Τετάρτη, 25 Οκτωβρίου 2017

Transforming growth factor-β enhances Rho-kinase activity and contraction in airway smooth muscle via the nucleotide exchange factor ARHGEF1

Abstract

Transforming growth factor-β (TGF-β), RhoA/Rho-kinase and Src-family kinases (SrcFK) have independently been implicated in airway hyper-responsiveness, but how they interact in order to regulate airway smooth muscle contractility is not fully understood. We found that TGF-β pre-treatment enhanced acute contractile responses to bradykinin (BK) in isolated rat bronchioles, and inhibitors of RhoGEFs (Y16) and Rho-kinase (Y27632), but not the SrcFK inhibitor PP2 prevented this enhancement. In cultured human airway smooth muscle cells (hASMC), TGF-β pre-treatment enhanced the protein expression of the Rho guanine nucleotide exchange factor ARHGEF1, MLC20, MYPT-1 and the actin-severing protein cofilin, but not of RhoA, ROCK2 or c-Src. In hASMC, acute treatment with BK triggered sub-cellular translocation of ARHGEF1 and RhoA and enhanced auto-phosphorylation of SrcFK and phosphorylation of MYPT1 and MLC20, but induced de-phosphorylation of cofilin. TGF-β pre-treatment amplified the effects of BK on RhoA translocation and MYPT1/MLC20 phosphorylation, but suppressed the effects of BK on RhoA-GTP content, SrcFK auto-phosphorylation and cofilin de-phosphorylation. In hASMC, an ARHGEF1 siRNA suppressed the effects of BK and TGF-β on RhoA-GTP content, RhoA translocation and MYPT1 and MLC20 phosphorylation, but minimally influenced the effects of TGF-β on cofilin expression and phosphorylation. ARHGEF1 expression was also enhanced in ASMC of asthmatic patients and in lungs of OVA-sensitized mice. Our data indicate that TGF-β enhances BK-induced contraction, RhoA translocation and Rho-kinase activity in airway smooth muscle largely via ARHGEF1, but independently of SrcFK and total RhoA-GTP content. A role for smooth muscle ARHGEF1 in asthmatic airway hyper-responsiveness is worthy of further investigation.

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Nitric oxide is required for the insulin sensitizing effects of contraction in mouse skeletal muscle

Abstract

The factors regulating the increase in skeletal muscle insulin sensitivity after exercise are unclear. We examined whether nitric oxide (NO) is required for the increase in insulin sensitivity after ex vivo contractions. Isolated C57BL/6J mouse EDL muscles were contracted for 10 min or remained at rest (basal) with or without the NO synthase (NOS) inhibition (L-NMMA; 100 μm). 3.5 h post contraction/basal, muscles were exposed to saline or insulin (120 μU ml−1) with or without L-NMMA during the last 30 min. L-NMMA had no effect on basal skeletal muscle glucose uptake. The increase in muscle glucose uptake with insulin (57%) was significantly (P < 0.05) greater after prior contraction (140% increase). NOS inhibition during the contractions had no effect on this insulin-sensitizing effect of contraction but NOS inhibition during insulin prevented the increase in skeletal muscle insulin sensitivity post-contraction. Soluble guanylate cyclase inhibition, PKG inhibition or PDE5 inhibition each had no effect on the insulin-sensitizing effect of prior contraction. In conclusion, NO is required for increases in insulin sensitivity several hours after contraction of mouse skeletal muscle via a cGMP/PKG independent pathway.

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The child's behavior during inhalational induction and its impact on the anesthesiologist's sevoflurane exposure

Summary

Background

Sevoflurane is commonly used for inhalational inductions in children, but the personnel's exposure to it is potentially harmful. Guidance to reduce gas pollution refers mainly to technical aspects, but the impact of the child's behavior has not yet been studied.

Aims

The purpose of this study was to determine how child behavior, according to the Frankl Behavioral Scale, affects the amount of waste sevoflurane in anesthesiologists' breathing zones.

Methods

Sixty-eight children aged 36-96 months undergoing elective ENT surgery were recruited for this prospective, observational investigation. After oral midazolam premedication (0.5 mg/kg body weight), patients obtained sevoflurane using a facemask with an inspiratory concentration of 8 Vol.% in 100% oxygen (flow 10 L/min). Ventilation was manually supported and a venous catheter was placed. The inspiratory sevoflurane concentration was reduced, and remifentanil and propofol were administered before the facemask was removed and a cuffed tracheal tube inserted. The child's behavior toward the operating room personnel during induction was evaluated by the anesthesiologist (Frankl Behavioral Scale: 1-2 = negative behavior, 3-4 = positive behavior). During induction mean (inline image) and maximum (inline image), sevoflurane concentrations were determined in the anesthesiologist's breathing zone by continuous photoacoustic gas monitoring.

Results

Mean and maximum sevoflurane concentrations were inline image = 4.38 ± 4.02 ppm and inline image = 70.06 ± 61.08 ppm in patients with positive behaviors and sufficient premedications and inline image = 12.63 ± 8.66 ppm and inline image = 242.86 ± 139.91 ppm in children with negative behaviors and insufficient premedications (inline image: P < .001; inline image: P < .001).

Conclusion

Negative behavior was accompanied by significantly higher mean and maximum sevoflurane concentrations in the anesthesiologist's breathing zone compared with children with positive attitudes. Consequently, the status of premedication influences the amount of sevoflurane pollution in the air of operating rooms.



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tDCS over the motor cortex improves lexical retrieval of action words in post-stroke aphasia

One-third of stroke survivors worldwide suffer from aphasia. Speech and language therapy (SLT) is considered effective in treating aphasia, but due to time constraints, improvements are often limited. Non-invasive brain stimulation is a promising adjuvant strategy to facilitate SLT. However, stroke might render "classical" language regions ineffective as stimulation sites. Recent work showed the effectiveness of motor-cortex stimulation together with intensive naming therapy to improve outcomes in aphasia (Meinzer et al., 2016). Although, this study highlights the involvement of the motor cortex, the functional aspects by which it influences language are yet unclear. In this study, we focus on the role of motor cortex in language, investigating its functional involvement in access to specific lexico-semantic (object- vs. action related) information in post-stroke aphasia. To this end, we tested effects of anodal tDCS to the left motor cortex on lexical retrieval in 16 patients with post-stroke aphasia in a sham-controlled, double-blind study design. Critical stimuli were action and object words, and pseudowords. Participants performed a lexical-decision task, deciding whether stimuli were words or pseudowords. Anodal tDCS improved accuracy in lexical decision, especially for words with action-related content and for pseudowords with an "action-like" ending (t15 = 2.65, p = 0.036), but not for words with object-related content and pseudowords with "object-like" characteristics. We show as a proof-of-principle that the motor cortex may play a specific role in access to lexical-semantic content. Thus, motor-cortex stimulation may strengthen content-specific word-to-semantic concept associations during language treatment in post-stroke aphasia.



