Effects of Sedentary Aging and Lifelong Exercise on Left Ventricular Systolic Function.

Purpose: The current study examined whether age-related changes in left ventricular (LV) longitudinal systolic function is an adaptation to a more sedentary lifestyle and can be preserved by lifelong exercise training. Methods: A cross-sectional examination of 18 sedentary young (37+/-6 years), 29 sedentary seniors (71+/-5 years, 0-3 exercise sessions/wk), and 26 seniors (68+/-5 years) who had performed a committed level (4-7 exercise sessions/wk) of lifelong (>25 years) exercise. Invasive right heart catheterization (pulmonary capillary wedge pressure) and non-invasive measures of LV function were collected at the following conditions: 1) supine rest, 2) during LV unloading (lower body negative pressure), and 3) LV loading (saline infusion). Ejection fraction (EF) and preload-recruitable stroke work (PRSW) were used to describe global LV systolic function, while peak systolic tissue velocity (S') and longitudinal strain (LS) indicate LV longitudinal systolic function. To adjust LS for aging and training-related differences in LV preload and afterload, LV end-diastolic volume and end-systolic pressure (ESP) were included as covariates in ANCOVA models. Results: EF and PRSW were unaffected by aging or lifelong exercise (P=0.22, P=0.08, respectively). S' decreased with aging (P

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Contralateral Repeated Bout Effect of the Knee Flexors.

Purpose: Eccentric exercise of the elbow flexors (EF) confers protective effect against muscle damage of the same exercise performed by the opposite arm at 1, 7 or 28 days later. This is known as the contralateral repeated bout effect (CL-RBE), but it is not known whether CL-RBE is evident for the knee flexors (KF). The present study tested the hypothesis that KF CL-RBE would be observed at 1, 7 and 28 days after the initial bout. Methods: Young untrained men were assigned to a control or one of three experimental groups (n=13/group). The experimental groups performed 60 maximal KF eccentric contractions (60MaxEC) by one leg followed 1 (1d), 7 (7d) or 28 days (28d) by 60MaxEC using the opposite leg. The control group used the non-dominant leg to repeat 60MaxEC separated by 14 days. Changes in several indirect muscle damage markers after 60MaxEC were compared between bouts and among the groups by mixed-design two-way ANOVAs. Results: Changes in maximal voluntary isokinetic concentric contraction torque, range of motion, muscle soreness, and plasma creatine kinase activity after the first 60MaxEC were similar among the groups. These changes were smaller after the second than the first 60MaxEC for the control, 1d and 7d groups, and the changes after the second 60MaxEC were smaller for the control than both 1d and 7d groups (P

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Gait Kinematics in Individuals with Acute and Chronic Patellofemoral Pain.

Purpose: This study aimed to identify the discriminating kinematic gait characteristics between individuals with acute and chronic patellofemoral pain (PFP), and healthy controls. Methods: Ninety-eight runners with PFP (39 male, 59 female) and 98 healthy control runners (38 male, 60 female) ran on a treadmill at a self-selected speed while three-dimensional lower limb kinematic data were collected. Runners with PFP were split into acute (n = 25) and chronic (n = 73) sub-groups based on whether they had been experiencing pain for less or greater than three months, respectively. Principal component analysis and linear discriminant analysis were used to determine the combination of kinematic gait characteristics that optimally separated individuals with acute PFP, chronic PFP, and healthy controls. Results: Compared to controls, both the acute and chronic PFP sub-groups exhibited greater knee flexion across stance and greater ankle dorsiflexion during early stance. The acute PFP sub-group demonstrated greater transverse plane hip motion across stance compared to healthy controls. In contrast, the chronic PFP sub-group demonstrated greater frontal plane hip motion, greater knee abduction, and reduced ankle eversion/greater ankle inversion across stance when compared to healthy controls. Conclusions: This study identified characteristics that discriminated between individuals with acute and chronic PFP when compared to healthy controls. Certain discriminating characteristics were shared between both the acute and chronic sub-groups when compared to healthy controls, while others were specific to the duration of PFP. (C) 2017 American College of Sports Medicine

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Short Trail Running Race: Beyond the Classic Model for Endurance Running Performance.

Purpose: To examine the extent to which the classical physiological variables of endurance running performance [VO2max, %VO2max at ventilatory threshold (VT), and running economy (RE)], but also muscle strength factors contribute to short trail running (TR) performance. Methods: A homogeneous group of nine highly-trained trail runners performed an official TR race (27-km) and laboratory-based sessions to determine VO2max, %VO2max at VT, level RE (RE0%) and RE on a +10% slope (RE+10%), voluntary concentric and eccentric knee extension torques (MVCCon and MVCEcc, respectively), local endurance assessed by a fatigue index (FI) and a time to exhaustion at 87.5% of the velocity associated with VO2max. A simple regression method and commonality analysis identifying unique and common coefficients of each independent variable were used to determine the best predictors for the TR race time (dependent variable). Results: Pearson correlations showed that FI and VO2max had the highest correlations (r = 0.91 and r = -0.76, respectively) with TR performance. The other selected variables were not significantly correlated with TR performance. The analysis of unique and common coefficients of relative VO2max, %VO2max at VT and RE0% provides a low prediction of TR performance (R2 = 0.48). However, adding FI and RE+10% (instead of RE0%) markedly improved the predictive power of the model (R2 = 0.98). FI and VO2max showed the highest unique (respectively 49.7 and 21.0% of total effect) and common (27.0% of total effect) contributions to the regression equation. Conclusions: The classic endurance running model does not allow meaningful prediction of short TR performance. Incorporating more specific factors to TR such as local endurance and gradient-specific RE testing procedures should be considered to better characterize short TR performance. (C) 2017 American College of Sports Medicine

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Risk and Causes of Death among Former National Football League Players (1986-2012).

PURPOSE: Previous research identified decreased overall and cardiovascular mortality for National Football League (NFL) players from the 1959-1988 era. The present study explored the mortality risk among recent NFL players who played in an era of heavier linemen and nearly year-round physical conditioning. METHODS: This cohort study included 9778 former NFL players with at least one year in the NFL whose last season was between 1986 and 2012. Players' pension fund records were matched to the National Death Index (NDI) to determine vital status, date of death, and cause of death. Standardized mortality ratios (SMRs) compared player mortality through 2014 with US men of the same age, race, and calendar year. Cox proportional hazards models assessed the effect of player characteristics on overall and cardiovascular mortality. RESULTS: Two percent (n=227) of players were deceased with a median age at death of 38 years (range: 23-61). The most common major causes of death were diseases of the heart (n=47, 21%), violence (n=39, 17%), and transportation injuries (n=34, 15%). Risk of death was significantly lower than the general population for overall mortality (SMR 0.46, 95% CI 0.40-0.52), cardiovascular disease (SMR 0.65, 95% CI 0.50-0.84), and other major causes. Players with playing-time BMI>35 kg/m2 had significantly higher cardiovascular disease mortality (SMR 2.20, 95% CI 1.32-3.44) than the general population and higher overall mortality risk (SRR 3.84, 95% CI 2.66-5.54) than players with BMI

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Physical Activity Device Reliability and Validity during Pregnancy and Postpartum.

