Do male athletes with already high initial hemoglobin mass benefit from ‘live high–train low’ altitude training?

Abstract

It has been proposed that athletes with high initial values of hemoglobin mass (Hb_mass) will have a lower Hb_mass increase in response to 'live high-train low' (LHTL) altitude training. To verify this assumption, the relationship between initial absolute and relative Hb_mass values and their respective Hb_mass increase following LHTL in male endurance and team-sport athletes was investigated. Overall, 58 male athletes (35 well-trained endurance athletes and 23 elite male field hockey players) undertook an LHTL training camp with similar hypoxic doses (200–230 h). Hb_mass was measured in duplicate pre- and post-LHTL with the carbon monoxide rebreathing method. While there was no relationship (r = 0.02, P = 0.91) between initial absolute Hb_mass (g) and percentage increase in absolute Hb_mass, a moderate relationship (r = −0.31, P = 0.02) between initial relative Hb_mass (g·kg⁻¹) and percentage increase in relative Hb_mass was detected. Mean absolute and relative Hb_mass increased to a similar extent (P ≥ 0.81) in endurance (from 916 ± 88 to 951 ± 96 g, +3.8%, P < 0.001 and from 13.1 ± 1.2 to 13.6 ± 1.1 g·kg⁻¹, +4.1%, P < 0.001) and team-sport (from 920 ± 120 to 957 ± 127 g, +4.0%, P < 0.001 and from 11.9 ± 0.9 to 12.3 ± 0.9 g·kg⁻¹, +4.0%, P < 0.001) athletes following LHTL. The direct comparison study using individual data of male endurance and team-sport athletes and strict methodological control (duplicate Hb_mass-measures, matched-hypoxic dose) indicated that even athletes with higher initial Hb_mass can reasonably expect Hb_mass gain post-LHTL.

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Oceanic dispersion of Fukushima-derived Cs-137 simulated by multiple oceanic general circulation models

Publication date: December 2017
Source:Journal of Environmental Radioactivity, Volume 180
Author(s): Hideyuki Kawamura, Akiko Furuno, Takuya Kobayashi, Teiji In, Tomoharu Nakayama, Yoichi Ishikawa, Yasumasa Miyazawa, Norihisa Usui
To understand the concentration and amount of Fukushima-derived Cs-137 in the ocean, this study simulated the oceanic dispersion of Cs-137 by atmospheric and oceanic dispersion simulations. The oceanic dispersion simulations were carried out with an oceanic dispersion model and multiple oceanic general circulation models. The Cs-137 concentrations were sensitive to ocean currents in the coastal, offshore, and open oceans. The mean Cs-137 concentrations of the multiple models relatively well agreed with the observed concentrations in the coastal and offshore oceans during the first few months after the Fukushima disaster, and in the open ocean during the first year after the disaster. The Cs-137 amounts were quantified in the coastal, offshore, and open oceans during the first year after the disaster. It was suggested that Cs-137 actively dispersed from the coastal and offshore oceans to the open ocean, and from the surface layer to the deeper layers in the North Pacific.



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Application of ISOCS system in the laboratory efficiency calibration

Publication date: Available online 10 October 2017
Source:Journal of Environmental Radioactivity
Author(s): Dominik Grządziel, Krzysztof Kozak, Jadwiga Mazur, Mariusz Mroczek
ISOCS (In Situ Counting Object System) from Canberra is applied in laboratory for creating efficiency calibrations of good quality without using radioactive standards. Besides of typical sample containers used in laboratory, ISOSC system also allows modelling containers and objects of almost any shape and elemental composition.The study was based on gamma spectrometry with HPGe semiconductor detector with electronics and software spectrum analysis GENIE 2000 + ISOCS. Measuring set is equipped with portable shield system with set of collimators ISOCS Shield Systems Model ISOXSHLD from Canberra. This shielding system provides attenuation of gamma background radiation with average value 33 (for gamma energies from 186 keV to 2615.5 keV).The portable shield system can be used for low-background laboratory measurements. For this purpose a measuring vessel of new geometry was constructed: the polystyrene cylinder with a height of 40 mm and a diameter of 70 mm. The efficiency calibration for this container was performed using both ISOCS system and classical calibration standard in the same geometry. In order to verify the correctness of performed calibration procedures, the measurements of radioactive standard CBSS 2 were made. The results of both calibrations were compared with the data from the standard certificate. Satisfactory agreement was achieved. Mean percentage difference between results from ISOCS calibration compared to reference values is 6% for all isotopes activities in CBSS 2 standard.The set of collimators was used to develop efficiency calibration for in situ measurements of the soil surface. Test measurements were carried out at the area of the Institute of Nuclear Physics Polish Academy of Sciences in Kraków, Poland (IFJ PAN). Two measurement methods were compared: in situ and laboratory gamma spectroscopy. The obtained average results (from all 10 measuring points) are consistent within the range of measurement uncertainty.



