Κυριακή 15 Οκτωβρίου 2017

Learning from UJAMBO: Perspectives on Gynecologic Care in African Immigrant and Refugee Women in Boston, Massachusetts

Abstract

African-born immigrant women, and particularly refugees and asylum seekers, are at risk for reproductive health disparities but inadequately use relevant gynecologic services. We sought to elucidate perspectives on gynecologic care in a population of Congolese and Somali immigrants. We conducted a secondary qualitative analysis of focus group data using a grounded theory approach and the Integrated Behavioral Model as our theoretical framework. Thirty one women participated in six focus groups. Participant beliefs included the states of pregnancy and/or pain as triggers for care, preferences included having female providers and those with familiarity with female genital cutting. Barriers included stigma, lack of partner support, and lack of resources to access care. Experiential attitudes, normative beliefs, and environmental constraints significantly mediated care preferences for/barriers to gynecologic health service utilization in this population. Centering of patient perspectives to adapt delivery of gynecologic care to immigrants and refugees may improve utilization and reduce disparities.



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Acculturation, Acculturative Stress, and Depressive Symptoms in International Migrants: A Study with Vietnamese Women in South Korea

Abstract

Globally, there have been increasing numbers of migrant women; these women are at an increased risk for depressive symptoms. The purpose of this study was to examine the associations among acculturation, acculturative stress and depressive symptoms in Vietnamese women who migrated to South Korea through marriages. We hypothesized that acculturative stress would serve as a mediator in the relationship between acculturation and depressive symptoms. Our findings from surveys with 217 Vietnamese immigrant women showed that the indirect effect of acculturation on depressive symptoms, mediated through acculturative stress [− .15 (.04)], was significant (bias corrected 95% confidence interval for the indirect effect = − .25, − .08). Low levels of acculturation increased acculturative stress, which in turn led to the elevated symptoms of depression. Our findings not only illuminate the adaptation processes of international, female migrants but also suggest avenues to protect and promote their mental well-being.



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Medical Pluralism in the Use of Sobadores among Mexican Immigrants to North Carolina

Abstract

Mexican immigrants have a rich history of traditional healers. This analysis describes the conditions for which Mexican immigrants seek treatment from sobadores, and delineates factors that influence seeking treatment from a sobador or a biomedical doctor. This systematic qualitative analysis uses interview data collected with 24 adult Mexican immigrants to North Carolina who had been treated by a sobador in the previous 2 years. Immigrants are engaged in medical pluralism, seeking care from sobadores and biomedical doctors based on the complaint and patient's age. Using a hierarchy of resort, adults seek treatment from sobadores for musculoskeletal pain not involving a fracture. Doctors are first consulted when treating children; sobadores are consulted if doctors do not provide culturally appropriate treatment. Mexican immigrants seek care that addresses their culturally determined health concerns. The need to improve access to culturally competent biomedical health care for vulnerable immigrant populations continues.



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Determinants of Child Attachment in the Years Postpartum in a High-Risk Sample of Immigrant Women

Abstract

Our goal was to examine maternal mental health and associated stresses in a sample of high-risk immigrant mothers, and its association with child insecure attachment in the years following childbirth. Mothers and their child (Mage = 37 months) were recruited through a Health and Social Service organization in the Parc-Extension neighborhood in Montreal, Quebec. Mothers completed the Hopkins Symptoms Checklist (HSCL-25), the Multidimensional Scale of Perceived Social Support (MPSS) and a sociodemographic questionnaire that included questions on premature delivery and birth weight. Attachment behaviors were coded out of a videotaped free play sequence using the Preschool and Early School-Age Attachment Rating Scales (PARS). Analysis revealed high levels of clinical anxiety and depression, low social support and low attachment security. Significant mean differences and associations were found between anxiety, depression, social support, preterm delivery and child attachment. These results underscore the importance of screening for anxiety and depression early in the postnatal years, in order to prevent associated consequences such as child insecure attachment. Results also highlight the importance of building positive social networks, especially with immigrant populations.



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Tenofovir, entecavir, and lamivudine in patients with severe acute exacerbation and hepatic decompensation of chronic hepatitis B

To compare the efficacy of and mortality after lamivudine (LAM), tenofovir (TDF), and entecavir (ETV) treatment in patients with severe acute chronic hepatitis B (CHB) exacerbation.

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ERC vs. direct cholangioscopy: dawn of a new reference standard



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Transglutaminase 6 antibodies are not yet mainstream in Neuro- Coeliac Disease



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TRANSMURAL HEALING IN CROHŃS DISEASE: BEYOND MURAL FINDINGS



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TRANSMURAL HEALING IN CROHN’S DISEASE: BEYOND MURAL FINDINGS − AUTHORS’ REPLY



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Role of diuretics in the harmful effects of beta blockers in patients with ascites. Author’s reply



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Depression and anxiety in caregivers of patients with celiac disease



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DONOR DIABETES AND PROLONGED COLD ISCHEMIA TIME INCREASE THE RISK OF GRAFT FAILURE AFTER LIVER TRANSPLANT: SHOULD WE NEED A REDEFINITION OF THE DONOR RISK INDEX?



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Spleen stiffness is positively correlated with HVPG and decreases significantly after TIPS implantation

Transjugular intrahepatic portosystemic shunt (TIPS) is indicated in patients with decompensated portal hypertension (PH). Hepatic venous pressure gradient (HVPG) is considered gold standard for assessment of PH. Because HVPG measurement is invasive, non-invasive methods for evaluating severity of PH are warranted.

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Quality of care indicators in inflammatory bowel disease in a tertiary referral center with open access and objective assessment policies

In the management of inflammatory bowel diseases, there is considerable variation in quality of care.

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Is histologic remission in ulcerative colitis ready for prime time?



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Gastric Preparation for Magnetically Controlled Capsule Endoscopy: A Prospective, Randomized Single-Blinded Controlled Trial

Magnetically Controlled Capsule Endoscopy (MCE) is a novel technique for which there is no agreed gastric preparation. We aimed to determine an optimal standardized gastric preparation regimen.

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Small bowel adenocarcinoma: French Intergroup Clinical Practice Guidelines for diagnosis, treatments and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO)

This document is a summary of the French Intergroup guidelines regarding the management of small bowel adenocarcinoma published in October 2016.

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Transient elastography to assess liver stiffness in patients with inflammatory bowel disease

Liver injury during inflammatory bowel disease (IBD) is primarily diagnosed by liver biopsy, which has a small but serious risk of severe complications. The aim of this study was to assess liver stiffness, and subsequently the prevalence and associations of liver fibrosis in IBD patients with thiopurine therapy and other clinical factors, by using transient elastography (TE).

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Celiac disease or positive tissue transglutaminase antibodies in patients undergoing renal biopsies

An association between celiac disease and renal diseases has been suggested, but the results are controversial.

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Immediate Postoperative Fibrosis-4 Predicts Postoperative Liver Failure for Patients with Hepatocellular Carcinoma Undergoing Curative Surgery

Postoperative liver failure remains the main complication and predominant cause of hepatectomy-related mortality for patients undergoing liver resection.

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The mycobiome: Role in health and disease, and as a potential probiotic target in gastrointestinal disease

The human gastrointestinal (GI) tract is home to trillions of microorganisms, some beneficial and others potentially harmful. Recent advances in science have allowed us to identify the multitude of organisms inhabiting the GI tract and parse out those that play a role in inflammatory bowel disease (IBD). Unfortunately, most research has focused on studying only the bacteria while ,overlooking a key player, fungus. In order to address this issue, we have focused our efforts on studying the fungal community in the GI tract known as the mycobiome.

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Pancreatic duct cytology, an underused diagnostic tool



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Editorial Board



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Obstructive sleep apnea is predictive of worse hospital outcomes in hospitalizations with acute pancreatitis in obese patients



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H&H Medical introduces the H*VENT Vented Chest Dressing

Product expands world leading chest seal line WILLIAMSBURG, Va. — H&H Medical Corporation, a leading provider of emergency trauma products, is proud to announce the introduction of our newest product in our chest seal line, the H*VENT vented chest dressing. Open chest wounds that develop into a tension pneumothorax, commonly referred as a sucking chest wound, can be life threatening if not ...

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KARL STORZ to exhibit video laryngoscope at EMS World Booth #1025

LAS VEGAS — Plan to visit us at EMS World Booth #1025 to test drive the latest airway management products from KARL STORZ. We will showcase the latest additions to the most comprehensive airway management devices for the pre-hospital market, including our C-MAC® S Single-use video laryngoscope for adults, pediatrics and neonates; as well as our re-useable blades. The C-MAC® platform can ...

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Genlantis introduces FirstResponder Sterilizer product to help EMTs and paramedics

Genlantis – a BioTech Company has a revolutionary product tailored just for you. Download this eBook to learn more about the FirstResponder Sterilizer. SAN DIEGO — The FirstResponder® Sterilizer is one of a kind as it can be used to sterilize spaces and vehicles from infestations that might lead to severe infections. Such infections can also often lead to lifelong medical conditions ...

