Τρίτη, 19 Σεπτεμβρίου 2017

Task-dependent output of human parasternal intercostal motor units across spinal levels

Abstract

During inspiration, there is differential activity in the human parasternal intercostal muscles across interspaces. We studied if the earlier recruitment of motor units in the rostral interspaces, compared to more caudal spaces, during inspiration is preserved for the non-respiratory task of ipsilateral trunk rotation. Single motor unit activity (SMU) was recorded from the first, second and fourth parasternal interspaces on the right side in five participants in two tasks: resting breathing and 'isometric' axial rotation of the trunk during apnoea. Recruitment of the same SMUs was compared between tasks (n = 123). During resting breathing, differential activity was indicated by earlier recruitment of SMUs in the 1st and 2nd interspaces, compared to the 4th space in inspiration (P < 0.01). In contrast, during trunk rotation, the same motor units showed an altered pattern of recruitment as SMUs in the 1st interspace were recruited later and at a higher rotation torque than those in the 2nd and 4th interspaces (P < 0.05). Tested for a subset of SMUs, the reliability of the breathing and rotation tasks, and the SMU recruitment measures was good-excellent (ICC(2,1): 0.69–0.91). Thus, the output of parasternal intercostal motoneurones is modulated differently across spinal levels depending on the task. Given that the differential inspiratory output of parasternal intercostal muscles is linked to their relative mechanical effectiveness for inspiration and that this output is altered in trunk rotation, we speculate that a mechanism that matches neural drive to muscle mechanics underlies the task-dependent differences in output of axial motoneurone pools.

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The Ubiquitin Ligase (E3) Psh1p Is Required for Proper Segregation of Both Centromeric and Two Micron Plasmids in Saccharomyces cerevisiae

Protein degradation by the ubiquitin-proteasome system is essential to many processes. We sought to assess its involvement in the turnover of mitochondrial proteins in Saccharomyces cerevisiae. We find that deletion of a specific ubiquitin ligase (E3), Psh1p, increases the abundance of a temperature-sensitive mitochondrial protein, mia40-4pHA, when it is expressed from a centromeric plasmid. Deletion of Psh1p unexpectedly elevates the levels of other proteins expressed from centromeric plasmids. Loss of Psh1p does not increase the rate of turn-over of mia40-4pHA, affect total protein synthesis, or increase the protein levels of chromosomal genes. Instead, psh1 appears to increase the incidence of missegregation of centromeric plasmids relative to their normal 1:1 segregation. After generations of growth with selection for the plasmid, ongoing missegregation would lead to elevated plasmid DNA, mRNA, and protein, all of which we observe in psh1 cells. The only known substrate of Psh1p is the centromeric histone H3 variant Cse4p, which is targeted for proteasomal degradation after ubiquitination by Psh1p. However, Cse4p overexpression alone does not phenocopy psh1 in increasing plasmid DNA and protein levels. Instead, elevation of Cse4p leads to an apparent increase in 1:0 plasmid segregation events. Further, two micron high-copy yeast plasmids also missegregate in psh1, but not when Cse4p alone is overexpressed. These findings demonstrate that Psh1p is required for the faithful inheritance of both centromeric and two micron plasmids. Moreover, the effects that loss of Psh1p has on plasmid segregation cannot be accounted for by increased levels of Cse4p.



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Spinal cord MRI signal changes at one year after cervical decompression surgery is useful for predicting mid-term clinical outcome: an observational study using propensity scores

There is little information on the relationship between magnetic resonance imaging (MRI) T2-weighted high signal change (T2HSC) in the spinal cord and surgical outcome for cervical myelopathy. We therefore examined whether T2HSC regression at one year postoperatively reflected 5-year prognosis after adjustment using propensity scores for potential confounding variables, which have been a disadvantage of earlier observational studies.

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Immunomodulation of Mesenchymal Stem Cells in discogenic pain

Back pain is a highly prevalent health problem in the world today and has a great economic impact on the healthcare budgets. Intervertebral disc degeneration has been identified as a main cause of back pain. Inflammatory cytokines produced by macrophages or disc cells in an inflammatory environment play an important role in painful progressive degeneration of intervertebral disc. Mesenchymal stem cells (MSCs) have shown to have immunosuppressive and anti-inflammatory properties. MSCs express a variety of chemokines and cytokines receptors having tropism to inflammation sites.

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The importance and impact of patients' health literacy on low back pain management: a systematic review of literature

Health literacy (HL) and the overall ability of patients to seek, understand and apply health information play an important role in the management of chronic pain conditions. Awareness of how patients' health literacy skills influence their pain experience and how their ability to understand the treatment regimen and manage chronic pain may allow physicians to adjust clinical treatment accordingly. Despite the prevalence and substantial economic impact of chronic low back pain (LBP), little is known about the relationship between health literacy and the treatment and management of this common disease entity.

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Radiological and clinical long-term results of heterotopic ossification following lumbar total disc replacement

The long-term results of heterotopic ossification (HO) following lumbar total disc replacement (TDR) and the corresponding clinical and radiological outcomes are unclear.

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Anterior release may not be necessary for idiopathic scoliosis with large curve of more than 75° and flexibility less than 25%

In order to improve the correction and fusion rates, an anterior release is often needed for treatment of idiopathic scoliosis with a curve of more than 75° before posterior correction, instrumentation and fusion. However, there are disadvantages to anterior release, and we are concerned about whether it is necessary for anterior/posterior spinal fusion in these patients.

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Clinical relation among dural adhesion, dural ossification, and dural laceration in the removal of ossification of the ligamentum flavum

Dural laceration frequently occurs during surgery in patients with OLF, mainly due to dural adhesion (DA) and dural ossification (DO) between the ligamentum flavum and dura mater. However, the radiologic predictive factors of DA in OLF have rarely been reported.

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Consistently High Level of Cardiorespiratory Fitness and Incidence of Type 2 Diabetes

imagePurpose: Although the benefit of high cardiorespiratory fitness (CRF) for the prevention of type 2 diabetes mellitus (T2DM) is widely accepted, whether consistently high CRF is necessary or transiently high CRF is sufficient is unclear. The present study was conducted to examine the hypothesis that consistently high level of CRF is more beneficial than transiently high CRF for the prevention of T2DM. Methods: This cohort study was conducted in nondiabetic 7158 men age 20 to 60 yr, enrolled from 1986 to 1987. The area under the curve with respect to ground (AUCG) for CRF measurements during an 8-yr measurement period (1979–1987) was calculated as an index of integrated CRF level during the period. The differences (ΔAUCP) between AUCG and peak AUC (peak CRF–measurement period) was also calculated as an index of the presence and the size of a "spike" in CRF. T2DM was defined by fasting blood glucose and a self-reported diagnosis of diabetes for participants with blood tests. For participants without blood tests, T2DM was defined by the result of oral glucose test after a nonfasting urinary test and a self-reported diagnosis of diabetes. T2DM was determined on health checkups until 2009. Results: During the follow-up period, 1495 men developed T2DM. After adjustment for confounders, as compared with the first quartile of AUCG for CRF, the hazard ratio (95% confidence interval) for the second, third, and fourth quartiles were 0.87 (0.76 to 1.00), 0.80 (0.68 to 0.95), and 0.72 (0.58 to 0.89), respectively. For CRF spike, there was no association between ΔAUCP in CRF and the incidence of T2DM. Conclusions: Consistently higher level of CRF over time was associated with lower risk of T2DM.

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Do Dynamic Fat and Fat-Free Mass Changes follow Theoretical Driven Rules in Athletes?

imageIntroduction: Maximizing fat mass (FM) loss while preserving or increasing fat-free mass (FFM) is a central goal for athletic performance but the composition of body weight (BW) changes over time with training are largely unknown. Purpose: We aimed to analyze FM and FFM contributions to BW changes and to test if these contributions follow established rules and predictions over one athletic season. Methods: Seventy athletes (42 men; handball, volleyball, basketball, triathlon, and swimming) were evaluated from the beginning to the competitive stage of the season and were empirically divided into those who lost (n = 20) or gained >1.5% BW (n = 50). FM and FFM were evaluated with a four-compartment model. Energy densities (ED) of 1.0 kcal·g−1 for FFM and 9.5 kcal·g−1 for FM were used to calculate ED/per kilogram BW change. Results: Athletes that lost >1.5% BW decreased FM by 1.7 ± 1.6 kg (P 1.5% BW increased FFM by 2.3 ± 2.1 kg (P

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Scaling the Oxygen Uptake Efficiency Slope for Body Size in Cystic Fibrosis

imagePurpose: The aim of this study was to describe the relationship between body size and oxygen uptake efficiency slope (OUES) in pediatric patients with cystic fibrosis (CF) and healthy controls (CON), to identify appropriate scaling procedures to adjust the influence of body size upon OUES. Methods: The OUES was derived using maximal and submaximal points from cardiopulmonary exercise testing in 72 children (36 CF and 36 CON). OUES was subsequently scaled for stature, body mass (BM), and body surface area (BSA) using ratio-standard (Y/X) and allometric (Y/Xb) methods. Pearson's correlation coefficients were used to determine the relationship between body size and OUES. Results: When scaled using the ratio-standard method, OUES had a significant positive relationship with stature (r = 0.54, P 0.05) correlations for the whole group were found between OUES and allometrically scaled BM (CF r = −0.25, CON, r = 0.15) and BSA (CF r = −0.27, CON r = 0.13). Conclusions: Only allometric scaling of either BM or BSA, and not ratio-standard scaling, successfully eliminates the influence of body size upon OUES. Therefore, this enables a more direct comparison of the OUES between patients with CF and healthy controls.

