Publication date: December 2017
Source:Journal of Environmental Radioactivity, Volume 180
Author(s): Agata Zaborska
Although primary sources of anthropogenic 137Cs have decreased nowadays, the Arctic is exposed to a variety of secondary sources. These include riverine run-off, oceanic currents, drifting sea ice, melting glaciers and permafrost. Recent reports underline the role of glaciers, specifically cryoconite holes, in radionuclide accumulation. Therefore, this study investigates the hypothesis that melting glaciers are an important means of delivering 137Cs for Arctic fjord (Hornsund, Svalbard). As marine sediments are the final sink for most contaminants, seven 30–40 cm long sediment cores collected in 2016 were investigated for 137Cs activity concentration. Five were collected in a transect from the central to the outer part of the fjord while two were collected within one km of the different melting tidewater glaciers. Sediment layers were dated using 210Pb to reveal the history of 137Cs accumulation. The measured 137Cs activity concentrations ranged from <0.1 to 7.7 Bq kg−1. The activity concentrations ranging from 0.3 to 3.1 Bq kg−1 were measured in surface (0–2 cm) sediments. The total 137Cs inventories were calculated for five station and ranged from 322 to 908 Bq m−2, of which 29–34 Bq m−2 were deposited within the last decade. At two stations characterized by largest sediment accumulation rates only the last decade inventories were calculated and they ranged from 13 to 444 Bq·m−2. The mean of 137Cs fluxes calculated for last decade ranged from 2.7 to 44.1 Bq m−2yr−1. The history of 137Cs environmental inputs was well revealed in the sediments as the 137Cs penetration depth agreed with the time of its introduction to the Arctic and the most pronounced 137Cs activity concentration peak was found in sediments dated for circa 1963. Although 137Cs fluxes and inventories were largest in the glacial bay (Brepollen), the 137Cs was diluted in a large amount of sedimenting material. Based on the results in this study, the glaciers do not appear to act as important sources of 137Cs to the marine environment in the Hornsund fjord.
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Παρασκευή 13 Οκτωβρίου 2017
Sources of 137Cs to an Arctic fjord (Hornsund, Svalbard)
Radionuclides in mushrooms and soil-to-mushroom transfer factors in certain areas of China
Publication date: December 2017
Source:Journal of Environmental Radioactivity, Volume 180
Author(s): Fei Tuo, Jing Zhang, Wenhong Li, Shuaimo Yao, Qiang Zhou, Zeshu Li
Activity concentrations of 238U, 226Ra, 228Ra, 137Cs and 40K in 64 mushroom samples collected in China from Yunnan, Fujian and Heilongjiang Provinces, were measured. Gamma-ray emissions were determined by using high-purity germanium (HPGe) γ spectrometry. The range of concentrations (Bq kg−1 dry weight) for 238U, 226Ra, 228Ra, 137Cs and 40K in all investigated mushroom samples were from 0.12 to 12, 0.05 to 7.5, 0.14 to 14, MDC(<0.01) to 339, and 396 to 1880, respectively. Activity concentrations of 137Cs in mushrooms showed some variation between species sampled at the same site. To calculate soil to mushroom transfer factors, levels of radionuclide in 15 paired soil samples and mushrooms were also investigated. The median transfer factors for 238U, 226Ra, 228Ra, 137Cs and 40K were 8.32 × 10−2, 3.03 × 10−2, 6.69 × 10−2, 0.40 and 1.19, respectively. The results were compared with values of other areas.
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Marine ecological risk assessment methods for radiation accidents
Publication date: December 2017
Source:Journal of Environmental Radioactivity, Volume 180
Author(s): Sufen Ye, Luoping Zhang, Huan Feng
Ecological risk assessment (ERA) is a powerful technical tool that can be used to analyze potential and extreme adverse environmental impacts. With the rapid development of nuclear power plants in coastal areas around the world, the establishment of approaches and methodologies for marine ERA with a focus on radiation accidents is an urgent requirement for marine environmental management. In this study, the approaches and methodologies for ERA pertaining to marine radiation accidents (MRA) are discussed and summarized with applications in case studies, such as the nuclear accident in Fukushima, Japan, and a hypothetical accident in Daya Bay, China. The concepts of ERA and Risk Degree of ERA on MRA are defined for the first time to optimize the ERA system. The results of case studies show that the ERA approach and methodology for MRA are scientifically sound and effective in both the early and late stage of MRAs along with classic ERA Approach and the ERICA Integrated Approach. The results can be useful in the decision-making processes and the risk management at the beginning of accident as well as the ecological restoration after the accident.
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Sternal malformations and anesthetic management
Summary
Shamberger and Welch classify sternal malformations into four types: thoracic ectopia cordis, cervical ectopia cordis, thoraco-abdominal ectopia cordis, and cleft sternum. Cleft sternum is the most common subset, with a reported incidence of 1 in 50,000 to 100,000 live births, representing 0.15% of all anterior chest wall malformations. Acostello et al further classify cleft sternum into complete or partial (superior, medium, inferior) with a simple superior partial cleft sternum being by far the most common with an orthotopic heart, intact pericardium, and normal skin coverage. Associated anomalies with superior partial cleft sternum are rare, but can include cervicofacial hemangiomas, midline raphe from the tip of the cleft to the umbilicus, and PHACES (posterior fossa malformations, facial hemangiomas, arterial anomalies with coarctation of aorta, cardiac defects, eye abnormalities, sternal cleft, and supraumbilical raphe) syndrome. The more rare inferior partial clefts are associated with thoraco-abdominal ectopia cordis as part of the Pentalogy of Cantrell (omphalocele, anterior diaphragmatic hernia, sternal cleft, ectopia cordis, ventricular septal defect/left ventricular diverticulum). This review summarizes the current knowledge of all four types of sternal malformations, and provides guidance for optimal anesthetic and perioperative care of these children.