Current physical activity (PA) recommendations for women experiencing a normal pregnancy reflect recent research showing numerous health benefits for mother and offspring. However, few studies have evaluated PA devices' reliability and validity during pregnancy, as anatomical and physiological changes throughout gestation could affect an instrument's accuracy. PURPOSE: To determine the reliability and validity of PA devices worn on the hip, ankle, and triceps during pregnancy and post-partum. METHODS: Thirty-three women performed six activities of daily living and one treadmill walk at approximately 21 and 32 weeks of pregnancy, and 12 weeks post-partum. There were two visits at each time-period, one week apart. Energy expenditure (VO2) was measured by indirect calorimetry (IC; criterion measure), while PA was quantified by accelerometers and pedometers placed at the right hip and ankle and left triceps. Interclass reliability and monitor validity compared to IC in relative (ml[middle dot]kg-1[middle dot]min-1) terms was calculated via Pearson correlation (PC). Both multi and single-trial intraclass reliabilities (ICC) were estimated from analysis of variance (ANOVA) to assess monitor reliability at each time-period. Standard errors of measurement (SEM) were calculated in relative terms for each time-period. RESULTS: The reliability of the devices was moderate/strong as 66% of the PCs were between 0.6-1.0. Multi-trial ICCs were largely in the moderate/strong range as 38% of the ICCs were between 0.6-0.79 and 50% were between 0.8-1.0. The SEMs for each device between visits ranged from 7-23% of the mean values. Comparison between IC and devices showed 40 and 46% of the validity coefficients were between 0.4-0.59 and 0.6-0.79, respectively. CONCLUSION: PA devices show moderate/strong reliability and moderate validity for measuring PA during pregnancy and post-partum. (C) 2017 American College of Sports Medicine

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Wilson's Disease in Children: A position paper by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee.

Background: Clinical presentations of Wilson's disease (WD) in childhood ranges from asymptomatic liver disease to cirrhosis or acute liver failure, while neurological and psychiatric symptoms are rare. The basic diagnostic approach includes serum ceruloplasmin and 24h-urinary copper excretion. Final diagnosis of WD can be established using a diagnostic scoring system based on symptoms, biochemical tests assessing copper metabolism and molecular analysis of mutations in the ATP7B gene. Pharmacological treatment is life-long and aims at removal of copper excess by chelating agents as D-penicillamine, trientine or inhibition of intestinal copper absorption with zinc salts. Acute liver failure often requires liver transplantation. This publication aims to provide recommendations for diagnosis, treatment and follow-up of WD in children. Methods: Questions addressing the diagnosis, treatment and follow-up of WD in children were formulated by a core group of ESPGHAN members. A systematic literature search on WD using MEDLINE, EMBASE, Cochrane Database from 1990 to 2016 was peformed focusing on prospective and retrospective studies in children. Quality of evidence was assessed according to the GRADE system. Expert opinion supported recommendations where the evidence was regarded as weak. The ESPGHAN core group and ESPGHAN Hepatology Committee members voted on each recommendation, using the nominal voting technique. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Family Health Related Quality of Life in Pediatric Cyclic Vomiting Syndrome.

Objective: To evaluate the relationship of disease characteristics and child anxiety symptoms to family health related quality of life (FHRQoL) in youth with cyclic vomiting syndrome (CVS). Methods: Forty-two parents of youth aged 8-18 years diagnosed with CVS completed the Family Impact Module of the PedsQL, a measure of the impact of the child's illness on the family. We evaluated the relationship of disease characteristics and child and parent proxy reports of anxiety symptoms on the Screen for Childhood Anxiety and Related Emotional Disorders (SCARED) to FHRQoL. Results: Parent report of child anxiety symptoms and missed school days (Mean = 11.93, SD = 14.62) were the strongest predictors of FHRQoL (R2 = .33, df = 1,39, F = 8.51, p = .006). Other disease characteristics, including frequency, duration, chronicity of CVS episodes, and delay in initial CVS diagnosis were not significantly associated with the FHRQoL Total score. Child anxiety symptoms by either parent and/or child report were associated with subscales of the FHRQoL, including family physical functioning, family communication, and family daily activities. Conclusions: HRQoL for the families assessed in this study was associated with anxiety symptoms to a greater extent than disease characteristics, indexing the importance of a biopsychosocial approach to CVS management. Screening for anxiety symptoms and support for school absences due to illness are indicated to help lessen the impact of CVS on the family as a whole. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Resolving Malnutrition with Parenteral Nutrition Prior to Liver Transplant in Biliary Atresia.

Objective: Malnutrition is a common complication of end-stage liver disease (ESLD) associated with poor liver transplant outcomes. Nasogastric feeds are used for nutritional supplementation, but some patients remain malnourished. Parenteral nutrition (PN) can be effective, but has potential complications. The primary objective was to evaluate the effect of PN on anthropometric measures in children with ESLD awaiting liver transplant. Secondary objectives were evaluation of PN associated complications, liver function tests, PELD scores, waitlist time, and post-transplant length of stay (total and time in the intensive care unit). Methods: A single-center, retrospective chart review analyzing pediatric patients with ESLD receiving PN who were transplanted over a 6-year period. Data were trended and described over time, as were the relationships between anthropometric data and time receiving PN. Results: 44 patients with ESLD were transplanted between January 2010 and December 2015. 18 (41%) received PN before transplant; all had biliary atresia with median age at transplant of 10 months (range, 5-18 months). Mid-upper arm circumference and triceps skinfold thickness showed resolution of malnutrition in 7 patients (39%) with normalization of one measure in another 4 patients (22%). Of the remaining, 6 had improved z-scores and one had worsening malnutrition. No deaths occurred in patients receiving PN. Central line infection rates were 3.8/1000 catheter days with 8 total infections in 6 patients over a total of 2117 catheter days. Conclusions: Children with ESLD and malnutrition who have failed enteral feeding may benefit from PN to improve and/or resolve malnutrition prior to liver transplant. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Sarcopenia in Children With End-stage Liver Disease.

Background: Sarcopenia, reflected by decreased psoas muscle surface area (PMSA), has been identified as a novel and independent predictor of waitlist mortality and outcomes in adult liver transplantation (LT). We hypothesized that children with end-stage liver disease (ESLD) would have smaller PMSA than healthy controls. Methods: Images of children (0-18y) listed for LT in 2015 and a control group comprised of 2:1 age- and gender-matched healthy pediatric trauma victims were reviewed. PMSA was determined at two intervertebral disc levels (L3/4; L4/5). A subset of images was reviewed by 2 radiologists to determine inter-rater correlation. Results: 23 children with ESLD were included, and the most prevalent diagnosis was biliary atresia (61%). On both lumbar levels, median PMSA was significantly smaller in ESLD subjects compared to the 46 healthy controls (L4/5; median tPMSA 407 mm2 (IQR 339, 537) vs. Controls 513 mm2 (IQR 437, 672); p = 0.004), independent of participants' weight z-scores (r = 0.01; p = 0.95). Excellent inter-rater correlation was seen (ICC 0.99). Conclusion: In this retrospective pilot study, PMSA was significantly lower in children with ESLD compared to healthy age- and gender-matched controls. Since this finding was independent of growth in ESLD subjects, PMSA may represent a novel objective nutritional biomarker in children with advanced liver disease. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Long-term Exposure of Children to a Mixed Lipid Emulsion is Less Hepatotoxic Than Soybean-Based Lipid Emulsion.

