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Πέμπτη 26 Οκτωβρίου 2017
Examination of the reliability of Gait Assessment and Intervention Tool in patients with a stroke.
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A Lumbosacral Plexopathy Compressed by Huge Uterine Myoma.
No abstract available
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Regional variation in the mechanical properties and fibre type composition of the rat extensor digitorum longus muscle
Abstract
Fibre type composition is heterogeneous and distribution varies spatially in many muscles, indicating there may be regional variation in recruitment and mechanical output. The rat extensor digitorum longus muscle is composed of predominantly fast-twitch fibres, and exhibits a gradient in phenotype, resulting in oxidative medial (areal composition 24.3% Type I/IIa) and glycolytic lateral (92.4% Type IIx/IIb) compartments. Here, we investigated the variation in mechanical performance between the medial and lateral compartments during isometric, isotonic and cyclical contractions. Isometric tetanic stress and force-velocity relationships were similar in both compartments, but isometric twitch kinetics were slower in the medial compared to the lateral compartment. The medial compartment also had a lower optimum cycle frequency for maximum net power generation (11 Hz vs. 15 Hz; P < 0.05) due to slower isometric kinetics, resulting in a lower level of activation and reduced net work generation at higher cycle frequencies, compared to the lateral compartment. The more oxidative, medial compartment had higher fatigue resistance, maintaining net power 26% longer than the lateral compartment. The predominant mechanisms underpinning the decrease in net power varied between the compartments, resulting from an increase in the work to extend the muscle and from a reduction in work during shortening in the medial and lateral compartments, respectively. Regional variation in mechanical performance and resistance to fatigue within a mixed muscle suggests a differential recruitment pattern is likely during locomotion, with the medial compartment being utilised during slow speed locomotion and the lateral compartment during burst activities.
This article is protected by copyright. All rights reserved
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Medic CE How To Use Live Course Calendar for VILT EMS Refresher
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Informed consent in pediatric anesthesiology
Summary
Background
Informed consent for pediatric anesthesia is unique because it is (1) obtained from surrogates (ie, parents) rather than from the patient and (2) sought after parents have authorized the surgical intervention. There are limited data on how pediatric anesthesia informed and consent discussions are conducted. The purpose of this study was to characterize the content of preanesthesia informed consent discussions and assess their impact on parent recall and understanding.
Methods
We conducted a cross-sectional observational study at a tertiary pediatric hospital. We audio-recorded and transcribed preanesthesia consent discussions between pediatric anesthesia providers and parents of children undergoing elective surgery. Parents were recruited on the day of surgery and completed a survey postdiscussion to assess their recall and perceived understanding. We used directed content analysis to identify 7 informed consent elements: (i) description of the plan; mention of (ii) alternatives, (iii) risks, and (iv) benefits; (v) discussion of uncertainties; (vi) assessment of comprehension; and (vii) solicitation of a decision. We used multivariable logistic regression to explore the association between discussions that included 3 informed consent elements (description of plan, mention of risks, and mention of benefits) and parent recall and understanding of these elements.
Results
We analyzed 97 discussions involving 41 different anesthesia providers. The element most frequently included in preanesthesia discussions was a description of the plan (100%); the least frequently included was decision solicitation (18%). Seventy-one percent of discussions included ≥5 informed consent elements and 70% included a description of the plan, mention of risks, and mention of benefits. Parental recall of these 3 informed consent elements was associated with their inclusion in the preanesthesia discussion (75% vs 34%), and more parents understood all 3 elements if they had reported (vs not reported) recall of all 3 elements (97% vs 53%).
Conclusions
Most pediatric preanesthesia discussions include ≥5 informed consent elements and describe the plan, mention risks, and mention benefits. Inclusion of these latter 3 consent elements was associated with parental recall of these elements but not understanding.
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What is the best size predictor for dose in the obese child?
Summary
Lean body mass is commonly proposed for anesthesia maintenance drug dosing calculations. However, total body mass used with allometric scaling has been shown to be better for propofol in obese adults and children. Fat-free mass has also been used instead of lean body mass. Fat-free mass is essentially the same as lean body mass but excludes a small percentage of mass of lipids in cell membranes, CNS, and bone marrow. Normal fat mass is a size descriptor that partitions total body mass into fat-free mass and fat mass calculated from total body mass minus fat-free mass. The relative influence of fat mass compared with fat-free mass is described by the fraction of fat mass that makes fat equivalent to fat-free mass in terms of allometric size. This fraction (Ffat) will differ for each drug and each parameter affected by body size (eg, clearance and volume of distribution). This fraction is based on the concept of theory-based allometric size. The normal fat mass based on allometric theory and partition of body mass into fat and fat-free components provides a principle-based approach explaining size and body composition effects on pharmacokinetics of all drugs in children and in adults.
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Medic CE How To Use Live Course Calendar for VILT EMS Refresher
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Medic CE How To Use Live Course Calendar for VILT EMS Refresher
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Medic CE How To Use Live Course Calendar for VILT EMS Refresher
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Enhanced Cerebral Perfusion during Brief Exposures to Cyclic Intermittent Hypoxemia
Cerebral vasodilation and increased cerebral oxygen extraction help maintain cerebral oxygen uptake in the face of hypoxemia. This study examined cerebrovascular responses to intermittent hypoxemia in eight healthy men breathing 10% O2 for 5 cycles, each 6 min, interspersed with 4 min of room air breathing. Hypoxia exposures raised heart rate (P<0.01) without altering arterial pressure, and increased ventilation (P<0.01) by expanding tidal volume. Arterial oxygen saturation (SaO2) and cerebral tissue oxygenation (ScO2) fell (P<0.01) less appreciably in the first bout (from 97.0±0.3% and 72.8±1.6% to 75.5±0.9% and 54.5±0.9%, respectively) than the fifth bout (from 94.9±0.4% and 70.8±1.0% to 66.7±2.3% and 49.2±1.5%, respectively). Flow velocity in the middle cerebral artery (VMCA) and cerebrovascular conductance increased with decreases in SaO2 and ScO2 in a sigmoid fashion. These stimulus-response curves shifted leftward and upward from the first to the fifth hypoxia bouts; thus, the centering points fell from 79.2±1.4 to 74.6±1.1% (P=0.01) and from 59.8±1.0 to 56.6±0.3% (P=0.002), and the minimum VMCA increased from 54.0±0.5 to 57.2±0.5 cm•s-1 (P=0.0001) and from 53.9±0.5 to 57.1±0.3 cm•s-1 (P=0.0001) for the SaO2-VMCA and ScO2-VMCA curves, respectively. Cerebral oxygen extraction increased from pre-hypoxia 0.22±0.01 to 0.25±0.02 in minute 6 of the first hypoxia bout, and remained elevated at 0.25±0.01 - 0.27±0.01 throughout the fifth hypoxia bout. These results demonstrate that cerebral vasodilation combined with enhanced cerebral oxygen extraction fully compensated for decreased oxygen content during acute, cyclic hypoxemia.
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Effects of contraction mode and stimulation frequency on electrical stimulation-induced skeletal muscle hypertrophy
We compared the skeletal muscle hypertrophy resulting from isometric (Iso) or eccentric (Ecc) electrical stimulation (ES) training with different stimulation frequencies. Male Wistar rats were assigned to the Iso and Ecc groups. These were divided into three further sub-groups that were stimulated at 10 Hz (Iso-10 and Ecc-10), 30 Hz (Iso-30 and Ecc-30), or 100 Hz (Iso-100 and Ecc-100). In experiment 1, the left plantarflexor muscles were stimulated every other day for 3 weeks. In experiment 2, mammalian target of rapamycin complex 1 (mTORC1) signaling was investigated 6 hours after one bout of ES. The contralateral right muscle served as control (non-ES). Ecc contractions comprised forced dorsiflexion combined with ES. The peak torque and torque-time integral during ES was higher in Ecc group than that in Iso group in all stimulation frequencies examined. The gastrocnemius muscle weight normalized to body weight (MW/BW) in ES side was increased compared to the non-ES side by 6%, 7%, and 17% in Ecc-30, Iso-100, and Ecc-100 groups, respectively, with a greater gain in Ecc-100 than Ecc-30 and Iso-100 groups. The p70S6K (Thr389) phosphorylation level was higher in Ecc-30 and -100 than Iso-30 and -100 group, respectively. The peak torque and torque-time integral were highly correlated with the magnitude of increase in muscle mass and the phosphorylation of p70S6K. These data suggest that ES-induced muscle hypertrophy and mTORC1 activity are determined by loading intensity and volume during muscle contraction independent of the contraction mode.
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A Time Course Evaluation of Inflammatory and Oxidative Markers Following High Intensity Exercise in Horses: a Pilot Study
Exercise is a physiological stress resulting in reactive oxygen species and inflammatory mediators, the accumulation of which are thought to contribute to degenerative articular diseases. The horse is of particular interest in this regard as equine athletes are frequently exposed to repetitive bouts of high intensity exercise. The purpose of this study was to provide a detailed description of the response of articular and systemic oxidative and inflammatory biomarkers following high intensity, exhaustive exercise in horses. A group of horses (Ex) underwent repeated bouts of high intensity exercise, at a target heart rate of 180 bpm, until voluntary exhaustion. Baseline plasma and synovial fluid (SF) samples were taken 24 h prior to exercise, then at 0.5, 1, 2, 4, 8, and 24 h following exercise cessation. This time course was repeated in a group of non-exercised control horses (Co). Plasma and SF samples were analysed for prostaglandin E2 (PGE2), nitric oxide (NO), total antioxidant status (TAS), and glycosaminoglycans (GAG). The Ex group had significantly higher plasma NO at 0.5, 1, and 2 h; and higher plasma PGE2 at 0.5 and 1 h compared to Co. SF PGE2 and GAG were also higher in Ex horses at 8 h compared with Co. It is concluded that high intensity exercise in horses results in a rapid increase in systemic oxidative and inflammatory markers from 0.5-2 h after exercise, which is followed by local articular inflammation and cartilage turnover at 8 h post exercise.