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Changes in blood volume indicators and dynamic indicators measured with transpulmonary ultrasound velocity during blood depletion and repletion in a neonatal swine model
Summary
Background
Dynamic indicators such as pulse pressure and stroke volume variations can be measured to track changes in preload during hemorrhage, and evaluate fluid therapy. However, these dynamic indicators require mechanical ventilation, and might be affected by cardiac dysrhythmias and changes in vascular tone. Blood volume indicators may offer alternatives for assessing changes in volume status.
Aims
The aims of this study were to measure changes in blood volume indicators and dynamic indicators during removal of blood in two stages and subsequent blood replacement in anesthetized, mechanically ventilated, neonatal pigs.
Methods
In eight anesthetized, mechanically ventilated piglets (5-6 weeks old), cardiac index, stroke volume index, total end-diastolic volume, central blood volume, active circulating volume, pulse pressure variation, and stroke volume variation were measured during blood removal in two stages (15 mL kg−1 each stage) and blood replacement (30 mL kg−1). Values after each intervention were measured for each parameter.
Results
All indicators differed from baseline after removal of 15 mL kg−1 of blood, except for stroke volume variation. Differences between both stages of hemorrhage were only observed for indexed stroke volume, total end-diastolic volume, central blood volume, and pulse pressure variation.
Conclusion
Total end-diastolic volume and central blood volume changed during blood depletion and repletion, and differed between stages of hemorrhage. These indicators might be useful for assessing volume status instead of, or in addition to cardiac index and dynamic indicators.
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Infection prevention in pediatric anesthesia practice
Summary
Healthcare-associated infections are an important source of morbidity and mortality in pediatric patients. Anesthesiologists have a unique role in infection prevention. Hand hygiene and anesthesia workspace decontamination decrease infection rates in surgical patients. Standard protocols exist for insertion and handling of central lines, arterial lines, and regional procedures, which should be strictly adhered to in order to prevent infectious complications. Temperature control and timely administration of antibiotics contribute to the prevention of surgical site infections. Education, culture shift, staff engagement, and effective change management are necessary for successful implementation of infection prevention strategies.
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Pharmacokinetics of S-ketamine during prolonged sedation at the pediatric intensive care unit
Summary
Background
S-ketamine is the S(+)-enantiomer of the racemic mixture ketamine, an anesthetic drug providing both sedation and analgesia. In clinical practice, significant interpatient variability in drug effect of S-ketamine is observed during long-term sedation.
Aims
The aim of this study was to evaluate the pharmacokinetic variability of S-ketamine in children aged 0-18 years during long-term sedation. Twenty-five children (median age: 0.42 years, range: 0.02-12.5) received continuous intravenous administrations of 0.3-3.6 mg/kg/h S-ketamine for sedation during mechanical ventilation. Infusion rates were adjusted to the desired level of sedation and analgesia based on the COMFORT-B score and Visual Analog Scale. Blood samples were drawn once daily at random time-points, and at 1 and 4 hours after discontinuation of S-ketamine infusion. Time profiles of plasma concentrations of S-ketamine and active metabolite S-norketamine were analyzed using nonlinear mixed-effects modeling software. Clearance and volume of distribution were allometrically scaled using the ¾ power model.
Results
A total of 86 blood samples were collected. A 2-compartment and 1-compartment model adequately described the PK of S-ketamine and S-norketamine, respectively. The typical parameter estimates for clearance and central and peripheral volumes of distribution were: CLS-KETAMINE=112 L/h/70 kg, V1S-KETAMINE=7.7 L/70 kg, V2S-KETAMINE=545L/70 kg, QS-kETAMINE=196 L/h/70 kg, and CLS-NORKETAMINE=53 L/h/70 kg. Interpatient variability of CLS-KETAMINE and CLS-NORKETAMINE was considerable with values of 40% and 104%, respectively, leading to marked variability in steady-state plasma concentrations.
Conclusion
Substantial interpatient variability in pharmacokinetics in children complicates the development of adequate dosage regimen for continuous sedation.
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Rapid Response Team activation for pediatric patients on the acute pain service
Summary
Introduction
Untreated pain or overly aggressive pain management may lead to adverse physiologic consequences and activation of the hospital's Rapid Response Team. This study is a quality improvement initiative that attempts to identify patient demographics and patterns associated with Rapid Response Team consultations for patients on the acute pain service.
Methods
A retrospective review of all patients on the acute pain service from February 2011 until June 2015 was cross-referenced with inpatients requiring consultation from the Rapid Response Team. Two independent practitioners reviewed electronic medical records to determine which events were likely associated with pain management interventions.
Results
Over a 4-year period, 4872 patients were admitted to the acute pain service of whom 135 unique patients required Rapid Response Team consults. There were 159 unique Rapid Response Team activations among 6538 unique acute pain service consults. A subset of 27 pain management-related Rapid Response Team consultations was identified. The largest percentage of patients on the acute pain service were adolescents aged 12-17 (36%). Compared to this age group, the odds of Rapid Response Team activation were higher among infants <1 year old (odds ratio = 2.85; 95% confidence interval: 1.59, 5.10; P < .001) and adults over 18 years (odds ratio = 1.68; 95% confidence interval: 1.01, 2.80; P = .046).
Discussion
Identifying demographics and etiologies of acute pain service patients requiring Rapid Response Team consultations may help to identify patients at risk for clinical decompensation.