Lipid emulsions have been associated with liver injury. Newer mixed emulsions (ML), such as SMOFlipid(R) (Fresenius Kabi, Germany), are thought to be more hepatoprotective than soybean-based emulsions (SL), such as Intralipid(R) (Baxter, U.S.A.). Pediatric studies comparing long-term use between the two are limited. This study compares the severity of hepatic injury between a prospective cohort of hospitalized children on ML (n = 20) and a historical age- and diagnosis-matched cohort of hospitalized children on SL (n = 20). Median exposure to ML and SL were 10 vs. 6 weeks (p = 0.030), respectively, at similar median lipid doses (2.2 g/kg/d vs. 2.1 g/kg/d). Using a generalized estimating equations approach, conjugated bilirubin trajectory was found to be lower in patients on ML compared to SL (p =4 weeks) to ML is associated with decreased liver injury compared to SL in hospitalized children. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Splenic Rupture in Children With Portal Hypertension.

Introduction: Massive splenomegaly from portal hypertension (PHTN) in children raises the specter of splenic rupture, however the incidence, etiology, and risk of rupture has not been studied, nor have existing practices to reduce risk. We therefore performed an international survey in order to describe the splenic rupture cases in PHTN and to describe the existing empirical practice among hepatologists. Methods: A questionnaire was constructed to elicit cases of splenic rupture and collect hepatologists' common practices for prevention of splenic rupture. Pediatric hepatologists working in selected tertiary academic centers in the USA, Canada and the United Kingdom were contacted. Results: Hepatologists from 30 out of 35 centers who met the inclusion criteria replied to the survey. Thirteen cases of splenic rupture were described of which 11 resulted from trauma. In the opinion of the practitioners, high risk activities were football, hockey, and wrestling. Sixty-one percent recommended total restriction from high risk activities. Seventy-four percent stated that platelet count had no effect on this decision and 61% advised a spleen guard for certain activities. Conclusion: Splenic rupture in patients with PHTN and splenomegaly seems to be rare. The reported splenic rupture cases were mostly related to falling (and not to participation in sports). There was general agreement among hepatologists about restricting high impact sports. There was variation in recommendations regarding the use of a spleen guard. The authors recommend use of spleen guards in children with splenomegaly from PHTN for physical activities with risk of fall or blunt abdominal trauma. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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How Much Free Sugars Intake Should Be Recommended for Children Younger Than Two Years Old?.

No abstract available

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Response to Letter: How Much Free Sugars Intake Should Be Recommended for Children Younger Than Two Years Old?.

No abstract available

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Lack of Correlation of Liver Tests with Fibrosis Stage at Diagnosis in Pediatric Primary Sclerosing Cholangitis.

Objectives: The aims of this study were to characterize pediatric primary sclerosing cholangitis (PSC) at a regional referral based institution, including scoring of biliary stricturing and liver fibrosis and correlation analyses of scores with serum liver tests, in order to identify biomarkers of disease severity. Methods: A retrospective review of 39 PSC subjects was performed, with collection of demographic and outcomes data. Magnetic resonance cholangiopancreaticogram (MRCP) and liver biopsies were re-reviewed and scores of stricturing and fibrosis were correlated with serum liver tests. Results: Average age at PSC diagnosis was 11.2 years, 74% had inflammatory bowel disease and 51% had autoimmune hepatitis. Despite 83% with symptoms at presentation, only ~1/3 were symptomatic at a mean follow-up of 4.1 years. Using a validated MRCP biliary scoring system, the mean intrahepatic score was 1.1 (out of 4) and extrahepatic score was 1.0 (out of 3). The mean Ishak liver fibrosis stage was 3.5 (out of 6) and 33% had cirrhosis. 92% were alive with their native liver and 5% had a liver transplant. Serum biomarker analyses revealed no correlation between Ishak liver fibrosis stage or MRCP score and laboratory values. Conclusions: Pediatric PSC patients cared for at a regional referral center had relatively mild disease compared to previously published reports, with low MRCP stricture scores despite significant liver fibrosis. Liver tests at presentation did not correlate with MRCP stricture score or liver fibrosis stage, suggesting the need for future studies to identify potential biomarkers of disease severity. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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5. Epilepsy and EEG activity in early-onset Alzheimer’s disease

The aim of this review was to evaluate and summarize the current literature regarding the incidence and features of epileptic seizures in early onset Alzheimer's disease (AD) as well as its epileptiform characteristics as described by electroencephalography (EEG).

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4. Prevention of trauma-induced epileptogenesis in mice via manipulation of the network excitability

A large proportion of patients with severe brain damage become epileptic several months to years after the trauma. The mechanisms leading to the development of epilepsy (epileptogenesis) are unknown. We hypothesize that brain damage leads to partial deafferentation and a drop in excitability of the affected area. To compensate, the brain employs a variety of mechanisms to restore this drop of excitability and if not properly controlled, this leads to epilepsy. We performed undercut in the somatosensory area in adult C57/BL6 mice and implanted LFP and EMG electrodes for continuous electrographic recordings for at least two months.

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Editorial Board

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3. Asymmetric hypsarrythmia: An insight into the pathophysiology of infantile spasms. A retrospective cohort

Infantile spasms (IS) is a catastrophic epilepsy where treatment precocity improves outcome. Previous studies demonstrated an association between asymmetric hypsarrhythmia on EEG and ipsilateral hemispheric lesions on MRI, suggesting a possible role of cortical lesions in the initiation of IS. Epileptiform abnormalities appearing during early infancy have also been linked to IS emergence. We hypothesized that focal lateralized EEG abnormalities during the prehyspasrrhythmic period will be associated with asymmetric hypsarrhythmia at IS onset.

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2. Do repeated limbic seizures induce depression-like behavior in rats?

It has been reported that rapid kindling of the hippocampus produces lasting depression-like behavior in rats, as evidenced by increased immobility in the forced swim test and a loss of preference for sweetened water (Mazarati et al., 2007). This might suggest that repeated limbic seizure activity could be the cause of the depression often seen in patients with temporal lobe epilepsy.Sixty-day old male Wistar rats were implanted with electrodes in the amygdala and ventral hippocampus and kindled (or sham kindled) daily to a criterion of 10 stage 5 seizures.

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1. Across all the seven seas: Fifty years in neurology, EEG and epilepsies

Since the 1960s, major neuroscience advances have facilitated the development of new antiepilepsy drugs (AEDs) targeting specific neurotransmitter-receptor systems, particularly the GABAergic, the NMDA-receptors and voltage-gated ion channels. In addition to the classical AEDs, carbamazepine and cogeners act at the voltage-gates sodium channels, while ethosuxumide acts at the calcium channel, improving the treatment of partial and generalized seizures. But approximately 30% of partial complex seizures remain refractory to AEDs, leading to novel AEDs: levetiracetam, tiagabine, lacosamide, perampanel and others.

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Contents

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Announcement

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Ultrasound in polyneuropathies – Is size or structure all that matters?

Polyneuropathies (PNPs) are systemic disorders of the peripheral nervous system, that may variably affect motor, sensory and autonomic nerve fibers. The etiological classification of PNPs still remains a challenging aspect of ongoing research, especially taking into account, that the early identification and therapy of immune-mediated causes may improve the functional outcome of the patient (Viala et al., 2010; Joint Task Force of the EFNS and the PNS, 2010). The continuous need for objective, morphological description of pathological peripheral nerve conditions led over the time to the development of different ultrasound measures and protocols, capable of quantifying and scoring the examiner's observations (Kerasnoudis et al., 2014a, 2016; Grimm et al., 2016; Padua et al., 2012).

