block in supine position combined with quadratus lumborum block using single-needle insertion for pediatric hip surgery



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How can the Perioperative Surgical Home be applied to pediatric anesthesia practice?



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The Ice Test to Differentiate Essential tremor from Parkinson’s disease tremor

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Publication date: Available online 8 September 2017
Source:Clinical Neurophysiology
Author(s): Aparna Wagle Shukla, Michael Okun, David Vaillancourt, Lisa Warren




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Standard computerized EEG reporting - it’s time to even the score

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Publication date: Available online 8 September 2017
Source:Clinical Neurophysiology
Author(s): William O. Tatum




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Processing of visual food cues during bitter taste perception in female patients with binge-eating symptoms: a cross-modal ERP study

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Publication date: Available online 8 September 2017
Source:Clinical Neurophysiology
Author(s): Anne Schienle, Wilfried Scharmüller, Daniela Schwab
ObjectiveIn healthy individuals, the perception of an intense bitter taste decreased the reward value of visual food cues, as reflected by the reduction of a specific event-related brain potential (ERP), frontal late positivity. The current cross-modal ERP study investigated responses of female patients with binge-eating symptoms (BES) to this type of visuo-gustatory stimulation.MethodsWomen with BES (n = 36) and female control participants (n = 38) viewed food images after they rinsed their mouth with either bitter wormwood tea or water.ResultsRelative to controls, the patients showed elevated late positivity (LPP: 400-700 ms) to the food images in the bitter condition. The LPP source was located in the medial prefrontal cortex. Both groups did not differ in the ratings for the fluids (intensity, bitterness, disgust).ConclusionsThis ERP study showed that a bitter taste did not decrease late positivity to visual food cues (reflecting food reward) in women with BES.SignificanceThe atypical bitter responding might be a biological marker of this condition and possibly contributes to overeating. Future studies should additionally record food intake behavior to further investigate this mechanism.



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Frontal EEG asymmetry and later behavior vulnerability in infants with congenital visual impairment

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Publication date: Available online 8 September 2017
Source:Clinical Neurophysiology
Author(s): Michelle A. O'Reilly, Joe Bathelt, Elena Sakkalou, Hanna Sakki, Alison Salt, Naomi Dale, Michelle de Haan
ObjectiveYoung children with congenital visual impairment (VI) are at increased risk of behavioral vulnerabilities. Studies on 'at risk' populations suggest that frontal EEG asymmetry may be associated with behavioral risk. We investigated frontal asymmetry at 1 year (Time 1), behavior at 2 years (Time 2) and their longitudinal associations within a sample of infants with VI. Frontal asymmetry in the VI sample at 1 year was also compared cross-sectionally to an age-matched typically sighted (TS) group.MethodsAt Time 1, 22 infants with VI and 10 TS infants underwent 128-channel EEG recording. Frontal asymmetry ratios were calculated from power spectral density values in the alpha frequency band. At Time 2, Achenbach Child Behavior Checklist data was obtained for the VI sample.Results63.6% of the VI sample and 50% of the TS sample showed left frontal asymmetry; no significant difference in frontal asymmetry was found between the two groups. 22.7% of the VI sample had subclinical to clinical range 'internalizing' behavior difficulties. Greater left frontal asymmetry at one year was significantly associated with greater emotionally reactive scores at two years within the VI sample (r=.50, p=.02).ConclusionsLeft frontal asymmetry correlates with later behavior risk within this vulnerable population. Significance: These findings make an important first contribution regarding the utility of frontal EEG asymmetry as a method to investigate risk in infants with VI.



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Beyond availability: the importance of routine videolaryngoscopy and institution-based rescue methods of difficult videolaryngoscopy

Editor—We appreciate the fabulous work of Cook and Kelly on the national survey of videolaryngoscopy (VL) in the UK.1 According to the Difficult Airway Society's 2015 guidelines2 videolaryngoscopes should be immediately available at all times and all anaesthetists should be trained and skilled in their use. We are glad to see the main finding that VL is available in >90% of UK hospital, though only one in seven hospitals have VL available in all relevant clinical areas. Beyond the availability of videolaryngoscopes, whether to be skilled in VL remains an important issue.