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Tonic inhibition of brown adipose tissue sympathetic nerve activity via muscarinic acetylcholine receptors in the rostral raphe pallidus

Abstract

We sought to determine if body temperature and energy expenditure are influenced by a cholinergic input to neurons in the rostral raphe pallidus (rRPa), the site of sympathetic premotor neurons controlling brown adipose tissue (BAT) thermogenesis. Nanoinjections of the muscarinic acetylcholine receptor (mAChR) receptor agonist, oxotremorine, or the cholinesterase inhibitor, neostigmine (NEOS), in the rRPa of anaesthetized rats decreased cold-evoked BAT sympathetic nerve activity (SNA, nadirs: −72%, and −95%), BAT temperature (TBAT, −0.5°C and −0.6°C), expired CO₂ (Exp. CO₂, −0.3% and −0.5%), and heart rate (HR, −22 bpm and −41 bpm). NEOS into rRPa reversed the increase in BAT SNA evoked by blockade of GABA receptors in rRPa. Nanoinjections of the mAChR antagonist, scopolamine (SCOP), in the rRPa of warm rats increased BAT SNA (peak: +1087%), TBAT (+1.8°C), Exp. CO₂ (+0.7%), core temperature (TCORE, +0.5°C), and HR (+54 bpm). SCOP nanoinjections in rRPa produced similar activations of BAT during cold exposure, following a brain transection caudal to the hypothalamus, and during the blockade of glutamate receptors in rRPa. We conclude that a tonically-active cholinergic input to the rRPa inhibits BAT SNA via activation of local mAChR. The inhibition of BAT SNA mediated by mAChR in rRPa does not depend on activation of GABA receptors in rRPa. The increase in BAT SNA following mAChR blockade in rRPa does not depend on the activity of neurons in the hypothalamus or on glutamate receptor activation in rRPa.

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On neuromechanical approaches for the study of biological and robotic grasp and manipulation

Biological and robotic grasp and manipulation are undeniably similar at the level of mechanical task performance. However, their underlying fundamental biological vs. engineering mechanisms are, by definition,...

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Postoperative rehabilitation following thumb base surgery: a systematic review of the literature

Publication date: Available online 10 October 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Robbert M. Wouters, Jonathan Tsehaie, Steven E.R. Hovius, Burcu Dilek, Ruud W. Selles
ObjectiveTo provide an overview of rehabilitation for patients who underwent CMC-1 arthroplasty, with emphasis on early active mobilization.Data Sources/Study SelectionPubMed/MEDLINE, Embase, CINAHL and Cochrane were searched for articles written in English that described postoperative regime (including immobilization period/method and/or description of exercises/physical therapy, follow-up ≥six weeks) on CMC-1 arthroplasty.Data ExtractionThe PRISMA statement was used as guidance in this review and methodological quality was assessed using the Effective Public Health Practice Project quality assessment tool. Randomized studies were additionally scored using the Physiotherapy Evidence Database scale.Data SynthesisTwenty-seven studies were included, concerning 1015 participants in whom 1118 surgical procedures were performed. A summary on the components of postoperative rehabilitation used in the included studies on CMC-1 OA is presented for different surgical interventions. We found that early active recovery (including short immobilization, early initiation of ROM and strength exercises) provides positive outcomes on pain, limitations in ADL and grip & pinch strength, but comparative studies are lacking. Furthermore, three postoperative exercises/therapy phases were identified in the literature: the 'acute phase', the 'unloaded phase' and the 'functional phase', but again comparative studies are lacking.ConclusionsEarly active recovery is used more often in the literature and does not lead to worse outcomes or more complications. This systematic review provides guidance for clinicians in the content of postoperative rehabilitation on CMC-1 arthroplasty. The review also clearly identifies the almost complete lack of high quality, comparative studies on postoperative rehabilitation after CMC-1 arthroplasty.