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Machine-Based Classification of ADHD and nonADHD Participants Using Time/Frequency Features of Event-Related Neuroelectric Activity

Biological signals are a challenge to analyse. Among these signals, the electrophysiological activity of the human brain during cognitive processing is undoubtedly the most challenging. For decades, neuroscientists have been studying the brain-mind relationship based on the electrophysiological responses of the brain. Most studies have been performed on signals in the time domain in the form of event-related potentials (ERPs). The starting point of a second approach was based on the principle that complex signals are composed of oscillatory responses of different frequencies (for a review, see Başar, 2011; Karakaş and Barry, 2017; Karakaş and Başar, 2004).

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Feasibility of Deep Brain Stimulation for Controlling the Lower Urinary Tract Functions: An Animal Study

Lower urinary tract (LUT) dysfunction is an increasingly common symptom worldwide. Neurological disorders are one of the main causes of LUT dysfunction. Specifically, aging-induced central neurodegeneration affects neurological control of bladder function. Since complex networks of the autonomic nervous system and central nervous system control micturition reflexes (Gomez-Pinilla et al., 2007), central neuromodulations are a potential approach for treating various troublesome of LUT disorders (Ju and Liao, 2016).

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Laser-evoked potentials in painful radiculopathy

Painful radiculopathy is induced by pathology of the nerve root or its ganglion and is perceived along the length of the lower limb most frequently in the L5/S1 dermatomal distribution. The current pathophysiological concepts of dorsal root damage differentiate between biochemical and mechanical processes. Mechanical compression can lead to fibrosis and total functional loss of the affected nerve fibers, which is often accompanied by a reduced number of axons. The compression might reduce neuronal impulse synchronization or induce a complete conduction block (Yoshii et al., 2010).

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Intraoperative direct cortical stimulation motor evoked potentials: Stimulus parameter recommendations based on rheobase and chronaxie

One elicits intraoperative direct cortical stimulation (DCS) muscle motor evoked potentials (MEPs) with a short train of monophasic rectangular electrical pulses having a user-selected interstimulus interval (ISI) and pulse duration (D). While practitioners commonly choose 4ms ISI and 0.5msD, reported parameters vary and none have been proven optimal, leaving no consistent scientific rationale for the selection (Taniguchi et al., 1993; Cedzich et al., 1996; Kombos et al., 2000; Neuloh et al., 2004; Kombos et al., 2009; Kamada et al., 2009; Szelényi et al., 2010; Nossek et al., 2011).

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Plasticity induced by non-invasive transcranial brain stimulation: A position paper

Transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) are the most commonly used methods of non-invasive transcranial brain stimulation that has been abbreviated by previous authors as either as NIBS or NTBS. Here we use NIBS since it seems to be the most common term at the present time. When it was first introduced in 1985, TMS was employed primarily as a tool to investigate the integrity and function of the human corticospinal system (Barker et al., 1985). Single pulse stimulation was used to elicit motor evoked potentials (MEPs) that were easily evoked and measured in contralateral muscles (Rothwell et al., 1999).

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Intermittent theta-burst stimulation induces correlated changes in cortical and corticospinal excitability in healthy older subjects

Transcranial Magnetic Stimulation (TMS) is a versatile tool for studying human neurophysiology in vivo (Barker et al., 1985; Hallett, 2007; Rossini and Rossi, 2007). Single TMS pulses applied to the primary motor cortex (M1) can elicit motor evoked potentials (MEPs) in contralateral muscles that can be quantified using surface electromyography (EMG). The amplitude of MEPs averaged across batches of single pulses provides an index of cortico-motor reactivity (Rothwell, 1997). When applied in repetitive trains (repetitive TMS, rTMS) or in specific patterns inspired by synaptic plasticity protocols (theta-burst stimulation, TBS), TMS can produce changes in cortico-motor excitability, indexed by changes in MEP amplitude.

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Termination patterns of stimulus-induced rhythmic, periodic, or ictal patterns and spontaneous electrographic seizures

Stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs) are rhythmic, periodic, or ictal-appearing patterns consistently elicited by stimulation of the patient (i.e. suctioning, physical examination of the patient, noxious stimulation, or sudden ambient noise) (Hirsch et al., 2004). They are a relatively common finding in the critically ill, with reported prevalence of 10–34% (Braksick et al., 2016; Hirsch et al., 2004; Ong et al., 2012). The reported causes of SIRPIDs include intracerebral hemorrhage, traumatic brain injury, anoxic brain injury, metabolic disturbances, and drug toxicity amongst other etiologies (Braksick et al., 2016).

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Spinal segmental myoclonus resembling “belly dance” in a pregnant woman

Myoclonus is a movement disorder with a wide differential diagnosis (Shibasaki, 2006) but with common semiological elements: sudden, brief, jerky movements, caused by muscle contraction or inhibition of ongoing muscle activity. Myoclonus can be classified by presumed site of origin into cortical, cortical-subcortical, subcortical-supraspinal, spinal and peripheral (Shibasaki, 2006). Neurophysiologic studies help confirm clinical diagnosis and understand underlying physiological mechanisms.

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Neural network topology in ADHD; evidence for maturational delay and default-mode network alterations

Throughout childhood and adolescence, healthy brain development is characterized by a range of neurobiological changes, such as synaptic pruning and myelination of long-distance axons (Craik and Bialystok, 2006) that ultimately lead to a matured brain that enables fast signal transduction while maintaining relatively low energy costs (Boersma et al., 2011). The organization of normal adult brain networks is described as an intermediate structure between tree extremes: (1) a locally connected, highly ordered (regular) network, (2) a random network and (3) a scale-free network, which is characterized by highly connected brain areas, or 'hubs' (Stam, 2014).

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Corticomuscular coherence in the acute and subacute phase after stroke

Stroke results from critically reduced blood flow to the brain tissue due to bleeding or obstruction of arteries. Globally, stroke remains a major cause of disability despite advances in preventive treatment and in acute management (Hankey, 2017). The most common impairment caused by stroke is motor disability affecting approximately 80% of the patients, most frequently seen as hemiparesis (Langhorne et al., 2009). Spontaneous recovery may occur in the following weeks and months after stroke and can be facilitated through rehabilitation involving exercise (Maulden et al., 2005).

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Fasciculations in nerve and muscle disorders – A prospective study of muscle ultrasound compared to electromyography

Fasciculations can be encountered in patients presenting with symptoms of nerve and muscle disorders (NMD) and can also be found in healthy subjects (HS). Fasciculations associated with chronic changes are clinically important findings in diagnosing amyotrophic lateral sclerosis (ALS) (Reimers et al., 1996; de Carvalho et al., 2008; Brooks, 1994; Costa et al., 2012; Mills, 2010) and were recognised as a part of the diagnostic criteria known as the Awaji criteria (de Carvalho et al., 2008). Electromyography (EMG) describes fasciculations as brief, involuntary muscle activity that represents the spontaneous discharge of a motor unit or a part hereof (Reimers et al., 1996) and it has been used to describe the complexity and the firing frequency of fasciculations in different disorders (Mills, 2010).