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Mitochondria-targeted antioxidant therapy with MitoQ ameliorates aortic stiffening in old mice
Aortic stiffening is a major independent risk factor for cardiovascular diseases, cognitive dysfunction and other chronic disorders of aging. Mitochondria-derived reactive oxygen species are a key source of arterial oxidative stress which may contribute to arterial stiffening by promoting adverse structural changes-including collagen overabundance and elastin degradation-and enhancing inflammation, but the potential for mitochondria-targeted therapeutic strategies to ameliorate aortic stiffening with primary aging is unknown. We assessed aortic stiffness (pulse-wave velocity (aPWV)), ex-vivo aortic intrinsic mechanical properties (elastic modulus (EM) of collagen and elastin regions), and aortic protein expression in young (~ 6 mo) and old (~27 mo) male c57BL/6 mice consuming normal drinking water (YC and OC) or water containing mitochondria-targeted antioxidant MitoQ (250 µM; YMQ and OMQ) for 4 weeks. Both baseline and post-intervention aPWV values were higher in OC versus YC (post: 482 ± 21 vs. 420 ± 5 cm/sec, p<0.05). MitoQ had no effect in young mice but reduced aPWV in old mice (OMQ, 426 ± 20, p<0.05 vs. OC). MitoQ did not affect age-associated increases in aortic collagen-region EM, collagen expression, or pro-inflammatory cytokine expression, but partially attenuated age-associated decreases in elastin-region EM and elastin expression. Our results demonstrating that MitoQ reverses in vivo aortic stiffness in old mice suggest that mitochondria-targeted antioxidants may represent a novel, promising therapeutic strategy for reducing aortic stiffness with primary aging and, possibly, age-related clinical disorders in humans. The de-stiffening effects of MitoQ treatment may be at least partially mediated by attenuation/reversal of age-related aortic elastin degradation.
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Muscle damage produced by isometric contractions in human elbow flexors
Isometric exercise is often prescribed during rehabilitation from injury in order to maintain muscle condition and prevent disuse atrophy. However such exercise can lead to muscle soreness and damage. Here we investigate which parameters of isometric contractions are responsible for the damage. Bouts of 30 repetitions of maximum voluntary contractions of elbow flexors in 38 subjects were carried out and peak force, soreness and tenderness were measured before the exercise, immediately afterwards, at 2h, and 24h post-exercise. When one arm was held near the optimum angle for force generation (90°), the force it produced was greater by 28% than by the other arm held at a longer length (155°). However, despite the smaller contraction forces of the muscle held at the longer length, after the exercise it exhibited a greater fall in force which persisted out to 24h (20% fall) and more delayed soreness than the muscle exercised at 90° (7% fall at 24h). The result indicates a length dependence of the damage process for isometric contractions at maximum effort. In four additional experiments evidence was provided that the damage occurred during the plateau of the contraction and not the relaxation phase. The damage had a prompt onset and was cumulative, continuing for the duration of the contraction. We interpret our findings in terms of the non-uniform lengthening of sarcomeres during the plateau of the contractions and conclude that muscle damage from isometric exercise is minimised if carried out at lengths below the optimum, using half-maximum or smaller contractions.
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Wearable Physiologic Sensors and Real-Time Algorithms for Detection of Acute Mountain Sickness
This is a mini-review of potential wearable physiological sensors and algorithms (process and equations) for detection of acute mountain sickness (AMS). Given the emerging status of this effort, the focus of the review is on the current clinical assessment of AMS, known risk factors (environmental, demographic and physiological), and current understanding of AMS pathophysiology. Studies that have examined a range of physiological variables to develop AMS prediction and/or detection algorithms are reviewed to provide insight and potential technological roadmaps for future development of real-time physiological sensors and algorithms to detect AMS. Given the lack of signs and non-specific symptoms associated with AMS, development of wearable physiologic sensors and embedded algorithms to predict in near term or detect established AMS will be challenging. Prior work using SaO2, HR or HRV has not provided the sensitivity and specificity for useful application to predict or detect AMS. Rather than using spot checks as most prior studies have, wearable systems that continuously measure SpO2 and HR are commercially available. Employing other statistical modeling approaches such as general linear and logistic mixed models or time series analysis to these continuously measured variables is the most promising approach for developing algorithms that are sensitive and specific for physiologic prediction or detection of AMS.
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Potential for non-invasive assessment of lung inhomogeneity using highly precise, highly time-resolved, measurements of gas exchange
Inhomogeneity in the lung impairs gas exchange and can be an early marker of lung disease. We hypothesised that highly precise measurements of gas exchange contain sufficient information to quantify many aspects of the inhomogeneity non-invasively. Our aim was to explore whether one parameterization of lung inhomogeneity could both fit such data and provide reliable parameter estimates. A mathematical model of gas exchange in an inhomogeneous lung was developed, containing inhomogeneity parameters for compliance, vascular conductance and deadspace, all relative to lung volume. Inputs were respiratory flow, cardiac output, and the inspiratory and pulmonary arterial gas compositions. Outputs were expiratory and pulmonary venous gas compositions. All values were specified every 10 ms. Some parameters were set to physiologically plausible values. To estimate the remaining unknown parameters and inputs, the model was embedded within a non-linear estimation routine to minimise the deviations between model and data for CO2, O2 and N2 flows during expiration. Three groups, each of six individuals, were studied: young (20--30 yr); old (70--80 yr); and patients with mild to moderate chronic obstructive pulmonary disease (COPD). Each participant undertook a 15 min measurement protocol six times. For all parameters reflecting inhomogeneity, highly significant differences were found between the three participant groups (p<0.001, ANOVA). Intraclass correlation coefficients were 0.96, 0.99 and 0.94 for the parameters reflecting inhomogeneity in deadspace, compliance and vascular conductance, respectively. We conclude that, for the particular participants selected, highly repeatable estimates for parameters reflecting inhomogeneity could be obtained from non-invasive measurements of respiratory gas exchange.
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Hybrid approach to laparoscopic decapsulation combined with splenic artery balloon occlusion in a patient with carbohydrate antigen 19-9 producing splenic cysts
Abstract
Introduction
Carbohydrate antigen 19-9 producing splenic cysts are relatively rare and usually occur in women and young individuals. This report describes the use of a novel splenic-preserving surgical approach in the hybrid operating room to reduce the risk of bleeding.
Materials and Surgical Technique
A 27-year-old woman presented at our hospital with a chief complaint of chest pain. CT showed an encapsulated left pleural effusion and multiple splenic cysts. The patient was diagnosed with carbohydrate antigen 19-9–producing splenic cysts and was treated with laparoscopic decapsulation. In the hybrid operating room, a balloon catheter was positioned in the splenic artery. Four ports were inserted into the abdomen, the cysts were punctured, and intracystic fluid was suctioned out. Combined splenic artery balloon occlusion was performed to control bleeding when the cyst wall was resected near the splenic parenchyma. Occlusion was performed to create intermittent blockage and consisted of 20-min ischemia and 5-min reperfusion. Then, the inner surface of the cyst wall was cauterized. The total operation time was 170 min (laparoscopic time, 110 min), and blood loss was 100 mL. There were no intraoperative or postoperative complications. The patient has remained healthy, with no recurrence for 8 months.
Discussion
Laparoscopic decapsulation for the treatment of splenic cysts can prevent life-threatening bacterial infections by preserving the spleen, but this can increase the risk of bleeding from the left splenic parenchyma. Combining splenic artery occlusion with laparoscopic decapsulation is a useful approach in the hybrid operating room.
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Robotic surgery for the upper gastrointestinal tract: Current status and future perspectives
Abstract
More than 4000 da Vinci Surgical Systems have been installed worldwide. Robotic surgery using the da Vinci Surgical System has been increasingly performed in the last decade, especially in urology and gynecology. The da Vinci Surgical System has not become standard in surgery of the upper gastrointestinal tract because of a lack of clear benefits in comparison with conventional minimally invasive surgery. We initiated robotic gastrectomy and esophagectomy for patients with upper gastrointestinal cancer in 2009, and we have demonstrated the potential advantages of the da Vinci Surgical System in reducing postoperative local complications after gastrectomy and recurrent laryngeal nerve palsy after esophagectomy. However, robotic surgery has the disadvantages of a longer operative time and higher costs than the conventional approach. In this review article, we present the current status of robotic surgery for gastric and esophageal cancer, as well as future perspectives on this approach, based on our experience and a review of the literature.
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Treating first responder mental health, addiction, PTSD and suicide
A new fire/EMS-specific treatment facility caters to specific job-related trauma while making first responders feel at home
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Treating first responder mental health, addiction, PTSD and suicide
This article first appeared on FireRehab.com, sponsored by Masimo. By Daniel Martynowicz, EMS1 Contributor Most in the fire/EMS community have a harrowing story of death, destruction and despair. These stories usually involve heartbreak and pain – not just for the victims involved, but also for the first responders tasked with restoring order to the chaos, perfusion to the pulseless, and hope ...