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6 ePCR best practices

Look for these features when choosing an electronic patient care reporting program

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EMS budget planning primer for new paramedic chiefs

Climbing the ranks of EMS often fails to prepare new chiefs to discuss financial issues with local elected and appointed officials

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The 3 Ps: Applying Policy, Procedure and Process to EMS

Paramedic chiefs can use the three Ps to communicate the organization's expectations regarding operational preparedness to EMS providers

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Exclusive end-of-year special for RISE™ vest by Angel Armor™ - for public safety officers only

Angel Armor is excited to announce an end-of-year special for the RISE body armor platform. If agencies order before December 31, 2017, they will receive up to $100 off each RISE vest.

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Drones to deliver defibrillators to 911 callers to treat cardiac arrest

A start-up called Flirtey partnered with REMSA Health to dispatch drones with portable defibrillators when 911 callers report cardiac arrest symptoms

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Inventors present drone that could help treat patients in disasters

The drone could be loaded with a medical kit containing supplies and a headset so civilians at a disaster site could receive medical instructions

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CPRP to exhibit support pillow at EMS World Expo, Booth 926

The Cardiopulmonary Resuscitation Support Pillow is designed to aid with performing proper CPR for single or dual first responders

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Doing more with less: 6 ways rural EMS makes providers better

By Lindsey Stein, EMS1 Contributor The challenges of rural EMS departments are well-known to those who practice in or manage them: funding, staffing, recruitment and retention, access to specialty care, equipment, training and so many more. While each of these challenges represents a significant topic on its own, there's another side to the story that's often forgotten: practicing EMS in ...

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Finding the joy: Job satisfaction in EMS

A strange thing happened during our first of four Regional Meetings for the EMS Agenda 2050 project. The setup is that everyone who participates is involved in a series of dialogues with members of the Technical Expert Panel. Each of these dialogues is focused around a question designed to provoke creativity and inspire visionary thinking. The topics include person-centered system design, inherent safety ...

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Top EMS Game Changers – #2: 12-lead EKGs

There was a time before prehospital 12-leads when I learned why we need prehospital 12-leads. The details are sketchy, but during paramedic school in 1995, I was treating a cardiac patient who presented with ST elevation in lead I. As for the other leads … well, there were only I, II and III on my Lifepak 10 – not much to go on. I knew ST elevation was a sign of badness – a heart ...

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Man arrives in ambulance with fake emergency to propose to nurse

By EMS1 Staff LONG BRANCH, N.J. — An ER nurse was proposed to by her boyfriend, who arrived in an ambulance with a fake emergency. CBS New York reported that emergency room nurse Lauren Trulli's boyfriend, Tom Ciancia, who is also a nurse at the hospital, pretended he was having an allergic reaction to peanuts and arrived at the hospital in an ambulance during Trulli's shift. "Tom ...

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NC city school board announces public safety program at high school

By Sharon Myers The Dispatch LEXINGTON, N.C. — The Lexington City Schools Board of Education announced the addition of a new public safety academy that would begin at Lexington Senior High School next fall. Nicole Piggott, director of secondary instruction and supervisor of career technical education for the Lexington City School System, said the new program would include classes focused on law ...

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Menstrual Disruption with Exercise is not Linked to an Energy Availability Threshold.

Introduction: Chronic reductions in energy availability (EA) suppress reproductive function. A particular calculation of EA quantifies the dietary energy remaining after exercise for all physiological functions. Reductions in LH pulse frequency have been demonstrated when EA using this calculation is

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Increased Walking's Additive and No Substitution Effect on Total Physical Activity.

Purpose: We assessed the associations between a change in time spent walking and a change in total physical activity (PA) time within an urban living adult sample, to test for additive or substitution effects. Methods: Participants living in the greater Seattle area were assessed in 2008-2009 and again 1-2 years later (2010-2011). At each time point, they wore accelerometers and GPS units and recorded trips and locations in a travel diary for 7 consecutive days. These data streams were combined to derive a more objective estimate of walking and total PA. Participants also completed the International Physical Activity Questionnaire to provide self-reported estimates of walking and total PA. Regression analyses assessed the associations between within-participant changes in objective and self-reported walking and total PA. Results: Data came from 437 participants. On average, a 1-minute increase in total walking was associated with an increase in total PA of 1 minute, measured by objective data and 1.2-minute, by self-reported data. A similar additive effect was consistently found with utilitarian, transportation, or job-related walking, measured by both objective and self-reported data. For recreational walking, the effect of change was mixed between objective and self-reported results. Conclusion: Both objective and self-reported data confirmed an additive effect of utilitarian and total walking on PA. (C) 2017 American College of Sports Medicine

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Biomechanical Implications of Training Volume and Intensity in Aging Runners.

Running speed is slower in middle-aged compared to younger runners due to reduced ankle but not hip and knee kinetic output. Running-specific training helps attenuate age-related declines in measures of endurance, muscle strength and gait speed. Considering the adaptability of the human body in response to imposed stresses, maintaining training volume and intensity may play a role in modifying running biomechanics in middle-aged runners. Purpose: To compare running biomechanics between young and middle-aged runners when controlling for the confounding effects of training volume and intensity. Methods: 15 middle-aged runners, 15 young runners with similar training volume as the middle-aged group and, 15 young runners with similar preferred training paces (i.e. intensity) as the middle-aged runners participated in the study. Lower limb joint kinetics were calculated from kinematic and ground reaction force data during over-ground running at a submaximal speed and compared among groups. Results: Middle-aged runners ran with similar peak ankle power compared to volume-matched younger runners although peak plantarflexor moment was 10.5% lower in the middle aged group (p = 0.046; Cohen's d = 0.78). Middle-aged runners ran with similar ankle plantarflexor moment and joint power compared to training pace-matched young runners. As expected, no age-related differences were observed in hip and knee kinetics when training volume or pace were matched between age groups. These results suggest that training pace may be more effective in attenuating age-related declines in plantarflexor kinetics in middle-aged runners. Conclusion: From these findings, we propose the hypothesis that both training volume and training pace may play a role in maintaining plantarflexor kinetics but that training pace may have a greater impact on ankle plantarflexor kinetics in middle-aged runners. (C) 2017 American College of Sports Medicine

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No Effect of [beta]-alanine on Muscle Function and Kayak Performance.

Purpose: It was investigated if [beta]-alanine supplementation counteracts muscular fatigue development or improves athletic performance. Methods: Elite kayak rowers (10 males and 7 females) were supplemented with either 80 mg/kg body mass/day [beta]-alanine or placebo for 8 weeks. Muscular fatigue development was investigated by applying a 2 min elbow flexor maximal voluntary contraction (MVC). Electromyography (EMG) was recorded continuously and voluntary activation (VA) was determined 30, 60, 90 and 115 s into the 2 min MVC. Additionally, performance was evaluated as 1000 m and 5 x 250 m kayak ergometer rowing. Results: Force reduction during the 2 min MVC was similar before and after supplementation with [beta]-alanine (30.9 +/- 10.3 % vs 36.0 +/- 14.1 %) and placebo (35.5 +/- 7.7 % vs 35.1 +/- 8.0 %). No time-effect was apparent in VA during the 2 min MVC. Additionally, there was no detectable effect of [beta]-alanine supplementation on 1000 m kayak ergometer performance ([beta]-alanine: 0.26 +/- 0.02 % vs placebo: -0.18 +/- 0.02 %) or accumulated 5 x 250 m time ([beta]-alanine: -1.0 +/- 0.3 % vs placebo: -1.0 +/- 0.2 %). In 5 x 250 m, mean power output (MPO) was reduced to a similar extend from 1st to 5th interval before and after supplementation with [beta]-alanine (23 +/- 11 % vs 22 +/- 10 %) and placebo (26 +/- 13 % vs 20 +/- 5 %). Conclusion: 2 min MVC characteristics are unaffected by [beta]-alanine supplementation in elite kayakers and likewise both a 1000 m kayak ergometer time trial lasting 4-5 min as well as 5 x 250 m repeated sprint ability was unaltered by supplementation. (C) 2017 American College of Sports Medicine

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Mechanisms of Fatigue and Recovery in Upper versus Lower Limbs in Men.

Purpose: To compare the mechanisms of fatigue and recovery between upper and lower limbs in the same subjects. Methods: Twelve healthy young males performed a 2-min sustained maximal voluntary isometric contraction (MVC) of the knee extensors (KE) and on another day a 2-min MVC of the elbow flexors (EF). Neuromuscular function evaluations were performed with both transcranial magnetic and peripheral stimulations before (PRE), at the end of the 2-min MVCs (POSTimm), and 5 more times within 8 min of recovery. Results: Decreases in MVC and cortical voluntary activation were ~12% (P 0.05) whereas the increase in silent period duration was ~30% greater in EF than KE (P

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Wrist Acceleration Cut-points for Moderate-to-Vigorous Physical Activity in Youth.