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Central pattern generators in the turtle spinal cord: selection among the forms of motor behaviors

Neuronal networks in the turtle spinal cord have considerable computational complexity even in the absence of connections with supraspinal structures. These networks contain Central Pattern Generators (CPGs) for each of several behaviors, including three forms of scratch, two forms of swim, and flexion reflex. Each behavior is activated by a specific set of cutaneous or electrical stimuli. The process of selection among behaviors within the spinal cord has multisecond memories of specific motor patterns. Some spinal cord interneurons are partially shared among several CPGs while other interneurons are active during only one type of behavior. Partial sharing is a proposed mechanism that contributes to the ability of the spinal cord to generate motor pattern blends with characteristics of multiple behaviors. Variations of motor patterns, termed deletions, assist in characterization of the organization of the pattern-generating components of CPGs. Single-neuron recordings during both normal and deletion motor patterns provide support for a CPG organizational structure with Unit Burst Generators (UBGs) whose members serve a direction of a specific degree of freedom of the hindlimb, e.g., the hip-flexor UBG, the hip-extensor UBG, the knee-flexor UBG, the knee-extensor UBG, etc. The classic half-center hypothesis that includes all the hindlimb flexors in a single flexor half-center and all the hindlimb extensors in a single extensor half-center lacks the organizational complexity to account for the motor patterns produced by turtle spinal CPGs. Thus, the turtle spinal cord is a valuable model system for studies of mechanisms responsible for selection and generation of motor behaviors.



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Object maintenance beyond their visible parts in working memory

Completion of a partially occluded object requires that a representation of the whole is constructed based on the information provided by the physically specified parts of the stimulus. Such processes of amodal completion rely on the generation and maintenance of a mental image that renders the completed object in visual working memory (VWM). The present study examined this relationship between VWM storage and processes of object completion. We recorded event-related potentials to track VWM maintenance by means of the contralateral delay activity (CDA) during a change detection task in which to-be-memorized composite objects (notched shapes abutting an occluding shape) were primed to induce either a globally completed object or a non-completed, mosaic representation. The results revealed an effect of completion in VWM despite physically identical visual input: Change detection was more accurate for completed as compared to mosaic representations when observers were required to memorize two objects, and these differences were reduced with four memorized items. At the electrophysiological level, globally completed (versus mosaic) objects gave rise to a corresponding increase in CDA amplitudes. These results indicate that, while incorporating the occluded portions of the presented shapes requires mnemonic resources, the complete-object representations thus formed in VWM improve change detection performance by providing a more simple, regular shape. Overall, these findings demonstrate that mechanisms of object completion modulate VWM, with the memory load being determined by the structured representations of the memorized stimuli.



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Retracing your footsteps: developmental insights to spinal network plasticity following injury.

During development of the spinal cord, a precise interaction occurs between descending projections and sensory afferents with spinal networks that lead to expression of coordinated motor output. In the rodent, during the last embryonic week, motor output first occurs as regular bursts of spontaneous activity progressing to stochastic patterns of episodes that express bouts of coordinated rhythmic activity perinatally. Locomotor activity becomes functionally mature in the second postnatal week and is heralded by the onset of weight-bearing locomotion on the 8th-9th postnatal day. Concomitantly there is a maturation of intrinsic properties and key conductances mediating plateau potentials. In this review, we discuss spinal neuronal excitability, descending modulation, and afferent modulation in the developing rodent spinal cord. In the adult, plastic mechanisms are much more constrained but become more permissive following neurotrauma such as spinal cord injury. We discuss parallel mechanisms that contribute to maturation of network function during development to mechanisms of pathological plasticity that contribute to aberrant motor patterns such as spasticity and clonus that emerge following central injury.



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Experience-Dependent Trends in CA1 Theta and Slow Gamma Rhythms in Freely Behaving Mice

CA1 place cells become more anticipatory with experience, an effect thought to be caused by NMDA receptor-dependent plasticity in the CA3-CA1 network. Theta (~5-12 Hz), slow gamma (~25-50 Hz), and fast gamma (~50-100 Hz) rhythms are thought to route spatial information in the hippocampal formation and to coordinate place cell ensembles. Yet, it is unknown whether these rhythms exhibit experience-dependent changes concurrent with those observed in place cells. Slow gamma rhythms are thought to indicate inputs from CA3 to CA1, and such inputs are thought to be strengthened with experience. Thus, we hypothesized that slow gamma rhythms would become more evident with experience. We tested this hypothesis using mice freely traversing a familiar circular track for three ten-minute sessions per day. We found that slow gamma amplitude was reduced in the early minutes of the first session of each day, even though both theta and fast gamma amplitudes were elevated during this same period. However, in the first minutes of the second and third sessions of each day, all three rhythms were elevated. Interestingly, theta was elevated to a greater degree in the first minutes of the first session than in the first minutes of later sessions. Additionally, all three rhythms were strongly influenced by running speed in dynamic ways, with the influence of running speed on theta and slow gamma changing over time within and across sessions. These results raise the possibility that experience-dependent changes in hippocampal rhythms relate to changes in place cell activity that emerge with experience.



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The Kolliker-Fuse orchestrates the timing of expiratory abdominal nerve bursting

Coordination of respiratory pump and valve muscle activity is essential for normal breathing. A hallmark respiratory responses to hypercapnia and hypoxia is the emergence of active exhalation, characterized by abdominal muscle pumping during the late one-third of expiration (late-E phase). Late-E abdominal activity during hypercapnia has been attributed to the activation of expiratory neurons located within the parafacial respiratory group (pFRG). However, the mechanisms that control emergence of active exhalation, and its silencing in restful breathing, are not completely understood. We hypothesized that inputs from the Kölliker-Fuse nucleus (KF) control the emergence of late E activity during hypercapnia. Previously, we reported that reversible inhibition of the KF reduced post-inspiratory (post-I) motor output to laryngeal adductor muscles and brought forward the onset of hypercapnia-induced late-E abdominal activity. Herein, we explored the contribution of the KF for late-E abdominal recruitment during hypercapnia by pharmacologically disinhibiting the KF in in situ decerebrate arterially-perfused rat preparations. These data were combined with previous results and incorporated into a computational model of the respiratory central pattern generator. Disinhibition of the KF through local parenchymal microinjections of gabazine (GABAA receptor antagonist) prolonged vagal post-I activity and inhibited late-E abdominal output during hypercapnia. In silico, we reproduced this behavior and predicted a mechanism where the KF provides excitatory drive to post-I inhibitory neurons, which, in turn, inhibit late-E neurons of the pFRG. Although the exact mechanism proposed by the model requires testing, our data confirm that the KF modulates the formation of late-E abdominal activity during hypercapnia.