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Minimally invasive surgery as a treatment option for gastric cancer with liver metastasis: a comparison with open surgery
Abstract
Background
As minimally invasive techniques advances, minimally invasive surgery (MIS) has emerged as an alternative modality for advanced gastric cancer. In this study, we compared the short- and long-term surgical outcomes of MIS and conventional open surgery for gastric cancer liver metastasis (GCLM) in terms of safety, feasibility, and efficacy.
Methods
This retrospective study used data from a prospective database at the Chinese People's Liberation Army General Hospital. From January 2006 to June 2016, 53 gastric cancer patients with synchronous liver metastasis accepted radical gastrectomy combined with either or both hepatectomy and radiofrequency ablation for liver metastases. The 53 patients enrolled in the study were divided into two groups: a conventional open surgery group (n = 42) and an MIS group (n = 11). Propensity score matching (PSM) analysis was performed to overcome possible bias.
Results
With PSM performed at a 1:3 ratio, 11 patients who received MIS were compared with 33 open surgery cases. Mean operation time was significantly longer for the MIS group compared with the open surgery group (301 vs. 236 min, P = 0.032), while the open surgery group had a larger estimated blood loss than the MIS group (421 vs. 196 ml, P = 0.019). Time to first flatus and postoperative complications, including Clavien–Dindo classification, were similar in the two groups. However, patients undergoing MIS had a significantly shorter time to first sips of water (P = 0.020) and soft diet (P = 0.020) compared with open surgery counterparts. Long-term outcomes were comparable between groups (P = 0.090) after adjustment by PSM analysis.
Conclusions
MIS achieved superior short-term outcomes and comparable long-term outcomes compared with open surgery in GCLM patients. For experienced surgeons, both laparoscopic and robotic methods of MIS are reasonable approaches for the management of highly selected GCLM patients.
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Clinical benefits of single-incision laparoscopic surgery for postoperative delirium in elderly colon cancer patients
Abstract
Background
The number of elderly patients with colon cancer is increasing in Japan. Postoperative delirium (POD) is a major complication for elderly patients who undergo surgery, and postoperative pain is a common inducer of POD. We reported previously that single-incision laparoscopic surgery (SLS) significantly reduces postoperative pain compared to conventional laparoscopic surgery (CLS). Data are lacking about the effect of SLS on POD. This retrospective study evaluated the clinical benefits of SLS for POD in elderly patients with colon cancer.
Methods
This retrospective case–control study included colon cancer patients (n = 134) over 75 years old who underwent elective surgery from 2009 to 2015 at Osaka University Hospital. Of these patients, 110 were evaluated using the comprehensive geriatric assessment (CGA) before surgery and were classified into lower or higher risk groups based on their scores.
Results
The rate of POD was significantly lower in the SLS group than the CLS group (13.8% vs. 30.0%; p = 0.0161). In the CGA-based higher risk group, the rate of POD was significantly higher in the CLS group than the SLS group (p = 0.0153).
Conclusions
SLS for elderly colon cancer patients may lower the incidence of POD compared with CLS.
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Seroma following transabdominal preperitoneal patch plasty (TAPP): incidence, risk factors, and preventive measures
Abstract
Background
The reported range of seroma formation in the literature after TEP repair is between 0.5 and 12.2% and for TAPP between 3.0 and 8.0%. Significant clinical factors associated with seroma formation include old age, a large hernia defect, an extension of the hernia sac into the scrotum, as well as the presence of a residual indirect sac. Seroma formation is a frequent complication of laparoendoscopic mesh repair of moderate to large-size direct (medial) inguinal hernia defects. This present analysis of data from the Herniamed Hernia Registry now explores the influencing factors for seroma formation in male patients after TAPP repair of primary unilateral inguinal hernia.
Methods
In total, 20,004 male patients with TAPP repair of primary unilateral inguinal hernia were included in uni- and multivariable analysis.
Results
Univariable analysis revealed the highly significant impact of the fixation technique on the seroma rate (non-fixation 0.7% vs. tacks 2.1% vs. glue 3.9%; p < 0.001). Multivariable analysis showed that glue compared to tacks (OR 2.077 [1.650; 2.613]; p < 0.001) and non-fixation (OR 5.448 [4.056; 7.317]; p < 0.001) led to an increased seroma rate. A large hernia defect (III vs. I: OR 2.868 [1.815; 4.531]; p < 0.001; II vs. I: OR 2.157 [1.410; 3.300]; p < 0.001) presented a significantly higher risk of seroma formation. Likewise, medial compared to lateral inguinal hernias had a higher seroma rate (OR 1.272 [1.020; 1.585]; p = 0.032).
Conclusions
Mesh fixation with tacks or glue, a larger hernia defect, and medial defect localization present a higher risk for seroma development in TAPP inguinal hernia repair.
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Inside Front Cover - Editorial Board Page
Source:Journal of Environmental Radioactivity, Volumes 178–179
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Nuclear weapons produced 236U, 239Pu and 240Pu archived in a Porites Lutea coral from Enewetak Atoll
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): M.B. Froehlich, S.G. Tims, S.J. Fallon, A. Wallner, L.K. Fifield
A slice from a Porites Lutea coral core collected inside the Enewetak Atoll lagoon, within 15 km of all major nuclear tests conducted at the atoll, was analysed for 236U, 239Pu and 240Pu over the time interval 1952-1964 using a higher time resolution than previously reported for a parallel slice from the same core. In addition two sediment samples from the Koa and Oak craters were analysed. The strong peaks in the concentrations of 236U and 239Pu in the testing years are confirmed to be considerably wider than the flushing time of the lagoon. This is likely due to the growth mechanism of the coral. Following the last test in 1958 atom concentrations of both 236U and 239Pu decreased from their peak values by more than 95% and showed a seasonal signal thereafter. Between 1959 and 1964 the weighted average of the 240Pu/239Pu atom ratio is 0.124 ± 0.008 which is similar to that in the lagoon sediments (0.129 ± 0.006) but quite distinct from the global fallout value of ∼0.18. This, and the high 239,240Pu and 236U concentrations in the sediments, provides clear evidence that the post-testing signal in the coral is dominated by remobilisation of the isotopes from the lagoon sediments rather than from global fallout.
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The 137Cs activity concentration of suspended and dissolved fractions in irrigation waters collected from the 80 km zone around TEPCO's Fukushima Daiichi Nuclear Power Station
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): Hirofumi Tsukada, Satoshi Nihira, Takashi Watanabe, Satoru Takeda
Fifty-four samples of irrigation water were collected in 2014 from agricultural ponds, rivers, and dams within the 80 km zone around TEPCO's Fukushima Daiichi Nuclear Power Station (FDNPS). The samples were filtered with a 0.45 μm pore-size membrane filter to produce suspended and dissolved fractions. The 137Cs activity concentration of the suspended fraction varied from 1.5 to 300 Bq g−1 dry weight and was significantly higher than that in the soil around each sampling site. The range of 137Cs activity concentrations in the dissolved fraction varied over three orders of magnitude at 0.0075–6.7 Bq l−1, which was a larger range than that of the suspended fraction; the higher values for samples were from within the 20 km zone. In the dissolved fraction 87 ± 9% of the 137Cs (n = 37) was in a monovalent cationic form (Cs+) and therefore potentially mobile. The distribution coefficient (Kd) ranged from 4100 to 2,100,000; the geometric mean value (110,000) was higher than that reported by the IAEA (2010). The geometric mean Kd of samples collected from the 20 km zone was 61,000 (n = 27), which was significantly lower than that collected from 20 to 80 km zone (200,000, n = 27). The Kd-value was negative correlated with the concentration of stable 133Cs and the electric conductivity in the dissolved fraction. This shows relatively higher mobility of radiocaesium in irrigation waters may occur when there are higher contents of cations present.
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Effects of bark washing and epiphytic moss on 137Cs activity concentration in bark and stemflow in Japanese persimmon (Diospyros kaki Thunb.)
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): Mamoru Sato, Tsugiko Takase, Katsuhiko Yamaguchi
The effects of bark washing, and of epiphytic moss growing on the bark surfaces, on the 137Cs activity concentrations in bark and stemflow samples were evaluated at two Japanese persimmon orchards located in Fukushima City and Date City, both approximately 60–65 km northwest of the Fukushima Dai-ichi nuclear power plant. The means of 137Cs in stemflow captured by 1 g of sphagnum placed on the main trunks of washed and unwashed trees, and on sites with moss and with no moss growing on bark of the non-washed trees in Date City, were 0.37 Bq, 1.08Bq, 0.77 Bq and 0.52 Bq respectively. The 137Cs was significantly lower in the washed bark and in the absence of moss at p = 0.00031 and p = 0.0443 by t-test respectively. The 137Cs in directly-collected stemflow on the main trunks was significantly higher for the unwashed tree at 6.0 Bq L−1 compared with the washed tree at 1.1 Bq L−1 (p = 0.017 by Tukey's test). The extraction rate of dissolved 137Cs with deionized water was 7.3% even after stirring for 40 h. These results indicate that the moss acts as reservoir of 137Cs, and that bark-washing decontamination can reduce the additional 137Cs supply from moss in subsequent years following the radioactive fallout.