Purpose: To examine the validity of wrist acceleration cut-points for classifying moderate (MPA), vigorous (VPA) and moderate-to-vigorous (MVPA) physical activity. Methods: Fifty-seven children (5-12y) completed 15 semi-structured activities. Three sets of wrist cut-points (>192mg, >250mg, >314mg), previously developed using Euclidian norm minus one (ENMO192+), GENEActiv software (GENEA250+) and Bandpass Filtered followed by Euclidian Norm (BFEN314+), were evaluated against indirect calorimetry. Analyses included classification accuracy, equivalence testing and Bland-Altman procedures. Results: All cut-points classified MPA, VPA and MVPA with substantial accuracy (ENMO192+: [kappa] = 0.72 [95% confidence interval: 0.72 - 0.73], MVPA: area under the receiver operating characteristic curve (ROC-AUC) = 0.85 [0.85 - 0.86]; GENEA250+: [kappa] = 0.75 [0.74 - 0.76], MVPA: ROC-AUC = 0.85 [0.85 - 0.86]; BFEN314+: [kappa] = 0.73 [0.72 - 0.74], MVPA: ROC-AUC = 0.86 [0.86 - 0.87]). BFEN314+ misclassified 19.7% non-MVPA epochs as MPA, whereas ENMO192+ and GENEA250+ misclassified 32.6% and 26.5% of MPA epochs as non-MVPA, respectively. Group estimates of MPA time were equivalent (p

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Exercise Prescription and Adherence for Breast Cancer: One Size Does Not FITT All.

Purpose: To prospectively assess adherence to oncologist-referred, exercise programming consistent with current recommendations for cancer survivors among women with early breast cancer across the trajectory of adjuvant treatment. Methods: Sixty-eight women participated in supervised, hour-long, moderate-intensity, aerobic and resistance exercise 3x/week during adjuvant chemotherapy +/- radiation, with a step-down in frequency for 20 additional weeks. Adherence to exercise frequency (i.e. attendance), intensity, and time/duration, and barriers to adherence were tracked and compared during chemotherapy versus radiation, and during treatment (chemotherapy plus radiation, if received) versus after treatment. Results: Attendance decreased with cumulative chemotherapy dose (cycles 1-2 vs. cycles 3-8, cycle 3 vs. cycles 7-8, all P

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Heavy-Load Lifting: Acute Response in Breast Cancer Survivors at Risk for Lymphedema.

Purpose: Despite a paucity of evidence, prevention guidelines typically advise avoidance of heavy lifting in an effort to protect against breast cancer-related lymphedema. This study compared acute responses in arm swelling and related symptoms after low- and heavy-load resistance exercise among women at risk of lymphedema while receiving adjuvant taxane-based chemotherapy. Methods: This is a randomized, cross-over equivalence trial. Women receiving adjuvant taxane-based chemotherapy for breast cancer who had undergone axillary lymph node dissection (n=21) participated in low- (60-65% 1 repetition maximum (RM), two sets of 15-20 repetitions) and heavy-load (85-90% 1RM, three sets of 5-8 repetition) upper-extremity resistance exercise separated by a one-week wash-out period. Swelling was determined by bioimpedance spectroscopy and dual energy x-ray absorptiometry, with breast cancer-related lymphedema symptoms (heaviness, swelling, pain, tightness) reported using a numeric rating scale (0-10). Order of low- versus heavy-load was randomized. All outcomes were assessed pre-, immediately post-, and 24- and 72-hours post-exercise. Generalized estimating equations were used to evaluate changes over time between groups, with equivalence between resistance exercise loads determined using the principle of confidence interval inclusion. Results: The acute response to resistance exercise was equivalent for all outcomes at all time points irrespective of loads lifted, with the exception of extracellular fluid at 72-hours post-exercise with less swelling following heavy-loads (estimated mean difference -1.00, 95% CI -3.17 to 1.17). Conclusion: Low- and heavy-load resistance exercise elicited similar acute responses in arm swelling and breast cancer-related lymphedema symptoms in women at risk for lymphedema receiving adjuvant taxane-based chemotherapy. These represent important preliminary findings, which can be used to inform future prospective evaluation of the long term effects of repeated exposure to heavy-load resistance exercise. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. (C) 2017 American College of Sports Medicine

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Associations of Muscle Mass and Strength with All-Cause Mortality among US Older Adults.

Introduction: Recent studies suggested that muscle mass and muscle strength may independently or synergistically affect aging-related health outcomes in older adults; however, prospective data on mortality in the general population are sparse. Methods: We aimed to prospectively examine individual and joint associations of low muscle mass and low muscle strength with all-cause mortality in a nationally representative sample. This study included 4,449 participants aged 50 years and older from the National Health and Nutrition Examination Survey (NHANES) 1999-2002 with public-use 2011 linked mortality files. Weighted multivariable logistic regression models were adjusted for age, sex, race, BMI, smoking, alcohol use, education, leisure-time physical activity (LTPA), sedentary time, and comorbid diseases. Results: Overall, the prevalence of low muscle mass was 23.1% defined by appendicular lean mass (ALM) and 17.0% defined by ALM/BMI, and the prevalence of low muscle strength was 19.4%. In the joint analyses, all-cause mortality was significantly higher among individuals with low muscle strength, whether they had low muscle mass (OR 2.03, 95% CI, 1.27-3.24 for ALM; OR 2.53, 95% CI, 1.64-3.88 for ALM/BMI) or not (OR 2.66, 95% CI 1.53-4.62 for ALM; OR 2.17, 95% CI 1.29-3.64 for ALM/BMI). In addition, the significant associations between low muscle strength and all-cause mortality persisted across different levels of metabolic syndrome (MetS), sedentary time, and LTPA. Conclusions: Low muscle strength was independently associated with elevated risk of all-cause mortality, regardless of muscle mass, MetS, sedentary time, or LTPA among US older adults, indicating the importance of muscle strength in predicting aging-related health outcomes in older adults. (C) 2017 American College of Sports Medicine

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Quadriceps Function and Knee Joint Ultrasonography following ACL Reconstruction.

Purpose: Individuals with anterior cruciate ligament reconstruction (ACLR) are at greater risk for knee osteoarthritis (OA), partially due to chronic quadriceps dysfunction. Articular cartilage is commonly assessed using magnetic resonance imaging and radiography, but these methods are expensive and lack portability. Ultrasound imaging may provide a cost-effective and portable alternative for imaging the femoral cartilage. The purpose of this study was to compare ultrasonography of the femoral cartilage between the injured and uninjured limbs of individuals with unilateral ACLR, and to examine the association between quadriceps function and ultrasonographic measures of femoral cartilage. Methods: Bilateral femoral cartilage ultrasonography and quadriceps function were assessed in 44 individuals with unilateral ACLR. Quadriceps function was assessed using peak isometric strength (PT), and early (RTD100) and late (RTD200) rate of torque development. Results: Cartilage thickness at the medial femoral condyle (P

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Maximum Skin Wettedness following Aerobic Training with and without Heat Acclimation.

PURPOSE: To quantify how maximum skin wettedness ([omega]max), i.e. the determinant of the boundary between compensable and uncompensable heat stress, is i) altered by aerobic training in previously unfit individuals, and ii) further augmented by heat acclimation. METHODS: Eight untrained individuals completed an 8-week aerobic training program immediately followed by 8 days of hot/humid (38[degrees]C, 65%RH) heat acclimation. Participants completed a humidity ramp protocol pre-training (PRE-TRN), post-training (POST-TRN), and post-heat acclimation (POST-HA), involving treadmill marching at a heat production of 450 W for 105 mins in 37.5[degrees]C, 2.0 kPa (35%RH). After attaining a steady-state esophageal temperature (Tes), humidity increased 0.04 kPa[middle dot]min-1. An upward inflection in Tes indicated the upper limit of physiological compensability (Pcrit), which was then used to quantify [omega]max. Local sweat rate (LSR), activated sweat gland density (ASGD) and sweat gland output (SGO) on the back and arm were simultaneously measured throughout. RESULTS: Peak aerobic capacity increased POST-TRN by ~14% (PRE-TRN:45.8+/-11.8 ml[middle dot]kg-1[middle dot]min-1; POST-TRN:52.0+/-11.1 ml[middle dot]kg-1[middle dot]min-1, P

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Kinetic Compensations due to Chronic Ankle Instability during Landing and Jumping.

Introduction: Skeletal muscles absorb and transfer kinetic energy during landing and jumping, which are common requirements of various forms of physical activity. Chronic ankle instability (CAI) is associated with impaired neuromuscular control and dynamic stability of the lower extremity. Little is known regarding an intra-limb, lower-extremity joint coordination of kinetics during landing and jumping for CAI patients. We investigated the effect of CAI on lower-extremity joint stiffness, and kinetic and energetic patterns across the ground contact phase of landing and jumping. Methods: 100 CAI patients and 100 matched able-bodied controls performed five trials of a landing and jumping task (a maximal vertical forward jump, landing on a force plate with the test leg only, and immediate lateral jump toward the contralateral side). Functional analyses of variance (FANOVA) and independent t-tests were used to evaluate between-group differences for lower extremity net internal joint moment, power and stiffness throughout the entire ground contact phase of landing and jumping. Results: Relative to the control group, the CAI group revealed (i) reduced plantarflexion and knee extension, and increased hip extension moments, (ii) reduced ankle and knee eccentric and concentric power, and increased hip eccentric and concentric power, and (iii) reduced ankle and knee joint stiffness, and increased hip joint stiffness during the task. Conclusion: CAI patients appeared to use a hip dominant strategy by increasing the hip extension moment, stiffness, and eccentric and concentric power during landing and jumping. This apparent compensation may be due to decreased capabilities to produce sufficient joint moment, stiffness and power at the ankle and knee. These differences might have injury risk and performance implications. (C) 2017 American College of Sports Medicine

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Mountain Cycling Ultramarathon Impacts in Inflammatory and Hemoglobin Responses.