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Activity Recognition in Youth Using Single Accelerometer Placed at Wrist or Ankle—Erratum

imageNo abstract available

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Calculated versus Measured MVV—Surrogate Marker of Ventilatory CPET

imageIntroduction: Maximum voluntary ventilation (MVV), a surrogate marker of maximum ventilatory capacity, allows for measuring ventilatory reserve during cardiopulmonary exercise testing (CPET), which is necessary to assess ventilatory limitation. MVV can be measured directly during a patient maneuver or indirectly by calculating from forced expiratory volume in 1 s (FEV1 × 40). We investigated for a potential difference between calculated MVV and measured MVV in pediatric subjects, and which better represents maximum ventilatory capacity during CPET. Methods: Data were collected retrospectively from CPET conducted in pediatric subjects for exercise-induced dyspnea from January 2014 to June 2015 at Akron Children's Hospital. Subjects with neuromuscular weakness, morbid obesity, and suboptimal effort during the testing were excluded from the study. Results: Thirty-five subjects (mean ± SD, age = 13.8 ± 2.7 yr, range = 7–18 yr) fulfilled the criteria. Measured MVV was significantly lower than calculated MVV (89.9 ± 26.4 vs 122.4 ± 34.5 L·min−1; P

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Breaks in Sitting Time: Effects on Continuously Monitored Glucose and Blood Pressure

imagePurpose: We examined the effects of interrupting prolonged sitting with multiple 2-min walking breaks or one 30-min continuous walking session on glucose control and ambulatory blood pressure (ABP). Methods: Ten overweight/obese, physically inactive participants (five men; 32 ± 5 yr; BMI, 30.3 ± 4.6 kg·m−2) participated in this randomized four-trial crossover study, with each trial performed on a separate, simulated workday lasting 9 h: 1) 30 min of continuous moderate-intensity (30-min MOD) walking at 71% ± 4% HRmax; 2) 21 × 2 min bouts of moderate-intensity (2-min MOD) walking at 53% ± 5% HRmax, each performed every 20 min (42 min total); 3) 8 × 2 min bouts of vigorous-intensity (2-min VIG) walking at 79% ± 4% HRmax, each performed every hour (16 min total); 4) 9 h of prolonged sitting (SIT). Participants underwent continuous interstitial glucose monitoring and ABP monitoring during and after the simulated workday spent in the laboratory, with primary data analysis from 12:30 h to 07:00 h the next morning. Results: Compared with SIT (5.6 ± 1.1 mmol·L−1), mean 18.7-h glucose was lower during the 2-min MOD (5.2 ± 1.1 mmol·L−1) and 2-min VIG (5.4 ± 0.9 mmol·L−1) trials and mean 18.7-h glucose during the 30-min MOD trial (5.1 ± 0.8 mmol·L−1) was lower than all other trials (P

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Children with Burn Injury Have Impaired Cardiac Output during Submaximal Exercise

imageIntroduction: Burn trauma damages resting cardiac function; however, it is currently unknown if the cardiovascular response to exercise is likewise impaired. We tested the hypothesis that, in children, burn injury lowers cardiac output (Q˙) and stroke volume (SV) during submaximal exercise. Methods: Five children with 49% ± 4% total body surface area (BSA) burned (two female, 11.7 ± 1 yr, 40.4 ± 18 kg, 141.1 ± 9 cm) and eight similar nonburned controls (five female, 12.5 ± 2 yr, 58.0 ± 17 kg, 147.3 ± 12 cm) with comparable exercise capacity (peak oxygen consumption [peak V˙O2]: 31.9 ± 11 vs 36.8 ± 8 mL O2·kg−1·min−1, P = 0.39) participated. The exercise protocol entailed a preexercise (pre-EX) rest period followed by 3-min exercise stages at 20 W and 50 W. V˙O2, HR, Q˙ (via nonrebreathing), SV (Q˙/HR), and arteriovenous O2 difference ([a-v]O2diff, Q˙/ V˙O2) were the primary outcome variables. Results: Using a 2-way factorial ANOVA (group [G] × exercise [EX]), we found that Q˙ was approximately 27% lower in the burned than the nonburned group at 20 W of exercise (burned 5.7 ± 1.0 vs nonburned: 7.9 ± 1.8 L·min−1) and 50 W of exercise (burned 6.9 ± 1.6 vs nonburned 9.2 ± 3.2 L·min−1) (G–EX interaction, P = 0.012). SV did not change from rest to exercise in burned children but increased by approximately 24% in the nonburned group (main effect for EX, P = 0.046). Neither [a-v] O2diff nor V˙O2 differed between groups at rest or exercise, but HR response to exercise was reduced in the burn group (G–EX interaction, P = 0.004). When normalized to BSA, SV (index) was similar between groups; however, Q˙ (index) remained attenuated in the burned group (G–EX interaction, P

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Physical Activity, Not Sedentary Time, Predicts Dual-Energy X-ray Absorptiometry–measured Adiposity Age 5 to 19 Years

imagePurpose: To examine the associations among physical activity (PA), sedentary time (SED), and TV viewing (TV) with fat mass (FAT) and visceral adipose tissue mass (VAT) from childhood through adolescence (5–19 yr). Methods: Participants in the Iowa Bone Development Study (n = 230 males and 233 females) were examined at ages 5, 8, 11, 13, 15, 17, and 19 yr. Accelerometers measured moderate- or vigorous-intensity PA (MVPA; min·d−1), light-intensity PA (LPA; min·d−1), and SED (h·d−1). Parent-proxy report (5 and 8 yr) and child-report (11, 13, 15, 17, and 19 yr) measured TV (h·d−1). X-ray absorptiometry scans measured FAT (kg) and VAT (g). Sex-specific growth models were used to create FAT and VAT growth curves for individual participants (level 1), and to test the effect of MVPA, LPA, SED, and TV (level 2) after adjusting for weight, height, linear age, nonlinear age, and maturity. Results: Growth models indicated that low levels of MVPA were associated with high levels of FAT and VAT for males and high levels of FAT for females. TV viewing was positively associated with FAT and VAT for males and females. LPA was positively associated with FAT in males. Sedentary time was not associated with FAT or VAT for males or females (P > 0.05). Conclusions: This study supports current PA guidelines focusing on MVPA rather than SED. The contribution of high TV, but not high SED, to high levels of adiposity suggests that TV's contribution to obesity is not just a function of low energy expenditure.

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Achilles Tendon Load is Progressively Increased with Reductions in Walking Speed

imageIntroduction: Achilles tendon rehabilitation protocols commonly recommend a gradual increase in walking speed to progressively intensify tendon loading. This study used transmission-mode ultrasound to evaluate the influence of walking speed on loading of the human Achilles tendon in vivo. Methods: Axial transmission speed of ultrasound was measured in the right Achilles tendon of 33 adults (mean ± SD: age, 29 ± 3 yr; height, 1.725 ± 0.069 m; weight, 71.4 ± 19.9 kg) during unshod, steady-state treadmill walking at three speeds (slow, 0.85 ± 0.12 ms; preferred, 1.10 ± 0.13 m·s−1; fast, 1.35 ± 0.20 m·s−1). Ankle kinematics, spatiotemporal gait parameters and vertical ground reaction force were simultaneously recorded. Statistical comparisons were made using repeated-measures ANOVA models. Results: Increasing walking speed was associated with higher cadence, longer step length, shorter stance duration, greater ankle plantarflexion, higher vertical ground reaction force peaks, and a greater loading rate (P

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Effect of Prior Injury on Changes to Biceps Femoris Architecture across an Australian Football League Season

imagePurpose: To assess in-season alterations of biceps femoris long head (BFlh) fascicle length in elite Australian footballers with and without a history of unilateral hamstring strain injury (HSI) in the past 12 months. Methods: Thirty elite Australian football players were recruited. Twelve had a history of unilateral HSI. Eighteen had no HSI history. All had their BFlh architecture assessed at approximately monthly intervals, six times across a competitive season. Results: The previously injured limb's BFlh fascicles increased from the start of the season and peaked at week 5. Fascicle length gradually decreased until the end of the season, where they were shortest. The contralateral uninjured limb's fascicles were the longest when assessed at week 5 and showed a reduction in-season where weeks 17 and 23 were shorter than week 1. Control group fascicles were longest at week 5 and reduced in-season. The previously injured limb's BFlh fascicles were shorter than the control group at all weeks and the contralateral uninjured limb at week 5. Compared with the control group, the contralateral uninjured limb had shorter fascicles from weeks 9 to 23. Conclusions: Athletes with a history of HSI end the season with shorter fascicles than they start. Limbs without a history of HSI display similar BFlh fascicle lengths at the end of the season as they begin with. All athletes increase fascicle length at the beginning of the season; however, the extent of the increase differed based on history of HSI. These findings show that a HSI history may influence structural adaptation of the BFlh in-season.

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Physical Activity and Sleep Quality in Breast Cancer Survivors: A Randomized Trial

imagePurpose: Data from large randomized controlled trials confirming sleep quality improvements with aerobic physical activity have heretofore been lacking for post–primary treatment breast cancer survivors. Our primary purpose for this report was to determine the effects of a physical activity behavior change intervention, previously reported to significantly increase physical activity behavior, on sleep quality in post–primary treatment breast cancer survivors. Methods: Post–primary treatment breast cancer survivors (n = 222) were randomized to a 3-month physical activity behavior change intervention (Better Exercise Adherence after Treatment for Cancer [BEAT Cancer]) or usual care. Self-report (Pittsburgh Sleep Quality Index [PSQI]) and actigraphy (latency and efficiency) sleep outcomes were measured at baseline, 3 months (M3), and 6 months (M6). Results: After adjusting for covariates, BEAT Cancer significantly improved PSQI global sleep quality when compared with usual care at M3 (mean between-group difference [M] = −1.4, 95% confidence interval [CI] = −2.1 to −0.7, P

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Writing Case Reports: A Practical Guide from Conception through Publication

No abstract available

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Beetroot Juice Increases Human Muscle Force without Changing Ca2+-Handling Proteins

imageDietary inorganic nitrate (NO3−) supplementation improves skeletal muscle (SkM) contractile efficiency, and although rodent literature has suggested improvements in calcium handling or redox modifications as likely explanations, the direct mechanism of action in humans remains unknown. Purpose: This study aimed to examine the effects of 7 d of beetroot juice (BRJ) supplementation on SkM contractile characteristics and function. Methods: Recreationally active males (n = 8) underwent transcutaneous electrical muscle stimulation of the vastus lateralis for the evaluation of contractile characteristics before and after 7 d of BRJ supplementation (280 mL·d−1, ~26 mmol NO3−). An additional group of individuals (n = 8) followed the same supplementation protocol but underwent SkM biopsies pre- and post-supplementation for the determination of proteins associated with calcium handling via Western blotting, and the ratio of reduced/oxidized glutathione (GSH:GSSG), an indicator of cellular redox state, via high-performance liquid chromatography (HPLC). Results: After supplementation, there was no change in maximal voluntary force production (602 ± 50 vs 596 ± 56 N) or electrically induced tetanic contractions. By contrast, force production was increased at 10 Hz electrical stimulation (41.1% ± 2.3% vs 37.6% ± 2.4% of peak force, P

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Solid Organ Laceration in an Adolescent Soccer Player: A Case Report

image Pediatric solid organ lacerations are a relatively uncommon but potentially dangerous injury that must be addressed urgently once recognized. Seen most often during recreational or team sports, they usually occur after a blunt or deceleration mechanism to the abdomen or flank. Depending on the severity of injury, solid organ laceration may not be immediately apparent clinically. This emphasizes the importance of sideline witnessing and evaluation, acting quickly once symptoms develop, and placing importance on safe sporting technique. In addition, management has changed over time to favor medical management for minor injuries, with laparotomy reserved for high-grade or hemodynamically unstable lacerations. Awareness of solid organ laceration in pediatric populations is more important than ever as they are beginning to appear in younger adolescents. Here we present a case of a 14-yr-old girl sustaining a grade IV liver laceration while playing contact team sports.