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Behavior of 137Cs in ponds in the vicinity of the Fukushima Dai-ichi nuclear power plant
Publication date: November 2017
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): Yoshifumi Wakiyama, Alexei Konoplev, Toshihiro Wada, Tsugiko Takase, Ian Byrnes, Matthew Carradine, Kenji Nanba
137Cs activity concentration in the water of four ponds, Suzuuchi (SU), Funasawa (FS), Inkyozaka (IZ), and Kashiramori (KM), that are within 10 km of the Fukushima Dai-ichi nuclear power plant were observed from April 2015 to August 2016. 137Cs inventories in soils surrounding SU, FS, IZ, and KM were 6.4, 2.9, 2.1, and 0.9 MBq m−2, respectively. 137Cs inventories in the bottom sediments of SU, FS, IZ, and KM were 13, 8.9, 1.6, and 1.1 MBq m−2, respectively. Higher 137Cs inventories in bottom sediment than those of soil in SU and FS suggest that 137Cs was delivered to and accumulated in these ponds. Mean total 137Cs activity concentrations in SU, FS, IZ, and KM were 41, 13, 9.5, and 1.4 Bq L−1, respectively. Particulate 137Cs concentration accounted for 71–90% of total 137Cs in the water samples, on average. The mean distribution coefficient, Kd, in SU, FS, IZ, and KM was 1.3 × 105, 2.1 × 105, 1.7 × 105, and 6.2 × 105 L kg−1, respectively. These Kd values were higher than the Kd values observed in the Chernobyl area by 1–2 orders of magnitude. Although no significant decreasing trends were found, dissolved 137Cs activity concentration tended to be low during winter in all four ponds. Dissolved 137Cs activity concentrations were proportional to K+ and DOC concentrations in all the ponds. The results from principal component analysis performed for 137Cs activity concentration and water chemistry data sets suggested that there were different mechanisms behind variability of dissolved 137Cs activity concentrations for each pond. Continuous monitoring is required to reveal temporal trends in 137Cs activity concentrations of these waters and controlling factors of such in closed water systems in Fukushima.
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Measurement of tributyl phosphate (TBP) in groundwater at a legacy radioactive waste site and its possible role in contaminant mobilisation
Publication date: November 2017
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): Brett Rowling, Andrew S. Kinsela, M. Josick Comarmond, Catherine E. Hughes, Jennifer J. Harrison, Mathew P. Johansen, Timothy E. Payne
At many legacy radioactive waste sites, organic compounds have been co-disposed, which may be a factor in mobilisation of radionuclides at these sites. Tri-butyl phosphate (TBP) is a component of waste streams from the nuclear fuel cycle, where it has been used in separating actinides during processing of nuclear fuels. Analyses of ground waters from the Little Forest Legacy Site (LFLS) in eastern Australia were undertaken using solid-phase extraction (SPE) followed by gas chromatographic mass spectrometry (GCMS). The results indicate the presence of TBP several decades after waste disposal, with TBP only being detected in the immediate vicinity of the main disposal area. TBP is generally considered to degrade in the environment relatively rapidly. Therefore, it is likely that its presence is due to relatively recent releases of TBP, possibly stemming from leakage due to container degradation. The ongoing presence and solubility of TBP has the potential to provide a mechanism for nuclide mobilisation, with implications for long term management of LFLS and similar legacy waste sites.
Graphical abstract
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Whole-organism concentration ratios in wildlife inhabiting Australian uranium mining environments
Publication date: November 2017
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): Gillian A. Hirth, Mathew P. Johansen, Julia G. Carpenter, Andreas Bollhöfer, Nicholas A. Beresford
Wildlife concentration ratios for 226Ra, 210Pb, 210Po and isotopes of Th and U from soil, water, and sediments were evaluated for a range of Australian uranium mining environments. Whole-organism concentration ratios (CRwo-media) were developed for 271 radionuclide-organism pairs within the terrestrial and freshwater wildlife groups. Australian wildlife often has distinct physiological attributes, such as the lower metabolic rates of macropod marsupials as compared with placental mammals. In addition, the Australian CRswo-media originate from tropical and semi-arid climates, rather than from the temperate-dominated climates of Europe and North America from which most (>90%) of internationally available CRwo-media values originate. When compared, the Australian and non-Australian CRs are significantly different for some wildlife categories (e.g. grasses, mammals) but not others (e.g. shrubs). Where differences exist, the Australian values were higher, suggesting that site-, or region-specific CRswo-media should be used in detailed Australian assessments. However, in screening studies, use of the international mean values in the Wildlife Transfer Database (WTD) appears to be appropriate, as long as the values used encompass the Australian 95th percentile values. Gaps in the Australian datasets include a lack of marine parameters, and no CR data are available for freshwater phytoplankton, zooplankton, insects, insect larvae or amphibians; for terrestrial environments, there are no data for amphibians, annelids, ferns, fungi or lichens & bryophytes. The new Australian specific parameters will aide in evaluating remediation plans and ongoing operations at mining and waste sites within Australia. They have also substantially bolstered the body of U- and Th-series CRwo-media data for use internationally.
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239Pu fallout across continental Australia: Implications on 239Pu use as a soil tracer
Publication date: November 2017
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): R. Lal, L.K. Fifield, S.G. Tims, R.J. Wasson
At present there is a need for the development of new radioisotopes for soil erosion and sediment tracing especially as fallout 137Cs levels become depleted. Recent studies have shown that 239Pu can be a useful new soil erosion and sediment radioisotope tracer. 239Pu was released in the major atmospheric nuclear weapons tests of 1950's and 1960's. However 239Pu has a half-life of 24110 years and more than 99% of this isotope is still present in the environment today. In contrast 137Cs with a half-life of 30.07 year has decayed to <35% of initially deposited activities and this isotope will become increasingly difficult to measure in the coming decades especially in the southern hemisphere, which received only about a third of the total global fallout from the atmospheric tests (UNSCEAR, 2000).In this study an assessment of the 239Pu fallout in Australia was carried out from comparison of measured 239Pu inventories with expected 239Pu inventories from fallout models. 239Pu inventories were also compared with rainfall and measured 240Pu/239Pu ratios across Australia.239Pu fallout inventories ranged from 430 to 1461 μB/cm2. Central Australia, with fallout 107% in excess of expected values, seems to be strongly impacted by local fallout deposition. In comparison other sites typically show 5–40% variation between expected and measured fallout values.The fallout inventories were found to weakly correlate (using power functions, y = axb) with rainfall with r2 = 0.50 across the southern catchments (25–40°S latitude band). Across the northern catchments (10–25°S latitude band) fallout showed greater variability with rainfall with r2 = 0.24. Central Australia and Alice Springs which seem to be strongly impacted by local fallout are excluded from the rainfall correlation data (with these sites included r2 = 0.08 and r2 < 0.01 respectively).240Pu/239Pu atom ratios range from 0.045 to 0.197, with averages of 0.139(0.017), 0.111(0.052) and 0.160(0.027) in the 10–20°S, 20–30°S and 30–40°S latitude bands respectively. The 240Pu/239Pu atom ratios in Central Australia (0.069) likely represent fallout from the Australian tests which also have low 240Pu/239Pu atom ratios i.e., Maralinga (0.113) and Montebello (0.045). The average ratios in the 20–30°S and 30–40° bands are closer to the global average (0.139 and 0.177 respectively when not including the close-in fallout data from the nuclear test sites) if the Australian test sites and Central Australian sites are neglected as they clearly represent the effects of close in fallout.
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Natural radionuclides and stable elements in weaver ants (Oecophylla smaragdina) from tropical northern Australia
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): Peter Medley, Che Doering, Fiona Evans, Andreas Bollhöfer
Natural radionuclides and stable elements were measured in weaver ants, leaves and soils collected from three sites in tropical northern Australia. Radionuclide concentration ratios for ants relative to soil were derived from the measurements and used to refine the current environmental radiological assessment for remediation of Ranger uranium mine. Use of site-specific concentration ratios for weaver ants gave a more conservative estimate of environmental exposure to the arthropod wildlife group than use of default concentration ratios in the ERICA Tool. This was primarily because the 226Ra concentration ratio for weaver ants was more than 7 times greater than for generic arthropods.
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Comparison of radium-228 determination in water among Australian laboratories
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): Atun Zawadzki, Megan Cook, Brodie Cutmore, Fiona Evans, Daniela Fierro, Alicea Gedz, Jennifer J. Harrison, Tom Loosz, Peter Medley, Lida Mokhber-Shahin, Sarah Mullins, Sandra Sdraulig
The National Health and Medical Research Council and Natural Resource Management Ministerial Council of Australia developed the current Australian Drinking Water Guidelines which recommend an annual radiation dose value of 1 mSv year−1. One of the potential major contributors to the radiation dose from drinking water is radium-228, a naturally occurring radionuclide arising from the thorium decay series. Various methods of analysing for radium-228 in water have been established and adapted by analytical radiochemistry laboratories. Seven laboratories in Australia participated in analysing radium-228 spiked water samples with activity concentrations ranging from 6 mBq L−1 to 20 Bq L−1. The aim of the exercise was to compare and evaluate radium-228 results reported by the participating laboratories, the methods used and the detection limits. This paper presents the outcome of the exercise.
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7Be and 210Pb wet/dry deposition in Melbourne, Australia and the development of deployable units for radiological emergency monitoring
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): Jane Courtier, Sandra Sdraulig, Gillian Hirth
A large stainless-steel collection tray (with a surface area of one square metre) was purpose built and mounted on the roof of the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) building at Yallambie, Victoria, Australia. Using this system two years' worth of wet/dry deposition samples have been collected and analysed. Smaller portable units were also developed for deployment in an emergency and/or for environmental monitoring. The cosmogenic radionuclide 7Be and the naturally occurring terrestrial radionuclide 210Pb have been used to validate the systems. The data from the smaller units was successfully compared to the larger permanent collection unit for validation, thus finding the portable units fit for purpose.Monitoring of wet and dry fallout deposition is an important response to radiological emergencies. It can provide useful information in verifying predictive models of radionuclide atmospheric transport and dispersion, in addition to providing local deposition data.