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Opioid use disorder and misuse: A review of the epidemiology and medical implications for pediatric anesthesiologists
Summary
This educational review presents an overview of opioid use disorder, misuse and overdose among adolescents, and the clinical implications for anesthesiologists. It provides definitions, discusses the epidemiology worldwide, (focusing on North America), and emphasizes the clinical implications of patients with chronic opioid exposure, including perioperative pain management, as well as opioid overdose and prolonged use of opioids after acute exposure. In the USA, opioid use disorder and negative outcomes related to opioids rose dramatically from 1999-2010; concomitantly heroin use and fatal overdoses have increased as heroin use is associated with the disordered use of licit opioids. Among adolescents and young adults, opioid use disorder is significant, with continued increases in disordered use specifically among young adults. Acute opioid intoxication may have multiple medical implications in addition to respiratory depression, and children are susceptible to acute intoxication via accidental ingestion of prescription opioids. Novel opioid formulations, such as acetyl fentanyl, with unpredictable pharmacology may also be present in acute intoxication. Chronically, opioid use presents challenges for safe and adequate pain management, in the presence of opioid-induced hyperalgesia and differential tolerance as well as mental health issues including depression and anxiety. Predictors of prolonged opioid use in adolescents and adults after surgery is an area of ongoing research. Young patients encountered by pediatric anesthesiologists may be involved in diversion and disordered use of opioids. Increased awareness among anesthesiologists is important, as perioperative discussions often provide an opportunity to detect at risk patients.
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Technical success of the ultrasound-guided supra-inguinal fascia iliaca compartment block in older children and adolescents for hip arthroscopy
Summary
Background
Hip arthroscopic surgery is performed on older pediatric patients. Fascia iliaca compartment block has proven efficacy in providing analgesia following hip surgery and can be performed with target location of local anesthetic below or above the inguinal ligament. The reported success of ultrasound-guided infra-inguinal fascia iliaca compartment block is lower when compared to traditional landmark technique, while the reliability of supra-inguinal fascia iliaca compartment block is unreported.
Aim
The primary aim was to report the results in obtaining sensory changes in the distribution of the femoral and lateral femoral cutaneous nerves following supra-inguinal fascia iliaca compartment block in patients undergoing arthroscopic hip surgery. Secondary outcomes are the ability to find echogenic landmarks and to report pain scores and opioid consumption.
Methods
We reviewed the electronic medical record and regional anesthesia database of patients receiving ultrasound-guided fascia iliaca compartment block for arthroscopic hip surgery. Sensory changes to the femoral and lateral femoral cutaneous nerves were determined. Identification of echogenic landmarks was quantified. Pain scores and opioid consumption were determined.
Results
Seventeen patients of mean age 15.4 years old (SD 1.3; range 13-17 years) were included. Sensory changes to both the femoral and lateral femoral cutaneous nerves occurred in 94% of patients (95% CI: 82%-100%). The average volume of ropivacaine 0.2% was 0.53 mL/Kg (SD 0.11 mL/Kg). Echogenic landmarks were identified in all patients. Pain scores and opioid consumption were generally low.
Conclusion
A supra-inguinal location for the deposition of local anesthetic when performing fascia iliaca nerve block for hip surgery is reliable in anesthetizing the femoral and lateral femoral cutaneous nerves and should encourage investigation into the clinical efficacy.
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Suitability of the forearm for non-invasive blood pressure measurement in children
Summary
Background
Measurement of forearm blood pressure (BP) in pediatric patients during general anesthesia is periodically employed despite a lack of evidence for this practice. Upper arm BP measurement may be impossible to perform for either patient or surgical reasons, and the forearm has theoretical benefits over the lower leg when an alternate site is required. We hypothesize that forearm BP measurement provides an accurate and reliable alternative to the upper arm. Published adult data do not support this hypothesis, and the little pediatric data published contain methodological shortcomings.
Methods
A dedicated, externally calibrated noninvasive oscillometer was used to compare BP measurements in the upper arm and ipsilateral forearm of pediatric patients undergoing general anesthesia prior to application of a surgical stimulus. Both upper arm BP and ipsilateral forearm BP were sequentially measured 20 seconds apart on 3 separate occasions with an appropriately sized cuff. The systolic, diastolic, and mean blood pressures were recorded under steady-state conditions.
Results
Thirty-five elective surgical patients aged 1 to 10 years were studied. The bias (±limits of agreement) for forearm minus upper arm blood pressures were as follows: mean BP −1.3 mm Hg (±7.2), diastolic BP −3.3 (±5.3), and systolic BP +3.2 mm Hg (±8.3). Differences greater than ±5 mm Hg occurred in 59% (systolic BP), 42% (diastolic BP), and 46% (mean BP) of all observations and greater than ±10 mm Hg in 17% (systolic BP), 8.6% (diastolic BP), and 15% (mean BP).
Conclusion
The differences within mean ±1.96 standard deviations reside considerably outside the clinically accepted tolerance of ±5 mm Hg. Thus, the forearm may not be used interchangeably with upper limb BP readings in anesthetized healthy children. Future use of the forearm for BP measurement requires a validated anthropomorphically appropriate forearm cuff.
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A prospective audit of pain profiles following general and urological surgery in children
Summary
Background
Postoperative pain is frequently undertreated in children both in hospital and at home following discharge. Pain has both short- and long-term consequences for children, their families, and the healthcare system. A greater understanding of procedure-specific postoperative pain trajectories is required to improve pain management.
Aim
To determine the duration and severity of acute postoperative pain experienced by children undergoing 8 different general and urological procedures (primary outcomes). Behavioral disturbance rates, nausea and vomiting scores, and parental satisfaction were also examined during the follow-up period (secondary outcomes).