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Systolic and Diastolic Left Ventricular Mechanics during and after Resistance Exercise

imagePurpose: To improve the current understanding of the impact of resistance exercise on the heart, by examining the acute responses of left ventricular (LV) strain, twist, and untwisting rate ("LV mechanics"). Methods: LV echocardiographic images were recorded in systole and diastole before, during and immediately after (7–12 s) double-leg press exercise at two intensities (30% and 60% of maximum strength, one-repetition maximum). Speckle tracking analysis generated LV strain, twist, and untwisting rate data. Additionally, beat-by-beat blood pressure was recorded and systemic vascular resistance (SVR) and LV wall stress were calculated. Results: Responses in both exercise trials were statistically similar (P > 0.05). During effort, stroke volume decreased, whereas SVR and LV wall stress increased (P 0.05). Immediately after exercise, systolic LV mechanics returned to baseline levels (P

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Longitudinal Physical Activity, Body Composition, and Physical Fitness in Preschoolers

imagePurpose: This study aimed to investigate longitudinal associations of objectively measured physical activity (PA) and sedentary behavior (SB) with body composition and physical fitness at a 12-month follow-up in healthy Swedish 4-yr-old children. Methods: The data from the population-based MINISTOP trial were collected between 2014 and 2016, and this study included the 138 children who were in the control group. PA and SB were assessed using the wrist-worn ActiGraph (wGT3x-BT) accelerometer during seven 24-h periods and, subsequently, defined as SB, light-intensity PA, moderate-intensity PA, vigorous-intensity PA (VPA), and moderate-to-vigorous PA (MVPA). Body composition was measured using air-displacement plethysmography and physical fitness (cardiorespiratory fitness, lower and upper muscular strength as well as motor fitness) by the PREFIT fitness battery. Linear regression and isotemporal substitution models were applied. Results: Greater VPA and MVPA at the age of 4.5 yr were associated with higher fat-free mass index (FFMI) at 5.5 yr (P

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A Cluster RCT to Reduce Workers’ Sitting Time: Impact on Cardiometabolic Biomarkers

imagePurpose: To evaluate the initial and long-term impacts on cardiometabolic health indicators of the Stand Up Victoria intervention—a 12-month, multicomponent workplace-delivered intervention that successfully reduced overall sitting time, primarily by increasing standing time. Methods: Office worksites (≥1 km apart) from a single organization were cluster randomized to intervention (n = 7) or control (n = 7). Participants were 136 intervention and 95 control desk-based workers (5–39 per worksite; 68% women; mean ± SD age = 45.6 ± 9.4 yr). Outcomes, assessed at baseline (0 months), 3, and 12 months, were 14 individual biomarkers of body composition, blood pressure, glucose metabolism, lipid metabolism, and a composite overall cardiometabolic risk score. Intervention effects were assessed by linear mixed models, accounting for repeated measures and clustering, baseline values, and potential confounders. Missing data were multiply imputed. Significance was set at P

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Environmental and Physiological Factors Affect Football Head Impact Biomechanics

imagePurpose: Recent anecdotal trends suggest a disproportionate number of head injuries in collegiate football players occur during preseason football camp. In warmer climates, this season also represents the highest risk for heat-related illness among collegiate football players. Because concussion and heat illnesses share many common symptoms, we need 1) to understand if environmental conditions, body temperature, and hydration status affect head impact biomechanics; and 2) to determine if an in-helmet thermistor could provide a valid measure of gastrointestinal temperature. Methods: A prospective cohort of 18 Division I college football players (age, 21.1 ± 1.4 yr; height, 187.7 ± 6.6 cm; mass, 114.5 ± 23.4 kg). Data were collected during one control and three experimental sessions. During each session, the Head Impact Telemetry System recorded head impact biomechanics (linear acceleration, rotational acceleration, and severity profile) and in-helmet temperature. A wet bulb globe device recorded environmental conditions, and CorTemp™ Ingestible Core Body Temperature Sensors recorded gastrointestinal temperature. Results: Our findings suggest that linear acceleration (P = 0.57), rotational acceleration (P = 0.16), and Head Impact Technology severity profile (P = 0.33) are not influenced by environmental or physiological conditions. Conclusions: We did not find any single or combination of predictors for impact severity. Rotational acceleration was approaching significance between our early experimental sessions when compared with our control session. More research should be conducted to better understand if rotational accelerations are a component of impact magnitudes that are affected due to changes in environmental conditions, body temperature, and hydration status.

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Heart rate variability biofeedback and other psychophysiological procedures as important elements in psychotherapy

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Publication date: Available online 19 September 2017
Source:International Journal of Psychophysiology
Author(s): Paul Lehrer
Lang's distinction of psychophysiological, behavioral, and cognitive domains in psychological problems and therapies provides a useful heuristic for guiding psychotherapy. Much psychotherapy practice emphasizes the cognitive domain, but behavioral and psychophysiological interventions show at least equivalent effectiveness for some kinds of problems. Most descriptions of cognitive behavior therapy emphasize cognitive procedures, although most CBT approaches also incorporate behavioral interventions such as social skills training, exposure, and behavior activation. The contribution of psychophysiological methods is often underemphasized. Muscle relaxation and breathing interventions, particularly heart rate variability biofeedback, have been shown to have clinically significant therapeutic effects for a variety of problems. Although used more sporadically in the West, similar methods are part of traditional medical practice in Eastern countries. Examples are given for how these methods can be integrated into more generic psychotherapy practice, using Lang's distinctions, for a variety of psychological problems.



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Television Viewing Time and Inflammatory-Related Mortality

imagePurpose: Television (TV) viewing time is associated with increased risk of all-cause, cardiovascular and cancer mortality. Although TV time is detrimentally associated with key inflammatory markers, the associations of TV time with other inflammatory-related mortality (with a predominant inflammatory, oxidative or infectious component, but not attributable to cancer or cardiovascular causes), are unknown. Methods: Among 8933 Australian adults (4593 never-smokers) from the baseline (1999–2000) Australian Diabetes, Obesity and Lifestyle Study (median follow-up, 13.6 yr), we examined TV time in relation to noninflammatory and inflammatory-related mortality (not attributable to cancer or cardiovascular causes, hereafter "inflammatory-related" mortality). Because smoking has a significant inflammatory component, we also examined this relationship in never-smokers. Results: Of 896 deaths, 248 were attributable to cardiovascular disease, 346 to cancer, 130 to other inflammatory-related causes (71 for never-smokers), and 172 to noninflammatory-related causes (87 for never-smokers). After multivariate adjustment for age, sex, education, household income, smoking status, alcohol intake, energy intake, diet, and cardiometabolic risk biomarkers (model 3), every additional hours per day of TV time was associated with increased risk of inflammatory-related mortality in the overall population (hazard ratio, 1.12; 95% confidence interval, 1.00–1.25) and in never-smokers (1.18; 1.00, 1.40). These results were attenuated after additional adjustment for leisure-time physical activity. After multivariate adjustment (model 3), no association was observed for noninflammatory mortality in the overall population (0.95; 0.85, 1.07), but risk tended to decrease for never-smokers (0.85; 0.75, 1.02). Conclusions: In summary, before adjustment for leisure-time physical activity, TV time was associated with increased risk of inflammatory-related mortality. This is consistent with the hypothesis that high TV viewing may be associated with a chronic inflammatory state.

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Empirical evidence for the relationship between cognitive workload and attentional reserve

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Publication date: Available online 18 September 2017
Source:International Journal of Psychophysiology
Author(s): Kyle J. Jaquess, Rodolphe J. Gentili, Li-Chuan Lo, Hyuk Oh, Jing Zhang, Jeremy C. Rietschel, Matthew W. Miller, Ying Ying Tan, Bradley D. Hatfield
While the concepts of cognitive workload and attentional reserve have been thought to have an inverse relationship for some time, such a relationship has never been empirically tested. This was the purpose of the present study. Aspects of the electroencephalogram were used to assess both cognitive workload and attentional reserve. Specifically, spectral measures of cortical activation were used to assess cognitive workload, while amplitudes of the event-related potential from the presentation of unattended "novel" sounds were used to assess attentional reserve. The relationship between these two families of measures was assessed using canonical correlation. Twenty-seven participants performed a flight simulator task under three levels of challenge. Verification of manipulation was performed using self-report measures of task demand, objective task performance, and heart rate variability using electrocardiography. Results revealed a strong, negative relationship between the spectral measures of cortical activation, believed to be representative of cognitive workload, and ERP amplitudes, believed to be representative of attentional reserve. This finding provides support for the theoretical and intuitive notion that cognitive workload and attentional reserve are inversely related. The practical implications of this result range include improved state classification using advanced machine learning techniques, enhanced personnel selection/recruitment/placement, and augmented learning/training.