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Robustness testing of an in-situ caesium extraction unit
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): Ilonka Bokor, Sandra Sdraulig, Masoumeh Sanagou
Following on from the successful development and validation of a prototype automated unit for the extraction of radiocaesium from seawater, the unit was redesigned to be smaller, easier to transport and better suited for field work. An extension of the validation process was undertaken to include robustness testing. Robustness testing evaluates the behaviour of a procedure when deliberate small changes are made. This requires the identification and testing of experimental factors which could have an impact on the results. The Plackett-Burman approach was adopted to minimise the number of experiments needed for testing. The study showed that the analytical method was not sensitive to any of the factors tested, indicating that the method is robust.
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Experimental comparison of the bioaccumulation of anthropogenic radionuclides by egg and juvenile life stages of a small shark
Publication date: November 2017
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): Ross A. Jeffree, Mathew P. Johansen
This study compared the bioaccumulation of anthropogenic nuclides (65Zn, 134Cs, 60Co and 241Am) between the egg and juvenile life stages of a small shark (Scyliorhinus canicula), based on previously published experimental data. Rates of accumulation over 15 days were derived and summed for the transfer pathways which were specific to these two life stages. Radionuclide transfers to the egg and its embryo & yolk were quantified for i) the maternal pathway following her uptake of radionuclides via food and seawater and ii) from seawater following its oviposition. For the juvenile, the transfer of radionuclides were measured for aqueous & dietary pathways. The results show that, compared to juveniles, eggs have equivalent rates of accumulation of 65Zn and 134Cs but enhanced accumulation of 241Am by a factor of five and of 60Co by two orders of magnitude. The radiological exposure of the embryo due to radionuclides maternally transferred to the embryo & yolk is also enhanced for the alpha-emitting 241Am. This enhanced accumulation of 241Am and 60Co, as well as the equivalent accumulation of 65Zn and 134Cs, suggest greater likely vulnerability to radiation damage in eggs as compared to juveniles. Radiological dose assessment confirmed highest doses to the egg which is predominantly due to accumulated 241Am.
Graphical abstract
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The Swedish radiological environmental protection regulations applied in a review of a license application for a geological repository for spent nuclear fuel
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): Pål Andersson, Karolina Stark, Shulan Xu, Maria Nordén, Björn Dverstorp
For the first time, a system for specific consideration of radiological environmental protection has been applied in a major license application in Sweden. In 2011 the Swedish Nuclear Fuel & Waste Management Co. (SKB) submitted a license application for construction of a geological repository for spent nuclear fuel at the Forsmark site. The license application is supported by a post-closure safety assessment, which in accordance with regulatory requirements includes an assessment of environmental consequences. SKB's environmental risk assessment uses the freely available ERICA Tool. Environmental media activity concentrations needed as input to the tool are calculated by means of complex biosphere modelling based on site-specific information gathered from site investigations, as well as from supporting modelling studies and projections of future biosphere conditions in response to climate change and land rise due to glacial rebound. SKB's application is currently being reviewed by the Swedish Radiation Safety Authority (SSM). In addition to a traditional document review with an aim to determine whether SKB's models are relevant, correctly implemented and adequately parametrized, SSM has performed independent modelling in order to gain confidence in the robustness of SKB's assessment. Thus, SSM has used alternative stylized reference biosphere models to calculate environmental activity concentrations for use in subsequent exposure calculations. Secondly, an alternative dose model (RESRAD-BIOTA) is used to calculate doses to biota that are compared with SKB's calculations with the ERICA tool. SSM's experience from this review is that existing tools for environmental dose assessment are possible to use in order to show compliance with Swedish legislation. However, care is needed when site representative species are assessed with the aim to contrast them to generic reference organism. The alternative modelling of environmental concentrations resulted in much lower concentrations compared to SKB's results. However, SSM judges that SKB's in this part conservative approach is relevant for a screening assessment. SSM also concludes that there are big differences in dose rates calculated to different organisms depending on which tool that is used, although not systematically higher for either of them. Finally, independent regulatory modelling has proven valuable for SSM's review in gaining understanding and confidence in SKB's assessment presented in the license application.
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A method for independent modelling in support of regulatory review of dose assessments
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): Björn Dverstorp, Shulan Xu
Several countries consider geological disposal facilities as the preferred option for spent nuclear fuel due to their potential to provide isolation from the surface environment on very long timescales. In 2011 the Swedish Nuclear Fuel & Waste Management Co. (SKB) submitted a license application for construction of a spent nuclear fuel repository. The disposal method involves disposing spent fuel in copper canisters with a cast iron insert at about 500 m depth in crystalline basement rock, and each canister is surrounded by a buffer of swelling bentonite clay. SKB's license application is supported by a post-closure safety assessment, SR-Site. SR-Site has been reviewed by the Swedish Radiation Safety Authority (SSM) for five years. The main method for review of SKB's license application is document review, which is carried out by SSM's staff and supported by SSM's external experts. The review has proven a challenging task due to its broad scope, complexity and multidisciplinary nature. SSM and its predecessors have, for several decades, been developing independent models to support regulatory reviews of post-closure safety assessments for geological repositories. For the review of SR-Site, SSM has developed a modelling approach with a structured application of independent modelling activities, including replication modelling, use of alternative conceptual models and bounding calculations, to complement the traditional document review. This paper describes this scheme and its application to biosphere and dose assessment modelling. SSM's independent modelling has provided important insights regarding quality and reasonableness of SKB's rather complex biosphere modelling and has helped quantifying conservatisms and highlighting conceptual uncertainty.
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Aquatic live animal radiotracing studies for ecotoxicological applications: Addressing fundamental methodological deficiencies
Publication date: November 2017
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): Tom Cresswell, Marc Metian, Lisa A. Golding, Mike D. Wood
The use of live animal gamma radioisotope tracer techniques in the field of ecotoxicology allows laboratory studies to accurately monitor contaminant biokinetics in real time for an individual organism. However, methods used in published studies for aquatic organisms are rarely described in sufficient detail to allow for study replication or an assessment of the errors associated with live animal radioanalysis to be identified. We evaluate the influence of some important methodological deficiencies through an overview of the literature on live aquatic animal radiotracer techniques and through the results obtained from our radiotracer studies on four aquatic invertebrate species. The main factors discussed are animal rinsing, radioanalysis and geometry corrections. We provide examples of three main techniques in live aquatic animal radiotracer studies to improve data quality control and demonstrate why each technique is crucial in interpreting the data from such studies. The animal rinsing technique is also relevant to non-radioisotope tracer studies, especially those involving nanoparticles. We present clear guidance on how to perform each technique and explain the importance of proper reporting of the validation of each technique for individual studies. In this paper we describe methods that are often used in lab-based radioecology studies but are rarely described in great detail. We hope that this paper will act as the basis for standard operating procedures for future radioecology studies to improve study replication and data quality control.
Graphical abstract
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Editorial Board
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 11
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Longitudinal recovery and reduced costs after 120 sessions of locomotor training for motor incomplete spinal cord injury
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Sarah A. Morrison, Douglas Lorenz, Carol P. Eskay, Gail F. Forrest, D. Michele Basso
ObjectiveTo determine the impact of long term, body weight supported locomotor training (BWSLT) after chronic, incomplete spinal cord injury (SCI). Also, health care costs were estimated related to lost recovery potential and preventable secondary complications that may have occurred due to visit limits imposed by insurers.DesignProspective observational cohort with longitudinal follow up.SettingEight outpatient rehabilitation centers that participate in the Christopher & Dana Reeve Foundation NeuroRecovery Network® (NRN).ParticipantsIndividuals with motor incomplete chronic SCI (Asia Impairment Scale C or D; n=69; 0.1-45 yr after SCI), who completed at least 120 NRN physical therapy sessions.InterventionsManually-assisted locomotor training in a body weight supported treadmill environment, overground standing and stepping activities, and community integration tasks.Main Outcome Measure(s)International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) motor and sensory scores, orthostatic hypotension, bowel/bladder/sexual function, SCI-FAI, Berg Balance Scale, Modified Functional Reach, 10-meter walk test and 6-minute walk test. Longitudinal outcome measure collection occurred every 20 treatments and at 6-12 month follow-up after discharge from therapy.ResultsSignificant improvement occurred for upper and lower motor strength, functional activities, psychological arousal, sensation of bowel movement and SCI-FAI community ambulation. Extended training enabled minimal detectable changes at 60, 80, 100, and 120 sessions. After detectable change occurred, it was sustained through 120 sessions and continued 6-12 months after treatment.ConclusionsDelivering at least 120 sessions of LT improves recovery from incomplete chronic SCI. Because walking reduces rehospitalization, LT delivered beyond the average 20 session insurance limit can reduce rehospitalizations and long term health costs.
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Table of Contents
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 11
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Editors' Selections From This Issue: Volume 98 / Number 11 / November 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 11
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Measuring Participation after Stroke in Africa: Development of the Participation Measurement Scale
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Oyéné Kossi, Félix Nindorera, Charles Sèbiyo Batcho, Thierry Adoukonou, Massimo Penta, Jean-Louis Thonnard
ObjectiveTo develop a valid stroke-specific tool for the measurement of participation in Africa, named the Participation Measurement Scale (PM-Scale).DesignObservational study and questionnaire development.SettingOutpatient Rehabilitation centers.ParticipantsStroke patients (N = 276); mean age ± standard deviation of 58.5 ± 11.1 years; 57% male.InterventionNot applicable.Main Outcome MeasuresParticipants completed a 100-item experimental questionnaire of the PM-Scale. Items were scored as "not at all", "weakly" or "strongly". The Hospital Anxiety and Depression Scale was used to evaluate the depression and the modified Rankin Scale was used to categorize the severity of disability on the basis of observation.ResultsAfter successive Rasch analyses using RUMM2030 software package under unrestricted partial-credit parameterization, a valid, unidimensional and linear 22-item scale for the measurement of participation was constructed. All 22 items fulfilled the measurement requirements of overall and individual item and person fits, category discrimination, invariance, and local response independence. The PM-Scale showed good internal consistency (person separation index = 0.93). The test–retest reliability of item difficulty hierarchy (r = 0.96, p <0.001) and patient location (r = 0.99, p <0.001) were excellent. This patient-based scale covers all nine ICF domains of participation.ConclusionsThe PM-Scale has good psychometric qualities and provides accurate measures of participation in patients with stroke in Africa.