Purpose: To analyze the cumulative physiological burden of repetitive, strenuous exercise held during mountain cycling ultramarathon on regulatory mechanisms of hemoglobin degradation. Methods: Fifty-five non-professional athletes (mean age 44.8+/-7.1 years old) participating in a 9-consecutive-day mountain cycling ultramarathon (TransPortugal), underwent anthropometric, hematological and biochemical assessments before and immediately after the race. Participants were further stratified as completers (9 courses) or non-completers, and divided according to the time they took to complete the race. The heme oxygenase-1 (HMOX1) functional genetic polymorphism and Haptoglobin (HP) phenotypic variants were also analyzed. Results: Total leucocytes, neutrophil and monocyte counts increased, whereas decreases in erythrocyte counts and hemoglobin were found between pre and post-ultramarathon. Circulating haptoglobin (Hp) was increased while its soluble receptor (sCD163) decreased. Athletes who completed all 9 courses presented with increased leucocyte, neutrophil, and erythrocyte counts, as well as hemoglobin, RDW, total bilirubin and total cholesterol levels. High sensitivity-C reactive protein (hs-CRP) and Hp decreased in comparison with non-completers. HMOX1 and HP genetic polymorphisms were associated with biochemical profile, notably with Hp levels. Analysis of covariance showed a significant effect of HP phenotype in Hp circulating levels at the end of race and on the magnitude of variation from pre- to post-race. Conclusion: Present findings support a co-modulatory influence of genetic- and exercise-associated factors on resulting inflammatory and hemoglobin catabolic marker Hp after highly demanding endurance exercise. (C) 2017 American College of Sports Medicine

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Caffeine Ingestion Attenuates Fatigue-induced Loss of Muscle Torque Complexity.

The temporal structure, or complexity, of muscle torque output decreases with neuromuscular fatigue. The role of central fatigue in this process is unclear. Purpose: We tested the hypothesis that caffeine administration would attenuate the fatigue-induced loss of torque complexity. Methods: Eleven healthy participants performed intermittent isometric contractions of the knee extensors to task failure at a target torque of 50% maximal voluntary contraction (MVC), with a 60% duty factor (6 s contraction, 4 s rest), 60 min after ingesting 6 mg[middle dot]kg-1 caffeine or a placebo. Torque and surface EMG signals were sampled continuously. Complexity and fractal scaling of torque were quantified using approximate entropy (ApEn) and the detrended fluctuation analysis (DFA) [alpha] scaling exponent. Global, central and peripheral fatigue were quantified using MVCs with femoral nerve stimulation. Results: Caffeine ingestion increased endurance by 30 +/- 16% (mean +/- SD, P = 0.019). Complexity decreased in both trials (decreased ApEn, increased DFA [alpha]; both P

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Does a Prolonged Work Day in the Heat Impair Heat Loss on the Next Day in Young Men?.

PURPOSE: Heat strain is known to be exacerbated on the second of consecutive work days. We therefore evaluated whether prolonged work in the heat would impair whole-body heat loss capacity on the next day. METHODS: To evaluate this possibility, we assessed changes in whole-body heat exchange and heat storage in eight young (26 years (SD 4)) males during heat stress tests performed on the same day prior to (Day 1), and on the day following (Day 2), a prolonged work simulation. Each heat stress test involved three, 30-min bouts of semi-recumbent cycling at fixed rates of metabolic heat production (200 (Ex1), 250 (Ex2) and 300 W.m-2 (Ex3)), each separated by 15-min recovery, in hot-dry conditions (40[degrees]C, 20% relative humidity). The work simulation (7.5 h) involved three moderate intensity intermittent work bouts (2 h), each separated by 30-min rest breaks, under similarly hot-dry conditions (38[degrees]C, 34% relative humidity). Total heat loss (evaporative +/- dry heat exchange) and metabolic heat production were measured using direct and indirect calorimetry, respectively. Body heat storage was quantified as the temporal summation of heat production and loss. RESULTS: Total heat loss did not differ between Day 1 and 2 (P=0.66), and averaged (mean+/-95% CI) 185+/-7 W (Ex1), 233+/-7 W (Ex2) and 261+/-5 W (Ex3) across test days. Consequently, the change in body heat storage was also similar between Day 1 and 2 (P=0.32), averaging 133+/-15 kJ (Ex1), 99+/-16 kJ (Ex2) and 184+/-15 kJ (Ex3) across test days. CONCLUSION: When assessed in controlled laboratory conditions in young men, prolonged work in the heat does not appear to impair whole-body heat loss nor exacerbate heat storage on the following day. (C) 2017 American College of Sports Medicine

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Genetic Variants and Hamstring Injury in Soccer: an Association and Validation Study.

Purpose: To investigate the association of candidate single nucleotide polymorphisms (SNPs) with non-contact hamstring muscle injuries in elite soccer players, and to create and validate a model to assess the risk of hamstring injury. Methods: 107 elite male outfield players were prospectively followed for 6 seasons. Players were genotyped for 37 SNPs previously investigated in relation to musculoskeletal injuries. The association of SNPs, previous injury, age, level of play, position and anthropometric data with 129 hamstring injuries (413 observations) was investigated in the discovery phase (2010-2015), and a multivariable Cox-frailty model was created using forward selection. The model's discriminative ability was tested in the validation phase (2015-2016, 31 injuries, 98 observations) using Harrell's C index. Results: Five SNPs were found to be significantly associated with hamstring injury in a multivariable model, MMP3 (Matrix metalloproteinase-3) rs679620 (A vs. G, hazard ratio (HR)=2.06, 95% confidence interval (CI)=1.51-2.81), TNC (Tenascin-C) rs2104772 (A vs. T, HR=1.65, 95% CI=1.17-2.32), IL6 (Interleukin-6) rs1800795 (GG vs. GC+CC, HR=1.68, 95% CI=1.11-2.53), NOS3 (Nitric oxide synthase-3) rs1799983 (G vs. T, HR=1.35, 95% CI=1.01-1.79), and HIF1A (Hypoxia-inducible factor-1[alpha]) rs11549465 (CC vs. CT, HR=2.08, 95% CI=1.00-4.29). Age also entered the model (>=24 vs.

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Physical Fitness in Young Men Between 1975 and 2015 with a Focus on the Years 2005-2015.

Purpose: The purpose of the present study was to investigate changes in physical fitness and anthropometry of young men entering the military service in Finland during the years 1975-2015. Methods: The study included the fitness test results of 627,142 healthy young male conscripts (age 19.1+/-0.4 yrs.). Data included results of aerobic capacity, muscle fitness tests, and anthropometric characteristics. Results: The results show that the increase in mean body mass of young men has slowed down during the last ten years. However, the total increase in body mass was 6.8 kg (8.8%, p

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Accelerometer-assessed Physical Activity in Epidemiology: Are Monitors Equivalent?.

Purpose: Accelerometers are increasingly being used to assess physical activity in large-scale surveys. Establishing whether key physical activity outcomes can be considered equivalent between three widely-used accelerometer brands would be a significant step towards capitalising on the increasing availability of accelerometry data for epidemiological research. Methods: Twenty participants wore a GENEActiv, Axivity AX3 and ActiGraph GT9X on their non-dominant wrist and were observed for two-hours in a simulated living space. Participants undertook a series of seated and upright light/active behaviours at their own pace. All accelerometer data were processed identically using open-source software (GGIR) to generate physical activity outcomes (including average dynamic acceleration (ACC) and time within intensity cut-points). Data were analysed using pairwise 95% equivalence tests (+/-10% equivalence zone), intra-class correlation coefficients (ICC) and limits of agreement. Results: The GENEActiv and Axivity could be considered equivalent for ACC (ICC=0.95, 95% confidence interval (CI) 0.87 to 0.98), but ACC measured by the ActiGraph was approximately 10% lower (ICC: GENEActiv/ActiGraph 0.86, 95% CI 0.56 to 0.95; Axivity/ActiGraph 0.82, 95% CI 0.50 to 0.94). For time spent within intensity cut-points, all three accelerometers could be considered equivalent to each other for over 85% of outcomes (ICC>=0.69, lower 95% CI>=0.36), with the GENEActiv and Axivity equivalent for 100% of outcomes (ICC>=0.95, lower 95% CI>=0.86). Conclusions: GENEActiv and Axivity data processed in GGIR are largely equivalent. If comparing GENEActiv or Axivity to the ActiGraph, time spent within intensity cut-points has good agreement. These findings can be used to inform selection of appropriate outcomes if comparing outputs from these accelerometer brands. (C) 2017 American College of Sports Medicine

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Objectively Measured Physical Activity and Risk of Knee Osteoarthritis.