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FUNCTIONAL ROLES OF THREE CUES THAT "PERVADE" THE BRAIN: ELECTRO-MAGNETIC FIELD, OXYGEN AND CARBON DIOXIDE

The brain integrative actions depend on the exchange of information among its computational elements. Hence, such a phenomenon plays the key role in driving the complex dynamics of central nervous system (CNS), in which true computations interact with non-computational dynamical processes to generate brain representations of the body in the external world, hence the finalistic behaviour of the organism. In this context, it should be pointed out that beside the intercellular interactions mediated by classical electro-chemical signals also other types of interactions, namely 'cue' and 'coercion' appear to be exploited by the system to achieve its function. Actually, the main focus of the present paper will be on cues present in the environment as well as produced by cells of the body, that "pervade" the brain contributing to its dynamics. These cues can also be metabolic substrates and in most cases, they are of a fundamental importance for the brain function and for the entire organism survival. Three of these highly pervasive cues will be analysed more in detail, namely oxygen, carbon dioxide and electromagnetic fields (EMF). A special emphasis will be given to EMF since it has been proposed by several authors that these highly pervasive energy fluctuations could play an important role in the global integrative actions of the brain, hence EMF signalling may transcend purely connectionist models of brain function. Thus, the new concept of "Broadcasted Neuro-Connectomics" (BNC) has been introduced that transcends the current connectomics view of the brain.



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Momentary level of slow default mode network activity is associated with distinct propagation and connectivity patterns in the anesthetized mouse cortex

Complex spatiotemporal changes of slow spontaneous activity occur in the form of propagating waves in the cortex, leading to the transient formation of a specific activation topography, followed by a transition in the topography. The topographies resemble the stimulation-induced activation patterns and the underlying structural projections, suggesting that they contain motifs of task-related activation. However, little is known about how propagation-mediated transitions between topographies are structured in terms of functional connectivity. Therefore, we investigated whether specific topographies or regions are associated with transitions involving long-range connections and hub modulation. We hypothesized that the activity level of the default mode network (DMN) at a given topography would affect the pattern of upcoming transitions, since high activity levels of the DMN are a distinct feature of the brain at rest. Using mesoscale voltage-sensitive dye imaging in the cortex of lightly anesthetized mice, we revealed that momentary levels of DMN activity are associated with distinct patterns of activity propagation and functional connectivity. High levels of DMN activity led to activity propagation across secondary and association cortices, increasing the centrality of a main hub region, while low level activity led to global, diffuse, yet efficient changes in functional connectivity. Furthermore, low levels of activity resulted in increased long-range connectivity between frontal and posterior regions of the cortex. Our results indicate that DMN activity is associated with functional connectivity and wave propagation patterns, raising the possibility that the DMN may be involved in the modulation of long-range information processing associated with upcoming transitions.



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Individualized tracking of self-directed motor learning in group-housed mice performing a skilled lever positioning task in the home cage

Skilled forelimb function in mice is traditionally studied through behavioural paradigms that require extensive training by investigators, and are limited by the number of trials individual animals are able to perform within supervised session. We developed a skilled lever positioning task that mice can perform within their home cage. The task requires mice to use their forelimb to precisely hold a lever mounted on a rotary encoder within a rewarded position in order to dispense a water reward. A Raspberry Pi microcomputer is used to record lever position during trials, and to control task parameters, thus making this low-footprint apparatus ideal for use within animal housing facilities. Custom Python software automatically increments task difficulty by requiring a longer hold duration, or a more accurate hold position in order to dispense a reward. The performance of individual animals within group-housed mice is tracked through RFID implants, and data stored on the microcomputer may be accessed remotely through an active internet connection. Mice continuously engage in the task for over 2.5 months, and perform ~500 trials/24 hrs. Mice required approximately 15,000 trials to learn to hold the lever within a 10° range for 1.5s, and were able to further refine movement accuracy by limiting their error to a 5° range within each trial. These results demonstrate the feasibility of autonomously training group housed mice on a forelimb motor task. This paradigm may be used in the future to assess functional recovery after injury or cortical reorganization induced by self-directed motor learning.



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Six-legged walking in insects: how CPGs, peripheral feedback, and descending signals generate coordinated and adaptive motor rhythms

Walking is a rhythmic locomotor behavior of legged animals and its underlying mechanisms have been the subject of neurobiological research for more than 100 years. In this article, we review relevant historical aspects and contemporary studies in this field of research with a particular focus on the role of central pattern generating networks (CPGs) and their role in the generation of the six-legged walking in insects. Aspects of importance are the generation of single leg stepping, the generation of interleg coordination, and how descending signals influence walking. We first review how CPGs interact with sensory signals from the leg in the generation of leg stepping. Next, we summarize how these interactions are modified in the generation of motor flexibility for forward and backward walking, curve walking, and speed changes. We then review the present state of knowledge with regard to the role of CPGs in intersegmental coordination and how CPGs might be involved in mediating descending influences from the brain for the initiation, maintenance, modification, and cessation of the motor output for walking. In all chapters, we aim to specifically address gaps in knowledge and we describe potential future avenues and approaches, conceptual and methodological, with the latter emphasizing in particular options arising from the advent of neurogenetic approaches to this field of research and its combination with traditional approaches.



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Immediate cortical adaptation in visual and non-visual areas functions induced by monovision

Abstract

A common and often successful option to correct presbyopia with contact lenses (CLs) is monovision. This is an unbalanced correction across the two eyes where one eye is corrected for far vision and the other eye is corrected for near vision. Monovision is therefore a form of acquired anisometropia that causes a superimposition of an in-focus image with a blurred image. In spite of this visual anisometropia, monovision has been successfully used for many decades, however the brain mechanism supporting monovision is not well understood. The aim of this study was to measure the visual evoked potentials (VEPs) with a high-density electrode array (64-channel) in a group of presbyopes and to provide a detailed spatiotemporal analysis of the cortical activity after a short period of adaptation to monovision with contact lenses. When compared to a balanced eye near correction, monovision produced both a clear reduction of the earliest VEP components, the C1 and the N1, and an amplitude increase of the P1 and pP1. These results indicate that the unilateral blurring induced by wearing monovision CLs reduces feed-forward activity in primary visual area and feedback activity in extrastriate areas (C1 and N1 reduction). Interestingly, other brain activities in both extrastriate visual areas (the P1 component) and in the anterior insula (the pP1 component) seem to compensate this dysfunction, increasing their activity during monovision. These changes confirm the presence of fluid brain adaptation in visual and non-visual areas during monocular interferences.

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Stimulus, response and excitability – what is new?

While it is pleasing to read about increasing awareness of the limitations of diagnostic approaches, and concepts of axonal excitability, the question remains whether novel approaches can be devised to offer more than what is currently available. As a case in point, Milants et al. (2017) have measured the lowest stimulus intensity necessary to produce a maximal CMAP (iMAX) from the innervated muscle in healthy subjects and in small cohorts of patients with hereditary and acquired demyelinating disease and in AMAN, and suggest that additional information can come from this measure over and above measurements of the threshold for a liminal CMAP.

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Behavioral and neurophysiological mechanisms underlying motor skill learning in patients with post-stroke hemiparesis

Skilled actions of daily life such as reaching across a busy table to pick a coffee mug are often performed with accurate, yet fast and efficient arm movements. Such complex skilled actions require optimization of speed and accuracy; and rely on efficient planning and execution (Begliomini et al., 2014; Fang et al., 2015; Orban de Xivry et al., 2017; Stewart et al., 2013). Following a neurological insult such as stroke, skilled arm movements are greatly impaired in the paretic (weaker) arm such that task performance is slow, inaccurate and fragmented (Cirstea et al., 2003; Levin, 1996; Liu et al., 2013; Shaikh et al., 2014; Silva et al., 2014).