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Providing Choice in Exercise Influences Food Intake at the Subsequent Meal

imageThe benefits of regular exercise for health are well established; however, certain behaviors after exercise, such as unhealthy or excessive food consumption, can counteract some of these benefits. Purpose: To investigate the effect of autonomy support (through the provision of choice) in exercise—relative to a no-choice condition with matched energy expenditure—on appetite and subsequent energy intake. Methods: Fifty-eight men and women (body mass index, 22.9 ± 2.3 kg·m−2; peak oxygen consumption, 52.7 ± 6.4 mL·kg−1·min−1) completed one familiarization session and one experimental trial, in which they were randomized to either a choice or no-choice exercise condition using a between-subjects yoked design. Ad libitum energy intake from a laboratory test meal was assessed after exercise, together with perceptions of mood, perceived choice, enjoyment, and value. Results: Despite similar ratings of perceived appetite across conditions (P > 0.05), energy intake was significantly higher after exercise performed under the no-choice condition (2456 ± 1410 kJ) compared with the choice condition (1668 ± 1215 kJ; P = 0.026; d = 0.60). In particular, the proportion of energy intake from unhealthy foods was significantly greater after exercise in the no-choice condition (1412 ± 1304 kJ) compared with the choice condition (790 ± 861 kJ; P = 0.037, d = 0.56). Participants in the choice condition also reported higher perceptions of choice (P 0.05). Conclusions: A lack of choice in exercise is associated with greater energy intake from "unhealthy" foods in recovery. This finding highlights the importance of facilitating an autonomy supportive environment during exercise prescription and instruction.

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Sex differences in sport-related concussion long-term outcomes

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Publication date: Available online 18 September 2017
Source:International Journal of Psychophysiology
Author(s): Tracey Covassin, Jennifer Savage, Abby Bretzin, Meghan Lafevor
Approximately 1.6 to 3.8 million recreational and sports-related concussions (SRC) occur each year in the Unites States. Research suggest that female athletes are at a greater risk for a SRC compared to male athletes competing in comparable sports (i.e., soccer, basketball). Moreover, female athletes have reported more total symptoms and greater neurocognitive impairments following a SRC. Female athletes have been found to report greater symptom provocation as measured by the Vestibular/Ocular Motor Screening (VOMS), and increased brain activation compared to males. There is a scarcity of research on long-term effects of SRC in male and female athletes. Therefore, the aim of this review article is to summarize the existing literature on sex differences in acute and sub-acute SRC outcomes.



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The test-retest reliability of three computerized neurocognitive tests used in the assessment of sport concussion

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Publication date: Available online 18 September 2017
Source:International Journal of Psychophysiology
Author(s): Jacob E. Resch, Mathew Schneider, C. Munro Cullum
Computerized neurocognitive tests (CNTs) are widely used at all competitive levels of sport to assess sport concussion (SC). Whereas there are multiple CNTs available, little is known about how some of the most popular platforms compare. The purpose of this study was to investigate the test-retest reliability of the Automated Neuropsychological Assessment Metrics (ANAM), Concussion Vital Signs (CVS) and the Immediate Postconcussion and Cognitive Testing battery (ImPACT) using clinically relevant time points in healthy college-age participants. Participants were healthy college-age students (N=128) randomly assigned into one of three groups which were administered ANAM, CVS, or ImPACT at Days 1, 45 and 50. Intraclass correlation coefficients (ICCs) and Pearson correlations were used to assess reliability of the various CNT scores and subtest scores between time points. Participants were tested approximately 47.1±2.75days after time point 1 and approximately 7.0±2.45days after time point 2. ICC values ranged from 0.18 (Procedural Reaction Time) to 0.53 (Mathematical Processing and Simple Reaction Time 1) for ANAM, 0.14 (Continuous Performance Test) to 0.85 (Reaction Time) for CVS, and 0.19 (Verbal Memory) to 0.89 (Visual Motor Speed) for ImPACT. Significant improvements (p<0.05) across time were observed for (7/10) CNS Vital Signs composite scores, but no additional significant changes in performance were observed for the remaining CNTs. Overall, weak to strong reliability coefficients for ANAM, CVS, and ImPACT were observed when using clinically relevant time points of repeated administration.



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Escherichia coli responds to environmental changes using enolasic degradosomes and stabilized DicF sRNA to alter cellular morphology [Genetics]

Escherichia coli RNase E is an essential enzyme that forms multicomponent ribonucleolytic complexes known as "RNA degradosomes." These complexes consist of four major components: RNase E, PNPase, RhlB RNA helicase, and enolase. However, the role of enolase in the RNase E/degradosome is not understood. Here, we report that presence of...

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Identification of individuals by trait prediction using whole-genome sequencing data [Genetics]

Prediction of human physical traits and demographic information from genomic data challenges privacy and data deidentification in personalized medicine. To explore the current capabilities of phenotype-based genomic identification, we applied whole-genome sequencing, detailed phenotyping, and statistical modeling to predict biometric traits in a cohort of 1,061 participants of diverse ancestry....

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Common variants in DLG1 locus are associated with non-syndromic cleft lip with or without cleft palate

Abstract

Non-syndromic cleft lip with or without cleft palate (nsCL/P) is a common craniofacial anomaly with a complex and heterogeneous etiology. Knowledge regarding specific genetic factors underlying this birth defect is still not well understood. Therefore, we conducted an independent replication analysis for the top-associated variants located within the DLG1 locus at chromosome 3q29, which was identified as a novel cleft-susceptibility locus in our genome-wide association study (GWAS). Mega-analysis of the pooled individual data from the GWAS and replication study confirmed that common DLG1 variants are associated with the risk of nsCL/P. Two SNPs, rs338217 and rs7649443, were statistically significant even at the genome-wide level (ptrend = 9.70E-10 and ptrend = 8.96E-09, respectively). Three other SNPs, rs9826379, rs6805920 and rs6583202, reached a suggestive genome-wide significance threshold (ptrend < 1.00E-05). The location of the strongest individual SNP in the intronic sequence of the gene encoding DLG1 antisense RNA suggests that the true causal variant implicated in the risk of nsCL/P may affect the DLG1 gene expression level rather than structure of the encoded protein. In conclusion, we identified a novel cleft-susceptibility locus at chromosome 3q29 with a DLG1 as a novel candidate gene for this common craniofacial anomaly.

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The origin of bipedality as the result of a developmental by-product: The case study of the olive baboon (Papio anubis)

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Publication date: December 2017
Source:Journal of Human Evolution, Volume 113
Author(s): François Druelle, Peter Aerts, Gilles Berillon
In this paper, we point to the importance of considering infancy in the emergence of new locomotor modes during evolution, and particularly when considering bipedal walking. Indeed, because infant primates commonly exhibit a more diverse posturo-locomotor repertoire than adults, the developmental processes of locomotion represent an important source of variation upon which natural selection may act. We have had the opportunity to follow the development of locomotion in captive individuals of a committed quadrupedal primate, the olive baboon (Papio anubis). We observed six infants at two different stages of their development. In total, we were able to analyze the temporal parameters of 65 bipedal steps, as well as their behavioral components. Our results show that while the basic temporal aspects of the bipedal walking gait (i.e., duty factor, dimensionless frequency, and hind lag) do not change during development, the baboon is able to significantly improve the coordination pattern between hind limbs. This probably influences the bout duration of spontaneous bipedal walking. During the same developmental stage, the interlimb coordination in quadrupedal walking is improved and the proportion of quadrupedal behaviors increases significantly. Therefore, the quadrupedal pattern of primates does not impede the developmental acquisition of bipedal behaviors. This may suggest that the same basic mechanism is responsible for controlling bipedal and quadrupedal locomotion, i.e., that in non-human primates, the neural networks for quadrupedal locomotion are also employed to perform (occasional) bipedal walking. In this context, a secondary locomotor mode (e.g., bipedalism) experienced during infancy as a by-product of locomotor development may lead to evolutionary novelties when under appropriate selective pressures.



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Development of a sexual needs rehabilitation framework in women post spinal cord injury: a study from Iran

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Publication date: Available online 18 September 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Raziyeh Maasoumi, Fatemeh Zarei, Effat Merghati-Khoei, Taylor Lawson, Seyyed Hasan Emami-Razavi
ObjectiveTo develop a sexual needs rehabilitation framework in women post spinal cord injury (SCI)DesignMixed-methods studySettingBrain and Spinal Cord Injury Research Center (BASIR), Neuroscience Institute, Tehran University of Medical Sciences, Tehran, IranParticipantsMarried women with at least one year passed injuryInterventionNot applicableMethodsThis study was designed in three steps; primary needs assessment with quantitative and qualitative methods, prioritizing identified needs by expert panels, and developing framework.ResultsQuantitative phase in the first phase showed that the total mean score of SQOL-F was 60.47±1.53 and the total mean score of FSFI was 50.54±11.35. Moreover, women's sexual understanding post-SCI in the qualitative assessment revealed that "dilemma leading to limited sexual activity", "seeking positive sexual adjustment", and "lack of client-based sexual and reproductive education/counseling in the rehabilitation process" as three main themes. Results from prioritizing identified needs in the second step indicated that the most important needs related to sexuality aspects of life. In the final step, the framework for Iranian woman with post-SCI sexual rehabilitative needs developed which focused on sexual behavior complication post-SCI as a main need.ConclusionIt is important to assess probable unmet needs before any designing, planning, and implementing interventional rehabilitative health care program especially in sexuality issues. Developed framework can be applied by rehabilitation team during initial caregiving and ongoing through time as needed.