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Medical Safety Huddles in Rehabilitation – A Novel Patient Safety Strategy

Publication date: Available online 10 October 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Meiqi Guo, Gaetan Tardif, Mark Bayley
ObjectiveTo describe the implementation process, outcomes, and lessons learned in the implementation of medical safety huddles, a novel patient safety monitoring strategy that promotes physician engagement with patient safety.DesignSingle-centre observational study.SettingThe Brain and Spinal Cord Injury Rehabilitation Program (BSCIRP) at an urban, academic adult rehabilitation hospital.Participants18 physicians associated with the program.InterventionsWeekly physicians' safety huddles were implemented to review, anticipate, and address patient safety issues.Main Outcome MeasuresThe main outcome measures were the number and nature of identified and anticipated patient safety incidents, actions taken and physician attendance during huddles. The number of adverse events in the program before and after huddle implementation were secondary measures.ResultsOver a 7-month period, average physician attendance at medical huddles was 76.0%. 1.0±0.8 patient safety incidents and 3.2±2.1 anticipated patient safety issues were identified in each weekly huddle. The majority of patient safety incidents identified were clinical administrative and clinical process-related, which differed from information gathered from the organization's pre-existing patient safety monitoring strategies. A total of 79 actions, or 3.3±1.8 actions/huddle were taken in response to improve patient safety for the program. Adverse events decreased from 31.2/month (95% confidence interval[CI] 27.0-35.3) to 22.9/month (CI 19.3-26.5) after implementation.Conclusion(s)Medical safety huddles are a novel strategy to engage physicians in patient safety and organizational quality improvement. They have the potential to enhance organizational anticipation of safety risks by supplementing existing methods. Other rehabilitation settings may wish to consider implementing and evaluating similar huddles into their existing patient safety and quality improvement frameworks.



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Reply to “Comment on “Ecological niche of Neanderthals from Spy Cave revealed by nitrogen isotopes of individual amino acids in collagen.” [J. Hum. Evol. 93 (2016) 82–90]” [J. Hum. Evol. (in press)]

Publication date: Available online 10 October 2017
Source:Journal of Human Evolution
Author(s): Yuichi I. Naito, Yoshito Chikaraishi, Dorothée G. Drucker, Naohiko Ohkouchi, Patrick Semal, Christoph Wißing, Hervé Bocherens




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The Efficacy of Peripheral Opioid Antagonists in Opioid-Induced Constipation and Postoperative Ileus: A Systematic Review of the Literature.

Opioid-induced constipation has a negative impact on quality of life for patients with chronic pain and can affect more than a third of patients. A related but separate entity is postoperative ileus, which is an abnormal pattern of gastrointestinal motility after surgery. Nonselective [mu]-opioid receptor antagonists reverse constipation and opioid-induced ileus but cross the blood-brain barrier and may reverse analgesia. Peripherally acting [mu]-opioid receptor antagonists target the [mu]-opioid receptor without reversing analgesia. Three such agents are US Food and Drug Administration approved. We reviewed the literature for randomized controlled trials that studied the efficacy of alvimopan, methylnaltrexone, and naloxegol in treating either opioid-induced constipation or postoperative ileus. Peripherally acting [mu]-opioid receptor antagonists may be effective in treating both opioid-induced bowel dysfunction and postoperative ileus, but definitive conclusions are not possible because of study inconsistency and the relatively low quality of evidence. Comparisons of agents are difficult because of heterogeneous end points and no head-to-head studies. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

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Bleeding and Neurologic Complications in 58,000 Interventional Pain Procedures.

Background and Objectives: Interventional pain procedures are commonly performed on patients receiving antiplatelet therapy. However, there is limited evidence to support or refute the safety of this practice. The goal of this investigation was to assess the rate of bleeding complications in a large cohort of patients undergoing intermediate- and low-risk pain procedures, with a specific focus on antiplatelet and anticoagulant medication use and baseline coagulation abnormalities. Methods: This is a retrospective cohort study of adult patients undergoing low- and intermediate-risk pain procedures from 2005 through 2014 by the division of pain medicine at a single academic tertiary care center. Baseline characteristics, antiplatelet and anticoagulant medication use, coagulation parameters, and procedural details were extracted from the electronic medical record. The primary outcome was a bleeding-related complication requiring emergency medicine, neurology, or neurosurgical evaluation within 31 days. The secondary outcome was the presence or absence of a periprocedural red blood cell transfusion occurring within 72 hours of needle placement. Results: A total of 58,066 procedures were performed on 24,590 unique patients. Preprocedural aspirin or nonsteroidal anti-inflammatory drug therapy was present for 17,825 procedures (30.7%). Sixteen procedures were associated with perioperative red blood cell transfusion (0.03%), with no difference based on preprocedural nonsteroidal anti-inflammatory drug, including aspirin, or other anticoagulation use (P = 0.107). Five patients (0.009%) had a neurologic complication requiring further evaluation, of which 2 were likely related to procedural bleeding. Conclusions: Bleeding complications are rare in patients undergoing low- or intermediate-risk pain procedures even in the presence of antiplatelet medications. This is consistent with recently released guidelines. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

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Pectoral Fascial (PECS) I and II Blocks as Rescue Analgesia in a Patient Undergoing Minimally Invasive Cardiac Surgery.