Purpose: To examine the association between objectively measured physical activity and risk of developing incident knee osteoarthritis (OA) in a community-based cohort of middle-aged and older adults. Methods: We used data from the Osteoarthritis Initiative (OAI), an ongoing prospective cohort study of adults aged 45 to 83 at initial enrollment with elevated risk of symptomatic knee OA. Moderate-vigorous physical activity (MVPA) was measured by a uniaxial accelerometer for seven continuous days in two data collection cycles, and was categorized as inactive (=150 minutes/week). Incident knee OA based on radiographic and symptomatic OA and joint space narrowing were analyzed as outcomes over four years of follow-up. Participants free of the outcome of interest in both knees at study baseline were included (sample sizes ranged from 694 to 1,331 for different outcomes). We estimated hazard ratio (HR) and its 95% confidence intervals (CI). Results: In multivariate adjusted analyses, active MVPA participation was not significantly associated with risk of incident radiographic knee OA (HR: 1.52; 95% CI: 0.68-3.40), symptomatic knee OA (HR: 1.17; 95% CI: 0.44-3.09), or joint space narrowing (HR: 0.87; 95% CI: 0.37-2.06), when compared with inactive MVPA participation. Similar results were found for participants with low activity MVPA. Conclusion: MVPA was not associated with the risk of developing incident knee OA or joint space narrowing over four years of follow-up among OAI participants who are at increased risk of knee OA. (C) 2017 American College of Sports Medicine

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Comment on: “How Biomechanical Improvements in Running Economy Could Break the 2-Hour Marathon Barrier”



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Effect of 2% Nasal Mupirocin Ointment on Decreasing Complications of Nasotracheal Intubation: A Randomized Controlled Trial.

Related Articles

Effect of 2% Nasal Mupirocin Ointment on Decreasing Complications of Nasotracheal Intubation: A Randomized Controlled Trial.

J Clin Diagn Res. 2017 Aug;11(8):PC08-PC12

Authors: Talesh KT, Gargary RM, Arta SA, Yazdani J, Roshandel M, Ghanizadeh M, Kafil HS, Mousavi MNS

Abstract
INTRODUCTION: In oral and maxillofacial surgeries, nasotracheal intubation is carried out to increase the surgeon's access to the oral cavity. During nasotracheal intubation the risk of trauma is higher than that in orotracheal intubation as there is passage of the tube through the mucosa of the nasal tract due to which bacteria might get transported into the trachea.
AIM: To evaluate the effect of 2% nasal mupirocin ointment before and after nasotracheal intubation on decreasing the complications of intubation for oral and maxillofacial surgeries.
MATERIALS AND METHODS: In the present single blinded randomised controlled clinical trial, 44 patients were randomly assigned to two equal groups. A sterile swab was used, eight to 10 hours before nasotracheal intubation, to take a sample for culturing from the vestibule of nostrils and the anterior septum of the patients. In Group 1, 2% nasal mupirocin ointment was applied to the vestibules of both nostrils and the anterior septum. In Group 2, no intervention was carried out. After general anaesthesia and extubation, microbial cultures were prepared from the 4 cm distal end of the tube and antibiogram test was carried out. Also, the patients were compared in terms of the severity of nasal bleeding, the ease of breathing through the nose after nasotracheal intubation. Data were analysed with suitable statistical tests.
RESULTS: In the mupirocin group, 27.2% of the subjects were carriers of Staphylococcus aureus in the nasal cavity but no S. aureus was detected at the distal end of nasotracheal tube after extubation. In the control group, 18.2% of the subjects were carriers of Staphylococcus aureus in the nasal cavity but there was no change in the number of S. aureus counts at the distal end of nasotracheal tube (p-value<0.001). After extubation, in the mupirocin and control groups, 18.2% and 22.7% of the subjects, respectively, exhibited severe bleeding (p-value=0.001). In the mupirocin and control groups, 86.4% and 59.1% of the subjects had easy extubation, respectively (p-value=0.044). In the mupirocin and control groups, 9.1% and 63.7% of the subjects immediately after regaining consciousness and 9.1% and 54.6% three hours after extubation had difficulty in breathing, respectively (p-value=0.001).
CONCLUSION: Use of mupirocin before nasotracheal intubation decreased the complications of nasal intubation in addition to decreasing the risk of colonization of S. aureus and other gram-negative bacteria.

PMID: 28969192 [PubMed]



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Evaluation of a new energy device for parenchymal transection in laparoscopic liver resection

Abstract

Introduction

THUNDERBEAT (TB) is a novel device that uses both ultrasonic and advanced bipolar energies for hemostasis. Several recent human studies have proved the safety and efficacy of TB in different surgical procedures, but there have been no similar studies about its efficacy in hepatic parenchymal transection. Therefore, the aim of the study was to assess the safety and efficacy of the TB device in laparoscopic liver resection.

Methods

This retrospective study compared TB and ultrasonic Harmonic devices in 80 patients who underwent laparoscopic liver resection from 2010 to 2016 in our institution. To reduce the selection bias, the two groups were matched in a 1-to-2 ratio on the basis of propensity scores.

Results

There were no differences in the preoperative patient characteristics between the two groups. The extent of liver resection was comparable between the groups. Although the Harmonic group's intraoperative blood loss and operative time were less than that of the TB group, the differences were not statistically significant (P = 0.08, P = 0.32, respectively). Postoperative complications, mortality within 90 days, and hospital stay were comparable between the two groups.

Conclusion

TB is as safe and effective for parenchymal transection in laparoscopic hepatectomy as ultrasonic devices, but it is not a superior alternative.



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Endoscopic surgery in Japan: The 12th national survey(2012–2013) by the Japan Society for Endoscopic Surgery

Abstract

In Japan, the first endoscopic surgery, a laparoscopic cholecystectomy, was performed in 1990. Since then, operative procedures have been standardized, and the safety and usefulness of endoscopic surgery have been evaluated. With the acceptance of endoscopic surgery as less invasive than open surgery, the number of the endoscopic procedures continues to increase in all surgical domains. The Japan Society for Endoscopic Surgery (JSES) has had an important role in the development of endoscopic surgery in Japan. For example, JSES established a technical skills certification system for physicians to train instructors to teach safe endoscopic surgery. Additionally, JSES has performed a national survey every 2 years. In 2013, 178 084 patients underwent endoscopic surgery in all surgical domains, including abdominal, thoracic, mammary and thyroid gland, cardiovascular, obstetrics and gynecology, urologic, orthopedic, and plastic surgery. The development and current status of laparoscopic surgery are reported here based on the results of the most recent questionnaire survey conducted by JSES.



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Prospective randomized controlled trial comparing partially absorbable lightweight mesh and multifilament polyester anatomical mesh in laparoscopic inguinal hernia repair

Abstract

Introduction

Tension-free mesh repair is currently the gold standard treatment for inguinal hernia. Recent evidence has shown that both open and laparoscopic approaches to inguinal hernia repair can achieve good results. Lots of meshes with different properties are available on the market, but direct comparisons between them are scare. We conducted a prospective randomized controlled trial comparing a partially absorbable lightweight mesh (ULTRAPRO™) and a multifilament polyester anatomical mesh (Parietex™) in laparoscopic total extraperitoneal inguinal hernia repair.

Methods

This study was a single-center, prospective randomized controlled trial to compare the surgical handling and clinical outcomes between two different types of meshes. All operations were performed using a standardized operative protocol. This study was approved by the Institutional Review Board of the Hong Kong East Cluster Health Service in 2009 (reference number: 2009-087). The study was registered in the Australian New Zealand Clinical Trial Registry (ACTRN12610000031066).

Results

From October 2009 to August 2011, 85 laparoscopic total extraperitoneal inguinal hernia repairs were performed. The mean mesh handling time was 152 s for the ULTRAPRO group and 206 s for the Parietex group (P = 0.001). There were three cases of seroma formation in the ULTRAPRO group and nine in the Parietex group (P = 0.02). The overall recurrence rate was 2.5%.

Conclusion

It took less time to manipulate the flat mesh (ULTRAPRO) than the anatomical mesh (Parietex) in laparoscopic total extraperitoneal inguinal hernia repair, but the time difference was small. Lightweight mesh and heavyweight mesh offered similar clinical outcomes in terms of discomfort sensation and foreign body sensation during long-term follow-up.



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Conversion during laparoscopic anterior resection for rectal cancer with a congenital solitary pelvic kidney: A case report

Abstract

A 54-year-old female patient was hospitalized with a chief complaint of anal discomfort. Based on biopsy results, she was diagnosed with highly differentiated adenocarcinoma, and colonoscopy findings indicated a type 3 rectal tumor. We observed a right pelvic kidney on enhanced abdominal CT. We began a laparoscopic operation but converted to an open operation after resecting the right pelvic renal artery by mistake. After low anterior resection, urologists performed angioplasty of the right renal pelvic artery. The patient was discharged on postoperative day 16, after the preservation of right renal function had been confirmed. This case strongly suggests that it is important to understand the positional relationship of the inferior mesenteric and renal arteries by preoperative assessment using either 3-D CT angiography or magnetic resonance angiography.



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Robotic surgery for rectal cancer

Abstract

Laparoscopic surgery has gained acceptance as a less invasive approach in the treatment of colon cancer. However, laparoscopic surgery for rectal cancer, particularly cancer of the lower rectum, is still challenging because of limited accessibility. Robotic surgery overcomes the limitations of laparoscopy associated with anatomy and offers certain advantages, including 3-D imaging, dexterity and ambidextrous capability, lack of tremors, motion scaling, and a short learning curve. Robotic rectal surgery has been reported to reduce conversion rates, particularly in low anterior resection, but it is associated with longer operative times than the conventional laparoscopic approach. Postoperative morbidities are similar between the robotic and conventional laparoscopic approaches, and oncological outcomes such as the quality of the mesorectum and the status of resection margins are also equivalent. The possible superiority of robotic surgery in terms of the preservation of autonomic function has yet to be established in research based on larger numbers of patients. Although robotic rectal surgery is safe, feasible, and appears to overcome some of the technical limitations associated with conventional laparoscopic surgery, the advantages provided by this technical innovation are currently limited. To justify its expensive cost, robotic surgery is more suitable for select patients, such as obese patients, men, those with cancer of the lower rectum, and those receiving preoperative chemoradiotherapy.