Method
Families of children (0-18 years) undergoing common general and urological procedures were invited to enroll in the study. Children's pain scores, measured using a parental proxy 0-10 numerical rating scale, were collected by telephone interview until pain was resolved. Analgesia prescribed and given, behavioral disturbance, nausea and vomiting scores, the method of medication education communication, and parental satisfaction were also measured.
Results
Of 360 patients recruited, 326 complete datasets were available. Patients underwent laparoscopic appendicectomy (57), open appendicectomy (19), circumcision (50), cystoscopy (52), hypospadias repair (22), inguinal hernia repair (51), orchidopexy (51), or umbilical hernia repair (24). Postoperative pain peaked on the day of or the day after surgery in all groups, and decreased over time. Pain lasted a median duration of 5 postoperative days following open appendicectomy, and 0-2 postoperative days for other procedures. Behavioral disturbance rates closely followed pain scores. Analgesia administration at home varied widely between and within groups.
Conclusion
Pain management was inadequate in most of the groups studied, particularly after appendicectomy or umbilical hernia repair, with most children experiencing at least moderate pain on the day of and day after surgery. There was a need for a standardized management, with increased dual analgesia prescribing, to ensure that children receive adequate postoperative analgesia in hospital and at home.
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APC/CFZR-1 Controls SAS-5 Levels To Regulate Centrosome Duplication in Caenorhabditis elegans
As the primary microtubule-organizing center, centrosomes play a key role in establishing mitotic bipolar spindles that secure correct transmission of genomic content. For the fidelity of cell division, centrosome number must be strictly controlled by duplicating only once per cell cycle. Proper levels of centrosome proteins are shown to be critical for normal centrosome number and function. Overexpressing core centrosome factors leads to extra centrosomes, while depleting these factors results in centrosome duplication failure. In this regard, protein turnover by the ubiquitin-proteasome system provides a vital mechanism for the regulation of centrosome protein levels. Here, we report that FZR-1, the Caenorhabditis elegans homolog of Cdh1/Hct1/Fzr, a co-activator of the anaphase promoting complex/cyclosome (APC/C), an E3 ubiquitin ligase, functions as a negative regulator of centrosome duplication in the Caenorhabditis elegans embryo. During mitotic cell division in the early embryo, FZR-1 is associated with centrosomes and enriched at nuclei. Loss of fzr-1 function restores centrosome duplication and embryonic viability to the hypomorphic zyg-1(it25) mutant, in part, through elevated levels of SAS-5 at centrosomes. Our data suggest that the APC/CFZR-1 regulates SAS-5 levels by directly recognizing the conserved KEN-box motif, contributing to proper centrosome duplication. Together, our work shows that FZR-1 plays a conserved role in regulating centrosome duplication in Caenorhabditis elegans.
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Adams-Oliver Syndrome With Moyamoya Disease for Cerebral Revascularisation Surgery.
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Wavelet coherence analysis: a new approach to distinguish organic and functional tremor types
Tremor is the most common neurological movement disorder (Louis and Ferreira 2010), with Parkinsonian tremor (PT), functional tremor (FT), essential tremor (ET), and enhanced physiological tremor (EPT) as the most common types. Distinguishing tremor types is important as it determines treatment options and prognosis (Gupta and Lang 2009).
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Impact of early unanticipated revision surgery on health-related quality of life after adult spinal deformity
Background contextRevision surgery represents a major event for patients undergoing ASD surgery. Previous reports suggest minimal or no impact on HRQOL outcomes.PurposeTo investigate the impact of early reoperations within the first year on health-related quality of life (HRQOL) and on the likelihood of reaching the MCID after ASD surgery.DesignRetrospective analysis of prospectively collected data from consecutive surgically treated adult deformity surgery (ADS) patients included in a multicenter, international database.
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Comparison of anterior/posterior vertebral column resection versus anterior/posterior spinal fusion for severe and rigid scoliosis
Many different correction methods have been reported to treat severe and rigid scoliosis. In the past, anterior/posterior spinal fusion (APSF), which included an anterior release followed by posterior instrumented fusion was widely applied. In recent years, anterior/posterior vertebral column resection (APVCR) is used to treat severe and rigid scoliosis.
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Radiation Exposure during the Course of Treatment for Early-Onset Scoliosis: Longitudinal Pilot Study
BACKGROUND CONTEXT: There is abundant evidence of the health hazards attributed to ionizing radiation (IR) exposure. However, no studies have estimated the amount of IR exposure in the treatment for early-onset scoliosis.
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PROMIS Physical Function and Pain Correlation with ODI and VAS in the Surgical Lumbar Disc Herniation Patient Population
BACKGROUND CONTEXT: Legacy patient-reported outcome measures such as ODI (Oswestry Disability Index) and VAS (Visual Analog Score) have become essential for analyzing treatment interventions in orthopedic spine surgery for lumbar disc herniations. Despite their usefulness, significant associated administrative burdens impose limits on completion of such measures. The Patient Reported Outcomes Measurement Information System (PROMIS) group developed a patient outcome measure based on Item Response Theory in order to improve reporting of patient symptoms, function and health and to reduce administrative burden and improve outcome measure reliability.
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Pattern of improvement in upper limb pointing task kinematics after a 3-month training program with robotic assistance in stroke
When exploring changes in upper limb kinematics and motor impairment associated with motor recovery in subacute post stroke during intensive therapies involving robot-assisted training, it is not known whether...
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Paretic versus non-paretic stepping responses following pelvis perturbations in walking chronic-stage stroke survivors
The effects of a stroke, such as hemiparesis, can severely hamper the ability to walk and to maintain balance during gait. Providing support to stroke survivors through a robotic exoskeleton, either to provide...