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Modified liver hanging maneuver focusing on outflow control in pure laparoscopic left-sided hepatectomy

Abstract

Background

Outflow control during laparoscopic liver resection necessitates the use of technically demanding procedures since the hepatic veins are fragile and vulnerable to damage during parenchymal transection. The liver hanging maneuver reduces venous backflow bleeding during deep parenchymal transection. The present report describes surgical outcomes and a technique to achieve outflow control during application of the modified liver hanging maneuver in patients undergoing laparoscopic left-sided hepatectomy.

Methods

A retrospective review was performed of clinical data from 29 patients who underwent laparoscopic left-sided hepatectomy using the modified liver hanging maneuver between February 2013 and March 2017. For this hanging technique, the upper end of the hanging tape was placed on the lateral aspect of the left hepatic vein. The tape was then aligned with the ligamentum venosum. The position of the lower end of the hanging tape was determined according to left-sided hepatectomy type. The hanging tape gradually encircled either the left hepatic vein or the common trunk of the left hepatic vein and middle hepatic vein.

Results

The surgical procedures comprised: left lateral sectionectomy (n = 10); left hepatectomy (n = 17); and extended left hepatectomy including the middle hepatic vein (n = 2). Median operative time was 210 min (range 90–350 min). Median intraoperative blood loss was 200 ml (range 60–600 ml). Two intraoperative major hepatic vein injuries occurred during left hepatectomy. Neither patient developed massive bleeding or air embolism. Postoperative major complications occurred in one patient (3.4%). Median postoperative hospital stay was 7 days (range 4–15 days). No postoperative mortality occurred.

Conclusions

The present modified liver hanging maneuver is a safe and effective method of outflow control during laparoscopic left-sided hepatectomy.



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Correction to: Safety and effectiveness of self-adhesive mesh in laparoscopic ventral hernia repair using transabdominal preperitoneal route

Abstract

The metadata listed the wrong given names and family names.



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The advantages of transumbilical single-site laparoscopic percutaneous extraperitoneal closure for inguinal hernia in 1583 children

Abstract

Background

There have been numerous surgical procedures for inguinal hernia in children, and recently the novel technique of single-site laparoscopic procedure was introduced. This study aimed to analyze the safety and efficacy of single-site laparoscopic hernia repair in a large number of children, while compared with the traditional open surgery.

Methods

From January 2012 to June 2015, we performed transumbilical single-site laparoscopic percutaneous extraperitoneal closure (TSLPEC) in 1583 patients, including bilateral hernia in 135 cases, and unilateral hernia in 1448 cases (left side in 582, right side in 866). From January 2007 to January 2010, we performed open inguinal hernia repair in 355 patients, including bilateral hernia in 52 cases, and unilateral hernia in 303 cases. Operating time, recurrence rate, incidence of contralateral hernia, and prevalence of contralateral patent processus vaginalis (cPPV) were recorded and compared.

Results

A total of 1583 patients underwent TSLPEC, without conversion to open surgery. For unilateral repair, the average operating time in TSLPEC group was shorter than open repair group (19.3 ± 6.1 vs. 28.0 ± 8.9, p < 0.05), and it was much shorter than open repair group for bilateral repair (26.2 ± 9.5 vs. 49.8 ± 12.9, P p < 0). The left hernia had higher prevalence of cPPV than right hernia (48.1% vs. 38.5%, p < 0.05). The wound recovered well with good cosmetic appearance in TSLPEC group. Hernia recurrence occurred in seven cases (0.4%) of TSLPEC group, and six cases (1.7%) of open repair group ( p < 00.05). No contralateral hernia developed in TSLPEC group, while 17 cased (5.6%) had contralateral hernia in open repair group ( p < 00.05).

Conclusions

TSLPEC is an effective and safe procedure for inguinal hernias with lots of advantages, including short operating time, simultaneous management of cPPV, excellent cosmetic appearance, low incidence of contralateral hernia, and low recurrence rate. This procedure could be recommended as a routine treatment for inguinal hernias in children.



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Feasibility and safety of a novel magnetic-assisted capsule endoscope system in a preliminary examination for upper gastrointestinal tract

Abstract

Background and study aim

Current capsule endoscopy procedures are ineffective for upper gastrointestinal (GI) tract examination because they do not allow for operator-controlled navigation of the capsule. External controllability of a capsule endoscope with an applied magnetic field is a possible solution to this problem. We developed a novel magnetic-assisted capsule endoscope (MACE) system to visualize the entire upper GI tract. The present study evaluated the safety and feasibility of the MACE system for the examination of the upper GI tract, including the esophagus, stomach, and duodenum.

Methods

The present open clinical study enrolled ten healthy volunteers. All participants swallowed a MACE, and an external magnetic field navigator was used for magnetic capsule manipulation in the upper GI tract. We assessed the maneuverability of the magnetic capsule and completeness of the MACE examination as well as the safety and tolerability of the procedure.

Results

The present study enrolled ten healthy volunteers with a mean age and body mass index of 47.7 years and 25.6 kg/m2, respectively. One volunteer withdrew because of difficulty in swallowing the capsule. In total, nine volunteers underwent the MACE examination. The average examination time was 27.1 min. The maneuverability of the capsule was assessed as good and fair in 55.6 and 44.4% of the participants, respectively. The overall completeness of the examination in the esophagus, stomach, and duodenum was 100, 85.2, and 86.1%, respectively. No severe adverse events occurred during this study. All participants exhibited satisfactory tolerance of the MACE examination.

Conclusion

The MACE system has satisfactory maneuverability and visualization completeness with excellent acceptance and tolerance.



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Automatically rating trainee skill at a pediatric laparoscopic suturing task

Abstract

Background

Minimally invasive surgeons must acquire complex technical skills while minimizing patient risk, a challenge that is magnified in pediatric surgery. Trainees need realistic practice with frequent detailed feedback, but human grading is tedious and subjective. We aim to validate a novel motion-tracking system and algorithms that automatically evaluate trainee performance of a pediatric laparoscopic suturing task.

Methods

Subjects (n = 32) ranging from medical students to fellows performed two trials of intracorporeal suturing in a custom pediatric laparoscopic box trainer after watching a video of ideal performance. The motions of the tools and endoscope were recorded over time using a magnetic sensing system, and both tool grip angles were recorded using handle-mounted flex sensors. An expert rated the 63 trial videos on five domains from the Objective Structured Assessment of Technical Skill (OSATS), yielding summed scores from 5 to 20. Motion data from each trial were processed to calculate 280 features. We used regularized least squares regression to identify the most predictive features from different subsets of the motion data and then built six regression tree models that predict summed OSATS score. Model accuracy was evaluated via leave-one-subject-out cross-validation.

Results

The model that used all sensor data streams performed best, achieving 71% accuracy at predicting summed scores within 2 points, 89% accuracy within 4, and a correlation of 0.85 with human ratings. 59% of the rounded average OSATS score predictions were perfect, and 100% were within 1 point. This model employed 87 features, including none based on completion time, 77 from tool tip motion, 3 from tool tip visibility, and 7 from grip angle.