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Comparison of laparoscopic Toupet and laparoscopic Nissen fundoplications in neurologically normal children

Abstract

Introduction

We compared laparoscopic Toupet fundoplication (LTF) and laparoscopic Nissen fundoplication (LNF) in neurologically normal children.

Methods

Forty neurologically normal children who were followed up for more than 3 years after LTF (n = 22) or LNF (n = 18) were reviewed retrospectively. LTF and LNF were performed between 2006 and 2012.

Results

There were no significant differences in gender (LTF, 15 male and 7 female patients; LNF:, 12 male and 6 female patients), mean age at surgery (LTF vs LNF: 2.5 vs 2.3 years), mean weight at surgery (LTF vs LNF: 9.6 vs 8.9 kg), preoperative symptoms, preoperative pH monitoring (pH <4) (LTF vs LNF: 26.7% vs 21.8%), mean operative time (LTF vs LNF: 117 vs 126 min), postoperative recommencement of enteral feeding (LTF vs LNF: 3.7 vs 3.8 days), or duration of hospitalization (LTF vs LNF: 5.5 vs 6.3 days). Intraoperative complications were esophageal trauma (LTF; n = 1; 4.5%) and liver trauma (LNF; n = 1; 5.6%) (P = 0.70). Post-LTF complications were wrap stenosis (n = 1; 4.5%), and post-LNF complications were wrap stenosis (n = 1; 5.5%) and gastric outlet obstruction (n = 1; 5.5%) (P = 0.43); all were managed conservatively. No case required conversion to open repair. There was no recurrence after LTF, but there were three cases (16.7%) after LNF (P = 0.08). Reoperation was performed at 4, 11, and 13 months, respectively.

Conclusion

Despite LTF and LNF appearing to be equally effective, three LNF cases required reoperation.



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Foreword

Radiation Research, Volume 188, Issue 4.2, Page 469-469, October 2017.


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Comments on “Cellular Therapies for Treatment of Radiation Injury after a Mass Casualty Incident” (Radiat Res 2017; 188:242-45)

Radiation Research, Volume 188, Issue 4, Page 463-463, October 2017.


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The LSS Cohort of Atomic Bomb Survivors and LNT. Comments on ‘‘Solid Cancer Incidence among the Life Span Study of Atomic Bomb Survivors: 1958–2009” (Radiat Res 2017; 187:513–37) and “Reply to the Comments by Mortazavi and Doss” (Radiat Res 2017; 188:369–71)

Radiation Research, Volume 188, Issue 4, Page 463-464, October 2017.


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Takeo Ohnishi, PhD, 1944–2017

Radiation Research, Volume 188, Issue 4, Page 465-467, October 2017.


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Is There a Trade-Off between Radiation-Stimulated Growth and Metabolic Efficiency?

Radiation Research, Volume 188, Issue 4.2, Page 486-494, October 2017.


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Exposure to Low-Dose X-Ray Radiation Alters Bone Progenitor Cells and Bone Microarchitecture

Radiation Research, Volume 188, Issue 4, Page 433-442, October 2017.


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Age Modifies the Effect of 2-MeV Fast Neutrons on Rat Mammary Carcinogenesis

Radiation Research, Volume 188, Issue 4, Page 419-425, October 2017.


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Impact of Ionizing Radiation on the Cardiovascular System: A Review

Radiation Research, Volume 188, Issue 4.2, Page 539-546, October 2017.


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The CGL1 (HeLa × Normal Skin Fibroblast) Human Hybrid Cell Line: A History of Ionizing Radiation Induced Effects on Neoplastic Transformation and Novel Future Directions in SNOLAB

Radiation Research, Volume 188, Issue 4.2, Page 512-524, October 2017.


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Developing operational items for the International Classification of Functioning, Disability and Health Rehabilitation Set: the experience from China.

The International Classification of Functioning, Disability and Health (ICF) Rehabilitation Set is proposed as a tool to measure functioning among a clinical population in Chinese rehabilitation services. It needs to be applied in a transparent and reliable way and considered from a measurement perspective. The aim of this study was to develop items operationalizing the ICF Rehabilitation Set to enhance the standardized and unified assessment in varied clinical settings. A list of proposed operational items was generated by (i) linking the items of four standard assessment instruments; (ii) literature review; and (iii) self-development. The candidate operational items were then evaluated by Chinese experts in rehabilitation medicine. One hundred and sixty-six operational items were generated using the three approaches and 54 were evaluated in the formal expert survey. Finally, 30 experts validated nine items from the assessment instruments, two found in the literature and 19 self-developed items for operationalizing the ICF Rehabilitation Set. The 30 operational items validated could potentially facilitate the implementation of the ICF Rehabilitation Set in clinical settings and provide a reference point for future research. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Alpha Particles and X Rays Interact in Inducing DNA Damage in U2OS Cells

Radiation Research, Volume 188, Issue 4, Page 400-411, October 2017.


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Effects of modified constraint-induced movement therapy in the recovery of upper extremity function affected by a stroke: a single-blind randomized parallel trial-comparing group versus individual intervention.

An extensive corpus of literature supports the positive impact of constraint-induced movement therapy (CIMT) on neuroplasticity and the recovery of function. However, its clinical applicability is limited by the time of intervention and individual modality. We propose to assess the efficacy of modified CIMT protocols through a group therapy intervention. To determine the effectiveness of a group therapy, compared with individual modified CIMT, in increasing the use and functionality of movement of a paretic upper limb. The study was a single-blind, randomized parallel trial. Thirty-six patients who had had a stroke more than 6 months previously were divided randomly into two intervention groups. The independent variable was the implementation of group or individual modalities for 3 h for 10 consecutive days and the dependent variables were evaluated by the Motor Activity Log and Action Research Arm Test, at baseline (preintervention evaluation), end (postintervention evaluation), and 6 months after intervention (follow-up). By controlling the preintervention evaluations, analyses of covariance indicated that both dependent variables presented significant differences in favor of the group therapy at both the postintervention evaluation and the follow-up evaluations. Both types of intervention generated increases in the function and use of the upper extremity, with these increases being higher in the group therapy. The effects of the group therapy modality were maintained 6 months after the intervention ended. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Research on prevalence of secondary conditions in individuals with disabilities: an overview.

Individuals with disabilities may be at increased risk of a number of secondary conditions. Secondary conditions influence health status and quality of life. Many of these conditions are preventable and their consequences can be managed. Knowledge of the prevalence, course, and association with age of secondary conditions is needed for better prevention and management. The aim of present study was to review the available literature on the prevalence of secondary conditions in individuals with disability. We performed searches of electronic databases for studies published between 1980 and 2017 that provided information on the prevalence of secondary conditions in individuals with disabilities. The reference list of all relevant citations was also reviewed for further material. Nineteen papers were included. The findings indicate that (i) studies were mainly population-based descriptive studies, (ii) researchers used different questionnaires, (iii) the most common studied population are patients with spinal cord injury, and (iv) even though secondary conditions are different in different patient populations, the main secondary conditions are pain, spasticity, urinary tract infections, fatigue, depression, and sleep problems. The prevalence of each condition varies widely depending on the studied population and research methodologies across studies. There is still much information that remains to be obtained on the prevalence, definition, and conceptual organization of secondary conditions. There is also a lack of longitudinal studies on the natural course of these conditions. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Cytogenetic Reconstruction of Gamma-Ray Doses Delivered to Atomic Bomb Survivors: Dealing with Wide Distributions of Photon Energies and Contributions from Hematopoietic Stem/Progenitor Cells

Radiation Research, Volume 188, Issue 4, Page 412-418, October 2017.


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Effects of physical exercise in older adults with reduced physical capacity: meta-analysis of resistance exercise and multimodal exercise.

Older adults with reduced physical capacity are at greater risk of progression to care dependency. Progressive resistance strength exercise and multimodal exercise have been studied to restore reduced physical capacity. To summarize the best evidence of the two exercise regimes, this meta-analysis study appraised randomized-controlled trials from published systematic reviews. Medline, Embase, and the Cochrane Database of Systematic Review and Cochrane Central Register of Controlled Clinical Trials were searched for relevant systematic reviews. Two reviewers independently screened the relevant systematic reviews to identify eligible trials, assessed trial methodological quality, and extracted data. RevMan 5.3 software was used to analyze data on muscle strength, physical functioning, activities of daily living, and falls. Twenty-three eligible trials were identified from 22 systematic reviews. The mean age of the trial participants was 75 years or older. Almost all multimodal exercise trials included muscle strengthening exercise and balance exercise. Progressive resistance exercise is effective in improving muscle strength of the lower extremity and static standing balance. Multimodal exercise is effective in improving muscle strength of the lower extremity, dynamic standing balance, gait speed, and chair stand. In addition, multimodal exercise is effective in reducing falls. Neither type of exercise was effective in improving activities of daily living. For older adults with reduced physical capacity, multimodal exercise appears to have a broad effect on improving muscle strength, balance, and physical functioning of the lower extremity, and reducing falls relative to progressive resistance exercise alone. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Effects of Localized X-Ray Irradiation on Peripheral Nerve Regeneration in Transected Sciatic Nerve in Rats

Radiation Research, Volume 188, Issue 4, Page 455-462, October 2017.