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A Bombyx homolog of ovo is a segmentation gene that acts downstream of Bm-wnt1(Bombyx wnt1 homolog)
Source:Gene Expression Patterns, Volume 27
Author(s): Hajime Nakao
Insect embryogenesis is divided into long and short/intermediate germ types. The long germ type may exhibit Drosophila-like hierarchical segmentation mechanisms, whereas the short/intermediate type assumes some repeating mechanisms that are considered to be ancestral. Embryogenesis in Bombyx mori possesses both characteristics. Here, Bombyx ovo homolog (Bm-ovo) was identified as a gene involved in segmentation. Ovo is a Drosophila gene that encodes a zinc finger transcription factor and studies on its homolog functions in other systems have suggested that it acts as a switch to enable the initiation of differentiation from a progenitor cell state. This is the first description for ovo homologs being involved in insect segmentation. Bm-ovo is expressed dynamically during embryogenesis in a pattern that resembles that of gap and pair-rule genes. In Bm-ovo RNAi knockdown embryos, posterior segmentation does not proceed. In addition, defects in anterior segments are observed. In Bm-wnt1 knockdown embryos, the Bm-ovo expression pattern was changed, suggesting that Bm-wnt1 is an upstream regulator of Bm-ovo. The involvement of Bm-ovo may represent a novel ancestral step under the control of wnt genes in insect segmentation: this step may resemble those operating in cell differentiation processes.
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Physiological and proteomic analysis of plant growth enhancement by the rhizobacteria Bacillus sp. JS
Abstract
In this study, the effects of the plant growth-promoting rhizobacterium (PGPR), Bacillus sp. JS on the growth of tobacco (Nicotiana tabacum 'Xanthi') and lettuce (Lactuca sativa 'Crispa'), were evaluated by comparing various growth parameters between plants treated with the bacterium and those exposed to water or nutrient broth as control. In both tobacco and lettuce, fresh weight and length of shoots were increased upon exposure to Bacillus sp. JS. To explain the overall de novo expression of plant proteins by bacterial volatiles, two-dimensional gel electrophoresis was performed on samples from PGPR-treated tobacco plants. Our results showed that chlorophyll a/b binding proteins were significantly up-regulated, and total chlorophyll content was also increased. Our findings indicate the potential benefits of using Bacillus sp. JS as a growth-promoting factor in agricultural practice, and highlight the need for further research to explore these benefits.
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Activation of cannabinoid receptor 1 is involved in protection against mitochondrial dysfunction and cerebral ischaemic tolerance induced by isoflurane preconditioning
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Early pitfalls in establishing the British Journal of Anaesthesia
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Effectiveness of enhanced pulse oximetry sonifications for conveying oxygen saturation ranges: a laboratory comparison of five auditory displays
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Drug safety in paediatric anaesthesia
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Is postspinal hypotension a sign of impaired cardiac performance in the elderly? An observational mechanistic study
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Low end-tidal CO 2 as a real-time severity marker of intra-anaesthetic acute hypersensitivity reactions
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Changes in platelet Bax levels contribute to impaired platelet response to thrombin after cardiopulmonary bypass: prospective observational clinical and laboratory investigations
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The role of declining adaptive homeostasis in ageing
Abstract
Adaptive homeostasis is, 'the transient expansion or contraction of the homeostatic range for any given physiological parameter in response to exposure to sub-toxic, non-damaging, signalling molecules or events, or the removal or cessation of such molecules or events (Davies, 2016a)." Adaptive homeostasis enables biological systems to make continuous short-term adjustments for optimal functioning despite ever-changing internal and external environments. Initiation of adaptation in response to an appropriate signal allows organisms to successfully cope with much greater, normally toxic, stresses. These short-term responses are initiated following effective signals, including hypoxia, cold shock, heat shock, oxidative stress, exercise-induced adaptation, caloric restriction, osmotic stress, mechanical stress, immune response, and even emotional stress. There is now substantial literature detailing a decline in adaptive homeostasis that, unfortunately, appears to manifest with ageing, especially in the last third of the lifespan.
In this review, we present the hypothesis that one hallmark of the ageing process is a significant decline in adaptive homeostasis capacity. The mechanistic importance of diminished capacity for short-term (reversible) adaptive responses (both biochemical and signal transduction/gene expression-based) to changing internal and external conditions, on short-term survival and on lifespan and healthspan. Studies of cultured mammalian cells, worms, flies, rodents, simians, apes, and even humans, all indicate declining adaptive homeostasis as a potential contributor to age-dependent senescence, increased risk of disease, and even mortality. Emerging work points to Nrf2-Keap1 signal transduction pathway inhibitors, including Bach1 and c-Myc, both of whose tissue concentrations increase with age, as possible major causes for age-dependent loss of adaptive homeostasis.
This article is protected by copyright. All rights reserved
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The role of PLIN protein in healthy lipid storage and lipid droplet expansion
Abstract
In skeletal muscle, fatty acids are stored in vesicle-like organelles known as lipid droplets (LDs). The importance of how lipids are stored in skeletal muscle has emerged from studies demonstrating a strong association between muscle lipids and insulin sensitivity.
This article is protected by copyright. All rights reserved
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Assessing the utility of a prognostication model to predict 1-year mortality in patients receiving radiation therapy for spinal metastases
Predicting survival outcomes after radiation therapy alone for metastatic disease of the spine is a challenging task that is important to guiding treatment decisions (e.g., determining dose fractionation and intensity). The New England Spinal Metastasis Score (NESMS) was recently introduced and validated in independent cohorts as a tool to predict 1-year survival following surgery for spinal metastases. This metric is composed of 3 factors: pre-operative albumin, ambulatory status, and modified Bauer score, with the total score ranging from 0 to 3.