Conclusions

Our novel hardware and software automatically rated previously unseen trials with summed OSATS scores that closely match human expert ratings. Such a system facilitates more feedback-intensive surgical training and may yield insights into the fundamental components of surgical skill.



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Masimo announces U.S. release of Trace™ data visualization and reporting tool

IRVINE, Calif.— Masimo (NASDAQ: MASI) announced today the U.S. release of Trace™, patient data visualization and reporting software designed for Masimo Root® and Radical-7® monitors. Trace is the first data visualization and reporting software compatible with the full capabilities of the Masimo Root Patient Monitoring and Connectivity Platform, including Radical-7 and Radius-7® ...

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Time is running short for a chance to "Choose Your Tools" from California Casualty

SAN MATEO, Calif. — It's the last chance to enter California Casualty's latest Work Hard/Play Hard Sweepstakes. One lucky first responder will receive their pick of $5,000 worth of DeWALT®* guaranteed tough tools. The deadline for entries is November 13 at http://ift.tt/2y4c517. The contest is open to peace officers, EMTs and firefighters; American heroes who work hard and ...

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Why paramedics do not run to treat patients

A user on Quora recently asked, "Why don't paramedics run to emergency patients"" A few answers stood out to us, especially one by EMT Ross Cohen. You can read his reply below: I'm glad you asked, because I promise you it's not due to a lack of concern. It's actually perfectly logical when you see it from our point of view. 3 Main Reasons: Running is risky. If we trip ...

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Ala. schools adopt 911 app to shorten response times

A staff member who is faced with an emergency can select from active shooter, fire, police, medical or 911, and a dispatcher will direct their call

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Influences of Caffeine Consumption Among Adult New Zealanders: A Qualitative Study

Journal of Caffeine Research , Vol. 0, No. 0.


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Influences of Caffeine Consumption Among Adult New Zealanders: A Qualitative Study

Journal of Caffeine Research , Vol. 0, No. 0.


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University to design ‘super ambulance’ to speed up cardiac arrest treatment

The University of Minnesota is researching how they can equip ambulances with the latest imaging and heart-lung bypass technology

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Migfilin promotes migration and invasion in glioma by driving EGFR and MMP-2 signalings: A positive feedback loop regulation

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Publication date: Available online 16 October 2017
Source:Journal of Genetics and Genomics
Author(s): Yunwei Ou, Qingnan Wu, Chuanyue Wu, Xuefeng Liu, Yongmei Song, Qimin Zhan
Glioma is the most common type of primary brain tumors in the central nervous system (CNS). Migfilin occurs in human glioma and enhances cellular motility via the epidermal growth factor receptor (EGFR) pathway. However, the underlying molecular mechanism is not fully understood. In this study, we found that Migfilin promoted matrix metalloproteinase-2 (MMP-2) activity, and restrained tissue inhibitor of metalloproteinase 2 (TIMP2) expression, which is an MMP-2 inhibitor. Functional and structural studies showed that the LIM1 domain of Migfilin was required for Migfilin-mediated TIMP2 expression and MMP-2 activity, and was also necessary in promoting cell motility. Furthermore, Migfilin-induced EGFR phosphorylation was greatly reduced by MMP-2 inhibitor (GM6001) or siRNA, while Migfilin-induced MMP-2 activation was also blocked by the EGFR inhibitor (AG1478) or siRNA. MMP-2 and EGFR inhibitors and their siRNAs can block Migfilin-induced migration and invasion, respectively. These results demonstrated that EGFR and MMP-2 signalings may form a positive feedback loop to enhance Migfilin-induced migration and invasion. Finally, we detected that expression of Migfilin, EGFR phosphorylation (Tyr1173) and MMP-2 activity had a positive correlation in the clinical glioma sample. Taken together, these results suggest that Migfilin is a critical regulator in cellular motility by driving the EGFR-MMP-2 feedback loop, and may be considered as a potential therapeutic target in glioma.



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A review of tactical tourniquets

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Dr. Richard Schwartz reviews the application of three different tourniquets on a simulated patient.

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Hydroxyethyl starch 130/0.4 versus crystalloid co-loading during general anesthesia induction: a randomized controlled trial

Abstract

Purpose

Hypotension and decreased cardiac output (CO) are common adverse effects during anesthesia induction depending on the patient's pre-anesthetic cardiac condition. The aim of this study was to assess the ability of hydroxyethyl starch (HES) 130/0.4 to prevent hypotension and decreased CO during the induction of general anesthesia.

Methods

Ninety patients undergoing laparoscopic surgery were randomly divided into a HES group and a crystalloid group. Following the insertion of an intravenous line, fluid was administered to each patient at a rate of 25 ml/min using either crystalloid or HES 130/0.4. Five minutes after the initiation of fluid loading, anesthesia was induced using propofol (1.5 mg/kg), rocuronium (0.9 mg/kg), and remifentanil (0.3 mcg/kg/min). Tracheal intubation was performed 5 min after the induction of anesthesia. Following tracheal intubation, general anesthesia was maintained using remifentanil and sevoflurane. Non-invasive blood pressure (BP) level was measured at 1-min intervals and CO was measured continuously using electrical cardiometry from the start of fluid loading until 5 min after tracheal intubation.

Results

The number of patients with hypotension (systolic BP < 90 mmHg or 80% of baseline) was significantly lower in the HES group (p < 0.001) than in the crystalloid group. Patients in the HES group showed smaller CO decreases than did patients in the crystalloid group (p < 0.001). The Kaplan–Meier method showed a lower incidence and significantly slower onset of hypotension in the HES group (p = 0.009). Multivariate logistic regression models indicated that the use of HES is an independent factor for the prevention of both hypotension and decreased CO (below 85% of baseline; p < 0.005 for both).

Conclusions

Co-loading using HES 130/0.4 prevented hypotension and decreased CO during general anesthesia induction.



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Array-CGH Analysis in Patients with Müllerian Fusion Anomalies

Abstract

Fusion anomalies of the Müllerian ducts are associated with an increased risk for miscarriage and premature labor. In most cases polygenic-multifactorial inheritance can be assumed but autosomal-dominant inheritance with reduced penetrance and variable manifestation should be considered. We performed array-CGH (comparative genomic hybridization) analysis in a cohort of 103 patients with Müllerian fusion anomalies. In eight patients we detected microdeletions and microduplications in chromosomal regions 17q12, 22q11.21, 9q33.1, 3q26.11 and 7q31.1. The rearrangement in 17q12 including LHX1 and HNF1β as well as in 22q11.21 have already been observed in MRKHS (Mayer-Rokitansky-Küster-Hauser syndrome).

In summary we i) detected causative micro-rearrangements in patients with Müllerian fusion anomalies, ii) show that Müllerian fusion anomalies and MRKHS may have a common etiology, and iii) identified new candidate genes for Müllerian fusion anomalies.