Introduction: Patients undergoing minimally invasive cardiac surgery have the potential for significant pain from the thoracotomy site. We report the successful use of pectoral nerve block types I and II (Pecs I and II) as rescue analgesia in a patient undergoing minimally invasive mitral valve repair. Case Report: In this case, a 78-year-old man, with no history of chronic pain, underwent mitral valve repair via right anterior thoracotomy for severe mitral regurgitation. After extubation, he complained of 10/10 pain at the incision site that was minimally responsive to intravenous opioids. He required supplemental oxygen because of poor pulmonary mechanics, with shallow breathing and splinting due to pain, and subsequent intensive care unit readmission. Ultrasound-guided Pecs I and II blocks were performed on the right side with 30 mL of 0.2% ropivacaine with 1:400,000 epinephrine. The blocks resulted in near-complete chest wall analgesia and improved pulmonary mechanics for approximately 24 hours. After the single-injection blocks regressed, a second set of blocks was performed with 266 mg of liposomal bupivacaine mixed with bupivacaine. This second set of blocks provided extended analgesia for an additional 48 hours. The patient was weaned rapidly from supplemental oxygen after the blocks because of improved analgesia. Conclusions: Pectoral nerve blocks have been described in the setting of breast surgery to provide chest wall analgesia. We report the first successful use of Pecs blocks to provide effective chest wall analgesia for a patient undergoing minimally invasive cardiac surgery with thoracotomy. We believe that these blocks may provide an important nonopioid option for the management of pain during recovery from minimally invasive cardiac surgery. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

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Network of nutrient-sensing pathways and a conserved kinase cascade integrate osmolarity and carbon sensing in Neurospora crassa [Genetics]

Identifying nutrients available in the environment and utilizing them in the most efficient manner is a challenge common to all organisms. The model filamentous fungus Neurospora crassa is capable of utilizing a variety of carbohydrates, from simple sugars to the complex carbohydrates found in plant cell walls. The zinc binuclear...

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Physical proximity of chromatin to nuclear pores prevents harmful R loop accumulation contributing to maintain genome stability [Genetics]

During transcription, the mRNA may hybridize with DNA, forming an R loop, which can be physiological or pathological, constituting in this case a source of genomic instability. To understand the mechanism by which eukaryotic cells prevent harmful R loops, we used human activation-induced cytidine deaminase (AID) to identify genes preventing...

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Perioperative point of care ultrasound in ambulatory anesthesia: thinking beyond nerve blocks.

Purpose of review: Ultrasound has become readily available in the perioperative area. In this review, we aim to bring forth some uses of ultrasound beyond that in regional anesthesia. Recent findings: Critical care and emergency physicians have embraced ultrasound in their respective fields. We as anesthesiologists and practitioners of acute care medicine are not immune to this penetration. There is been a lot of recent literature on the various uses of perioperative point of care ultrasound. Our review summarizes the recent data and provides the reader with an overall idea of the uses of ultrasound in the perioperative arena. Summary: Focus towards improving patient outcomes is the goal of all physicians and point of care ultrasound is one modality that can help us manage some common conditions in the perioperative period. Perioperative point of care ultrasound training may soon become a prerequisite for an anesthesiology residency. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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History of concussion impacts electrophysiological correlates of working memory

Publication date: Available online 10 October 2017
Source:International Journal of Psychophysiology
Author(s): Caitlin M. Hudac, Cathryn S. Cortesa, Patrick S. Ledwidge, Dennis L. Molfese
Sports-related concussions occur in approximately 21% of college athletes with implications for long-term cognitive impairments in working memory. Working memory involves the capacity to maintain short-term information and integrate with higher-order cognitive processing for planning and behavior execution, critical skills for optimal cognitive and athletic performance. This study quantified working memory impairments in 36 American football college athletes (18–23years old) using event-related potentials (ERPs). Despite performing similarly in a standard 2-back working memory task, athletes with history of concussion exhibited larger P1 and P3 amplitudes compared to Controls. Concussion History group latencies were slower for the P1 and faster for the N2. Source estimation analyses indicated that previously concussed athletes engaged different brain regions compared to athletes with no concussion history. These findings suggest that ERPs may be a sensitive and objective measure to detect long-term cognitive consequences of concussion.