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Lack of benefit of near-infrared spectroscopy monitoring for improving patient outcomes. Case closed?

Near-infrared spectroscopy (NIRS) monitoring of regional cerebral oxygen saturation (rSco2) during cardiac surgery has been available to clinicians for more than three decades.12 This monitoring is attractive because it is non-invasive, requires minimal user technical expertise, provides an intuitively important end point (oxygenation of the superficial cerebral cortex), and has a continuous output. As a result of these features, NIRS monitoring overcomes many of the limitations of existing monitors for judging adequacy of cerebral perfusion during surgery [(particularly, throughout cardiopulmonary bypass (CPB)], such as electroencephalography, transcranial Doppler monitoring, and jugular bulb venous oxygen saturation. Early reports showing the value of bilateral rSco2 monitoring for early detection of CPB oxygenator malfunction, arterial or venous cannula malposition, and occult aortic dissection, in addition to utility during aortic arch surgery, fuelled enthusiasm for its adoption in cardiac surgery.2 This enthusiasm was broadened with publication of non-randomized, observational studies showing a link between reduction from baseline rSco2 (i.e. 'desaturations') during CPB and a variety of neurological end points, including postoperative cognition dysfunction (POCD) and stroke.2 Interpretation of these data, however, are confounded by many methodological limitations.

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Response to: Go/no-go decision in anaesthesia: wide variation in risk tolerance amongst anaesthetists

Editor—The work by Greig and colleagues1 brings to light conflicting organizational and management practices for the operating theatre. A majority of the confusion and tension in this high-pressure environment can be traced back to the fundamental misunderstanding of high-reliability organizations (HRO) and ultra-safe systems (USS). In fact, the authors state that "health care providers aspire to become high-reliability organizations, but this practice contrasts with existing high-reliability organizations, such as aviation, where decision-making aids and standardized operating procedures are widely used."1 However, the aviation industry is predominantly an ultra-safe system, not a high-reliability organization.

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Can predicting transfusion in cardiac surgery help patients?

In this issue of the British Journal of Anaesthesia, Klein and colleagues1 describe the ACTA-PORT, a new score for predicting the risk of one or more red blood cell transfusions in patients undergoing cardiac surgery. The authors' desire to provide a simple, accurate tool to help predict the risk of transfusion in patients undergoing cardiac surgery is commendable, but does it help our patients?

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Influence of deep neuromuscular block on the surgeonś assessment of surgical conditions during laparotomy: a randomized controlled double blinded trial with rocuronium and sugammadex

Abstract
Background. During laparotomy, surgeons may experience difficult surgical conditions if the patient's abdominal wall or diaphragm is tense. Deep neuromuscular block (NMB), defined as a post-tetanic-count (PTC) between 0-1, paralyses the abdominal wall muscles and the diaphragm. We hypothesized that deep NMB (PTC 0-1) would improve subjective ratings of surgical conditions during upper laparotomy as compared with standard NMB.Methods. This was a double blinded, randomized study. A total of 128 patients undergoing elective upper laparotomy were randomized to either continuous deep NMB (infusion of rocuronium 2 mg ml−1) or standard NMB (bolus of rocuronium 10 mg or increased depth of anaesthesia). Surgical conditions were evaluated using a 5-point subjective rating scale (1: extremely poor, 5: optimal) every 30 min. Primary outcome was the average of scores for a patient's surgical conditions. Other outcomes were surgical rating score during fascial closure, episodes of a need to optimize surgical conditions, occurrence of wound dehiscence, and wound infection.Results. Deep compared with standard NMB resulted in better ratings of surgical conditions; median 4.75 (range 3–5) compared with 4.00 (range 1–5) (P<0.001), respectively. Deep compared with standard NMB resulted in better ratings of surgical conditions during fascial closure (P<0.001), fewer episodes of need to optimize surgical conditions (P<0.001), and fewer incidents with sudden movements (P<0.001). No differences in operating time, occurrence of wound infection, and wound dehiscence were found.Conclusions. Deep NMB compared with standard NMB resulted in better subjective ratings of surgical conditions during laparotomy.Clinical trial registration: NCT02140593.