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Phosphorylation of Pnut at the Early Steps of Drosophila Embryo Development Affects Association of the Septin Complex with Membrane and Is Important for Viability

Septin proteins are polymerizing GTPases that are found in most eukaryotic species. Septins are important for cytokinesis and participate in many processes involving spatial modifications of the cell cortex. In Drosophila, septin proteins Pnut, Sep1 and Sep2 form a hexameric septin complex. Here, we found that septin protein Pnut is phosphorylated during the first two hours of Drosophila embryo development. To study the effect of Pnut phosphorylation in a live organism, we created a new Drosophila pnut null mutant which allows for the analysis of Pnut mutations during embryogenesis. To understand the functional significance of Pnut phosphorylation, Drosophila strains carrying non-phosphorylatable and phospho-mimetic mutant pnut transgenes were established. The expression of the non-phosphorylatable Pnut protein resulted in semi-lethality and abnormal protein localization, whereas, the expression of the phospho-mimetic mutant form of Pnut disrupted the assembly of a functional septin complex and septin filament formation in vitro. Overall, our findings indicate that the controlled phosphorylation of Pnut plays an important role in regulating septin complex functions during organism development.

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Non-canonical GA and GG 5' Intron Donor Splice Sites Are Common in the Copepod Eurytemora affinis

The non-canonical 5' intron donor splice sites GA and GG are exceedingly rare in described eukaryotic genomes, however they are present in approximately 12% of introns in the genome of the copepod Eurytemora affinis. Failure to recognize the high frequency of these donor sites compromised the modeling of genes in this newly sequenced genome, including ten conserved ionotropic glutamate receptor family genes curated herein. These introns appear to have been acquired recently, along with many additional idiosyncratic introns. Their high frequency implies the evolution of modified intron donor splice site recognition in this copepod.

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ARSDA: A New Approach for Storing, Transmitting and Analyzing Transcriptomic Data

Two major stumbling blocks exist in high-throughput sequencing (HTS) data analysis. The first is the sheer file size typically in gigabytes when uncompressed, causing problems in storage, transmission and analysis. However, these files do not need to be so large and can be reduced without loss of information. Each HTS file, either in compressed .SRA or plain text .fastq format, contains numerous identical reads stored as separate entries. For example, among 44603541 forward reads in the SRR4011234.sra file (from a Bacillus subtilis transcriptomic study) deposited at NCBI's SRA database, one read has 497027 identical copies. Instead of storing them as separate entries, one can and should store them as a single entry with the SeqID_NumCopy format (which I dub as FASTA+ format). The second is the proper allocation of reads that map equally well to paralogous genes. I illustrate in detail a new method for such allocation. I have developed ARSDA software that implement these new approaches. A number of HTS files for model species are in the process of being processed and deposited at http://ift.tt/2mcG65G to demonstrate that this approach not only saves a huge amount of storage space and transmission bandwidth, but also dramatically reduces time in downstream data analysis. Instead of matching the 497027 identical reads separately against the Bacillus subtilis genome, one only needs to match it once. ARSDA includes functions to take advantage of HTS data in the new sequence format for downstream data analysis such as gene expression characterization. I contrasted gene expression results between ARSDA and Cufflinks so readers can better appreciate the strength of ARSDA. ARSDA is freely available for Windows, Linux and Macintosh computers at http://ift.tt/2mcMbPE.

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Understanding microRNA Regulation Involved in the Metamorphosis of the Veined Rapa Whelk (Rapana venosa)

The veined rapa whelk (Rapana venosa) is widely consumed in China. Nevertheless, it preys on oceanic bivalves, thereby reducing this resource worldwide. Its larval metamorphosis comprises transition from pelagic to benthic form, which implicates considerable physiological and structural changes and plays vital roles in its natural populations and commercial breeding. Thus, understanding the endogenous microRNAs that drive metamorphosis is of great interest. This is the first study to use high-throughput sequencing to examine the alterations in microRNA (miRNA) expression that occur during metamorphosis in a marine gastropod. A total of 195 differentially expressed miRNAs was obtained. Sixty-five of these were expressed during the transition from pre-competent- to competent larvae. Thirty-three of these were upregulated and the others were downregulated. Another 123 miRNAs were expressed during the transition from competent- to post-larvae. Ninety-six of these were upregulated and the remaining 27 were downregulated. The expression of miR-276-y, miR-100-x, miR-183-x, and miR-263-x showed an over 100-fold change during development, while the miR-242-x and novel-m0052-3p expression levels changed over 3000-fold. Putative target gene co-expression, gene ontology, and pathway analyses suggest that these miRNAs play important roles in cell proliferation, migration, apoptosis, metabolic regulation, and energy absorption. Twenty miRNAs and their target genes involved in ingestion, digestion, cytoskeleton, cell adhesion, and apoptosis were identified. Nine of them were analysed with real-time PCR, which showed an inverse correlation between the miRNA and their relative expression levels. Our data elucidates the role of microRNAs in R. venosa metamorphic transition and serve as a solid basis for further investigation into regulatory mechanism of gastropod metamorphosis.

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C1 neurons: a nodal point for stress?

Abstract

The C1 cells are catecholaminergic and glutamatergic neurons located in the rostral ventrolateral medulla (RVLM). Collectively, these neurons innervate sympathetic and parasympathetic preganglionic neurons, the hypothalamic paraventricular nucleus, and countless brain structures involved in autonomic regulation, arousal and stress. Optogenetic inhibition of rostral C1 neurons has little effect on BP at rest in conscious rats but produces large BP drops when the animals are anesthetized or exposed to hypoxia. Optogenetic C1 stimulation increases BP and produces arousal from non-REM sleep. C1 cell stimulation mimics the effect of restraint stress to attenuate kidney injury caused by renal ischemia-reperfusion. These effects are mediated by the sympathetic nervous system through the spleen and eliminated by silencing the C1 neurons. These few examples illustrate that, depending on the nature of the stress, the C1 cells mediate adaptive responses of a homeostatic or allostatic nature.

This article is protected by copyright. All rights reserved

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Lateral corticospinal tract damage correlates with motor output in incomplete spinal cord injury

Publication date: Available online 26 October 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Andrew C. Smith, Kenneth A. Weber, Denise R. O'Dell, Todd B. Parrish, Marie Wasielewski, James M. Elliott
ObjectiveTo investigate the relationship between spinal cord damage and specific motor function in participants with incomplete spinal cord injury (iSCI).Designsingle-blinded cross-sectional study designSettingUniversity setting research laboratory.ParticipantsFourteen individuals with chronic cervical iSCI (1 female and 13 males, average age = 43 ± 12 years old).InterventionsNot applicable.Main Outcome MeasuresAxial T2 MRI of spinal cord damage was performed in 14 participants with iSCI. Each participants' damage was processed for total damage quantification, lateral corticospinal tract (LCST) and gracilis fasciculus (GF) analysis. Plantarflexion and knee extension were quantified using an isokinetic dynamometer. Walking ability was assessed using a 6-minute walk test.ResultsTotal damage was correlated with plantarflexion, knee extension, and distance walked in 6 minutes. Right LCST damage was correlated with right plantarflexion and right knee extension, while left LCST damage was correlated with left sided measures. Right and left GF damage were not correlated with the motor output measures.ConclusionsMRI measures of spinal cord damage were correlated to motor function, and this measure appears to have spatial specificity to descending tracts, which may offer prognostic value following spinal cord injury.