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An online resource to promote vocational interests among job-seekers with multiple sclerosis: a randomized controlled trial in Australia

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Publication date: Available online 18 September 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Diana Dorstyn, Rachel Roberts, Gregory Murphy, Ian Kneebone, Ashley Craig, Christine Migliorini
ObjectiveTo provide a preliminary evaluation of the effectiveness of an on-line resource for job-seekers with multiple sclerosis.DesignRandomized controlled design.SettingCommunity-dwelling cohort in Australia.ParticipantsForty-seven adults with relapsing-remitting or progressive MS accessed an email-delivered, 7-module resource - 'Work and MS' - over a 4-week period. Fifty wait-list control participants were offered the opportunity to access 'Work and MS' 4 weeks post-enrolment.Main Outcome MeasuresPrimary outcomes focused on vocational interests (My Vocational Situation Scale; MVS) and self-efficacy in job-seeking activities (Job-Procurement Self Efficacy Scale; JSES). Secondary outcomes focused on perceived workplace difficulties (Multiple Sclerosis Work Difficulties Questionnaire; MSWDQ), optimism (Life Orientation Test – Revised; LOT-R), and mood (Patient Health Questionnaire-9; PHQ-9).ResultsITT analyses revealed pre-post gains: participants who accessed 'Work and MS' reported improved confidence in their career goals (MVS g = 0.55 [CI: 0.14, 0.96] P = 0.008) and positively re-appraised potential workplace difficulties (MSWDQ g range: 0.42 to 0.47; P range = 0.023 to 0.042). The effect on job self-efficacy was not significant, although changed in the expected direction (g = 0.17, [CI: -0.23, 0.57] P = 0.409). Completer data revealed larger, significant effect estimates (g range = 0.52 to 0.64, P range = 0.009 to 0.035).ConclusionsFindings provide preliminary support for the utility of a job-information resource, 'Work and MS', to augment existing employment services. The results also suggest the need to test employment-ready interventions in a larger study population. This might include the addition of on-line peer support to increase intervention compliance.



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Priorities for closing the evidence-practice gaps in post-stroke aphasia rehabilitation: A scoping review

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Publication date: Available online 18 September 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Kirstine Shrubsole, Linda Worrall, Emma Power, Denise A. O'Connor
ObjectiveTo identify implementation priorities for post-stroke aphasia management relevant to the Australian healthcare context.Data SourcesUsing systematized searches of databases (CINAHL, Medline), guideline and stroke websites, and other sources, evidence was identified and extracted for seven implementation criteria for 13 topic areas relevant to aphasia management. These seven priority-setting criteria were identified in the implementation literature; strength of the evidence; current evidence-practice gap; clinician preference; client preference; modifiability; measurability; and health impact.Study SelectionArticles were included if they were in English, related to a specific recommendation requiring implementation, and contained information pertaining to any of the seven prioritisation criteria.Data ExtractionThe scoping review methodology was chosen to address the broad nature of the topic.Evidence was extracted and placed in an evidence matrix. Following this, evidence was summarised, then aphasia rehabilitation topics prioritised using an approach developed by the research team.Data SynthesisEvidence from 100 documents was extracted and summarised. Four topic areas were identified as implementation priorities for aphasia: Timing, Amount and Intensity of Therapy; Goal Setting; Information, Education and Aphasia-Friendly Information; and Constraint-Induced Language Therapy.ConclusionsClosing the evidence-practice gaps in the four priority areas identified may deliver the greatest gains in outcomes for Australian stroke survivors with aphasia. Our approach to developing implementation priorities may be useful for identifying priorities for implementation in other healthcare areas.



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Development, Implementation and Use of a Process to Promote Knowledge Translation in Rehabilitation

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Publication date: Available online 18 September 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Jennifer L. Moore, Julia Carpenter, Anne Marie Doyle, Laura Doyle, Piper Hansen, Bridget Hahn, T. George Hornby, Heidi R. Roth, Susan Spoeri, Rachel Tappan, Krista Van Der Laan
ObjectiveTo examine the use and impact of the BRAIN on evidence-based practice (EBP) over 6 years.DesignA successive independent samples study.SettingA large rehabilitation system.ParticipantsSuccessive samples of allied health clinicians in 2009 (n=136), 2012 (n=115), and 2015 (n=121).Interventions.The BRAIN includes two components: 1) a process to synthesize, adapt and make recommendations about the application of evidence; and 2) a process to implement the recommended practices in 3 levels of care.Main Outcome Measures.To assess the impact of the project, surveys on EBP perspectives, use, and barriers were conducted before BRAIN implementation and 3 and 6 years after implementation. Questions about impact of the BRAIN on clinical practice were included 3 and 6 years post-implementation.ResultsSurvey data indicate the BRAIN resulted in a significant increase in use of EBPs to make clinical decisions and justify care. As a result of the BRAIN, survey participants reported a substantial increase in use of outcome measures in 2012 (74%) and 2015 (91%) and evidence-based interventions in 2012 (62%) and 2015 (82%). In 2012, significant differences (p < .01) in impact of the BRAIN on practice were identified between therapists who were directly involved in the BRAIN as compared to uninvolved therapists. In 2015, no significant differences existed between involved and uninvolved therapists.ConclusionsAfter 6 years of sustained implementation, the BRAIN expedited the adoption of EBPs throughout a large system of care in rehabilitation.



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Preparing for the first breath: in the developing lung, maternal overnutrition takes center stage

Abstract

Clinical observations link maternal obesity to neonatal respiratory complications. However, a direct mechanistic link between maternal overnutrition and neonatal respiratory outcomes is difficult to establish.

This article is protected by copyright. All rights reserved



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A Home for Surgical Pain Management: The Perioperative Pain Service

imageNo abstract available

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Red Blood Cell Transfusion and Surgical Site Infection After Colon Resection Surgery: A Cohort Study

imageBACKGROUND: Surgical site infections (SSIs) after colon surgery remain a critical safety issue. Patients with an SSI have an increased risk of death, prolonged hospitalization, and increased costs of care. Red blood cell (RBC) transfusion is given during the perioperative period to increase blood oxygen delivery, but it is associated with complications, including infection. We hypothesized that RBC transfusion would be associated with increased SSI risk in patients undergoing colon resection surgery. METHODS: A retrospective cohort study was performed using the 2014 National Surgical Quality Improvement Program participant use file. Patients who had colon resection surgery were identified using current procedural terminology codes. The association between perioperative RBC transfusion and superficial and deep incisional SSIs, organ space SSIs, and postoperative septic shock was modeled using logistic regression with propensity score analysis. RESULTS: Of 23,388 patients who had colon resection surgery, 1845 (7.9%) received perioperative RBC transfusion. After controlling for confounders with propensity score analysis and inverse probability of treatment weighting, RBC transfusion had no apparent association with superficial incisional SSI (odds ratio [OR], 1.18; 99% confidence interval [CI], 0.48–2.88) or deep incisional SSI (OR, 1.47; 99% CI, 0.23–9.43). However, RBC transfusion appeared to be associated with increased risk of organ space SSI (OR, 2.93; 99% CI, 1.43–6.01) and septic shock (OR, 9.23; 99% CI, 3.53–24.09). CONCLUSIONS: RBC transfusion has no apparent association with increased risk for incisional SSIs, but may be associated with increased risk for organ space SSI and septic shock after colon resection surgery.

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Does the [beta]-receptor antagonist esmolol have analgesic effects? A randomised placebo-controlled cross-over study on healthy volunteers undergoing the cold pressor test.

BACKGROUND: Esmolol may attenuate the sympathetic response to pain and reduce postoperative opioid consumption. It is not clear whether esmolol has an analgesic effect per se. OBJECTIVES: The aim of this study was to evaluate the analgesic effect of esmolol in the absence of anaesthetics and opioids. We tested the hypothesis that esmolol would reduce the maximum pain intensity perceived during the cold pressor test (CPT) by 2 points on a 0 to 10 numeric pain rating scale (NRS) compared to placebo. DESIGN: Randomised, placebo-controlled cross-over study. SETTING: Postoperative recovery area, Orebro University Hospital. Study period, November 2013 to February 2014. PARTICIPANTS: Fourteen healthy volunteers. Exclusion criteria included ongoing medication, pregnancy and breastfeeding and participation in other medical trials. INTERVENTIONS: At separate study sessions, participants received interventions: esmolol (0.7 mg kg-1 bolus over 1 min followed by infusion at 10 [mu]g kg-1 min-1); 0.9% normal saline bolus then remifentanil infusion at 0.2 [mu]g kg-1 min-1 and 0.9% normal saline bolus and infusion according to a random sequence. All infusions were administered over 30 min. MAIN OUTCOME MEASURES: Perceived maximum pain intensity score, pain tolerance and haemodynamic changes during CPT, and occurrence of side-effects to interventions compared to placebo, respectively. RESULTS: Esmolol did not reduce perceived pain intensity or pain tolerance during the CPT. The NRS-max score was similar for esmolol, 8.5 (+/-1.4) and placebo, 8.4 (+/-1.3). The mean difference was 0.1 [95% confidence interval (-1.2 to 1.4)], P value equal to 0.83. Remifentanil significantly reduced NRS-max scores, 5.4 (+/-2.1) compared to placebo, [mean difference -3.1 (95% confidence interval (-4.4 to -1.8)), P

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Incidence and risk factors of anaesthesia-related perioperative cardiac arrest: A 6-year observational study from a tertiary care university hospital.

BACKGROUND: In recent decades, the incidences of anaesthesia-related perioperative mortality and adverse outcomes have decreased drastically. However, to date, data on perioperative cardiac arrest and risk factors of perioperative cardiac arrest from European countries are scarce. OBJECTIVES: To determine the incidences of perioperative cardiac arrest and rates of anaesthesia-related and anaesthesia-contributory cardiac arrest. Identification of pre-existing risk factors leading to perioperative cardiac arrest. DESIGN: Retrospective cohort study. SETTING: Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany. INTERVENTIONS: Perioperative critical incident reports between 2007 and 2012 were screened, and reports on cardiac arrest within 24 h postoperatively were identified. Cardiac arrests were classified as 'anaesthesia-related', 'anaesthesia-contributory' or 'anaesthesia-unrelated' by two reviewers independently. Univariate and multi-variate logistic regression analysis was used to identify risk factors associated with perioperative cardiac arrest. RESULTS: Analysis of 318 critical incidents from 169 500 anaesthetics revealed 99 perioperative cardiac arrests. This is an overall incidence of perioperative cardiac arrest of 5.8/10 000 anaesthetics [95% confidence interval (CI), 4.7 to 7.0]. The rate of anaesthesia-related cardiac arrest was 0.7/10 000 (95% CI, 0.3 to 1.1), and the rate of anaesthesia-contributory cardiac arrest was 1.7/10 000 (95% CI, 1.1 to 2.3). Most cardiac arrests related to anaesthesia were due to respiratory events. From the multi-variate analysis, American Society of Anesthesiologists physical status grade at least 3 [P = 0.007, odds ratio (OR) 2.59 (95% CI, 1.29 to 5.19)], emergency surgery [P

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The impact of continuous non-invasive arterial blood pressure monitoring on blood pressure stability during general anaesthesia in orthopaedic patients: A randomised trial.