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Viscoelastometric testing, fibrinogen and transfusion during post-partum haemorrhage

Editor—Many readers will recognize the pleasure of a new pair of glasses (Fig. 1). They are perfectly tailored to our own visual defect, and wearing them gives one a feeling of clarity and brightness that is comparable with opening the curtains after a good night's sleep. In an era of evidence-based medicine, should we question the evidence base for eyeglasses? Might this be unnecessary when there is a palpable association between a specific intervention and an intended outcome such that we are easily convinced of the causal nature of that association? There will certainly be an effect of using viscoelastometric testing on plasma transfusion if practice changes from giving plasma 'blindly' to giving plasma based on the coagulation testing. The real question is whether this change in practice will lead to better outcomes. In this issue of the BritishJournalof Anaesthesia, Collins and colleagues12 provide new information on monitoring and managing haemostasis in patients with post-partum haemorrhage.

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Videolaryngoscopy and obstetric anaesthesia

Editor—We congratulate Professor Cook and Dr Kelly on their important national survey of videolaryngoscopy in the UK.1 They highlighted that while videolaryngoscopes (VLs) are widely available in main operating theatres, availability in other areas where tracheal intubation is undertaken is much lower, being around only 50% of intensive care units and obstetric theatres. We would suggest that this figure is a particular concern to obstetric anaesthesia, where the risk of failed intubation is greater than the general population. In 2011, we conducted a national Obstetric Anaesthetists' Association approved survey of the availability of VLs in UK obstetric units. This survey (response rate 72%) found that only 42% of obstetric units had a dedicated VL with widespread variation in the type of device available.2

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Theseus, the Labyrinth, and the Minotaur of anaesthetic-induced developmental neurotoxicity

When Theseus set sail to slay the mighty Minotaur, he likely spared a thought for the difficulty in navigating the Labyrinth that surrounded his foe. The search for therapies for anaesthetic-induced developmental neurotoxicity shares a similar mythical context. In our version of these events, Prince Theseus is the cure (potentially played by dexmedetomidine), the Minotaur is sevoflurane-induced neurotoxicity and the Labyrinth (a maze of confounding factors) is represented by physiological aberrations. In this issue of the British Journal of Anaesthesia, two reports12 appear to arrive at contradictory conclusions regarding the success of dexmedetomidine in combating sevoflurane-induced developmental neurotoxicity in neonatal rat pups. The two research teams are to be congratulated for reporting the results in a manner that enables the reader to appreciate the entire gamut from protection against organ toxicity to toxicity to the entire organism because of the clarity and detail in their reports. However, the physiological derangements observed in these studies, and their contradictory findings, lead to labyrinthine interpretation. Readers should also refer to the accompanying editorial on the same studies by Vutskits and Sall3 when considering these issues.

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In the September BJA…

This issue of the BJA contains a special section on anaesthetic neurotoxicity and neuroplasticity following a call for papers associated with the Second BJA Seminar on Neurotoxicity and Neuroplasticity held in June 2016 at Churchill House in London. The main issue includes a number of articles relevant to bleeding, transfusion and coagulation in cardiac surgery, postpartum haemorrhage, and liver transplantation, as well as important contributions on airway management.

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Anaesthesia-induced developmental neurotoxicity: reality or fiction?

As animal evidence continues to mount, we face a real dilemma regarding the clinical relevance of anaesthesia-induced developmental neurotoxicity. In December 2016, the US Food and Drug Administration (FDA) issued an announcement stating that commonly used general anaesthetics could potentially be detrimental to very young and rapidly developing brains. This announcement was based on an extensive body of animal research.1–24 Now we must grapple with the FDA's official recommendation that potential risks should be balanced with the benefits of appropriate anaesthesia in young children. More importantly, as we deal with the official expectation that potential risks should be discussed with families and heath-care providers, we are reminded how crucial it is to deepen our understanding of the pertinent mechanisms and potential long-lasting behavioural outcomes relating to the exposure of the young brain to anaesthesia.