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Duplication of Yq- and proximal Yp-arms with deletion of almost all PAR1 (including SHOX) in a young man with non-obstructive azoospermia, short stature and skeletal defects

Abstract

Duplications of Yq arm (and AZF) seems to be tolerated by fertile males, while mutations, deletions, duplications or haploinsufficiency of SHOX can originate a wide range of phenotypes, including short stature and skeletal abnormalities. We report a case of non-obstructive azoospermia in a young man with short stature, skeletal anomalies, normal intelligence and hormonal parameters. This male showed a very singular Y-chromosome aberration, consisting of a duplication of Yq and proximal regions of Yp, with a deletion of almost all PAR1 in Yptel, including SHOX. CBA- and RBA-banding and FISH-mapping with telomeric, centromeric, AZF and SHOX probes were used. These results were confirmed by array CGH, which revealed the following karyotype constitution: arr [hg19] Xp22.33 or Yp11.32p11.31 (310,932–2,646,815 or 260,932–2,596,815) ×1, Yp11.2q12 (8,641,183–59,335,913) ×2. We conclude that the haploinsufficience of SHOX may be the cause of short stature and skeletal defects in the patient, while the non-obstructive azoospermia could be related to the lack of X–Y pairing during meiosis originated by the anomalous configuration of this chromosome abnormality and large deletion which occurred in Yp-PAR1.

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Wide phenotypic spectrum in axonal Charcot–Marie–Tooth neuropathy type 2 patients with KIF5A mutations

Abstract

The kinesin heavy chain isoform 5A (KIF5A) gene, which encodes a microtubule-based motor protein, plays an important role in the transport of organelles in the nerve cells. Mutations in the KIF5A showed a wide phenotypic spectrum from hereditary spastic paraplegia (HSP) to axonal Charcot–Marie–Tooth peripheral neuropathy type 2 (CMT2). This study identified three pathogenic KIF5A mutations in Korean CMT2 patients by whole exome sequencing. Two mutations (p.Arg204Trp and p.Arg280His) were previously reported, but p.Leu558Pro was determined to be a novel de novo mutation. All the mutations were not observed in the healthy controls and were located in highly conserved domains among vertebrate species. The p.Arg204Trp mutation was identified from a CMT2 patient with additional complex phenotypes of HSP, ataxia, fatigability and pyramidal sign, but the p.Arg280His and p.Leu588Pro mutations were identified in each axonal CMT2 patient. The p.Arg204Trp mutation was previously reported in a HSP patient with no CMT symptom. The p.Arg280His mutation was reported in a CMT2 patient, which was similarly with our case. However, it was also once reported in a HSP patient with pes cavus. As the first report in Korea, this study identified three KIF5A mutations as the underlying cause of axonal peripheral neuropathy with or without the HSP phenotype. We confirmed a wide inter- and intra-allelic phenotypic spectrum by the mutations in the KIF5A.

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Genetics in Pulmonary Arterial Hypertension in a Large Homogeneous Japanese Population

Abstract

Pulmonary arterial hypertension (PAH) is a rare but serious disease with a grave prognosis. Bone morphogenetic protein type 2 receptor (BMPR2) gene is a strong pathogenic factor for PAH. As a collaborative team from Kyorin University and Keio University in Japan, we have analyzed the BMPR2 gene in 356 probands and more than 50 family members, including secondary patients. Importantly, the study population is a racially, ethnically, and socially homogeneous population. In PAH patients, there is a high incidence of unique mutations in BMPR2, and several mutations are frequently observed in the Japanese population, suggesting that these common and recurring mutations may be highly pathogenic or have high penetrance, explaining why they are found frequently throughout the world. We have also mapped each breakpoint of exonic deletions/duplications and found that most break and rejoining points are in the Alu elements. Reviewing the distribution of the reported mutations on each exon of BMPR2 revealed that the number and frequency of mutations are imbalanced among exons. The penetrance of BMPR2 gene mutations was threefold higher in females than males. Full elucidation of BMPR2-mediated pathogenic mechanisms in PAH requires persistent efforts to achieve precision or individualized medicine as a therapeutic strategy for PAH.

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First direct evidence of involvement of a homozygous loss-of-function variant in the EPS15L1 gene underlying split-hand/split-foot malformation

ABSTRACT

Split-hand/split-foot malformation (SHFM) is a severe form of congenital limb deformity characterized by the absence of one or more digits and/or variable degree of median clefts of hands and feet. The present study describes an investigation of a consanguineous family of Pakistani origin segregating SHFM in an autosomal recessive manner. Human genome scan using SNP markers followed by whole exome sequencing revealed a frameshift deletion (c.409delA, p.Ser137Alafs*19) in the EPS15L1 gene located on chromosome 19p13.11. This is the first biallelic variant identified in the EPS15L1 gene underlying SHFM. Our findings report the first direct involvement of EPS15L1 gene in the development of human limbs.