Thumbnail image of graphical abstract

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Genetic Profile and Mutation Spectrum of Leber Congenital Amaurosis in a Larger Indian Cohort using High Throughput Targeted Re-sequencing

ABSTRACT

The prevalence of mutations in Leber congenital amaurosis (LCA) candidate genes varies in different populations and comprehensive data from a larger Indian cohort on known candidate genes is still unavailable. Ninety-two subjects were recruited after complete ophthalmic examination and informed consent. Targeted re-sequencing of 20 candidate genes was performed using Agilent HaloPlex target enrichment assay and sequenced on Ilumina MiSeq platform. The data was analyzed using standard bioinformatics pipeline, variants annotated, validated and segregated. Genotype-phenotype correlation was performed for the mutation positive cases. Targeted NGS for the 20 candidate genes generated data with an average sequence coverage and depth of 99.03% and 134X, respectively. Mutations were identified in 61% (56/92) of the cohort, which was validated, segregated in the families and absent in 200 control chromosomes. These mutations were observed in 14/20 candidate genes and 47% (25/53) were novel. A digenic mutation was also observed. Distinct phenotypes were observed with respect to genotypes. To our knowledge, this study presents the first comprehensive mutation spectrum of LCA in a large Indian cohort. The mutation negative cases indicate scope for finding novel candidate gene(s) though mutations in deep intronic and regulatory regions cannot be ruled out.

Thumbnail image of graphical abstract

Frequency of Mutations in 14/20 LCA Candidate Genes in The 61% (56/95) Indians With GUCY2D Gene Contributing The Highest (13%).



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A review of tactical tourniquets

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Dr. Richard Schwartz reviews the application of three different tourniquets on a simulated patient.

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A review of tactical tourniquets

maxresdefault.jpg

Dr. Richard Schwartz reviews the application of three different tourniquets on a simulated patient.

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A review of tactical tourniquets

maxresdefault.jpg

Dr. Richard Schwartz reviews the application of three different tourniquets on a simulated patient.

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Correction to: Understanding the Therapist Contribution to Psychotherapy Outcome: A Meta-Analytic Approach



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Assessing anaesthesia in rabbits receiving rocuronium. Response to: Effects of arterial load variations on dynamic arterial elastance: an experimental study

Editor—The study published by Monge Garcia and colleagues1 in the British Journal of Anaesthesia was conducted on 18 rabbits anaesthetized with xylazine and ketamine and paralysed with rocuronium. The authors reported that the study involved procedures that had been approved by the Ethical Committee for Animal Experimentation of the School of Medicine of the University of Cadiz (license 07–9604), conformed to European Ethical Standards (2012/707/EU) and Spanish Law (RD 53/2013) for the care and use of laboratory animals for experimental research, and adhered to relevant aspects of the ARRIVE guidelines. Consequently, we were disappointed to discover that these regulatory bodies, along with the editorial process of the BJA, appear to be satisfied that assessing the animals' physiological responses to a nociceptive stimulus (tail clamping) represents a suitable method for determining adequacy of anaesthesia in animals receiving neuromuscular blocking agents. Putting aside concerns with the reliability of physiological (i.e. cardiovascular), responses as indicators of anaesthetic depth, we question the wisdom of this approach in an animal study primarily aimed at examining the interrelationship of many of the same variables commonly affected by accidental awareness under general anaesthesia.

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Response to ‘Healthcare and ecological economics at a crossroads’

Editor—We thank Odefey and colleagues1 for their thoughtful letter. The authors were appreciative of our article, but were concerned that we did not comprehensively explore issues regarding water use for cleaning reusable anaesthetic equipment. Our article primarily considered the financial costs and carbon footprints associated with processing reusable and single-use anaesthetic equipment.2 We did examine all other environmental footprints routinely examined in life cycle assessment, but noted that apart from water use, these footprints were small and varied little between approaches. Most of the water use for the reusable equipment stemmed from the washer loads (70% total water use).

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Survival with disability. Whose life is it, anyway?

Editor—We read with interest the editorial by Dr Lönnqvist entitled "Medical Research and the Ethics of Medical Treatments: Disability-free Survival".1 The editorial refers to our study, RESCUEicp, that interrogated the effect of secondary decompressive craniectomy in traumatic brain injury (TBI) patients with refractory intracranial hypertension.2 The editorial states 'the conclusion to draw is instead that, despite reducing overall mortality, surgery is not associated with any true long-term benefits in this setting; it only increases the number of patients in a vegetative state or suffering serious disability, and should therefore not be used'. We have major concerns about this statement with reference to our study, and with the wider premise that underpins the editorial, and we will address each of these in turn.

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Low end-tidal carbon dioxide as a marker of severe anaesthetic anaphylaxis: the missing piece of the puzzle?

Perioperative anaphylaxis has assumed increased prominence in recent times with the Royal College of Anaesthetists of Great Britain and Ireland focusing on this topic for the 6th National Audit Project "NAP6".1 The reporting period for cases has recently closed and as a result analysis from this audit will provide large amounts of data that will help our understanding of the incidence, causes and sequelae of anaphylaxis in 2017.

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Reply to: Does deep neuromuscular block optimise surgical space better than moderate block?

Editor—We thank the authors1 for the valuable comments on our paper entitled "Deep neuromuscular block to optimize surgical space conditions during laparoscopic surgery: a systematic review and meta-analysis".2

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In the November issue

This month's issue is notable for a wealth of articles on various aspects of paediatric anaesthesia, and digital technology in quality and patient safety.

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Healthcare and ecological economics at a crossroads. Response to: financial and environmental costs of reusable and single-use anaesthetic equipment

Water relationships would be simple and linear were they not complicated by all those other ways that human beings are connected with and divided from each other.              —Stanley Crawford

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Does deep neuromuscular block optimize surgical space better than moderate block?

Editor—We read with great interest the meta-analysis by Bruintjes"]?> and colleagues.1 We would like to discuss several methodological limitations that may have led this meta-analysis to a wrong conclusion.

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Reply to Clutton and colleagues: assessing anaesthesia in rabbits receiving rocuronium

Editor—Thanks to Clutton and colleagues1 for their comments about our paper2. On behalf of my co-authors, I would like to reply regarding two points raised: (i) the welfare of animals in our research; and (ii) the experimental protocol.

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Postoperative conditions after antagonism of neuromuscular blocking agent and extubation without use of a neuromuscular monitor

Editor—We thank Muggleton & Muggleton1 and Sethi and colleagues2 for their interest in our study.3 In that particular study we measured postoperative haemoglobin oxygen saturation in patients whilst not receiving supplemental oxygen by mask after extubation under so called "blinded conditions", that is without the use of a neuromuscular monitor but based solely on clinical signs, after antagonism with either sugammadex or neostigmine.