BACKGROUND: In patients undergoing general anaesthesia, intraoperative hypotension occurs frequently and is associated with adverse outcomes such as postoperative acute kidney failure, myocardial infarction or stroke. A history of chronic hypertension renders patients more susceptible to a decrease in blood pressure (BP) after induction of general anaesthesia. As a patient's BP is generally monitored intermittently via an upper arm cuff, there may be a delay in the detection of hypotension by the anaesthetist. OBJECTIVE: The current study investigates whether the presence of continuous BP monitoring leads to improved BP stability. DESIGN: Randomised, controlled and single-centre study. PATIENTS: A total of 160 orthopaedic patients undergoing general anaesthesia with a history of chronic hypertension. INTERVENTION: The patients were randomised to either a study group (n = 77) that received continuous non-invasive BP monitoring in addition to oscillometric intermittent monitoring, or a control group (n = 83) whose BP was monitored intermittently only. The interval for oscillometric measurements in both groups was set to 3 min. After induction of general anaesthesia, oscillometric BP values of the two groups were compared for the first hour of the procedure. Anaesthetists were blinded to the purpose of the study. MAIN OUTCOME MEASURE: BP stability and hypotensive events. RESULTS: There was no difference in baseline BP between the groups. After adjustment for multiple testing, mean arterial BP in the study group was significantly higher than in the control group at 12 and 15 min. Mean +/- SD for study and control group, respectively were: 12 min, 102 +/- 24 vs. 90 +/- 26 mmHg (P = 0.039) and 15 min, 102 +/- 21 vs. 90 +/- 23 mmHg (P = 0.023). Hypotensive readings below a mean pressure of 55 mmHg occurred more often in the control group (25 vs. 7, P = 0.047). CONCLUSION: Continuous monitoring contributes to BP stability in the studied population. TRIAL REGISTRATION: NCT02519101. (C) 2017 European Society of Anaesthesiology

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Role of the internet as an information resource before anaesthesia consultation: A French prospective multicentre survey.

BACKGROUND: Use of the internet as an information search tool has increased dramatically. Our study assessed preoperative use of the internet by patients to search for information regarding anaesthesia, surgery, pain or outcomes. OBJECTIVE(S): The aim of this study was to test whether patients used the internet prior to surgery and what kinds of information they looked for (anaesthetic technique, pain, adverse events, outcomes and surgery). Correlation between patient age and information sought about surgery from the internet was also explored. DESIGN: A prospective multicentre observational study. SETTING: In total, 14 French private and public institutions from May 2015 to January 2016. PATIENTS: In total, 3161 adult patients scheduled for elective surgery under regional or general anaesthesia. INTERVENTION(S): An anonymous questionnaire was presented to adult patients scheduled for elective surgery under regional or general anaesthesia for completion before the first meeting with the anaesthesiologist. The investigator at each centre completed specific items that the patient could not complete. MAIN OUTCOME MEASURES: We defined the primary endpoint as the number of patients who searched for information about their anaesthesia or surgery on the internet by the time of the their preanaesthetic consultation. RESULTS: Of the 3234 questionnaires distributed, responses were received from 3161 patients. Within this respondent sample, 1304 (45%) were professionally active and 1664 (59%) used the internet at least once per day. Among 3098 (98%) patients who answered the question concerning the primary endpoint, 1506 (48%) had searched the internet for information about their health. In total, 784 (25%) used the internet to find information about their surgery and 113 (3.5%) looked for specific information about anaesthesia. Of the 3161, 52% reported difficulty searching for appropriate information about anaesthesia on the internet. 'Daily use of the web' [odds ratio (OR) 2.0; (95% CI: 1.65 to 2.55) P

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Dietary Fiber Intake in Children in Remission Or With Mild Inflammatory Bowel Disease.

Objectives: The aim of the study was to estimate intake of total dietary fiber, and its soluble and insoluble fractions, by children with inflammatory bowel disease (IBD) in comparison to healthy controls. Methods: This was a prospective controlled study on children with IBD. Food consumption data were collected by using the 3-day diet record. For intake of soluble and insoluble fibers author's questionnaire was used. Results: The study included 50 children with IBD (80% in clinical remission) and 50 healthy controls. There were no statistically significant differences in age, weight, height and BMI percentiles between both groups. The mean disease duration was 3.5 +/- 2.5 years. The daily median dietary fiber intake in patients was 15.3 +/- 4.2 g whereas controls consumed about 14.1 +/- 3.6 g/day; differences were not statistically significant. The median intake of soluble fiber in the study group was 5.0 g/day and in controls 4.7 g/day. Whereas the intake of insoluble fractions was 10.2 g/day vs 9.7 g/day, respectively. The total fiber intake significantly increased with age and it was higher among boys in each age group. The boys better achieved adequate intake (AI) recommendations (p = 0.003). Both, children with IBD and healthy controls, didn't meet the AI recommendations. Conclusions: Intake of fiber in patients with IBD and healthy controls was comparable, however in both groups it was lower than recommended. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Gastrointestinal Symptoms of Food Challenge-Proven Non-Ige Cow's Milk Allergy are Dissipated by Early School Age.

Objectives: To evaluate the current well-being and dietary restrictions in children six years after food challenge confirmed diagnosis of non-IgE cow's milk protein allergy, compared to peers with gastrointestinal symptoms but negative food challenge. To evaluate the diagnostic process retrospectively. Methods: Internet-based survey for mothers whose children underwent six years ago the double-blind, placebo-controlled food challenge for cow's milk because of gastrointestinal symptoms causing suspicion of non-IgE cow's milk protein allergy. Concurrent dietary restrictions, overall well-being, medical history and retrospective views on the food challenge were queried using a study-specific questionnaire, the Quality of life using PedsQL general score and parental stress with the Parenting Stress Index questionnaire. Results: Mothers of 42 children (23 girls), median age of 6.7 years (range 5.7-8.6), participated in the survey, the response rate was 70%. All children now consumed cow's milk protein. The only food restrictions reported were empirical lactose-free diets in seven children (17%). One-third of the children in both groups were currently reported to have eating-related issues such as picky eating. Quality of life was good and present parenting stress was average in both groups. The majority of the mothers (87%) felt positive or neutral about the food challenge performed in infancy. Conclusions: The non-IgE cow's milk allergy with gastrointestinal symptoms diagnosed in infancy was a transient condition with good outcome. At an early school age, nearly all children have a good quality of life and a regular diet. The use of the double-blind, placebo-controlled food challenge was well-endorsed. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Increased Risk of Inflammatory Bowel Disease In A Population-Based Cohort Study of Patients with Hirschsprung Disease.

Objectives: Hirschsprung disease (HSCR) has previously been associated with inflammatory bowel disease (IBD). There are no data to show how common this association is. The aim of this study was to assess the risk of IBD in individuals with HSCR in a population-based cohort. Methods: This was a nationwide, population-based cohort study. The study exposure was HSCR and the study outcome was IBD. The cohort included all individuals with HSCR registered in the Swedish National Patient Register between 1964-2013 and ten age- and sex-matched controls per patient, randomly selected from the Swedish Population Register. Individuals with IBD were identified in the Swedish National Patient Register. Data were validated by checking for relevant surgical procedures, and, or prescription of drugs for IBD registered in the Swedish Drug Registry. Results: The cohort comprised 739 individuals with HSCR (565 males) and 7390 controls (5650 males). The median age at diagnosis of IBD was not different between the groups; 19 years (5-34) vs 21 years (7-37), p = 0.21. Twenty of the 739 individuals with HSCR and 41 of the 7390 controls had IBD, Odds ratio (OR) 4.99, 95% Confidence interval (CI) 2.85-8.45. In the exposed group, 15 individuals had Crohn's disease and 5 ulcerative colitis at their latest admission compared to 18 individuals with Crohn's disease and 23 with ulcerative colitis in the unexposed group, p = 0.030. Conclusion: There is an increased risk of IBD in patients with Hirschsprung disease, which should be considered in clinical practice. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Endoscopic and Histological Assessment of Paediatric Inflammatory Bowel Disease Over a Three Year Follow-up Period.

Objectives: Discrepancies between Inflammatory bowel disease (IBD) endoscopic/histological extent are documented at diagnosis. It is unclear whether these differences persist through disease course, with potential impact on categorisation and management. We aimed to analyse the progression of disease over a 3-year period. Methods: Patients aged = 1 repeat endoscopies. Disease extent reduced from diagnosis to first follow-up endoscopy for both endoscopic and histological disease extent (CD/UC/IBDU, all p =

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The Effect of Gluten Free Diet on Clinical Symptoms and the Intestinal Mucosa of Patients With Potential Celiac Disease.

In this prospective study, we evaluated the effect of gluten free diet (GFD) in a cohort of 65 children with potential celiac disease (PCD). Patients received GFD for signs/symptoms (N = 47) or parents' choice (N = 18). Most frequent signs/symptoms were low Body Mass Index (BMI) (36%), recurrent abdominal pain (34%) and diarrhea (19%). Of the 35/47 patients followed-up on GFD, only 54% (19/35) showed a complete clinical response. In 9/65 patients an intestinal biopsy was also performed after at least one year of GFD. No significant differences were observed in terms of Marsh grade (p = 0.33), lamina propria CD25+ cells (p = 0.80), CD3+ (p = 0.9) and [gamma][delta]+ (p = 0.59) intraepithelial lymphocytes density and intestinal anti-TG2 deposits (p = 0.60). In conclusion, caution is necessary before attributing all symptoms to gluten in this condition. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Sugar in Infants, Children and Adolescents: A Position Paper of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition.