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Clinician's guide to genes associated with Rett-like phenotypes – Investigation of a Danish cohort and review of the literature

Abstract

The differential diagnostics in Rett syndrome has evolved with the development of next generation sequencing based techniques and many patients have been diagnosed with other syndromes or variants in newly described genes where the associated phenotype(s) is yet to be fully explored. The term Rett-like refers to phenotypes with distinct overlapping features of Rett syndrome where the clinical criteria are not completely fulfilled. In this paper we have combined a review of Rett-like disorders with data from a Danish cohort of 35 patients with Rett-like phenotypes emphasizing the diagnostic overlap with Pitt-Hopkins syndrome, Cornelia de Lange syndrome with SMC1A variants, and epileptic encephalopathies for example due to STXBP1 variants. We also found a patient with a pathogenic variant in KCNB1, which has not previously been linked to a Rett-like phenotype. This study underlines the clinical and genetic heterogeneity of a Rett syndrome spectrum, and provides an overview of the Rett syndrome-related genes described to date, and hence serves as a guide for diagnosing patients with Rett-like phenotypes.

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Plasma membrane Ca2+ ATPase 1 is required for maintaining atrial Ca2+ homeostasis and electrophysiological stability in the mouse

Abstract

To determine the role of PMCA1 in maintaining Ca²⁺ homeostasis and electrical stability in the atrium under physiological and stress conditions, mice with a cardiomyocyte-specific deletion of PMCA1 (PMCA1^cko) and their control littermates (PMCA1^loxP/loxP) were studied at the organ and cellular levels.   At the organ level, the PMCA1^cko hearts became more susceptible to atrial arrhythmias under rapid programmed electrical stimulation (PES) compared with the PMCA1^loxP/loxP hearts, and such arrhythmic events became more severe under Ca²⁺ overload conditions. At the cellular level, the occurrence of irregular-type APs of PMCA1^cko atrial myocytes increased significantly under Ca²⁺ overload conditions and/or at higher frequency of stimulation. The decay of Na⁺-Ca²⁺ exchanger (NCX) current that followed a stimulation protocol was significantly prolonged in PMCA1^cko atrial myocytes under basal conditions, with Ca²⁺ overload leading to even greater prolongation. In conclusion, PMCA1 is required for maintaining Ca²⁺ homeostasis and electrical stability in the atrium. This is particularly critical during fast removal of Ca²⁺ from the cytosol which is required under stress conditions.

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

British Journal of Anaesthesia, 2017; 119(3): 435–42, DOI 10.1093/bja/aex241

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Gastric emptying for liquids of different compositions in children

Abstract

Background

Pre-operative fasting balances safety against patient discomfort. We compared the gastric emptying profiles of a novel clear, high protein drink against a "traditional" clear and a non-clear fluid.

Methods

We conducted a prospective cross-sectional study with 48 healthy volunteers, eight to 14 yr of age, fasted overnight and without risk factors for abnormal gastrointestinal motility. Subjects were randomized in equal ratio to ingest 296 ml of apple juice, 2% milk or Ensure Clear. The gastric antrum was seen by ultrasound in the right lateral decubitus position at baseline, after ingestion, then every 30 min thereafter until return to baseline or six h. Gastric antral cross-sectional area was measured independently by two anaesthetists, and compared between drinks.

Results

Gastric emptying differed between apple juice, 2% milk and Ensure Clear by analysis of co-variance (P<0.0001), and was faster in males than females (P<0.01). The terminal phase however was similar using interval-censored time to gastric emptying in a survival model (P=0.17) or by comparing proportions with empty stomach vs not empty at 90 min (P=1.0), 120 min (P=0.32), 150 min (P=0.11), 180 min (P=0.76) or 210 min (P=1.0).

Conclusions

Despite early differences, clearance from the stomach of apple juice, 2% milk or Ensure Clear is similar at the terminal phase, which is the period of greatest relevance to preoperative fasting recommendations. The stomach is essentially clear by 3-3.5 h for all three drinks studied. The differentiation between liquids in current guidelines is not supported by this study.

Clinical trial registration

clinicaltrials.gov NCT02938065 http://ift.tt/2yd7RDh.

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Overuse of preoperative laboratory coagulation testing and ABO blood typing: a French national study

Abstract

Background

Following publication of guidelines on routine preoperative tests, the French Society of Anaesthesiology and Intensive Care (SFAR), in association with French national public health insurance, conducted a survey to evaluate adherence to guidelines and the economic consequences.

Methods

Using the French Hospital Discharge Database and National Health Insurance Information system, tests performed during the 30 days before surgery were analysed for two situations: (1) standard laboratory coagulation tests and ABO blood typing in children able to walk and scheduled for tonsillectomy/adenoidectomy; and (2) ABO blood typing in adults before laparoscopic cholecystectomy, thyroidectomy, lumbar discectomy or breast surgery. Guidelines do not recommend any preoperative tests in these settings.