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Archives of Physical Medicine and Rehabilitation Supplements
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 11
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Routine Urine Testing at the Spinal Cord Injury Annual Evaluation Leads to Unnecessary Antibiotic Use: A Pilot Study and Future Directions
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Felicia Skelton, Larissa Grigoryan, Sally Ann Holmes, Ivy Oiyee Poon, Barbara Trautner
ObjectiveTo measure the prevalence of ASB in persons with spinal cord injury (SCI) at the time of their annual examination, and examine the impact on urine testing during the annual examination on subsequent antibiotic use.Designretrospective cohort studySettinga major Veterans Health Administration SCI centerParticipantsVeterans with SCI seen for an outpatient annual evaluation in 2012 or 2013 (n=393)Main Outcome Measureantibiotic use for bacteriuria within seven days of the annual evaluation encounterResultsOf the 327 clinic visits that met inclusion criteria, of which 249 had a urine culture performed. 171 (69%) of the urine cultures were positive; 22 (13%) represented UTI cases, while 149 (87%) were ASB. Over a third of the ASB cases (53, 36%) were treated with antibiotics. None of the 78 visits with negative urine cultures received antibiotics to treat the urine; thus, a positive urine culture alone was associated with antibiotic use (p<0.01). Factors predicting antibiotic use were higher age, nitrite presence on urinalysis and urease-producing organism on culture. When comparing bladder management strategies, indwelling catheterization was associated with higher levels of pyuria and hematuria than spontaneous voiding or intermittent catheterization (p<0.01).ConclusionTwo-thirds of the urine cultures of persons with SCI presenting for their annual examination were positive. Most of the positive cultures represented ASB, and over a third of these were treated with antibiotics. A better understanding of the mandate for urine testing at the annual examination and the outcomes of this practice is an important first step to developing antibiotic stewardship for UTI in persons with SCI.
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Perceived participation and its correlates among first-stroke survivors at six months after discharge from a tertiary hospital in China
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Xuemei Chen, Yanan He, Xianmei Meng, Chenchen Gao, Zhihui Liu, Lanshu Zhou
ObjectivesTo describe perceived participation of first-stroke survivors in mainland China, and to determine variables that may correlate with perceived participation six months after discharge.DesignCross-sectional survey.SettingNeurology department of a tertiary hospital in Shanghai, China, with subsequent follow-up of patients in their homes.SubjectsTwo hundred and thirty-six first-stroke survivors who had been treated in the neurology department and discharged six months prior to their participation in our study.InterventionNot applicable.MeasuresParticipation was assessed using the Chinese version of the self-report Impact on Participation and Autonomy questionnaire. Performance on activities of daily living was measured using the Barthel Index and physical function was measured with the Chinese Stroke Scale. The Hospital Anxiety and Depression Scale and the Social Support Rating Scale were also used.ResultsMean score of perceived participation was 40.39±15.29. 52.1%, 38.1%, 33.1% and 5.5% of the participants reported insufficient participation in domains of autonomy outdoors, family role, social relations and autonomy outdoors respectively. Physical function served as the strongest correlate for domains of family role and autonomy outdoors (standardized coefficients =0.426 and 0.336); while depression was strongest correlate for domains of social relations ((standardized coefficients = 0.315).ConclusionsPhysical function and activities of daily living were significantly associated with perceived participation in almost all domains. Depression was an important correlater of participation in the social relations domain. Perceived participation may be influenced by multiple factors and tailored strategies should be implemented early in the rehabilitation phase post-stroke to promote participation in all domains of daily living.
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Transversus abdominis plane block using a short-acting local anesthetic for postoperative pain after laparoscopic colorectal surgery: a systematic review and meta-analysis
Abstract
Background
Transversus abdominis plane (TAP) block using a short-acting local anesthetic as part of multimodal analgesia is efficient in various abdominal surgeries, including laparoscopic surgery. However, information regarding its use in laparoscopic colorectal surgery is still limited and sometimes controversial. Therefore, we conducted a systematic review and meta-analysis to determine whether TAP block using a short-acting anesthetic has a positive postoperative analgesic outcome in patients who have undergone laparoscopic colorectal surgery.
Methods
We searched for studies comparing the postoperative pain outcome after laparoscopic colorectal surgery between patients who received TAP block and a control group (placebo or no treatment). Outcome measures were early pain at rest (numeric rating scale [NRS] score at 0–2 h postoperatively), late pain at movement (NRS score at 24 h postoperatively), late pain at rest (NRS score at 24 h postoperatively), and postoperative opioid consumption (up to 24 h postoperatively). We used a random-effects model for the meta-analysis and Egger's regression test to detect publication bias.
Results
We included six studies involving 452 patients (224 in the TAP block group, 228 in the control group). Early and late pain scores at movement were significantly different between the TAP block and control groups (standardized mean difference: − 0.695, P < 0.0001 for early pain and − 0.242, P = 0.029 for late pain). There was no significant difference between the TAP block and control groups in early pain at rest (P = 0.475), late pain at rest (P = 0.826), and postoperative opioid consumption (P = 0.257).
Conclusions
The TAP block using a short-acting anesthetic had a significant effect on the postoperative pain outcome in the early (0–2 h) and late (24 h) period at movement. However, it did not have a significant effect on the postoperative pain outcome in the early (0–2 h) and late (24 h) periods at rest after laparoscopic surgery.
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What are the influencing factors for chronic pain following TAPP inguinal hernia repair: an analysis of 20,004 patients from the Herniamed Registry
Abstract
Background
In inguinal hernia repair, chronic pain must be expected in 10–12% of cases. Around one-quarter of patients (2–4%) experience severe pain requiring treatment. The risk factors for chronic pain reported in the literature include young age, female gender, perioperative pain, postoperative pain, recurrent hernia, open hernia repair, perioperative complications, and penetrating mesh fixation. This present analysis of data from the Herniamed Hernia Registry now investigates the influencing factors for chronic pain in male patients after primary, unilateral inguinal hernia repair in TAPP technique.
Methods
In total, 20,004 patients from the Herniamed Hernia Registry were included in uni- and multivariable analyses. For all patients, 1-year follow-up data were available.
Results
Multivariable analysis revealed that onset of pain at rest, on exertion, and requiring treatment was highly significantly influenced, in each case, by younger age (p < 0.001), preoperative pain (p < 0.001), smaller hernia defect (p < 0.001), and higher BMI (p < 0.001). Other influencing factors were postoperative complications (pain at rest p = 0.004 and pain on exertion p = 0.023) and penetrating compared with glue mesh fixation techniques (pain on exertion p = 0.037).
Conclusions
The indication for inguinal hernia surgery should be very carefully considered in a young patient with a small hernia and preoperative pain.
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Laparoscopic parenchymal sparing resections in segment 8: techniques for a demanding and infrequent procedure
Abstract
Background
Laparoscopic liver resections for lesions in the postero-superior segments are technically demanding due their deep location and relation with the vena cava. However, previous reports have demonstrated the feasibility and safety of these resections in centres with advanced experience in laparoscopic liver surgery. In this case series, we present our results and experience of laparoscopic parenchymal sparing liver resections of lesions in segment 8.
Methods
All patients undergoing laparoscopic liver resections of segment 8 lesions, alone or combined with other liver resections, between August 2003 and July 2016 were included. Analysis of baseline characteristics and perioperative results was performed for the whole cohort. A separate subgroup analysis was performed for isolated segment 8 resections. Long-term results were analyzed in patients with colorectal liver metastases. A video is attached for thorough explanation of surgical technique.
Results
A total of 30 patients were included. Among them, 13 patients had isolated segment 8 resections. Operative time for the whole cohort and isolated segment 8 resections were 210 min (range 180–247 min) and 200 min (range 90–300 min), respectively. The conversion rate was 3.4% for the entire cohort and 0 for isolated segment 8 resections. Major morbidity was 7 and 0%, respectively. R0 rates were 96% for the entire cohort and 92% for isolated segment 8 resections. Recurrence free survival in the colorectal liver metastasis subgroup was 82, 71 and 54% at 1, 3 and 5 years. Overall survival was 94, 82 and 65% at 1, 3 and 5 years.
Conclusions
Laparoscopic resection of lesions in segment 8 is feasible and offers the benefits of minimally invasive surgery with parenchyma sparing resections. However, advanced experience in LLR is essential to ensure safety and oncological results.
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Strategy of laparoscopic surgery for colon cancer of the splenic flexure: a novel approach
Abstract
Background
The splenic flexure (SF) anatomy is complex due to multiple vessels, surrounding organs, layers, and irregular adhesions [1–3].