The consumption of sugars, particularly sugar-sweetened beverages (SSBs; beverages or drinks that contain added caloric sweeteners (i.e. sucrose, high-fructose corn syrup, fruit-juice concentrates), in European children and adolescents exceeds current recommendations. This is of concern because there is no nutritional requirement for free sugars, and infants have an innate preference for sweet taste, which may be modified and reinforced by pre- and postnatal exposures. Sugar containing beverages/free sugars increase the risk for overweight/obesity and dental caries, can result in poor nutrient supply and reduced dietary diversity and may be associated with increased risk of type 2 diabetes mellitus, cardiovascular risk, and other health effects. The term 'free sugars', includes all monosaccharides/disaccharides added to foods/beverages by the manufacturer/cook/consumer, plus sugars naturally present in honey/syrups/unsweetened fruit juices and fruit juice concentrates. Sugar naturally present in intact fruits and lactose in amounts naturally present in human milk or infant formula, cow/goat milk and unsweetened milk products is not free sugar. Intakes of free sugars should be reduced and minimised with a desirable goal of = 2-18 years. Intakes should probably be even lower in infants and toddlers

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Development of the Aim To Decrease Anxiety and Pain Treatment (ADAPT) for pediatric functional abdominal pain disorders.

Objectives: To evaluate the feasibility and acceptability of the Aim to Decrease Anxiety and Pain Treatment (ADAPT), a brief, on-line and in-person behavioral intervention targeting pain and anxiety in youth with functional abdominal pain disorders (FAPD). Methods: Patients were recruited from several outpatient pediatric gastroenterology clinics. Nine participants (ages 9-13) completed the full protocol. Thematic analysis of detailed qualitative feedback was obtained via semi-structured patient and caregiver interviews after treatment was conducted. Feasibility and preliminary outcomes were examined using non parametric tests. Results: Preliminary results indicate that the ADAPT treatment is feasible, acceptable, and potentially effective for youth with FAPD. Treatment completers reported that they enjoyed the program and used the skills to manage their pain and worry. Results also indicated that the majority of participants experienced a reduction in anxiety and several reported reductions in pain and functional disability levels. Conclusions: Findings from this study suggest that targeting both pain and anxiety may positively impact outcomes in youth with FAPD. The ADAPT intervention has the potential to provide a cost effective and practical application of CBT using an innovative combination of in-person and technology-based platforms. Overall, the ADAPT intervention is a promising and innovative intervention to improve the outcomes of youth with FAPD. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Incidence and Risk Factors of Coagulation Profile Derangement After Liver Surgery: Implications for the Use of Epidural Analgesia-A Retrospective Cohort Study.

BACKGROUND: Hepatic surgery is a major abdominal surgery. Epidural analgesia may decrease the incidence of postoperative morbidities. Hemostatic disorders frequently occur after hepatic resection. Insertion or withdrawal (whether accidental or not) of an epidural catheter during coagulopathic state may cause an epidural hematoma. The aim of the study is to determine the incidence of coagulopathy after hepatectomy, interfering with epidural catheter removal, and to identify the risk factors related to coagulopathy. METHODS: We performed a retrospective review of a prospective, multicenter, observational database including patients over 18 years old with a history of liver resection. Main collected data were the following: age, preexisting cirrhosis, Child-Pugh class, preoperative and postoperative coagulation profiles, extent of liver resection, blood loss, blood products transfused during surgery. International normalized ratio (INR) >=1.5 and/or platelet count =1.3 (OR = 2.39 [1.10-5.17]; P = .027), preoperative platelet count =1000 mL (OR = 1.85 [1.08-3.18]; P = .025) were associated with postoperative coagulopathy. CONCLUSIONS: Coagulopathy is frequent (53.5% [95% confidence interval, 50.0-57.1]) after liver resection. Epidural analgesia seems safe in patients undergoing minor hepatic resection without preexisting hepatic cirrhosis, showing a normal preoperative INR and platelet count. (C) 2017 International Anesthesia Research Society

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Anesthesia Capacity in Ghana: A Teaching Hospital's Resources, and the National Workforce and Education.

BACKGROUND: Quality anesthetic care is lacking in low- and middle-income countries (LMICs). Global health leaders call for perioperative capacity reports in limited-resource settings to guide improved health care initiatives. We describe a teaching hospital's resources and the national workforce and education in this LMIC capacity report. METHODS: A prospective observational study was conducted at Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana, during 4 weeks in August 2016. Teaching hospital data were generated from observations of hospital facilities and patient care, review of archival records, and interviews with KATH personnel. National data were obtained from interviews with KATH personnel, correspondence with Ghana's anesthesia society, and review of public records. RESULTS: The practice of anesthesia at KATH incorporated preanesthesia clinics, intraoperative management, and critical care. However, there were not enough physicians to consistently supervise care, especially in postanesthesia care units (PACUs) and the critical care unit (CCU). Clean water and electricity were usually reliable in all 16 operating rooms (ORs) and throughout the hospital. Equipment and drugs were inventoried in detail. While much basic infrastructure, equipment, and medications were present in ORs, patient safety was hindered by hospital-wide oxygen supply failures and shortage of vital signs monitors and working ventilators in PACUs and the CCU. In 2015, there were 10,319 anesthetics administered, with obstetric and gynecologic, general, and orthopedic procedures comprising 62% of surgeries. From 2011 to 2015, all-cause perioperative mortality rate in ORs and PACUs was 0.65% or 1 death per 154 anesthetics, with 99% of deaths occurring in PACUs. Workforce and education data at KATH revealed 10 anesthesia attending physicians, 61 nurse anesthetists (NAs), and 7 anesthesia resident physicians in training. At the national level, 70 anesthesia attending physicians and 565 NAs cared for Ghana's population of 27 million. Providers were heavily concentrated in urban areas, and NAs frequently practiced independently. Two teaching hospitals provided accredited postgraduate training modeled after European curricula to 22 anesthesia resident physicians. DISCUSSION: While important limitations to capacity exist in Ghana, the overall situation is good compared to other LMICs. Many of the challenges encountered resulted from insufficient PACU and CCU provisions and few providers. Inadequate outcomes reporting made analysis and resolution of problem areas difficult. While many shortcomings stemmed from limited funding, strengthening physician commitment to overseeing care, ensuring oxygen supplies are uninterrupted, keeping ventilators in working order, and making vital signs monitors ubiquitously available are feasible ways to increase patient safety with the tools currently in place. (C) 2017 International Anesthesia Research Society

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MicroRNAs as Clinical Biomarkers and Therapeutic Tools in Perioperative Medicine.

Over the past decade, evolutionarily conserved, noncoding small RNAs-so-called microRNAs (miRNAs)-have emerged as important regulators of virtually all cellular processes. miRNAs influence gene expression by binding to the 3'-untranslated region of protein-coding RNA, leading to its degradation and translational repression. In medicine, miRNAs have been revealed as novel, highly promising biomarkers and as attractive tools and targets for novel therapeutic approaches. miRNAs are currently entering the field of perioperative medicine, and they may open up new perspectives in anesthesia, critical care, and pain medicine. In this review, we provide an overview of the biology of miRNAs and their potential role in human disease. We highlight current paradigms of miRNA-mediated effects in perioperative medicine and provide a survey of miRNA biomarkers in the field known so far. Finally, we provide a perspective on miRNA-based therapeutic opportunities and perspectives. 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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Optimal Dose of Perineural Dexamethasone to Prolong Analgesia After Brachial Plexus Blockade: A Systematic Review and Meta-Analysis.

BACKGROUND: Perineural dexamethasone has gained popularity in regional anesthesia to prolong analgesia duration. However, uncertainty remains regarding the optimal perineural dose. Clarification of this characteristic is of significant importance as the administration of dexamethasone may lead to dose-dependent complications. The objective of this meta-analysis was to define the optimal perineural dexamethasone dose to prolong analgesia after brachial plexus blockade for adult patients undergoing upper limb surgery. METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines and searched databases including MEDLINE, PubMed, and EMBASE until January 2017, without language restriction. Only trials comparing perineural dexamethasone and local anesthetics with local anesthetics alone for brachial plexus blocks were included in the present meta-analysis. The Cochrane Collaboration's Risk of Bias Tool was used to assess the methodological quality of each trial and meta-analyses were performed following a random effects model. The primary outcome was duration of analgesia for each type of local anesthetic (short-/intermediate-acting and long-acting local anesthetics). A meta-regression followed by a subgroup analysis were performed to assess the impact of different perineural dexamethasone doses on duration of analgesia; for the latter analysis, trials were grouped in low (1-4 mg) and moderate (5-10 mg) dexamethasone doses. Secondary outcomes included the rate of neurologic complication and resting pain scores and morphine consumption within the first 24 hours. RESULTS: Thirty-three controlled trials, including 2138 patients, were identified. The meta-regression revealed a ceiling effect with a perineural dexamethasone dose of 4 mg when combined with short-/intermediate-acting (8 trials; 366 participants) or long-acting local anesthetics (23 trials; 1869 participants). This finding was confirmed by subgroup analyses comparing low and moderate dexamethasone doses. With short-/intermediate-acting local anesthetics, the mean difference (95% confidence interval) of analgesia duration with low and moderate doses was 277 (234-322) minutes and 229 (161-297) minutes, respectively. With long-acting local anesthetics, the mean differences with low and moderate doses were 505 (342-669) minutes and 509 (443-575) minutes. Perineural dexamethasone did not increase the rate of neurologic complications (risk ratio [95% confidence interval], 1.40 [0.54-3.63]). The Grades of Recommendation, Assessment, Development, and Evaluation quality of evidence for the primary and secondary outcomes were very low, due mainly to limitations, inconsistency, indirectness, and publication bias. CONCLUSIONS: There is currently very low quality evidence that 4 mg of perineural dexamethasone represents a ceiling dose that prolongs analgesia duration by a mean period of 6 and 8 hours when combined with short-/intermediate- or long-acting local anesthetics, respectively. Additional data are needed to explore the threshold for this effect, particularly with doses below 4 mg. The risk of neurologic complications is probably not increased (very low evidence). (C) 2017 International Anesthesia Research Society

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Use of Regional Anesthesia for Outpatient Surgery Within the United States: A Prevalence Study Using a Nationwide Database.