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Clinical classification criteria for neurogenic claudication caused by lumbar spinal stenosis. The N-CLASS criteria
Since imaging findings of lumbar spinal stenosis (LSS) may not be associated with symptoms, clinical classification criteria based on patient symptoms and physical examination findings are needed.
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The GDF5 mutant BB-1 enhances the bone formation induced by an injectable, PLGA-fiber reinforced, brushite-forming cement in a sheep defect model of lumbar osteopenia
Targeted delivery of osteoinductive bone morphogenetic proteins (BMPs; e.g., GDF5) in bioresorbable calcium phosphate cement (CPC), potentially suitable for vertebroplasty/kyphoplasty of osteoporotic vertebral fractures, may be required to counteract augmented local bone catabolism and support complete bone regeneration. The biologically optimized GDF5 mutant BB-1 may represent an attractive drug candidate for this purpose.
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The Complications and Risk Factors Analysis of High Dose TXA Used in Spinal Correction Surgery: Data from 726 Patients Over Six Years
BACKGROUND CONTEXT: High levels of intraoperative blood loss are widely documented in spinal correction surgery, and intraoperative administration of antifibrinolytics to reduce intraoperative bleeding has gained popularity. Because of severe complications, aprotinin was forbidden in clinic, and TXA has been widely used in surgery. The effectiveness of high dose TXA has been proved in spinal correction surgery, but there is few systematic data about the complications of the high dose TXA, especially in spinal correction surgery.
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Radiographic Assessment of Spinopelvic Parameters in Surgically Treated Patients with Symptomatic Low Grade Spondylolisthesis
BACKGROUND CONTEXT: While the importance of spinopelvic parameters is well established in the context of adult spinal deformity, there is little data in the current literature on their importance in the context of low grade spondylolisthesis.
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Reduced Length of Stay and Contained Hospital Costs with Cortical Pedicle Screws: A Prospective Cohort Study
BACKGROUND CONTEXT: The use of cortical pedicle screws (CPS) with transforaminal interbody fusion (TLIF) is an alternative to traditional fixation with posterior pedicle screws (PPS) with or without TLIF. Reduced surgical trauma and dissection during CPS may lead to faster patient recovery. Despite higher device cost, CPS+TLIF could be associated with total cost decrease and improved outcomes in treatment of spondylolisthesis with spinal stenosis if improvements exist in the associated length of stay or other inpatient charges.
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What Are the Factors Influencing the Treatment Modality for Patients with Adult Spinal Deformity?
BACKGROUND CONTEXT: The decision-making process for adult spinal deformity (ASD) correction is challenging, because the ASD population is highly heterogeneous. There have been a handful of studies investigating the factors influencing the treatment modality. However, spinopelvic radiographic parameters while correlated to HRQOL, have not been analyzed as decision-making factors.
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TCMEP Alarm Criteria to Predict Foot Drop Injury during Lumbosacral Surgery
BACKGROUND CONTEXT: Iatrogenic nerve injury has been described in many studies with the reported rates varying from 0.8% to 10% with the common deficit being a foot drop. Intraoperative neurophysiologic monitoring is commonly used during lumbar spine surgery to detect and prevent intraoperative iatrogenic neurological complications. Considering the limitations of SSEP and EMG monitoring alone some authors did suggest that TCMEPs could be considered for monitoring lumbosacral roots.
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Determinants of Intraoperative Transfusions in Adult Spinal Deformity Patients
BACKGROUND CONTEXT: Adult spinal deformity (ASD) surgeries are known to have significant morbidity. Blood loss is a major concern and often results in high transfusion rates. Transfusions may be associated with increased infection risks and transfusion reactions. The goal of this study was to determine predictors of allogeneic packed red blood cell (pRBC) transfusion in ASD patients.
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Asia-Pacific Multicenter, Prospective, Randomized, Trial Comparing Arthroplasty vs Anterior Cervical Discectomy and Fusion in the Treatment of Symptomatic Cervical Disc Degeneration
BACKGROUND CONTEXT: In multiple FDA-regulated trials in the United States, cervical total disc replacement (TDR) produced results similar or superior to anterior cervical discectomy and fusion (ACDF).
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Early vs Delayed Rod Fracture in Adult Spinal Deformity Surgery Fused to the Sacrum Differ in Presentation and Revision Rates
BACKGROUND CONTEXT: Rod fracture (RF) is a challenging complication in adult spinal deformity (ASD) surgery. A detailed analysis of the patients correlating time of onset of RF after ASD surgery has not been previously described in the literature.
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Hospital Readmission Following Spinal Fusion throughout the United States
BACKGROUND CONTEXT: Spinal fusion is one of the most commonly performed procedures in spine surgery. In order to evaluate health care utilization and allocation of resources, it is essential to understand the demographic and economic data surrounding readmissions associated with spinal fusion procedures performed in the United States.
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Distal Lordosis is Defined by Regional Alignment while Proximal Lordosis is More Affected by the Pelvic Incidence
BACKGROUND CONTEXT: Restoring proper regional alignment after short fusion is protective against revision for adjacent segment disease (ASD). However, there is a paucity of data regarding the distribution of segmental lordosis and its relationship with pelvic morphology is unknown.