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Effects of propofol and surgery on neuropathology and cognition in the 3xTgAD Alzheimer transgenic mouse model

Abstract
Background. Previous work suggests that anaesthesia and surgery amplify the pathology and cognitive impairment of animals made vulnerable via age or specific transgenes. We hypothesized that surgery under propofol anaesthesia, a widely used i.v. general anaesthetic, has minimal delayed cognitive and neuroinflammatory sequelae in a vulnerable mouse transgenic model.Methods. We conducted caecal ligation and excision surgery in cognitively presymptomatic (11-month-old) 3xTgAD mice under i.p. propofol anaesthesia. Age-matched 3xTgAD control mice received vehicle or propofol without surgery. Morris water maze testing was conducted 3 and 15 weeks later. Brains were examined with quantitative immunohistochemistry for amyloid β plaques, tau pathology, and microglial activation. Acute changes in neuroinflammatory cytokines were assessed in separate cohorts at 6 h.Results. We detected no significant differences between groups in escape latencies at either 3 or 15 weeks, but detected a significant effect of surgery in the probe test at both 3 and 15 weeks. Spatial working memory was unaffected at 16 weeks in any group. No effects of either propofol alone or propofol with surgery were detected on plaque formation, tau aggregates, or neuroinflammation. Acute biochemical assays detected no effects in brain interleukin-10 or interleukin-6 concentrations.Conclusions. Surgery in a vulnerable transgenic mouse under propofol anaesthesia was associated with minimal to no changes in short- and long-term behaviour and no changes in neuropathology. This suggests that propofol anaesthesia is associated with better cognitive outcomes in the aged, vulnerable brain compared with inhalation anaesthesia.

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Perioperative goal-directed therapy with uncalibrated pulse contour methods: impact on fluid management and postoperative outcome

Editor—The conclusions of the very recent meta-analysis by Michard and colleagues1 in the British Journal of Anaesthesia is that the use of perioperative goal-directed therapy (GDT) with uncalibrated pulse contour (uPC) techniques is associated with a decrease in postoperative morbidity, but not associated with an increase in total fluid administration. An accompanying editorial has analysed in detail some methodological issues related to this and other systematic reviews, but has not challenged its conclusions.2 In fact, the editorial expanded these conclusions claiming that this systematic review provides us with the best currently available evidence on this topic. Although these conclusions seem logical, and may even be true, a more careful examination of this meta-analysis leads me to believe that its conclusions should be very different.

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Causes of sudden death of young anesthesiologists in China Response to Zhang and colleagues: Rising sudden death among anaethesiologists in China.

Editor—We read with great interest the survey results of Chinese anaesthesiologists by Zhang and colleagues.1 The authors claimed that anaesthesiologists in China are currently suffering from work overload, and sudden death is increasing dramatically. More than 10 anaesthesiologists aged 30–45 yr had a cardiac arrest as a result of a heavy workload in China from 2013 to 2014.2 The cause of death attributed to cardiac arrest is overly inclusive as one can make the argument that all demise can be eventually attributed to cardiopulmonary arrest. The causal relationship between relative 'work overload' and sudden death is lacking in pathophysiological explanation.

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Response to: Routine use of viscoelastic blood tests for diagnosis and treatment of coagulopathic bleeding in cardiac surgery: updated systematic review and meta-analysis

Editor—With great interest we read the systematic review and meta-analysis on the routine use of viscoelastic haemostatic assays (VHA) for diagnosis and treatment of coagulopathic bleeding in cardiac surgery published by Serraino and Murphy.1 Significant reductions in red blood cell transfusion requirements by the use of VHA have been confirmed by previous Cochrane reviews.23 Reducing the exposure to allogeneic blood products is a clear perioperative management goal improving patient outcome and recommended by evidence-based bleeding guidelines.4 Moreover, Serraino and Murphy report significant reductions in platelet transfusion and plasma transfusion (RR 0.78, 95% CI 0.66–0.93; P=0.004), which is also clinically highly relevant considering specific transfusion-associated risks. Most importantly, the authors also report a significant reduction in acute renal failure (RR 0.42, 95% CI 0.20–0.86; P=0.02). Causality cannot be identified by meta-analyses, but acute renal failure has been shown to be associated with a significant increase in long-term mortality in cardiac and noncardiac surgery.5–8

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Reply to Lucas and Vaughan: videolaryngoscopy and obstetric anaesthesia?