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Hip Symptoms, Physical Performance and Health Status in Older Adults with Chronic Low Back Pain: A Preliminary Investigation

Publication date: Available online 27 October 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Gregory E. Hicks, J. Megan Sions, Teonette O. Velasco
ObjectiveThe purposes of this study were to determine: a) if there are differences in the prevalence of clinical hip symptoms between older adults with and without CLBP; and b) whether co-existing hip symptoms are associated with worse physical performance and poorer health-related quality of life (HRQOL).DesignCase-control studySettingIndividuals participated in a standardized evaluation in a clinical laboratory.Patient SampleClinical hip symptoms, which are proposed predictors of radiographic hip osteoarthritis according to American College of Rheumatology guidelines, were evaluated in a volunteer sample of 54 community-dwelling older adults, aged 60-85, with CLBP and 54 age- and sex-matched healthy controls.InterventionNot applicable.Main Outcome MeasuresPhysical performance was measured by the repeated chair rise test and stair climbing test. HRQOL was measured by the Short Form-36 Health Survey.ResultsHip joint pain, morning stiffness and pain with hip internal rotation were more common among older adults with CLBP (p<.05). Participants with CLBP and co-existing hip symptoms had worse physical performance than individuals without CLBP or hip symptoms (p<.0001). Additionally, the presence of co-existing hip symptoms was associated with worse HRQOL, particularly in the domains of social functioning, mental health and role limitations due to emotional problems as measured by the SF-36 (p<.01).ConclusionsGiven our limited understanding of CLBP among older adults, there is a definitive need to systematically explore co-existing pain conditions that may contribute to worse outcomes. Based on these data, future longitudinal studies should explore whether co-existing hip symptoms are associated with a worse prognosis in older adults with CLBP.



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Measurement Characteristics and Clinical Utility of the West Haven-Yale Multidimensional Pain Inventory in a Chronic Pain Population

Publication date: Available online 27 October 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Allison Peipert, Edeth Engel, Linda Ehrlich-Jones




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Participant-reported benefits of involvement in an adaptive sports program: a qualitative study

While participation in adaptive sports offers numerous benefits for persons with disabilities, a substantial number of eligible persons do not take part. Previous studies have identified personal and environmental factors that promote or inhibit adaptive sports participation. However, these studies have considered a relatively narrow range of factors.

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Reverse Shoulder Arthroplasty In Weight-Bearing Shoulders Of Wheelchair-Dependent Patients

Wheelchair-dependent patients rely on their upper extremities for mobility and transfers. This entails the heavy use of upper extremities as weight-bearing joints, leading to shoulder overuse with increased prevalence of rotator cuff-related disorders, and ultimately to challenging cases for shoulder surgeons when a joint replacement is needed.

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Effectiveness of Circuit-Based Exercises on gait speed, balance and functional mobility in People Affected by Stroke: A Meta-Analysis

Several interventions are proposed to rehabilitate patients with neurological dysfunctions due to stroke. The effectiveness of Circuit-Based Exercises according to its actual definition, i.e., an overall program to improve strength, stamina, balance or functioning, was not provided.

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Diagnostic validity of combining history elements and physical examination tests for traumatic and degenerative symptomatic meniscal tears

Current approach to the clinical diagnosis of traumatic and degenerative symptomatic meniscal tears (SMT) propose combining history elements and physical examination tests without systematic prescription of imaging investigations, yet the evidence to support this diagnostic approach is scarce.

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Anxiety and insomnia in young- and middle-aged adult hip pain patients with and without femoroacetabular impingement and developmental hip dysplasia

Hip pain in young and middle- aged adults with and without hip deformity receive treatment focused primarily related to hip structure. Because their hip pain may be chronic, these patients develop other modifiable co-existing disorders related to pain that go undiagnosed in this young and active population including insomnia and anxiety.

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Successful Treatment of Multifactorial Chronic Daily Headaches at an Interdisciplinary Chronic Pain Program: A Case Study

Chronic daily headaches (CDH) are common, disabling, and difficult to treat. We report a case of a patient with complex medical history experiencing multifactorial CDH referred for and eventually enrolled in an interdisciplinary chronic pain program. Focusing on enhancing the patient's function while minimizing the use of medications and invasive procedures, this comprehensive rehabilitation intervention consists of diverse treatment approaches, including cognitive-behavioral therapy, physical and occupational therapy, and medical interventions.

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Sonographic Identification of the Flexor Digitorum Accessorius Longus Tendon

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Human subthalamic oscillatory dynamics following somatosensory stimulation

The functional significance of neural oscillations in somatosensory and motor control has been of growing interest in the last years. Specific frequency changes can be elicited both during voluntary (Pfurtscheller and Aranibar, 1977; Salenius et al., 1997) and passive movements (Alegre et al., 2002; Cassim et al., 2001), as well as due to somatosensory stimulation (Hari and Forss, 1999). Besides focusing on sensorimotor mu and beta rhythms the investigation of gamma and high-frequency (> 100 Hz) oscillations has gained increasing interest.

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Reply to “Stimulus, response and excitability – what is new?”

We thank Burke and Kiernan for their interesting and constructive comments (Burke and Kiernan, 2017) on our recent Letter to the Editor (Milants et al., 2017). We agree with most of these comments. It is absolutely correct that by considering only iMAX, we lose valuable information related to the stimulus-response curve, particularly the curve slope or discontinuities in the curve as it can be seen in amyotrophic lateral sclerosis. Nevertheless, the delta between iMAX and motor threshold values might contain a similar information to the curve slope.

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The insular cortex and QTc interval in HIV+ and HIV- individuals: Is there an effect of sympathetic nervous system activity?

The insular cortex and QTc interval in HIV+ and HIV- individuals: Was there the effect of sympathetic nervous system activity?

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No effect of comorbidities on the association between social deprivation and geographical access to the reference care center in the management of colon cancer

Patients with colon cancer in France exhibit one of the steepest socioeconomic survival gradients in Europe. Among the putative causes for this situation, comorbidities are frequently incriminated but evidence of this is lacking.

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Long-term course of precancerous lesions arising in patients with gastric MALT lymphoma

To evaluate the prevalence and the long-term course of gastric precancerous lesions in patients with GML.

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Transrectal endoscopic ultrasound-guided paracentesis for diagnosis of malignant ascites in the pelvis

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No effect of comorbidities on the association between social deprivation and geographical access to the reference care center in the management of colon cancer

Patients with colon cancer in France exhibit one of the steepest socioeconomic survival gradients in Europe. Among the putative causes for this situation, comorbidities are frequently incriminated but evidence of this is lacking.

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Long-term course of precancerous lesions arising in patients with gastric MALT lymphoma

To evaluate the prevalence and the long-term course of gastric precancerous lesions in patients with GML.