BACKGROUND: Regional anesthesia is of benefit for outpatient surgery given its demonstrated improvement in analgesia and decrease in complications, resulting in shorter average recovery room times and lower hospital readmission rates. Unfortunately, there are few epidemiological studies outlining the overall utilization of peripheral nerve blocks (PNBs) in this setting. Therefore, the primary objective of this study was to report the overall utilization of several types of PNBs among all candidate cases in the outpatient setting within the United States. METHODS: We identified all cases from the National Anesthesia Clinical Outcomes Registry that were performed as an outpatient surgery. We reported the frequency of various types of PNBs among all candidate cases, defined as cases that potentially could have received a PNB. Changes in prevalence of PNB utilization from 2010 to 2015 were analyzed by using logistic regression. RESULTS: Of the 12,911,056 outpatient surgeries in the National Anesthesia Clinical Outcomes Registry, 3,297,372 (25.5%) were amenable to a PNB. However, the overall PNB frequency was only 3.3% of the possible cases. The overall utilization for PNB of the brachial plexus, sciatic nerve, and femoral nerve were 6.1%, 1.5%, and 1.9%, respectively. The surgical procedures generating the highest volume of PNBs were shoulder arthroscopies and anterior cruciate ligament reconstruction, in which 41% and 32% received a PNB, respectively. During this time period, there was a significant increase in overall PNB utilization for both single-injection and continuous PNB (P

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The "Ear-Sternal Notch" Line-How Should You Lie?.

No abstract available

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Endoscopic Versus Open Repair for Craniosynostosis in Infants Using Propensity Score Matching to Compare Outcomes: A Multicenter Study from the Pediatric Craniofacial Collaborative Group.

BACKGROUND: The North American Pediatric Craniofacial Collaborative Group (PCCG) established the Pediatric Craniofacial Surgery Perioperative Registry to evaluate outcomes in infants and children undergoing craniosynostosis repair. The goal of this multicenter study was to utilize this registry to assess differences in blood utilization, intensive care unit (ICU) utilization, duration of hospitalization, and perioperative complications between endoscopic-assisted (ESC) and open repair in infants with craniosynostosis. We hypothesized that advantages of ESC from single-center studies would be validated based on combined data from a large multicenter registry. METHODS: Thirty-one institutions contributed data from June 2012 to September 2015. We analyzed 1382 infants younger than 12 months undergoing open (anterior and/or posterior cranial vault reconstruction, modified-Pi procedure, or strip craniectomy) or endoscopic craniectomy. The primary outcomes included transfusion data, ICU utilization, hospital length of stay, and perioperative complications; secondary outcomes included anesthesia and surgical duration. Comparison of unmatched groups (ESC: N = 311, open repair: N = 1071) and propensity score 2:1 matched groups (ESC: N = 311, open repair: N = 622) were performed by conditional logistic regression analysis. RESULTS: Imbalances in baseline age and weight are inherent due to surgical selection criteria for ESC. Quality of propensity score matching in balancing age and weight between ESC and open groups was assessed by quintiles of the propensity scores. Analysis of matched groups confirmed significantly reduced utilization of blood (26% vs 81%, P

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Consensus Statement by the Congenital Cardiac Anesthesia Society: Milestones for the Pediatric Cardiac Anesthesia Fellowship.

Pediatric cardiac anesthesiology has evolved as a subspecialty of both pediatric and cardiac anesthesiology and is devoted to caring for individuals with congenital heart disease ranging in age from neonates to adults. Training in pediatric cardiac anesthesia is a second-year fellowship with variability in both training duration and content and is not accredited by the Accreditation Council on Graduate Medical Education. Consequently, in this article and based on the Accreditation Council on Graduate Medical Education Milestones Model, an expert panel of the Congenital Cardiac Anesthesia Society, a section of the Society of Pediatric Anesthesiology, defines 18 milestones as competency-based developmental outcomes for training in the pediatric cardiac anesthesia fellowship. (C) 2017 International Anesthesia Research Society

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Perioperative Inflammation and Its Modulation by Anesthetics.

Surgery and other invasive procedures, which are routinely performed during general anesthesia, may induce an inflammatory response in the patient. This inflammatory response is an inherent answer of the body to the intervention and can be both beneficial and potentially harmful. The immune system represents a unique evolutionary achievement equipping higher organisms with an effective defense mechanism against exogenous pathogens. However, not only bacteria might evoke an immune response but also other noninfectious stimuli like the surgical trauma or mechanical ventilation may induce an inflammatory response of varying degree. In these cases, the immune system activation is not always beneficial for the patients and might carry the risk of concomitant, harmful effects on host cells, tissues, or even whole organ systems. Research over the past decades has contributed substantial information in which ways surgical patients may be affected by inflammatory reactions. Modulations of the patient's immune system may be evoked by the use of anesthetic agents, the nature of surgical trauma and the use of any supportive therapy during the perioperative period. The effects on the patient may be manifold, including various proinflammatory effects. This review focuses on the causes and effects of inflammation in the perioperative period. In addition, we also highlight possible approaches by which inflammation in the perioperative may be modulated in the future. (C) 2017 International Anesthesia Research Society

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Efficacy Outcome Measures for Pediatric Procedural Sedation Clinical Trials: An ACTTION Systematic Review.

Objective evaluations comparing different techniques and approaches to pediatric procedural sedation studies have been limited by a lack of consistency among the outcome measures used in assessment. This study reviewed those existing measures, which have undergone psychometric analysis in a pediatric procedural sedation setting, to determine to what extent and in what circumstances their use is justified across the spectrum of procedures, age groups, and techniques. The results of our study suggest that a wide range of measures has been used to assess the efficacy and effectiveness of pediatric procedural sedation. Most lack the evidence of validity and reliability that is necessary to facilitate rigorous clinical trial design, as well as the evaluation of new drugs and devices. A set of core pediatric sedation outcome domains and outcome measures can be developed on the basis of our findings. We believe that consensus among all stakeholders regarding appropriate domains and measures to evaluate pediatric procedural sedation is possible and that widespread implementation of such recommendations should be pursued. (C) 2017 International Anesthesia Research Society

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Minimizing the Harm of Accidental Awareness Under General Anesthesia: New Perspectives From Patients Misdiagnosed as Being in a Vegetative State.

No abstract available

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In Response: Comment on "Assessing the Utility of Fluoroscopy for Thoracic Epidural Catheter Placement: What End Points Are Important?".

No abstract available

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Effect of High Inspiratory Oxygen Fraction on Endothelial Function in Healthy Volunteers: A Randomized Controlled Crossover Pilot Study.

It has been suggested that high inspiratory oxygen concentrations during anesthesia may be associated with higher postoperative mortality due to endothelial dysfunction. A randomized controlled crossover study was conducted with 25 healthy male volunteers. They inhaled an oxygen concentration of 30% and 80%. The endothelial function was assessed using noninvasive digital pulse amplitude tonometry (EndoPAT) supported by endothelial biomarkers. The difference in endothelial function between the 2 treatments was 0.05 (95% confidence interval, -0.36 to 0.27; P = .77). Endothelial biomarkers were unaffected. Inhalation of a high oxygen fraction in healthy volunteers did not result in a significant reduction of endothelial function. (C) 2017 International Anesthesia Research Society

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Escaping Virgil's underworld: dissociating Aeneas's task from his toil

Abstract

When Virgil's hero Aeneas sought to return from the underworld the task (power output) was carefully discriminated from the toil (exercise intensity) "hoc opus, hic labor est".

This article is protected by copyright. All rights reserved



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The Placement of Syringe Labels May Reduce Medication Errors and Cognitive Load

No abstract available

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A Risky Proposition: Blood Transfusion and the Risk of Surgical Site Infections

imageNo abstract available

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The Perioperative Surgical Home: A New Role for the Acute Pain Service

imageNo abstract available

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Opioid-Free Analgesia in the Era of Enhanced Recovery After Surgery and the Surgical Home: Implications for Postoperative Outcomes and Population Health

imageNo abstract available

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Tablet e-Logbooks: Four Thousand Clinical Cases and Complications e-Logged by 14 Nondoctor Anesthesia Providers in Nepal

imageBACKGROUND: To meet the need for essential surgery across rural Nepal, anesthesia at district level is delivered by nondoctor anesthetists. They require support to maintain confidence and competence, and upgraded professional registration to secure their status. To meet these needs, a distance-blended learning course was pioneered and delivered. A core course requirement was to log all clinical cases; these were logged on a new e-logbook. METHODS: Fourteen nondoctor anesthesia providers working in 12 different districts across Nepal were enrolled in the 1-year course. The course is based on self-completion on a tablet loaded with new learning modules, a resource library, and a case logbook. Continuous educational mentoring was provided by anesthesiologists by phone and email. The logbook included preanesthesia assessment and interventions, American Society of Anesthesiologists (ASA) grading, types of cases and anesthesia given, monitors used, complications, outcomes and free text remarks. Cases were uploaded monthly to a database, and mentors reviewed all logbook entries. RESULTS: The 14 nondoctor anesthesia providers were widely distributed across the country in district, zonal, community, and mission hospitals, and had different levels of clinical experience and caseloads. Logbooks and uploads were regularly completed without difficulty; 1% cases were entered incompletely with no case details provided. A total of 4143 cases were recorded. Annual caseload per nondoctor anesthesia provider ranged from 50 to 788, the majority of which were under spinal anesthesia; 34% of the total cases were cesarean deliveries, of which 99% received spinal anesthesia. Fifty gastrointestinal laparotomies (1% total) were recorded. Ninety-one percent of cases were ASA I, 0.8% ASA III/IV. Pulse oximetry was used in 98% of cases. Complications were recorded in 6% of cases; the most common were circulation problems (69%) including hypotension and occasional bradycardia after spinal anesthesia. Airway complications were usually under ketamine anesthesia requiring basic airway maneuvers; 4 difficult intubations were recorded under general anesthesia. Anesthesia outcomes were good with overall mortality of 0.1% (total 4 cases). Causes of death included severe preeclampsia, sepsis postlaparotomy, and patients with multiorgan failure for minor procedure. CONCLUSIONS: The tablet-based electronic anesthesia logbook was successfully used to record cases, complications, and outcomes across rural Nepal. The nondoctor anesthesia providers had trust and confidence in recording outcomes. It remains to be tested whether an e-logbook would be routinely completed outside of a specific training course. Such a logbook could be incorporated into all continuous professional development programs for rural nondoctor anesthetists.

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