Editor—We thank Lucas and Vaughan for their comments on our paper.1 Their survey correlates with our survey in 20152 in finding that approximately half of UK obstetric units have a dedicated videolaryngoscope (VL): 42% in the survey of Noblet and colleagues in 20113 and 55% in our survey in 2013.2 A survey by Hales and colleagues, also in 2014, reported that 90% of UK obstetric units have a VL, but this has yet to be published in full.4

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Optimal patient blood management in cardiac surgery using viscoelastic point-of-care testing Response to: Routine use of viscoelastic blood tests for diagnosis and treatment of coagulopathic bleeding in cardiac surgery: updated systematic review and meta-analysis

Editor—We read with interest the study of Serraino and Murphy1 on routine use of point-of-care (POC) testing for diagnosis and treatment of coagulopathy in cardiac surgery patients. During cardiac surgery major blood loss is common. There is general agreement that less bleeding and optimal patient blood management are essential determinants of postoperative outcome.2 The conclusion of Serraino and Murphy that POC viscoelastic testing lacks clinical effectiveness is an important negative finding, but should not disparage the significance of efficiently reducing the rate of unnecessary transfusions.

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Reply to Chang: After availability, training and experience are needed

Editor—We thank Dr Chang for his kind comments.1 It is becoming increasingly common for videolaryngoscopy to be included in guidelines for the management of difficulty during intubation, and the evidence supports this.23 With this in mind it is a concern that one of the findings of our survey was that, although videolaryngoscopy is available in the vast majority of hospitals, it generally appears to be much less available in areas where intubation fails more frequently (obstetrics, intensive care, emergency department). We hope that this has been addressed since the time the survey was completed, but if this is not the case then we hope that the guidelines and other literature, such as our survey, may stimulate change.

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Safety assessments in the avoidance of preoperative α-receptor blockade in phaeochromocytoma surgery: the pitfalls of a zero numerator

Editor—The recent observational case series reported by Groeben and colleagues1 addressing the avoidance of preoperative α-receptor blockade in patients undergoing phaeochromocytoma surgery clearly challenges conventional thought. Their study showed that the maximal intraoperative blood pressure in non-α-blocked patients was no different than in those having received preoperative phenoxybenzamine or doxazosin therapy (185 mm Hg vs 178 mm Hg, respectively; P=0.25). In addition, there were no major complications reported – notably an absence of myocardial infarction (MI) – making this practice, at least according to the authors, seemingly "safe". Unfortunately, because of the present study's scope (i.e. an eight yr period of patient accrual) and subject matter, it is unlikely that a confirmatory study will ever be undertaken, so we are left having to rely on the authors' conclusions that "phaeochromocytoma surgery without medical pre-treatment is feasible and safe".

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Viscoelastometry guided fresh frozen plasma infusion for postpartum haemorrhage: OBS2, an observational study