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Transrectal endoscopic ultrasound-guided paracentesis for diagnosis of malignant ascites in the pelvis

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Uptake and speciation of uranium in synthetic gypsum (CaSO4•2H2O): Applications to radioactive mine tailings

Publication date: January 2018
Source:Journal of Environmental Radioactivity, Volume 181
Author(s): Jinru Lin, Wei Sun, Jacques Desmarais, Ning Chen, Renfei Feng, Patrick Zhang, Dien Li, Arthur Lieu, John S. Tse, Yuanming Pan
Phosphogypsum formed from the production of phosphoric acid represents by far the biggest accumulation of gypsum-rich wastes in the world and commonly contains elevated radionuclides, including uranium, as well as other heavy metals and metalloids. Therefore, billions-of-tons of phosphogypsum stockpiled worldwide not only possess serious environmental problems but also represent a potential uranium resource. Gypsum is also a major solid constituent in many other types of radioactive mine tailings, which stems from the common usage of sulfuric acid in extraction processes. Therefore, management and remediation of radioactive mine tailings as well as future beneficiation of uranium from phosphogysum all require detailed knowledge about the nature and behavior of uranium in gypsum. However, little is known about the uptake mechanism or speciation of uranium in gypsum. In this study, synthesis experiments suggest an apparent pH control on the uptake of uranium in gypsum at ambient conditions: increase in U from 16 μg/g at pH = 6.5 to 339 μg/g at pH = 9.5. Uranium L3-edge synchrotron X-ray absorption spectroscopic analyses of synthetic gypsum show that uranyl (UO2)²⁺ at the Ca site is the dominant species. The EXAFS fitting results also indicate that uranyl in synthetic gypsum occurs most likely as carbonate complexes and yields an average U-O distance ∼0.25 Å shorter than the average Ca-O distance, signifying a marked local structural distortion. Applications to phosphogypsum from the New Wales phosphoric acid plant (Florida, USA) and uranium mine tailings from the Key Lake mill (Saskatchewan, Canada) show that gypsum is an important carrier of uranium over a wide range of pH and controls the fate of this radionuclide in mine tailings. Also, development of new technologies for recovering U from phosphogypsum in the future must consider lattice-bound uranyl in gypsum.

Graphical abstract

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Interagency Board releases recommended fentanyl exposure best practices

The board included best practices for PPE, decontamination and medical countermeasures

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Characterization of a new, inducible transgenic mouse model with GFP expression in melanocytes and their precursors

Publication date: Available online 21 October 2017
Source:Gene Expression Patterns
Author(s): Sandeep S. Joshi, Bishal Tandukar, Maira Castaneda, Shunlin Jiang, Ganesh Diwakar, Ronna P. Hertzano, Thomas J. Hornyak
Melanocytes are neural crest-derived cells that are responsible for mammalian hair follicle (HF) pigmentation. The Dct-LacZ transgenic mouse is extensively used to study melanocyte biology but lacks conditionally-inducible labelling and fluorescent labelling, enabling specific, viable isolation of melanocytes using fluorescence-activated cell sorting (FACS). Here, we have generated a Tet-off bitransgenic mouse model, Dct-H2BGFP, containing Dct-tTA and TRE-H2BGFP transgenes. Characterization of Dct-H2BGFP mice confirmed a pattern of Dct-H2BGFP expression in melanoblasts, melanocyte stem cells (McSCs), and terminally differentiated melanocytes similar to the expression pattern of previously published mouse models Dct-LacZ and iDct-GFP. GFP expression is regulated by doxycycline. GFP is shown to co-localize with melanocyte label-retaining cells (LRCs) identified through BrdU retention. The GFP-expressing cells identified in vivo in the bulge and the secondary hair germ of telogen HFs of Dct-H2BGFP mice express the melanocyte and melanocyte stem cell markers Dct and Kit. Using Dct-H2BGFP mice, we separated GFP-expressing cells from the telogen HF based on FACS and showed that GFP-expressing cells express high levels of Kit and Dct, and lower levels of HF epithelial keratin genes. We also show that GFP-expressing cells express high levels of the melanocyte differentiation genes Tyr, Tyrp1, and Pmel17, further substantiating their identity within the melanocyte lineage. Thus, Dct-H2BGFP mice are not only useful for the in vivo identification of melanocytic cells, but also for isolating them viably and studying their molecular and biological properties.



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Editorial board members

Publication date: November 2017
Source:Gene Expression Patterns, Volumes 25–26





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Postimplantation Mga expression and embryonic lethality of two gene-trap alleles

Publication date: Available online 21 October 2017
Source:Gene Expression Patterns
Author(s): Sally F. Burn, Andrew J. Washkowitz, Svetlana Gavrilov, Virginia E. Papaioannou
BackgroundThe dual-specificity T-box/basic helix-loop-helix leucine zipper transcription factor MGA is part of the MAX-interacting network of proteins. In the mouse, MGA is necessary for the survival of the pluripotent epiblast cells of the peri-implantation embryo and a null, gene-trap allele Mga^Gt results in embryonic lethality shortly after implantation. We have used this allele to document expression of Mga in postimplantation embryos and also investigated a second, hypomorphic gene-trap allele, Mga^Inv.ResultsCompound heterozygotes, Mga^Gt/Mga^Inv, die prior to midgestation. The extraembryonic portion of the embryos appears to develop relatively normally while the embryonic portion, including the pluripotent cells of the epiblast, is severely retarded by E7.5. Mga expression is initially limited to the pluripotent inner cell mass of the blastocyst and epiblast, but during organogenesis it is widely expressed notably in the central nervous system and sensory organs, reproductive and excretory systems, heart, somites and limbs.ConclusionsWidespread yet specific areas of expression of Mga during organogenesis raise the possibility that the transcription factor may play roles in controlling proliferation and potency in the progenitor cell populations of different organ systems. Documentation of these patterns sets the stage for the investigation of specific progenitor cell types.



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Behind the wheel of an ambulance: Training needed

Fire and EMS agencies owe their crews, and the citizens they serve and protect, competent fire apparatus and ambulance driver/operators

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Comment on: “The Great British Medalists Project: A Review of Current Knowledge on the Development of the World’s Best Sporting Talent”

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Authors’ Reply to Hill: Comment on “The Great British Medalists Project: A Review of Current Knowledge on the Development of the World’s Best Sporting Talent”

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What it's like joining London Ambulance Service

Fancy a new adventure? Listen to Michaela Shaw, who is training to be a Paramedic, outline her work as Emergency Ambulance Crew and consider a career with us - http://bit.ly/2d3v8z6

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20 more thoughts only a paramedic will understand

By EMS1 Staff Paramedics are a special breed. There are many thoughts only you will understand, and there's absolutely nothing wrong with that. We've all experienced the tones dropping before a shift change and have thought to ourselves, "Really"" And you haven't been in EMS long enough if you don't yell "Clear right!" when you're driving off-duty. Our Facebook ...

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What it's like joining London Ambulance Service

Fancy a new adventure? Listen to Michaela Shaw, who is training to be a Paramedic, outline her work as Emergency Ambulance Crew and consider a career with us - http://bit.ly/2d3v8z6

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Perinatal Periods of Risk Analysis: Disentangling Race and Socioeconomic Status to Inform a Black Infant Mortality Community Action Initiative

Abstract

Objectives The goal of this study is to use Perinatal Periods of Risk (PPOR) analysis to differentiate broad areas of risk (Maternal-Health/Prematurity, Maternal Care, Newborn Care, and Infant Health) associated with being Black from those associated with being poor. Methods Phase I PPOR compared two target populations (Black women/infants and poor women/infants) against a gold standard reference group (White, non-Hispanic women, aged 20+ years with 13+ years of education), then against each other. Phase II PPOR further partitioned excess risk into (1) Very-low-birthweight-risk and (2) Birthweight-specific-mortality-risk and identified individual-level risk factors. Results Phase I PPOR revealed Black excess mortality within the Maternal-Health/Prematurity category (67% of total excess mortality). Phase II PPOR revealed that Black excess mortality within this category was primarily due to premature deliveries of very-low-birthweight infants. In a unique extension of the PPOR methodology, a poverty-excess-PPOR was subtracted from the Black-excess-PPOR, and showed that Black women have substantial excess mortality above and beyond that associated with poverty. Subsequent analyses to identify Black-specific risks, controlling for poverty, found that vaginal bleeding, premature rupture of membranes, history of preterm delivery, and having no prenatal care significantly predicted preterm delivery. Conclusions This study demonstrated the utility of PPOR, a standardized risk assessment approach for focusing health promotion efforts. In the study community, PPOR identified that maternal preconception and prenatal factors contributed the greatest risk for Black infants due to prematurity and low birthweight. Higher socioeconomic status did little to mitigate this risk. These findings informed a community-wide plan that integrated evidence-based strategies for addressing systematic racial inequity with strategies for addressing systematic socioeconomic disadvantage.