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Medical research and the ethics of medical treatments: disability-free survival. Reply from the author

Editor—I read with great interest the comments by Menon and colleagues1 in response to my previous editorial in British Journal of Anaestehsia.2 I find their comments very appropriate and level-headed and I have no intention to get into any polemic argument, but would like to clarify a few points:

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Obstetric neuraxial anaesthesia in the context of maternal immune thrombocytopenia: secondary analysis of a retrospective cohort study

Editor—Immune thrombocytopenia (ITP) is an autoimmune condition affecting 1–10 in 10 000 pregnancies.1 The bleeding risk associated with significant thrombocytopenia poses a challenge peripartum, particularly for placement of neuraxial anaesthesia, where evidence to guide practice remains scant.2 Our aim is to describe our experience with neuraxial anaesthesia in the setting of ITP in pregnancy at two tertiary-level academic institutions. The report is a secondary analysis of a retrospective study of pregnant women with ITP at two tertiary-level Canadian academic institutions: Mount Sinai Hospital (MSH), Toronto and McMaster University Medical Centre, Hamilton (MUMC) from January 2000 to August 2014.3 Research ethics board approval was granted at both hospital sites.

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Hypotonic maintenance i.v. fluids are not appropriate in acutely ill patients. Conclusions can't be extrapolated from healthy volunteers

Editor—A critical aspect in the care of acutely ill patients is the administration of i.v. fluids.1 Debate exists in the both pediatric and adult literature regarding the optimal sodium composition of i.v. fluids. Our group has advocated for the use of an isotonic solution, such as 0.9% NaCl (154 mEq litre−1), for the prevention of hospital-acquired hyponatraemia, as hypotonic solutions have been associated with a high incidence of hospital-acquired hyponatraemia and neurologic complications in both children and adults.2–5 Acutely ill patients have numerous physiological and disease related stimuli for vasopressin (AVP) production, which makes virtually all hospitalized patients at risk for hyponatraemia.1 Concerns against the use of 0.9% NaCl are the potential for developing hypernatraemia, fluid overload and hyperchloraemic acidosis.

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Evaluation of postoperative recovery in day surgery patients using a mobile phone application: a multicentre randomized trial

Abstract
Background
Many patients undergoing anaesthesia and surgery experience postoperative complications. Our aim was to investigate whether a systematic follow-up smartphone-based assessment, using recovery assessment by phone points (RAPP) compared with standard care, had a positive effect on day surgery patients' postoperative recovery. We also investigated whether there were differences in women and men's recovery and recovery scores.
Methods
The study was a single-blind, multicentre randomized controlled trial. A total of 997 patients were randomly allocated to either RAPP or standard care. The Swedish web version of a quality of recovery (SwQoR) questionnaire was used to evaluate the patients' postoperative recovery, either on paper or using an application (RAPP) on postoperative days seven and 14.
Results
On postoperative day seven the RAPP group reported significantly better values in seven out of 24 items of the SwQoR: sleeping difficulties; not having a general feeling of wellbeing; having difficulty feeling relaxed/comfortable; and dizziness; headache; pain in the surgical wound; and a swollen surgical wound compared with the control group, implying a good postoperative recovery. Both men and women in the RAPP group reported significantly better values (and, hence good postoperative recovery) compared with the control group in the items sleeping difficulties; not having a general feeling of wellbeing and pain in the surgical wound.
Conclusions
Measurement of patient-reported outcomes using a smartphone-based application was associated with decreased discomfort from several postoperative symptoms. Systematic e-assessment can thereby increase patients' quality of recovery and identify key areas for improvement in perioperative care.
Clinical trial registration
NCT02492191.

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Effect of isotonic vs hypotonic maintenance fluid therapy on urine output, fluid balance, and electrolyte homeostasis: a crossover study in fasting adult volunteers. Reply from the authors

Editor—We read with interest the comments by Leroy & Hoorn1 and Moritz & Ayus,2 mainly focusing on the occurrence of hyponatraemia after the use of hypotonic maintenance solutions, an association extensively demonstrated in paediatric populations. First and foremost, we set out to investigate whether, how and how much fluid retention could be induced by isotonic compared with hypotonic maintenance fluid therapy.3 All prior studies systematically neglected this potential side-effect. Although the clinical impact remains to be judged in dedicated trials, fluid retention of the magnitude we observed will not be regarded as trivial by most physicians dealing with postoperative or critical care patients.4–7 The effect size after being exposed to salt-rich solutions for more than 48 h, as frequently encountered in clinical practice, can be expected to be even more substantial. There is no reason to suppose that our findings on fluid retention would be different in a situation of non-osmotic stimulation of antidiuretic hormone (ADH).

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Novel stabilization technique for insertion of Bonfils intubating endoscope: the “pool cue” grip

Editor—The Bonfils Intubating endoscope is a useful adjunct when managing anticipated and unanticipated difficult airways.1 It is a sturdy, versatile, portable and easy to clean device. However recent guidelines have suggested that this and similar devices be used in the unanticipated difficult airway only by experienced users.2 The Bonfils endoscope is generally considered to have a steep learning curve of approximately twenty patients.13 We describe the "pool cue" grip, a technique that we use as part of our standard Bonfil insertion and teaching method.

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Cost-effectiveness of a systematic e-assessed follow-up of postoperative recovery after day surgery: a multicentre randomized trial

Abstract
Background
Most surgeries are done on a day-stay basis. Recovery assessment by phone points (RAPP) is a smartphone-based application (app) to evaluate patients after day surgery. The aim of this study was to estimate the cost-effectiveness of using RAPP for follow-up on postoperative recovery compared with standard care.
Methods
This study was a prospective parallel single-blind multicentre randomized controlled trial. Participants were randomly allocated to the intervention group using RAPP or the control group receiving standard care. A cost-effectiveness analysis was performed based on individual data and included costs for the intervention, health effect [quality-adjusted life-years (QALYs)], and costs or savings in health-care use.
Results
The mean cost for health-care consumption during 2 weeks after surgery was estimated at €37.29 for the intervention group and €60.96 for the control group. The mean difference was €23.66 (99% confidence interval −46.57 to − 0.76; P=0.008). When including the costs of the intervention, the cost-effectiveness analysis showed net savings of €4.77 per patient in favour of the intervention. No difference in QALYs gained was seen between the groups (P=0.75). The probability of the intervention being cost-effective was 71%.
Conclusions
This study shows that RAPP can be cost-effective but had no effect on QALY. RAPP can be a cost-effective tool in providing low-cost health-care contacts and in systematically assessing the quality of postoperative recovery.
Clinical trial registration
NCT02492191.