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Feasibility and reliability of functional muscle tests in lung transplant recipients.

Objective: This study investigates the feasibility, reliability, and correlations of recommended functional tests in lung transplant recipients shortly after surgery. Design: Observational study Methods: 50 patients (28 females) performed well standardized maximum isometric back extension in a sitting position, hand grip strength, and Biering-Sorensen endurance tests shortly before discharge from the acute hospital, shortly thereafter, and two months later following subacute rehabilitation. Results: Back extension testing was well feasible but only two thirds of the patients could perform the Biering-Sorensen test at baseline and they experienced a greater number of minor but no major adverse events. Absolute reliability measures and the intraclass-correlation-coefficients were excellent for the strength [0.97 - 0.98 (0.95 - 0.99)] and good for the endurance tests [0.69 (0.26 - 0.87)]. Hand grip revealed high correlation with back strength (>=0.75) but not with Biering-Sorensen scores. Conclusion: Well controlled maximum back strength testing is feasible, reliable, and the scores are highly correlated with grip strength in lung transplant recipients shortly before hospital discharge. The Biering-Sorensen test should be limited to patients without dominant weakness and/or fear. Future research should investigate if grip instead of back extension strength can safely be used for proper exercise prescription. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Exercise in Adulthood after Irradiation of the Juvenile Brain Ameliorates Long-Term Depletion of Oligodendroglial Cells

Radiation Research, Volume 188, Issue 4, Page 443-454, October 2017.


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Low-intensity Pulsed Ultrasound Stimulation for Tendon-Bone Healing: A Dose-dependent Study.

Objectives: This study aimed to evaluate the dosage effect of low-intensity pulsed ultrasound stimulation (LIPUS) on tendon-bone (T-B) healing. Design: Standard partial patellectomies were performed on 120 mature New Zealand rabbits randomly assigned into three groups: a control group (daily mock sonication, 20 min), a qd group (daily ultra-sonication, 20 min), and a bid group (ultra-sonication twice a day, 20 min each time). The rabbits were sacrificed 8 or 16 weeks postoperatively, and the microarchitectural, histological, and mechanical properties of the patella-patellar tendon (PPT) interface were evaluated. Results: Micro-computed tomography analysis showed that the bid group exhibited more new bone formation and mineralization than the other groups in the T-B healing position at both 8 and 16 weeks postoperatively. Histological assessments confirmed the bid group exhibited a significantly better PPT interface than the other groups, as shown by the increased formation and remodeling of newly formed bone and a fibrocartilage layer. The biomechanical properties of the regenerated PPT interface significantly improved in the bid group. Conclusions: LIPUS treatment twice a day was more effective than the once-a-day treatment on tendon-bone healing. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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"Heart Shaped Sign" A Rare Stroke Syndrome.

No abstract available

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Low-Energy Ion-Species-Dependent Induction of DNA Double-Strand Breaks: Ion Energy and Fluence Thresholds

Radiation Research, Volume 188, Issue 4, Page 426-432, October 2017.


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Alterations in the Mechanical Response of Deep Dorsal Neck Muscles in Individuals Suffering from Whiplash-Associated Disorders Compared to Healthy Controls: An Ultrasound Study.

Objective: The purpose of this study was to investigate and compare the mechanical responses of dorsal neck muscles in individuals with whiplash-associated disorders (WAD) versus healthy individuals. Design: This study included 36 individuals with WAD (26 women and 10 men) and 36 healthy controls (26 women and 10 men). Ultrasound imaging with speckle tracking was used to measure deformation and deformation rate in five dorsal neck muscles during a neck extension task. Results: Compared to controls, individuals with WAD showed higher deformation of the semispinalis cervicis (P = 0.02) and multifidus (P = 0.002) muscles and higher deformation rates (P = 0.03 and 0.0001, respectively). Among individuals with WAD, multifidus deformation and deformation rate were significantly associated with pain, disability, and fatigue (r = 0.31-0.46, P = 0.0001-0.01). Conclusion: These findings indicate that the mechanical responses of the deep dorsal neck muscles differ between individuals with WAD and healthy controls, possibly reflecting that these muscles utilize altered strategies while performing a neck extension task. This finding provides new insight into neck muscle pathology in patients with chronic WAD, and may help to improve rehabilitation programs. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Role of NADPH Oxidase as a Mediator of Oxidative Damage in Low-Dose Irradiated and Hindlimb-Unloaded Mice

Radiation Research, Volume 188, Issue 4, Page 392-399, October 2017.


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Evaluation of the effectiveness of neuromuscular electrical stimulation after total knee arthroplasty: a meta-analysis.

Objective: to evaluate the efficacy of the use of the neuromuscular electrical stimulation (NMES) after total knee arthroplasty (TKA). Design: a systematic review of randomized controlled trials (MEDLINE, PubMed, Cochrane Library, and PEDro) using PICOS approach to formulate the research question, Controlled terms and Boolean operators. Inclusion and exclusion criteria were defined in advance. "Neuromuscular electrical stimulation" and "total knee arthroplasty" were used as keywords. The overall risk of bias was determined according to: random sequence generation, concealment, blinding mass of participants and staff, commissioning blind assessment results, incomplete data and loans received. Results: out of the 36 identified studies, six were included in the review (496 participants). In these studies, one group of patients followed a rehabilitation protocol (control-group) and the other followed a rehabilitation program plus a session of neuromuscular electrical stimulation (NMES-group). Patients of NMES-groups got the best scores (Timed Up and Go Test, Stair-Climbing Test and Walk Test). NMES benefits were strong in the first postoperative weeks/months and gradually diminished. Conclusion: NMES allows a slightly better functional recovery following TKA, especially in the first period, with more evident benefits in patients with a severe lack of muscular activation. Nevertheless, there is no difference at medium-long term. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Ionizing Radiation Enhances Breast Tumor Cell Migration In Vitro

Radiation Research, Volume 188, Issue 4, Page 381-391, October 2017.


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Disability and health consequences of Traumatic Brain Injury: national prevalence.

Objective: To measure the prevalence of traumatic brain injury-related disability and health status in the general population. Design: The French National Survey, conducted in households and institutions, assessed 33,896 adults. Data included sequelae from traumatic brain injury, impairments, current health conditions and uses of health services. Analyses, adjusted for age and gender, compared subjects who declared sequelae from traumatic brain injury (n=479) to the remaining survey population (n=33,287). Use of weighting factors ensured that results were representative of the national population. Results: Prevalence of persistent sequelae from traumatic brain injury in France was 704/100,000. Median time since injury was 14 years. For all Core Set items of the International Classification of Functioning, subjects with traumatic brain injury reported more impairments than the control population: adjusted odds ratios from 1.7 (behavioral difficulties) to 8.6 (motor difficulties). Rates of cardiovascular, respiratory, musculoskeletal, digestive, urological, neurological and psychiatric conditions were higher in the traumatic brain injury population. Use of health services was greater, and women with traumatic brain injury had higher rates of unmet health needs. Conclusion: Persistent sequelae from traumatic brain injury significantly affect health in the general population. Planning of post-traumatic brain injury-care should address the chronic needs of these persons. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Low-Dose Ionizing Radiation Exposure, Oxidative Stress and Epigenetic Programing of Health and Disease

Radiation Research, Volume 188, Issue 4.2, Page 525-538, October 2017.


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Potential Harms With Long-Term Glucocorticoid Use.

No abstract available

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A Single Exposure to Low- or High-LET Radiation Induces Persistent Genomic Damage in Mouse Epithelial Cells In Vitro and in Lung Tissue

Radiation Research, Volume 188, Issue 4, Page 373-380, October 2017.


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Priming with 1-Hz rTMS over contralesional leg motor cortex does not increase the rate of regaining ambulation within 3 months of stroke: A randomized controlled trial.

Background: The potential benefits of repetitive transcranial magnetic stimulation (rTMS), applied either alone or as a combination treatment, on recovery of lower extremities after stroke have been insufficiently studied. Objective: To evaluate the effect of priming with 1-Hz rTMS over contralesional leg motor area with a double cone coil prior physical therapy (PT) on regaining ambulation. Methods: Thirty-eight subacute stroke patients with significant leg disabilities were randomly assigned into the experimental (E) group or control (C) group to receive a 15-min real or sham 1-Hz rTMS, respectively, over the contralesional motor cortex representing the quadriceps muscle followed by 45-min PT for 15 sessions over 3 weeks. Functional measures, motor evoked potentials and quality of life were assessed. Results: There was no significant difference between Group E and C regarding the recovery in ambulation, balance, motor functions, and activity of daily living. No significant difference was found in other functional measures and the quality of life. Only group C displayed significantly increased cortical excitability of the contralesional hemisphere after the intervention. Conclusions: The present study found insufficient evidence that contralesional priming with 1-Hz rTMS improves ambulatory and other motor functions among patients with a severe leg dysfunction in subacute stroke. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Multiple CT Scans Extend Lifespan by Delaying Cancer Progression in Cancer-Prone Mice

Radiation Research, Volume 188, Issue 4.2, Page 495-504, October 2017.


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Poststroke Headache: An Underdiagnosed Entity?.