Abstract
Background. Postpartum haemorrhage (PPH) can be exacerbated by haemostatic failure. Based on data from trauma studies, empirical infusions of fresh frozen plasma (FFP) are often given during severe PPH if coagulation tests are unavailable. This study observed a cohort of women with moderate/severe PPH in whom FFP infusion was guided by the use of viscoelastometric point-of-care testing (VE-POCT) and clinical assessment.Methods. Women were enrolled into this observational study when blood loss was measured or suspected to be about 1000 mL. If Fibtem A5 determined by Rotem® thromboelastometry remained >15 mm, or bleeding stopped, FFP was withheld. If Fibtem A5 was ≤15 mm and bleeding ongoing, women were randomized into an interventional study as previously reported. Clinical and laboratory outcomes were recorded.Results. The study recruited 605 women and 98% had FFP withheld. The median (25th–75th centile) total blood loss was 1500 (1300–2000) mL with 300 (50–545) mL occurring after enrolment. Total blood loss was >2500 mL in 40/605 (6.6%) women. RBCs were transfused in 141/605 (23.3%) patients and 11 (1.8%) received ≥4 units. At least one invasive procedure was performed in 283/605 (46.8%) women. Level 3 care was required for 10/605 (1.7%) women. No women developed clinically significant haemostatic impairment.Conclusions. Restrictive use of FFP guided by clinical assessment of bleeding and VE-POCT is feasible and did not result in clinically significant haemostatic impairment. Studies should compare the clinical and cost effectiveness of empirical FFP infusions, according to current guidelines, with targeted use of FFP based on VE-POCT.Clinical trial registration: ISRCTN46295339 (http://ift.tt/2uIJ5tt) (accessed July 24, 2017), EudraCT 2012-005511-11 (http://ift.tt/2wgwjip) (accessed July 24, 2017).

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Author’s reply to Grocott: Risk of cardiac ischaemia in patients without α-receptor blockade for phaeochromocytoma surgery

Editor—We thank Prof Grocott for his comments.1 The author questions whether the incidence of perioperative myocardial infarction in patients with phaeochromocytoma without perioperative α-receptor blockade is truly zero, without taking serial troponin measurements.

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Editorial Board



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Table of Contents



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Academy News – September PM&R

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

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Spanish Translated Abstracts



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Getting the Right Answer: Four Statistical Principles

Researchers often go into studies with preconceived notions of what they expect or hope to see. These expectations and hopes may color how researchers interpret their final data. For example, they may cherry-pick results that appear to support their hypothesis while ignoring results that contradict it. This can lead to biased papers, with flawed analyses, even including examples in which authors wrongly report the exact opposite of what the data actually show. I will present one such example here.

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Copyright Page



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Information for Authors



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Approaches to modelling radioactive contaminations in forests – Overview and guidance

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Publication date: November 2017
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): A. Diener, P. Hartmann, L. Urso, J. Vives i Batlle, M.A. Gonze, P. Calmon, M. Steiner
Modelling the radionuclide cycle in forests is important in case of contamination due to acute or chronic releases to the atmosphere and from underground waste repositories. This article describes the most important aspects to consider in forest model development. It intends to give an overview of the modelling approaches available and to provide guidance on how to address the quantification of radionuclide transport in forests. Furthermore, the most important gaps in modelling the radionuclide cycle in forests are discussed and suggestions are presented to address the variability of forest sites.



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Effects of blood flow restriction during moderate-intensity eccentric knee extensions

Abstract

We investigated if blood flow restriction (BFR, cuff pressure 20 mmHG below individual occlusion pressure) increases metabolic stress, hormonal response, release of muscle damage markers, and muscle swelling induced by moderate-intensity eccentric contractions. In a randomized, matched-pair design, 20 male subjects (25.3 ± 3.3 years) performed four sets of unilateral eccentric knee extensions (75% 1RM) to volitional failure with (IG) or without (CG) femoral BFR. Despite significant differences of performed repetitions between IG (85.6 ± 15.4 repetitions) and CG (142.3 ± 44.1 repetitions), peak values of lactate (IG 7.0 ± 1.4 mmol l−1, CG 6.9 ± 2.7 mmol l−1), growth-hormone (IG 4.9 ± 4.8 ng ml−1, CG 5.2 ± 3.5 ng ml−1), insulin-like growth factor 1 (IG 172.1 ± 41.9 ng ml−1, CG 178.7 ± 82.1 ng ml−1), creatine-kinase (IG 625.5 ± 464.8 U l−1, CG 510.7 ± 443.5 U l−1), the absolute neutrophil count (IG 7.9 ± 1.3 103 µl−1, CG 8.7 ± 2.0 103 µl−1), induced muscle swelling of rectus femoris and vastus lateralis and perceived pain did not differ. The present data indicate that BFR is suitable to intensify eccentric exercises.



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