Results

Between 2013 and 2015, a coagulation test was performed in 49% of the 241 017 children who underwent tonsillectomy and 39% of the 133 790 children who underwent adenoidectomy. A similar pattern was observed for ABO blood typing although re-operation rates for bleeding on the first postoperative day were very low (0.12–0.31% for tonsillectomy and 0.01–0.02% for adenoidectomy). Between 2012 and 2015, ABO blood typing was performed in 32–45% of the 1 114 082 patients who underwent one of the four selected procedures. The transfusion rate was very low (0.02–0.31%). The mean cost for the four procedures over the 4 yr period was €5 310 000 (sd €325 000).

Conclusions

Standard laboratory coagulation tests and ABO blood typing are still routinely prescribed before surgery and anaesthesia despite current guidelines. This over-prescription represents a high and unnecessary cost, and should therefore be addressed.

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Death or near-death in patients with obstructive sleep apnoea: a compendium of case reports of critical complications

Abstract

The care of surgical patients with obstructive sleep apnoea (OSA) invokes concerns with safety and liability because of the risk that exists for perioperative death or near-death. The purpose of this review is to analyse the available literature to identify risk factors for perioperative critical complications in patients with OSA. Literature reports were screened for life threatening complications and deaths in surgical patients with OSA. The critical complications were sub-grouped as death/near-death events (death and anoxic brain damage) vs critical respiratory events (CRE)/other events and analysed for various risk factors. Both univariate and multivariate analyses were conducted to identify the potential risk factors.In total, 15 case reports and two medico-legal reports, comprising of 60 total patients with OSA were included in our analysis. Overall, there were 43 deaths or near-death events and 12 critical respiratory events and five other life threatening events. Ten patients (17%) with OSA were undiagnosed before surgery. Only 31% (11/35) were on preoperative continuous positive airway pressure (CPAP), with 36% (4/11) of them continuing CPAP in the postoperative period. The majority of them received a morphine equivalent daily dose less than 10 mg. Eighty percent of the events occurred in the first 24 h and 67% occurred on the general hospital ward.Patients with OSA are at risk of critical complications including death during the initial 24 h after surgery. Morbid obesity, male sex, undiagnosed OSA, partially treated/untreated OSA, opioids, sedatives, and lack of monitoring are risk factors for death or near-death events.

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Does Caesarean Section Affect Breastfeeding Practices in China? A Systematic Review and Meta-Analysis

Abstract

Objectives To ascertain the association between caesarean delivery and breastfeeding practices in China. Methods We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. Electronic databases of CNKI, Medline, EMBASE, CINAHL, ProQuest and Science Direct were searched and screened to identify relevant articles from January 1990 to June 2015. Both fixed and random effect meta-analysis techniques were used to estimate the pooled effect size between caesarean delivery and breastfeeding outcomes at different time points. Sensitivity analysis and publication bias test were also conducted. Results Forty six studies were eligible for the qualitative synthesis of systematic review; among them, 27 studies were included for the meta-analysis. At the early postpartum period, the odds of exclusive breastfeeding after caesarean section was 47% (pooled OR 0.53, 95% CI 0.41, 0.68) lower than that after vaginal delivery. At 4 months postpartum, the odds of breastfeeding was similarly lower (pooled OR 0.61, 95% CI 0.53, 0.71) for caesarean mothers. Substantial heterogeneity among studies was detected for both breastfeeding outcomes. Subgroup analyses stratified by study design, time points of breastfeeding outcomes and definitions of breastfeeding all confirmed the negative association between caesarean section and breastfeeding prevalence. Conclusions In China, breastfeeding practices were affected adversely by caesarean delivery. Therefore, health policy to improve breastfeeding outcomes should take this into consideration.

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Impacting Entry into Evidence-Based Supported Employment: A Population-Based Empirical Analysis of a Statewide Public Mental Health Program in Maryland

Abstract

We use discrete-time survival regression to study two empirical issues relating to take-up of individual placement and support (IPS) supported employment (SE) services for persons with serious mental illness: (1) the influence of client characteristics on take-up probability, and (2) the possible impacts of a major recent initiative in one state (Maryland) to overcome barriers to IPS-SE expansion. Our longitudinal analysis of population-based Medicaid cohorts, during 2002–2010, provides tentative evidence of positive state initiative impacts on SE take-up rates, and evidence of effects on take-up for clients' diagnoses, prior work-history, health and demographic characteristics, and geographic accessibility to SE providers.

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The corticospinal responses of metronome-paced, but not self-paced strength training are similar to motor skill training

Abstract

Purpose

The corticospinal responses to skill training may be different to strength training, depending on how the strength training is performed. It was hypothesised that the corticospinal responses would not be different following skill training and metronome-paced strength training (MPST), but would differ when compared with self-paced strength training (SPST).