Methods
Our laparoscopic approach involves a lateral-to-medial approach to the left-sided transverse mesocolon (TM), a medial-to-lateral approach to the left mesocolon (LM), and take-down of the remnant SF. First, the omental bursa is opened and its posterior wall and the anterior layer of the TM are dissected along the pancreas, where a gauze is placed. The TM is spread cephalad. A window in the TM is opened in the gauze seen through the TM. If necessary, the middle colic vessels are divided with lymph node (LN) dissection. Then the left colic artery is divided with LN dissection using a medial approach. The LM is widely dissected from the retroperitoneum to reach the TM window. While observing the pancreas through the window, the LM and TM are divided from the pancreas close to the SF. The descending colon is mobilized from its lateral attachment. Finally, the SF is taken down from the spleen by separating remnant structures, including adhesions. Subsequently, functional end-to-end anastomosis was performed extracorporeally.
Results
During March 2012–December 2016, 39 patients with left-sided transverse or descending colon cancer underwent this treatment. The mean operative time, blood loss, number of harvested LNs, and hospital stay duration were 283 min, 45 ml, 15, and 9 days, respectively. No patient needed conversion to open surgery or had organ injury, anastomotic leakage, or Clavien–Dindo III–V complications. There were 7/13/18/1 patients with Stage I/II/III/IV colon cancer, respectively. Nineteen cases had positive LNs. All patients were alive with one local and two distant recurrences at a mean 24-month follow-up.
Conclusions
This is a safe and effective surgical strategy for treating colon cancer of the SF, strategically designed to resect the SF after dissecting the surrounding structures.
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Endoscopic sutured gastroplasty: procedure evolution from first-in-man cases through current technique
Abstract
Background
Endoscopic sutured gastroplasty (ESG) has evolved over time. With the advent of full-thickness endoscopic suturing, an efficient technique for ESG was developed and refined.
Methods
This prospective first-in-man trial started in April 2012 and represents the first use of full-thickness endoscopic suturing for primary obesity therapy. The trial focused on procedure development, reproducibility, safety, and short-term efficacy. The trial was performed at centers in five countries, in three phases. Phase I was evaluation of safety and technical feasibility of various procedure techniques; stitch patterns and sequences were assessed for efficiency, safety, and feasibility. Phase II entailed continued procedure refinement to establish a standardized technique. Phase III entailed evaluation of technical feasibility and weight loss outcomes in 77 patients; the procedure was performed using the standardized technique, and there was no procedure development. Data were prospectively collected into a registry.
Results
In Phase I, the procedure was created and modified to improve time efficiency. Safety and technical feasibility were established, and short-term weight loss was demonstrated. In Phase II, a number of stitch patterns were attempted, and the stitch pattern was modified and finalized. 22 patients were included, and 1-year total weight loss was 17.3 ± 2.6%. In Phase III, conformity with the final technique was high. 77 patients were included, with a mean BMI of 36.1 ± 0.6 kg/m2. Mean weight loss was 16.0 ± 0.8% at 6 months and 17.4 ± 1.2% at 12 months (n = 44). Postprocedural nausea, vomiting, and epigastric pain were frequently reported; there were no reported significant adverse events post-procedure or during the follow-up period.
Conclusions
Following a methodical procedure development phase, ESG demonstrated safety and short-term efficacy in this trial. The procedure also achieved meaningful weight loss during the follow-up period.
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Low invasiveness of thoracoscopic esophagectomy in the prone position for esophageal cancer: a propensity score-matched comparison of operative approaches between thoracoscopic and open esophagectomy
Abstract
Background
In this study, cytokine levels, outcome, and survival rates after esophagectomy for esophageal cancer were retrospectively investigated in a propensity score-matched comparison of operative approaches between the thoracoscopic esophagectomy (TE) in the prone position and open esophagectomy (OE).
Patients and Methods
Between 2005 and 2014, TE was performed on a group of 85 patients, which was compared with a group of 104 OE cases. Eventually, 65 paired cases were matched using propensity score matching.
Results
Although the TE group underwent a significantly longer operation time than the OE group (P < 0.001), the TE group exhibited less blood loss (P < 0.001) and had a shorter postoperative hospital stay (P = 0.038) than the OE group. The serum interleukin-6 levels on ICU admission (P < 0.001) and on POD 1 (P < 0.001) were significantly lower in the TE group. The interleukin-10 levels on ICU admission (P < 0.001), POD 1 (P = 0.016), and POD 3 (P < 0.001) were also significantly lower in the TE group. Pulmonary complication was significantly lower in the TE group (P = 0.043). The 5-year PFS rates in the TE and OE groups were 70.6 and 58.7% (P = 0.328), respectively, and OS rates were 64.9 and 50.2% (P = 0.101), respectively.
Conclusion
TE compared to OE is a less invasive procedure with lower surgical stress and less pulmonary complication for the treatment of esophageal squamous cell carcinoma.
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Video content analysis of surgical procedures
Abstract
Background
In addition to its therapeutic benefits, minimally invasive surgery offers the potential for video recording of the operation. The videos may be archived and used later for reasons such as cognitive training, skills assessment, and workflow analysis. Methods from the major field of video content analysis and representation are increasingly applied in the surgical domain. In this paper, we review recent developments and analyze future directions in the field of content-based video analysis of surgical operations.
Methods
The review was obtained from PubMed and Google Scholar search on combinations of the following keywords: 'surgery', 'video', 'phase', 'task', 'skills', 'event', 'shot', 'analysis', 'retrieval', 'detection', 'classification', and 'recognition'. The collected articles were categorized and reviewed based on the technical goal sought, type of surgery performed, and structure of the operation.
Results
A total of 81 articles were included. The publication activity is constantly increasing; more than 50% of these articles were published in the last 3 years. Significant research has been performed for video task detection and retrieval in eye surgery. In endoscopic surgery, the research activity is more diverse: gesture/task classification, skills assessment, tool type recognition, shot/event detection and retrieval. Recent works employ deep neural networks for phase and tool recognition as well as shot detection.
Conclusions
Content-based video analysis of surgical operations is a rapidly expanding field. Several future prospects for research exist including, inter alia, shot boundary detection, keyframe extraction, video summarization, pattern discovery, and video annotation. The development of publicly available benchmark datasets to evaluate and compare task-specific algorithms is essential.
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Texas school district partners with fire department for EMT academy
By EMS1 Staff PFLUGERVILLE, Texas — A school district teamed up with a fire department to launch the first-ever EMT academy in the area for high school seniors. Statesman reported that six high school seniors from Connally High School and Hendrickson High School began participating in the academy as a result of a partnership between the Pflugerville school district and Pflugerville Fire Department ...
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Fla. fire department to add ballistic armor to ambulance
Gainesville Fire Rescue plans to add ballistic protection to the ambulance's front, sides and back to protect against handgun-caliber bullets
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Endoscopic diagnosis of hiatus hernia under deep inspiration is not consistent with esophageal manometric diagnosis
Abstract
Background
To investigate the relationship between endoscopic and esophageal manometric hiatus hernia (HH).
Methods
Forty-six gastroesophageal reflux disease patients with endoscopic HH under maintenance therapy were recruited. Endoscopy was performed on all patients in a fully conscious state. Endoscopic HH was defined as apparent separation greater than 1 cm of the lower margin of the esophageal palisade vessels and the diaphragm hiatus on endoscopy under deep inspiration. Esophageal manometry was conducted using high-resolution manometry (HRM). The length between the lower margin of the lower esophageal sphincter and pulmonary inversion point was measured 10 times. The mean and maximum of the length was then calculated.
Results
The mean HH length on HRM was 0 cm (0–0) [median (25th to 75th percentile)], 0 cm (0-0), 0.5 cm (0–1.1), and 2.2 cm (1.3–2.5) in the groups with endoscopic HH lengths of 1–2, 2–3, 3–4, and 4–5 cm, respectively. The maximum HH length on HRM was 0 cm (0–0), 0 cm (0–0), 0.8 cm (0–1.4), and 2.4 cm (1.5–2.9) in the 1–2, 2–3, 3–4, and 4–5 cm endoscopic HH groups, respectively. The mean and maximum HH lengths increased significantly in the group with an endoscopic HH length of 4–5 cm compared with the other groups, but did not differ significantly among the 1–2, 2–3, and 3–4 cm groups. Of patients with endoscopic HH less than 3 cm, few had esophageal manometric HH greater than 2 cm.
Conclusions
Endoscopic diagnosis of HH under deep inspiration is not consistent with esophageal manometric diagnosis, leading to overdiagnosis.
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REMSA releases comprehensive white paper on its nationally acclaimed community health programs
RENO, Nev. — REMSA, the Regional Emergency Medical Services Authority based in northern Nevada, has released a new comprehensive White Paper that provides detailed information on its highly successful Community Health Programs. These nationally-acclaimed programs were launched in 2012 after REMSA received funding through a $9.1 million Health Care Innovation Award grant from the Center for Medicare ...