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Perioperative Jehovah's Witnesses: a review

British Journal of Anaesthesia, 2015; 115(5): 676–687, DOI 10.1093/bja/aev161

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Low end-tidal CO 2 as a real-time severity marker of intra-anaesthetic acute hypersensitivity reactions

Abstract
Background
Prompt diagnosis of intra-anaesthetic acute hypersensitivity reactions (AHR) is challenging because of the possible absence and/or difficulty in detecting the usual clinical signs and because of the higher prevalence of alternative diagnoses. Delayed epinephrine administration during AHR, because of incorrect/delayed diagnosis, can be associated with poor prognosis. Low end-tidal CO2 (etCO2) is known to be linked to low cardiac output. Yet, its clinical utility during suspected intra-anaesthetic AHR is not well documented.
Methods
Clinical data from the 86 patients of the Neutrophil Activation in Systemic Anaphylaxis (NASA) multicentre study were analysed. Consenting patients with clinical signs consistent with intra-anaesthetic AHR to a neuromuscular blocking agent were included. Severe AHR was defined as a Grade 3–4 of the Ring and Messmer classification. Causes of AHR were explored following recommended guidelines.
Results
Among the 86 patients, 50% had severe AHR and 69% had a confirmed/suspected IgE-mediated event. Occurrence and minimum values of arterial hypotension, hypocapnia and hypoxaemia increased significantly with the severity of AHR. Low etCO2 was the only factor able to distinguish mild [median 3.5 (3.2;3.9) kPa] from severe AHR [median 2.4 (1.6;3.0) kPa], without overlap in inter-quartile range values, with an area under the receiver operator characteristic curve of 0.92 [95% confidence interval: 0.79–1.00]. Among the 41% of patients who received epinephrine, only half received it as first-line therapy despite international guidelines.
Conclusions
An etCO2 value below 2.6 kPa (20 mm Hg) could be useful for prompt diagnosis of severe intra-anaesthetic AHR, and could facilitate early treatment with titrated doses of epinephrine.
Clinical trial registration
NCT01637220.

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Effect of gum chewing on gastric volume and emptying: a prospective randomized crossover study

Abstract
Background
Current fasting guidelines allow oral intake of water up to 2 h before induction of anaesthesia. We assessed whether gum chewing affects gastric emptying of 250 ml water and residual gastric fluid volume measured 2 h after ingestion of water.
Methods
This prospective randomized observer-blind crossover trial was performed on 20 healthy volunteers who attended two separate study sessions: Control and Chewing gum (chlorophyll flavour, with 2.1 g carbohydrate). Each session started with an ultrasound measurement of the antral area, followed by drinking 250 ml water. Then, volunteers either chewed a sugared gum for 45 min (Chewing gum) or did not (Control). Serial measurements of the antral area were performed during 120 min, and the half-time to gastric emptying (t½), total gastric emptying time, and gastric fluid volume before ingestion of water and 120 min later were calculated.
Results
Gastric emptying of water was not different between sessions; the mean (sdsd) t½ was 23 (10) min in the Control session and 21 (7) min in the Chewing gum session (P=0.52). There was no significant difference between sessions in gastric fluid volumes measured before ingestion of water and 120 min later.
Conclusions
Chewing gum does not affect gastric emptying of water and does not change gastric fluid volume measured 2 h after ingestion of water.
Clinical trial registration
NCT02673307.

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Transcriptomic analysis of the heat stress response for a commercial baker’s yeast Saccharomyces cerevisiae

Abstract

The aim of this study is to explore the effects of heat stresses on global gene expression profiles and to identify the candidate genes for the heat stress response in commercial baker's yeast (Saccharomyces cerevisiae) by using microarray technology and comparative statistical data analyses. The data from all hybridizations and array normalization were analyzed using the GeneSpringGX 12.1 (Agilent) and the R 2.15.2 program language. In the analysis, all required statistical methods were performed comparatively. For the normalization step, among alternatives, the RMA (Robust Microarray Analysis) results were used. To determine differentially expressed genes under heat stress treatments, the fold-change and the hypothesis testing approaches were executed under various cut-off values via different multiple testing procedures then the up/down regulated probes were functionally categorized via the PAMSAM clustering. The results of the analysis concluded that the transcriptome changes under the heat shock. Moreover, the temperature-shift stress treatments show that the number of differentially up-regulated genes among the heat shock proteins and transcription factors changed significantly. Finally, the change in temperature is one of the important environmental conditions affecting propagation and industrial application of baker's yeast. This study statistically analyzes this affect via one-channel microarray data.



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Association Between Maternal and Child Health Handbook and Quality of Antenatal Care Services in Palestine

Abstract

Objectives The Maternal and Child Health (MCH) handbook is an integrated home-based record allowing clients to keep records on the continuum of care for mothers and children. This study aimed to assess associations between MCH handbook ownership and receipt of selected content of antenatal care services in Palestine. Methods Distribution of the MCH handbook in Palestine was launched in 2008. We used an anonymous data set of the Palestinian Family Survey 2010 and analyzed the data of 2026 women who had live births within the past 12 months. Descriptive statistical analysis was conducted to assess differences between MCH handbook holders and non-holders. Multivariable logistic regression models were used to estimate adjusted odds ratios of the effects of MCH handbook use according to proxy indicators of antenatal care quality. Results Accounting for about 60% (n = 1202) of study participants, handbook holders were more likely to be primipara, live in the Gaza Strip, live in refugee camps, and live within a 30-min distance to antenatal care facilities; however, household wealth levels for handbook holders were lower compared with non-holders. Handbook users had significantly higher odds of receiving all three kinds of medical tests and receiving information on five or more health education topics as part of antenatal care. The higher odds remained after adjusting for possible confounding variables, such as household wealth, region, residential area, birth order of the child, frequency of antenatal care, and time required to reach antenatal care facilities. Conclusions for Practice Use of the handbook as a portable checklist possibly promoted providers' higher adherence to the national guideline.



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Parvalbumin interneurons in the dorsal horn: it's not all about GABA

Abstract

Parvalbumin containing inhibitory interneurons (PV + INs) are a key element controlling co-ordinated activity of neuronal ensembles in the mammalian central nervous system (CNS).

This article is protected by copyright. All rights reserved



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Utilization of independent component analysis for accurate pathological ripple detection in intracranial EEG recordings recorded extra- and intra-operatively

Approximately 30% of patients with epilepsy continue to have disabling seizures despite treatment with multiple antiepileptic drugs (Kwan and Brodie, 2000). Of those patients with focal epilepsy that are resistant to multiple medications, resective surgery is an intervention that has been proven to reduce the seizure burden, improve the patients' quality of life, and reduce mortality rate (Wiebe et al. 2001; Sperling et al. 2016). The goal of resective epilepsy surgery is to identify and remove epileptogenic brain regions while minimizing residual neurological deficits.

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Culture of gastric biopsies in celiac disease and its relationship with gastritis and Helicobacter Pylori infection.



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The optimal bowel preparation intervals before colonoscopy: a randomized study comparing polyethylene glycol and low-volume solutions

The optimal duration of bowel preparation has only been assessed for polyethylene glycol (PEG). The aim of the study was to determine the intervals for achieving a satisfactory quality/tolerability of the preparation using PEG/ascorbic acid (PEGA) and sodium picosulphate/magnesium citrate (SPMC), and to compare them with 4L of PEG.

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Culture of gastric biopsies in celiac disease and its relationship with gastritis and Helicobacter Pylori infection.



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The optimal bowel preparation intervals before colonoscopy: a randomized study comparing polyethylene glycol and low-volume solutions

The optimal duration of bowel preparation has only been assessed for polyethylene glycol (PEG). The aim of the study was to determine the intervals for achieving a satisfactory quality/tolerability of the preparation using PEG/ascorbic acid (PEGA) and sodium picosulphate/magnesium citrate (SPMC), and to compare them with 4L of PEG.

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