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Improving Usability of PROMIS® Physical Function Scores in the Clinical Setting
BACKGROUND CONTEXT: The Patient Reported Outcome Measurement Information System (PROMIS®) is a system of instruments that implements item response theory (IRT) and computerized adaptive testing (CAT) designing it to be precise, reliable, and versatile. PROMIS has been validated in the lumbar spine patient population and has been found to be more useful than other popular patient reported outcome measures. However, currently the use of PROMIS is limited in part because many clinicians lack a common language understanding of the meaning and the significance of PROMIS scores.
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Restorative Neurostimulation for Refractory Chronic Low Back Pain: Two-Year Results from the Reactiv8: A Clinical Trial
BACKGROUND CONTEXT: Chronic low back pain (CLBP) without an identifiable anatomical cause is a common condition in a spine surgery practice. An underappreciated cause of CLBP is the loss of lumbar stabilization due to arthrogenic inhibition of the multifidus muscle after an acute injury of one of the joints or discs. In most cases this spontaneously resolves within of days or weeks as the initial injury heals. However, persisting inhibition can result in a self-sustained chronic nociceptive pain state.
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Preliminary Results of Anterior Lumbar Interbody Fusion Anterior Column Realignment for the Treatment of Sagittal Malalignment
BACKGROUND CONTEXT: Sagittal malalignment decreases patients′ quality of life and may require surgical correction to achieve realignment goals and spinopelvic balance. High-risk posterior based osteotomy techniques are the current standard treatment for addressing sagittal malalignment. More recently, ALIF ACR has been introduced as an alternative for correction of sagittal deformity.
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Impact of Obesity on Radiographic Alignment and Short-Term Complications after Surgical Treatment of Adult Cervical Deformity
BACKGROUND CONTEXT: Obesity can alter compensation for sagittal deformity and is an established risk factor that increases complications in thoracolumbar deformity surgeries. However, little is known whether higher BMI alters radiographic cervical alignment or increases complications after cervical deformity correction.
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Minimally Invasive Surgery in Neuromuscular Scoliosis: a Superior Approach for Severely Impaired Patients
BACKGROUND CONTEXT: Minimally invasive surgery (MIS) approach has been shown to decrease blood loss, pain, transfusion rate and hospital stays in adolescent idiopathic scoliosis (AIS) patients. This approach has never been reported on neuromuscular patients, who have multiple comorbities and complications and can benefit greatly from this technique. Therefore, we postulate that the MIS approach in neuromuscular patients will have superior outcomes to that of the standard approach.
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Hospital Acquired Conditions Following Adult Spinal Deformity Surgery: Predictors for the Development of HACs and HACs as a Risk Factor for Other 30 Day Complications
BACKGROUND CONTEXT: Adult spinal deformity (ASD) is one of the most complex spinal disorders and includes a wide variety of spinal disease. Considering the aging population, the number of patients who will likely require spinal deformity surgery will greatly increase. The Centers for Medicare and Medicaid Services (CMS) has initiated a non-payment policy for certain hospital-acquired conditions (HACs).
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Predictive Model for Nonroutine Discharge in Adult Spinal Deformity Surgery
BACKGROUND CONTEXT: Surgical intervention in adult spinal deformity (ASD) is increasingly common. While postoperative outcomes have been extensively studied in ASD surgery, to our knowledge no data exists regarding the factors predicting nonroutine discharge.
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The preventive effects of dexmedetomidine on endotoxin-induced exacerbated post-incisional pain in rats
Abstract
Purpose
Low-grade endotoxin (lipopolysaccharide; LPS) exposure may contribute to the development of exaggerated acute postoperative pain. In the present study, we investigated the possible impact of intraoperative administration of dexmedetomidine (DEX) on LPS-induced postoperative hyperalgesia in a rat incisional pain model.
Methods
The surgical and sham-surgical animals were randomly divided into saline-treated control, 5.0 mg/kg LPS-treated, 10 µg/kg DEX-treated, and 5.0 mg/kg LPS + 10 µg/kg DEX-treated groups. In the surgical animals, a 1-cm-long plantar incision was made through the skin and fascia under isoflurane anesthesia. The sham-surgical rats were only anesthetized. All treatments were administered by a single intraperitoneal (i.p.) injection 60 min before surgery. Acute postoperative pain was assessed using the Rat Grimace Scale (RGS) one day before surgery (baseline) and at 2 h post incision. In another experiment, the involvement of the α2-adrenergic receptor was tested using atipamezole, an α2-adrenergic receptor antagonist.
Results
In the sham-surgical animals, the RGS did not increase at 2 h after sham surgery compared with the corresponding baseline values in all groups. In the surgical rats, however, the postoperative RGS value of the LPS group was significantly higher than the control group, indicating LPS-induced postoperative hyperalgesia. Administration of intraoperative DEX could prevent the development of such LPS-induced exacerbated post-incisional pain. In addition, the preventive effects of intraoperative DEX were inhibited by pretreatment with atipamezole.
Conclusion
Our findings indicate that intraoperative DEX treatment can prevent LPS-induced exacerbated post-incisional pain via the α2-adrenergic receptor signaling pathway.