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Tesla turns power on at Puerto Rico children’s hospital
Hospital del Nino, which serves around 3,000 children, has power again in the wake of Hurricane Maria thanks to a new solar power system
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Factors contributing to lower metabolic demand of eccentric compared with concentric cycling
This study compared muscle-tendon behavior, muscle oxygenation, and muscle activity between eccentric and concentric cycling exercise at the same work output to investigate why metabolic demand is lower during eccentric cycling than with concentric cycling. Eleven untrained men (27.1 ± 7.0 y) performed concentric cycling (CONC) and eccentric cycling (ECC) for 10 min (60 rpm) at 65% of the maximal concentric cycling power output (191 ± 45 W) 4 wk apart. During cycling, oxygen consumption (Vo2), heart rate (HR), vastus lateralis (VL) tissue total hemoglobin (tHb), and oxygenation index (TOI) were recorded, and muscle-tendon behavior was assessed using ultrasonography. The surface electromyogram (EMG) was recorded from VL, vastus medialis (VM), rectus femoris (RF), and biceps femoris (BF) muscles, and cycling torque and knee joint angle during each revolution were also recorded. Average Vo2 (–65 ± 7%) and HR (–35 ± 9%) were lower and average TOI was greater (16 ± 1%) during ECC than CONC, but tHb was similar between bouts. Positive and negative cycling peak crank torques were greater (32 ± 21 and 48 ± 24%, respectively) during ECC than CONC, but muscle-tendon unit and fascicle and tendinous tissue length changes during pedal revolutions were similar between CONC and ECC. VL, VM, RF, and BF peak EMG amplitudes were smaller (24 ± 15, 22 ± 18, 16 ± 17, and 18 ± 9%, respectively) during ECC than CONC. These results suggest that the lower metabolic cost of eccentric compared with concentric cycling was due mainly to a lower level of muscle activation per torque output.
NEW & NOTEWORTHY This study shows that lower oxygen consumption of eccentric compared with concentric cycling at the same workload is explained by lower muscle activity of agonist and antagonist muscles during eccentric compared with during concentric cycling.
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Muscle hypertrophy in prediabetic men after 16 wk of resistance training
Resistance training of healthy young men typically results in muscle hypertrophy and a shift in vastus lateralis composition away from type IIx fibers to an increase in IIa fiber content. Our previous studies of 8 wk of resistance training found that many metabolic syndrome men and women paradoxically increased IIx fibers with a decrease in IIa fibers. To confirm the hypothesis that obese subjects might have muscle remodeling after resistance training very different from healthy lean subjects, we subjected a group of nine obese male volunteers to progressive resistance training for a total of 16 wk. In these studies, weight loss was discouraged so that muscle changes would be attributed to the training alone. Detailed assessments included comparisons of histological examinations of needle biopsies of vastus lateralis muscle pretraining and at 8 and 16 wk. Prolonging the training from 8 to 16 wk resulted in increased strength, improved body composition, and more muscle fiber hypertrophy, but euglycemic clamp-quantified insulin responsiveness did not improve. Similar to prior studies, muscle fiber composition shifted toward more fast-twitch type IIx fibers (23 to 42%). Eight weeks of resistance training increased the muscle expression of phosphorylated Akt2 and mTOR. Muscle GLUT4 expression increased, although insulin receptor and IRS-1 expression did not change. We conclude that resistance training of prediabetic obese subjects is effective at changing muscle, resulting in fiber hypertrophy and increased type IIx fiber content, and these changes continue up to 16 wk of training.
NEW & NOTEWORTHY Obese, insulin-resistant men responded to 16 wk of progressive resistance training with muscle hypertrophy and increased strength and a shift in muscle fiber composition toward fast-twitch, type IIx fibers. Activation of muscle mTOR was increased by 8 wk but did not increase further at 16 wk despite continued augmentation of peak power and rate of force generation.
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Exposure to intermittent hypoxia and sustained hypercapnia reduces therapeutic CPAP in participants with obstructive sleep apnea
Our purpose was to determine whether exposure to mild intermittent hypoxia leads to a reduction in the therapeutic continuous positive airway pressure required to eliminate breathing events. Ten male participants were treated with twelve 2-min episodes of hypoxia (PETCO2 50 mmHg) separated by 2-min intervals of normoxia in the presence of PETCO2 that was sustained 3 mmHg above baseline. During recovery from the last episode, the positive airway pressure was reduced in a stepwise fashion until flow limitation was evident. The participants also completed a sham protocol under normocapnic conditions, which mimicked the time frame of the intermittent hypoxia protocol. After exposure to intermittent hypoxia, the therapeutic pressure was significantly reduced (i.e., 5 cmH2O) without evidence of flow limitation (103.4 ± 6.3% of baseline, P = 0.5) or increases in upper airway resistance (95.6 ± 15.0% of baseline, P = 0.6). In contrast, a similar decrease in pressure was accompanied by flow limitation (77.0 ± 1.8% of baseline, P = 0.001) and an increase in upper airway resistance (167.2 ± 17.5% of baseline, P = 0.01) after the sham protocol. Consistent with the initiation of long-term facilitation of upper airway muscle activity, exposure to intermittent hypoxia reduced the therapeutic pressure required to eliminate apneic events that could improve treatment compliance. This possibility, coupled with the potentially beneficial effects of intermittent hypoxia on comorbidities linked to sleep apnea, suggests that mild intermittent hypoxia may have a multipronged therapeutic effect on sleep apnea.
NEW & NOTEWORTHY Our new finding is that exposure to mild intermittent hypoxia reduced the therapeutic pressure required to treat sleep apnea. These findings are consistent with previous results, which have shown that long-term facilitation of upper muscle activity can be initiated following exposure to intermittent hypoxia in humans.
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Dietary nitrate supplementation increases acute mountain sickness severity and sense of effort during hypoxic exercise
Dietary nitrate supplementation enhances sea level performance and may ameliorate hypoxemia at high altitude. However, nitrate may exacerbate acute mountain sickness (AMS), specifically headache. This study investigated the effect of nitrate supplementation on AMS symptoms and exercise responses with 6-h hypoxia. Twenty recreationally active men [age, 22 ± 4 yr, maximal oxygen consumption (Vo2max), 51 ± 6 ml·min–1·kg–1, means ± SD] completed this randomized double-blinded placebo-controlled crossover study. Twelve participants were classified as AMS– on the basis of Environmental Symptoms Questionnaire [Acute Cerebral Mountain Sickness score (AMS-C)] <0.7 in both trials, and five participants were classified as AMS+ on the basis of AMS-C ≥0.7 on placebo. Five days of nitrate supplementation (70-ml beetroot juice containing ~6.4 mmol nitrate daily) increased plasma NO metabolites by 182 µM compared with placebo but did not reduce AMS or improve exercise performance. After 4-h hypoxia [inspired O2 fraction (FIO2) = 0.124], nitrate increased AMS-C and headache severity (visual analog scale; whole sample 10 [1, 20] mm, mean difference [95% confidence interval]; P = 0.03) compared with placebo. In addition, after 5-h hypoxia, nitrate increased sense of effort during submaximal exercise (7 [–1, 14]; P = 0.07). In AMS–, nitrate did not alter headache or sense of effort. In contrast, in AMS+, nitrate increased headache severity (26 [–3, 56] mm; P = 0.07), sense of effort (14 [1, 28]; P = 0.04), oxygen consumption, ventilation, and mean arterial pressure during submaximal exercise. On the next day, in a separate acute hypoxic exercise test (FIO2 = 0.141), nitrate did not improve time to exhaustion at 80% hypoxic Vo2max. In conclusion, dietary nitrate increases AMS and sense of effort during exercise, particularly in those who experience AMS. Dietary nitrate is therefore not recommended as an AMS prophylactic or ergogenic aid in nonacclimatized individuals at altitude.
NEW & NOTEWORTHY This is the first study to identify that the popular dietary nitrate supplement (beetroot) does not reduce acute mountain sickness (AMS) or improve exercise performance during 6-h hypoxia. The consumption of nitrate in those susceptible to AMS exacerbates AMS symptoms (headache) and sense of effort and raises oxygen cost, ventilation, and blood pressure during walking exercise in 6-h hypoxia. These data question the suitability of nitrate supplementation during altitude travel in nonacclimatized people.
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UBC-Nepal expedition: markedly lower cerebral blood flow in high-altitude Sherpa children compared with children residing at sea level
Developmental cerebral hemodynamic adaptations to chronic high-altitude exposure, such as in the Sherpa population, are largely unknown. To examine hemodynamic adaptations in the developing human brain, we assessed common carotid (CCA), internal carotid (ICA), and vertebral artery (VA) flow and middle cerebral artery (MCA) velocity in 25 (9.6 ± 1.0 yr old, 129 ± 9 cm, 27 ± 8 kg, 14 girls) Sherpa children (3,800 m, Nepal) and 25 (9.9 ± 0.7 yr old, 143 ± 7 cm, 34 ± 6 kg, 14 girls) age-matched sea level children (344 m, Canada) during supine rest. Resting gas exchange, blood pressure, oxygen saturation and heart rate were assessed. Despite comparable age, height and weight were lower (both P < 0.01) in Sherpa compared with sea level children. Mean arterial pressure, heart rate, and ventilation were similar, whereas oxygen saturation (95 ± 2 vs. 99 ± 1%, P < 0.01) and end-tidal Pco2 (24 ± 3 vs. 36 ± 3 Torr, P < 0.01) were lower in Sherpa children. Global cerebral blood flow was ~30% lower in Sherpa compared with sea level children. This was reflected in a lower ICA flow (283 ± 108 vs. 333 ± 56 ml/min, P = 0.05), VA flow (78 ± 26 vs. 118 ± 35 ml/min, P < 0.05), and MCA velocity (72 ± 14 vs. 88 ± 14 cm/s, P < 0.01). CCA flow was similar between Sherpa and sea level children (425 ± 92 vs. 441 ± 81 ml/min, P = 0.52). Scaling flow and oxygen uptake for differences in vessel diameter and body size, respectively, led to the same findings. A lower cerebral blood flow in Sherpa children may reflect specific cerebral hemodynamic adaptations to chronic hypoxia.
NEW & NOTEWORTHY Cerebral blood flow is lower in Sherpa children compared with children residing at sea level; this may reflect a cerebral hemodynamic pattern, potentially due to adaptation to a hypoxic environment.
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