No abstract available

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Single CT Scan Prolongs Survival by Extending Cancer Latency in Trp53 Heterozygous Mice

Radiation Research, Volume 188, Issue 4.2, Page 505-511, October 2017.


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Radial Extracorporeal Shock Wave Therapy in an Individual With Primary Trigeminal Neuralgia: A Case Report and Literature Review.

A patient with primary trigeminal neuralgia exhibited pain relief without medication after radial extracorporeal shock wave therapy. The 52-yr-old woman had a 3-yr history of primary trigeminal neuralgia, involving the right maxillary division (V2) and the mandibular division (V3). She became refractory to carbamazepine and exhibited hepatic dysfunction. She hence received 3000 to 6000 impulses of craniofacial radial extracorporeal shock wave therapy to the region centered on the surface projection of the trigeminal ganglion and pain areas at 10 Hz; the intensity ranged from 1.4 to 4.5 bars twice per week for 8 wks. At baseline, and 1, 2, and 5 mos after treatment, the Barrow Neurological Institute scores were IV, IIIa, II, and II, and the visual analog scale scores were 8, 3, 1, and 1, respectively. No complications or adverse effects were observed. The hepatic function returned to normal after the discontinuation of carbamazepine. This case report demonstrates the feasibility of radial extracorporeal shock wave therapy for primary trigeminal neuralgia without complications or adverse effects with careful regulation of the therapy intensity. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Implementation of a Multifaceted Interactive Electrodiagnostic Medicine Workshop in a Physical Medicine and Rehabilitation Residency Program.

Electrodiagnostic medicine is a required component of Physical Medicine and Rehabilitation residency education, but limited resources exist to guide curriculum development. Our objective was to create a focused workshop to enhance our residency program's electrodiagnostic curriculum. We created two separate 1.5-day workshops, one basic and one advanced, for all residents. Each workshop included didactic sessions, case discussion, question and answer sessions, demonstrations, and hands-on participation with direct supervision and feedback. Presurveys and postsurveys were administered to evaluate the value of the workshops. We also assessed trends in electrodiagnostic self-assessment examination scores. Residents reported clinical electrodiagnostic rotations to be more valuable to their education than previous didactic sessions and independent learning. Self-reported knowledge of electrodiagnostic concepts, resident comfort level in planning, performing, and interpreting studies, and perceived value in independent learning of electrodiagnostic medicine improved after implementation of the workshops. There was a 7% improvement in the American Association of Neuromuscular and Electrodiagnostic Medicine electrodiagnostic self-assessment examination score compared with the previous year and a 15% improvement in the Physical Medicine and Rehabilitation self-assessment examination electrodiagnostic subscore compared with the previous 5 yrs. All participants recommended similar educational experience for other residents. This successful workshop may serve as a resource for other training programs. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Cochrane Rehabilitation: Organization and Functioning.

No abstract available

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Efficacy of Noninvasive Brain Stimulation on Unilateral Neglect After Stroke: A Systematic Review and Meta-analysis.

Objective: Unilateral neglect (UN) is a common debilitating consequence of stroke. This review focused on the effect of noninvasive brain stimulation (NIBS) techniques in the recovery of UN in poststroke patients. Methods: Relevant databases were comprehensively searched, including Cochrane Central Register of Controlled Trials, Medline, Embase, the Web of Knowledge, and relevant websites. All randomized controlled trials were identified which used NIBS for poststroke UN. The methodological quality and risk of bias were systematically evaluated. Results: Twelve studies were included, and 11 randomized controlled trials were made further meta-analysis. Participants who were randomized to active transcranial direct current stimulation (effect size [ES], -0.51; 95% confidence interval [CI], -1.02 to -0.01; P = 0.04) and repetitive transcranial magnetic stimulation (ES, -1.76; 95% CI, -2.40 to -1.12; P

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Changes in Basic Movement Ability and Activities of Daily Living After Hip Fractures: Correlation Between Basic Movement Scale and Motor-Functional Independence Measure Scores.

Objective: The aim of this study was to examine the correlation between basic movement ability and activities of daily living (ADL) in elderly patients after hip fracture surgery and predict ADL outcomes from changes in basic movement ability. Design: Fifty-four patients receiving rehabilitation after hip fracture surgery were collected prospectively. Ambulatory ability was evaluated using a Basic Movement Scale (BMS), and ADL was evaluated using the motor subscale of the Functional Independence Measure (motor-FIM). From the results of evaluating BMS and motor-FIM weekly, the important postoperative period to regain ADL was investigated. Results: There was a close correlation between BMS and motor-FIM scores at each evaluation point (r = 0.971, P

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Using the common marmoset for neurophysiological studies of neocortical functions

Abstract

The common marmoset is a small new world monkey and highlighted as an experimental primate model species to which the genetic engineering techniques have become applicable.

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Antioxidant therapy in a mouse model of Duchenne Muscular Dystrophy: some promising results but with a weighty caveat

Abstract

Antioxidants have been proposed as potential therapies for a host of cardiac and neuromuscular conditions.

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Altered NMDA receptor-evoked intracellular Ca2+ dynamics in magnocellular neurosecretory neurons of hypertensive rats

Abstract

A growing body of evidence supports an elevated NMDA receptor-mediated glutamate excitatory function in the SON and PVN of hypertensive rats that contributes to neurohumoral activation in this disease. Still, the precise mechanisms underlying altered NMDAR signalling in hypertension remains to be elucidated. In this study, we performed simultaneous electrophysiology and fast confocal Ca2+ imaging to determine whether an altered NMDAR-mediated changes in intracellular Ca2+ levels (NMDAR-ΔCa2+) occurred in hypothalamic magnocellular neurosecretory cells (MNCs) in renovascular hypertensive (RVH) rats. We found that despite evoking a similar excitatory inward current, activation of NMDARs resulted in a larger and prolonged ΔCa2+ in MNCs from RVH rats. Changes in NMDAR-ΔCa2+ dynamics were observed both in somatic and dendritic compartments. Inhibition of the ER SERCA pump activity with thapsigargin prolonged NMDAR-ΔCa2+ responses in MNCs of sham rats, but this effect was occluded in RVH rats, thus equalizing the magnitude and time course of the NMDA-ΔCa2 responses between the two experimental groups. Taken together, our results support (1) an exacerbated NMDAR-ΔCa2+ response in somatodendritic compartments of MNCs of RVH rats, and (2) that a blunted ER Ca2+ buffering capacity contributes to the altered NMDAR-ΔCa2+ dynamics in this condition. Thus, an altered spatiotemporal dynamics of NMDAR-ΔCa2+ response stands as an underlying mechanisms contributing to neurohumoral activation in neurogenic hypertension.

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Carotid chemoreceptor control of muscle sympathetic nerve activity in hypobaric hypoxia

Abstract

High altitude hypoxia causes pronounced sympathoexcitation but the underlying mechanisms remain unclear. We tested the hypothesis that intravenous infusion of dopamine to attenuate carotid chemoreceptor responsiveness would reduce muscle sympathetic nerve activity (MSNA) at high altitude. Nine healthy individuals (mean [SD]; 26 [4] yr) were studied at sea level (SL, Zurich) and at high altitude (ALT, 3454 m, 15–17 days after arrival), both while breathing the ambient air and during an acute incremental hypoxia test (8 × 3 min stages, PETO2 90-45 mmHg). Intravenous infusion of dopamine (3 μg·kg−1·min−1) and placebo (saline) were administered on both study days, according to a single blind randomized cross-over design. Sojourn to high altitude decreased PETO2 (to ≈60 mmHg) and increased minute ventilation (VE; mean±SE; saline [SL, ALT], 8.6 ± 0.5 to 11.3 ± 0.6; dopamine, 8.2 ± 0.5 to 10.6 ± 0.8 L·min−1; P < 0.05) and MSNA burst frequency by ≈80% (saline [SL, ALT], 16 ± 3 to 28 ± 4; dopamine, 16 ± 4 to 31 ± 4 bursts·min−1; P < 0.05) when breathing the ambient air, but were not different with dopamine. Increases in MSNA burst frequency and VE during the acute incremental hypoxia test were greater at ALT than SL (P < 0.05). Dopamine did not affect the magnitude of the MSNA burst frequency response to acute incremental hypoxia at either SL or ALT. However, VE was lower with dopamine than saline administration throughout the acute incremental hypoxia test at ALT. These data indicate that intravenous infusion of low-dose dopamine to blunt the responsiveness of the carotid chemoreceptors does not significantly decrease MSNA at high altitude.

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A Systematic Review and Meta-Analysis on the Use of Repetitive Transcranial Magnetic Stimulation for Spasticity Post Stroke

Spasticity is a common and potentially debilitating complication that develops after stroke, arising in approximately 30% of patients.

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Nonsteroidal anti-inflammatory drugs for postoperative pain control after lumbar spine surgery: A meta-analysis of randomized controlled trials

Nonsteroidal anti-inflammatory drugs (NSAIDs) play a role in pain relief, especially in postoperative pain caused by inflammation. They have demonstrated significant opioid dose-sparing effects, which help in reducing postoperative effects and opioid side effects. The objective of this meta-analysis was to explore the role of NSAIDs in reducing postoperative pain at different time intervals and provide reference for medication after lumbar spine surgery by a meta-analysis of randomized controlled trials (RCT).

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