Methods

Corticospinal excitability, short-interval intra-cortical inhibition (SICI) and strength and tracking error were measured at baseline and 2 and 4 weeks. Participants (n = 44) were randomly allocated to visuomotor tracking, MPST, SPST or a control group.

Results

MPST increased strength by 7 and 18%, whilst SPST increased strength by 12 and 26% following 2 and 4 weeks of strength training. There were no changes in strength following skill training. Skill training reduced tracking error by 47 and 58% at 2 and 4 weeks. There were no changes in tracking error following SPST; however, tracking error reduced by 24% following 4 weeks of MPST. Corticospinal excitability increased by 40% following MPST and by 29% following skill training. There was no change in corticospinal excitability following 4 weeks of SPST. Importantly, the magnitude of change between skill training and MPST was not different. SICI decreased by 41 and 61% following 2 and 4 weeks of MPST, whilst SICI decreased by 41 and 33% following 2 and 4 weeks of skill training. Again, SPST had no effect on SICI at 2 and 4 weeks. There was no difference in the magnitude of SICI reduction between skill training and MPST.

Conclusions

This study adds new knowledge regarding the corticospinal responses to skill and MPST, showing they are similar but different when compared with SPST.

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The importance of cutaneous feedback on neural activation during maximal voluntary contraction

Abstract

Purpose

The purpose of this study was to investigate the importance of cutaneous feedback on neural activation during maximal voluntary contraction (MVC) of the ankle plantar flexors.

Methods

The effects of cutaneous plantar anaesthesia were assessed in 15 subjects and compared to 15 controls, using a one-day pre/post-repeated measures design. Cutaneous plantar anaesthesia was induced by lidocaine injection at the centre of forefoot, lateral midfoot, and heel. Each subject performed isometric MVCs of the ankle plantar flexors. During each isometric ramp contraction, the following variables were assessed: maximal isometric torque; surface electromyography (EMG) activity of the medial gastrocnemius (MG) and tibialis anterior (TA) muscles; and co-contraction index (CCI) between the MG and TA.

Results

For ankle torque, two-way ANOVA showed no significant interaction between the pre/post-measurements × group (p = 0.166). However, MG activity presented significant interactions between the pre/post-measurements × group (p = 0.014). Post hoc comparisons indicated a decrease of MG activity in the experimental group, from 85.9 ± 11.9 to 62.7 ± 30.8% (p = 0.016). Additionally, the post-anaesthesia MG activity of the experimental group differed statistically with pre- and post-MG activity of the control group (p = 0.027 and p = 0.008, respectively). For TA activity and CCI, two-way ANOVA detected no significant interactions between the pre/post-measurements × group (p = 0.605 and p = 0.332, respectively).

Conclusion

Our results indicate that during MVC, cutaneous feedback modulates neural activity to MG muscle, without changing the extent of MG–TA co-contraction.

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Effects of prior aerobic exercise on sitting-induced vascular dysfunction in healthy men

Abstract

Introduction

Acute aerobic exercise prevents sitting-induced impairment of flow-mediated dilation (FMD). Further, evidence suggests that sitting-induced impairment of FMD occurs via an oxidative stress-dependent mechanism that disrupts endothelial function.

Purpose

We hypothesized that acute aerobic exercise would prevent impairment of femoral artery FMD by limiting oxidative stress responses that increase endothelin-1 (ET-1) levels and disrupt nitric oxide (NO) status.

Methods

In a randomized, cross-over study, healthy men (n = 11; 21.2 ± 1.9 years) completed two 3 h sitting trials that were preceded by 45 min of either quiet rest (REST) or a single bout of continuous treadmill exercise (65% maximal oxygen consumption) (EX). Superficial femoral artery FMD, plasma glucose, malondialdehyde (MDA), ET-1, arginine (ARG) and its related metabolites [homoarginine (HA), asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA)] were assessed at baseline, 1 h following EX (or REST) (0 h), and at 1 h intervals during 3 h of uninterrupted sitting. Data were analyzed using repeated measures ANOVA.

Results

During REST, femoral artery FMD declined from baseline (2.6 ± 1.8%) at 1, 2, and 3 h of sitting and resting shear rate decreased at 3 h. In contrast, when sitting was preceded by EX, femoral artery FMD (2.7 ± 2.0%) and resting shear rate responses were unaffected. No between trial differences were detected for plasma glucose, MDA, ET-1, ARG, HA, ADMA, or SDMA.

Conclusion

Prior aerobic exercise prevented the decline in femoral artery FMD that is otherwise induced by prolonged sitting independent of changes in oxidative stress, ET-1, and NO status.

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