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Long term correlation of subthalamic beta band activity with motor impairment in patients with Parkinson’s disease
Source:Clinical Neurophysiology, Volume 128, Issue 11
Author(s): Wolf-Julian Neumann, Franziska Staub-Bartelt, Andreas Horn, Julia Schanda, Gerd-Helge Schneider, Peter Brown, Andrea A. Kühn
ObjectivesTo investigate the long term association of subthalamic beta activity with parkinsonian motor signs.MethodsWe recruited 15 patients with Parkinson's disease undergoing subthalamic DBS for local field potential recordings after electrode implantation, and at 3 and 8months post-operatively using the implantable sensing enabled Activa PC+S (Medtronic). Three patients dropped out leaving 12 patients. Recordings were conducted ON and OFF levodopa at rest. Beta (13–35Hz) peak amplitudes were extracted, compared across time points and correlated with UPDRS-III hemibody scores.ResultsPeaks in the beta frequency band (13–35Hz) in the OFF medication state were found in all hemispheres. Mean beta activity was significantly suppressed by levodopa at all recorded time points (P<0.007) and individual beta power amplitude correlated with parkinsonian motor impairment across time points and dopaminergic states (pooled data; ρ=0.25, P<0.001).ConclusionsOur results indicate that beta-activity is correlated with parkinsonian motor signs over a time period of 8months.SignificanceBeta-activity may be a chronically detectable biomarker of symptom severity in PD that should be further evaluated under ongoing DBS.
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Termination patterns of stimulus-induced rhythmic, periodic, or ictal patterns and spontaneous electrographic seizures
Source:Clinical Neurophysiology, Volume 128, Issue 11
Author(s): Emily L. Johnson, Peter W. Kaplan, Eva K. Ritzl
ObjectiveTo investigate the ability of the evolution and termination patterns to distinguish stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs) from spontaneous electrographic seizures, a challenge to the neurophysiologist and clinician.MethodsWe screened the prospectively collected database of patients undergoing continuous EEG (cEEG) and identified 25 cases of SIRPIDs. We compared patients with SIRPIDs to 25 patients with spontaneous seizures. Two experienced neurophysiologists graded the termination pattern of both on fast fourier transform (FFT) as "abrupt" or "sputtering."ResultsThe identification of a "sputtering" or cyclical tapering pattern accurately discriminated SIRPIDs from spontaneous seizures with 88% sensitivity and 87% specificity, yielding a positive predictive value of 82% for SIRPIDs when the pattern was present (negative predictive value 87% when the sputtering termination was not seen). Similarly, the identification of an "abrupt" termination pattern identified clinically determined seizures with 84% sensitivity and 88% specificity.ConclusionsThe termination pattern quickly and accurately distinguishes SIRPIDs from spontaneous seizures, suggesting that at least some SIRPIDs have an underlying mechanism distinct from that of spontaneous seizures.SignificanceIf validated in other studies, the use of evolution and termination patterns to classify EEG patterns as epileptiform seizures versus SIRPIDs will help guide treatment of these patients.
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NEURONOPATHY AND NEUROPATHY IN AUTOSOMAL DOMINANT SPINO-CEREBELLAR ATAXIA (SCA): A PRELIMINARY PERIPHERAL NERVE ULTRASOUND STUDY
Source:Clinical Neurophysiology
Author(s): Luciana Pelosi, Eoin Mulroy, Miriam J. Rodrigues, Richard H. Roxburgh
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Ear-EEG detects ictal and interictal abnormalities in focal and generalized epilepsy -A comparison with scalp EEG monitoring
Source:Clinical Neurophysiology
Author(s): IC. Zibrandtsen, P. Kidmose, CB. Christensen, TW. Kjaer
ObjectiveEar-EEG is recording of electroencephalography from a small device in the ear. This is the first study to compare ictal and interictal abnormalities recorded with ear-EEG and simultaneous scalp-EEG in an epilepsy monitoring unit.MethodsWe recorded and compared simultaneous ear-EEG and scalp-EEG from 15 patients with suspected temporal lobe epilepsy. EEGs were compared visually by independent neurophysiologists. Correlation and time-frequency analysis was used to quantify the similarity between ear and scalp electrodes. Spike-averages were used to assess similarity of interictal spikes.ResultsThere were no differences in sensitivity or specificity for seizure detection. Mean correlation coefficient between ear-EEG and nearest scalp electrode was above 0.6 with a statistically significant decreasing trend with increasing distance away from the ear. Ictal morphology and frequency dynamics can be observed from visual inspection and time-frequency analysis. Spike averages derived from ear-EEG electrodes yield a recognizable spike appearance.ConclusionsOur results suggest that ear-EEG can reliably detect electroencephalographic patterns associated with focal temporal lobe seizures. Interictal spike morphology from sufficiently large temporal spike sources can be sampled using ear-EEG.SignificanceEar-EEG is likely to become an important tool in clinical epilepsy monitoring and diagnosis.
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Adaptive hybrid robotic system for rehabilitation of reaching movement after a brain injury: a usability study
Brain injury survivors often present upper-limb motor impairment affecting the execution of functional activities such as reaching. A currently active research line seeking to maximize upper-limb motor recover...
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Ty3 / Gypsy retrotransposons in the Pacific abalone Haliotis discus hannai : characterization and use for species identification in the genus Haliotis
Abstract
Transposable elements are highly abundant elements that are present in all eukaryotic species. Here, we present a molecular description of abalone retrotransposon (Abret) elements. The genome of Haliotis discus hannai contains 130 Abret elements which were all Ty3/Gypsy retrotransposons. The Ty1/Copia elements were absent in the H. discus hannai genome. Most of the elements were not complete due to sequence truncation or coding region decay. However, three elements Abret-296, Abret-935, and Abret-3259 had most of the canonical features of LTR (long terminal repeat)-retrotransposons. There were several reading frame shifts in Abret-935 and Abret-3259 elements. Surprisingly, phylogenetic analysis indicated that all of the elements belonged to the Osvaldo lineage. The sequence divergence between LTRs revealed that the Abret elements were mostly active within 2 million years ago. Abret elements were used as molecular markers in SSAP analyses, which allowed clear distinction of different species in the genus Haliotis. The polymorphic markers were converted into SCAR markers for use in species identification by simple PCR in the Haliotis genus.
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