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What it's like joining London Ambulance Service

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Behind the wheel of an ambulance: Training needed

Fire and EMS agencies owe their crews, and the citizens they serve and protect, competent fire apparatus and ambulance driver/operators

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What it's like joining London Ambulance Service

Fancy a new adventure? Listen to Michaela Shaw, who is training to be a Paramedic, outline her work as Emergency Ambulance Crew and consider a career with us - http://bit.ly/2d3v8z6

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Early esophageal cancer with epidermization diagnosed and treated with endoscopic resection

Abstract

The patient was a 57-year-old man who had undergone endoscopic submucosal dissection for early esophageal cancer (distance from incisor tooth, 30 cm) when he was 50 years of age. Pathological findings showed squamous cell carcinoma invading the lamina muscularis mucosae and mild lymphatic invasion. Considering the possibility of lymph node metastasis and distant metastasis, we administered radiation chemotherapy (CDDP+ 5-FU, total radiation 41.4 Gy) in the same year. Two years later, follow-up endoscopy revealed a white, flat, elevated lesion in the thoracic esophagus (distance from incisor tooth, 36 cm) that was not stained by Lugol's iodine. A biopsy of this lesion was performed. Although esophageal epidermization was seen, there were no findings suggestive of malignancy. The lesion grew slightly during four and a half years of follow-up after identification. We performed a repeat biopsy of the lesion, and the tissue was diagnosed as atypical epithelium, so we performed endoscopic mucosal resection for diagnostic and therapeutic purposes. The postoperative pathological diagnosis was squamous cell carcinoma of T1a-LPM with epidermization due to its histological features. To the best of our knowledge, this is the first report of esophageal cancer accompanied by epidermization.

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Clinical efficacy of a next-generation sequencing gene panel for primary immunodeficiency diagnostics

Primary immunodeficiencies (PIDs) are rare monogenic inborn errors of immunity that result in impairment of functions of the human immune system. PIDs have a broad phenotype with increased morbidity and mortality and treatment choices are often complex. With increased accessibility of next-generation sequencing the rate of discovery of genetic causes for PID has increased exponentially. Identification of an underlying monogenic diagnosis provides important clinical benefits for patients with the potential to alter treatments, facilitate genetic counselling, and pre-implantation diagnostics. We investigated a next-generation sequencing PID panel of 242 genes within clinical care across a range of PID phenotypes. We also evaluated Phenomizer to predict causal genes from human phenotype ontology (HPO) terms. 27 participants were recruited and a total of 15 reportable variants were identified in 48% (13/27) of the participants. The panel results had implications for treatment in 37% (10/27) of participants. Phenomizer identified the genes harbouring variants from HPO terms in 33% (9/27) of participants. This study demonstrates the clinical efficacy that genetic testing has in the care of PID. However, it also highlights some of the disadvantages of gene panels in the rapidly moving field of PID genomics and current challenges in HPO term assignment for PID.

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Multiple Actions of Phencyclidine and (+)MK-801 on Isolated Bovine Cerebral Arteries.

This study examines the direct effects of 3 noncompetitive N-methyl-D-aspartate receptor antagonists, phencyclidine (PCP), (+)MK-801, and (-)MK-801, on bovine middle cerebral arteries (BMCA). Rings of BMCA were mounted in isolated tissue chambers equipped with isometric tension transducers to obtain pharmacologic dose-response curves. In the absence of endogenous vasoconstrictors, the 3 N-methyl-D-aspartate antagonists each produced direct constriction of BMCA. The thromboxane A2 receptor antagonist SQ-29,548, the TxA2 synthase inhibitor furegrelate, the calcium antagonist nimodipine, and calcium-deficient media all inhibited maximal phencyclidine or (+)MK-801-induced constriction. Direct constriction by PCP or (+)MK-801 was independent of the presence of endothelium. When BMCA were preconstricted with potassium-depolarizing solution, PCP, (+)MK-801, and (-)MK-801 each produced only concentration-dependent relaxation. When BMCA were preconstricted with the stable TxA2 analog U-46,619 and exposed to increasing concentrations of PCP, (+)MK-801, or (-)MK-801, tension increased. Thromboxane A2 may contract BMCA by acting as a potassium channel blocker; iberiotoxin and tetraethylammonium both constrict BMCA. In Ca2+-deficient media containing either potassium or U-46,619, phencyclidine and (+)MK-801 each produced competitive inhibition of subsequent Ca2+-induced constriction. In additional experiments, arterial strips were mounted in isolated tissue chambers to directly measure calcium uptake, using 45Calcium as a radioactive tracer. Both phencyclidine and (+)MK-801 blocked potassium-stimulated or U-46,619-stimulated 45Ca uptake into arterial strips. These results suggest that phencyclidine and (+)MK-801 have 2 separate actions on BMCA. They may constrict arterial rings by releasing TxA2 from cerebrovascular smooth muscle, and relax arterial rings by acting as calcium antagonists. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved

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Effects of Transcutaneous Electrical Acupoint Stimulation on the Stress Response During Extubation After General Anesthesia in Elderly Patients Undergoing Elective Supratentorial Craniotomy: A Prospective Randomized Controlled Trial.

Background: Elderly patients have an increased risk of a stress response during extubation after general anesthesia. In this study, we aimed to investigate whether transcutaneous electrical acupoint stimulation (TEAS) might decrease the stress response and improve the quality of recovery in elderly patients after elective supratentorial craniotomy. Materials and Methods: In this prospective randomized controlled study, patients were randomly assigned to either a TEAS group (n=37) or a control group (n=38). The primary outcomes were the hemodynamic parameters and plasma concentrations of epinephrine, norepinephrine, and cortisol. The secondary outcome included the consumption of remifentanil and propofol, time to extubation and reorientation, extubation quality score, postoperative quality of recovery, and postoperative complications. Results: Compared with the control group, hemodynamic parameters and plasma concentrations of epinephrine, norepinephrine, and cortisol during extubation were decreased in the TEAS group. TEAS reduced the consumption of remifentanil (P

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The Impact of Intraoperative Magnetic Resonance Imaging on Patient Safety Management During Awake Craniotomy.

Background: Awake craniotomy paired with intraoperative magnetic resonance imaging (iMRI) is now the established technique for maximizing surgical resection, while preserving neurological function. However, leaving an unsecured airway patient in the iMRI gantry represents considerable risk. Our study aimed at identifying the incidence of critical adverse events in unsecured airway patients during iMRI as part of awake craniotomy. Materials and Methods: We conducted a clinical chart review of consecutive awake craniotomies performed between November 1999 and December 2015. Sequences of iMRI performed without invasive airway management were selected for assessment and the incidence of critical adverse events, including general convulsive seizure, respiratory arrest, nausea/vomiting and agitation, was identified. Results: Critical adverse events occurred in 21 of 356 unsecured airway patients within 24 of the 579 iMRI sequences. In cases using the low-field strength open MRI scanner, emergency termination of scans due to patient decline was recorded in only 4 cases: no cases of cardiac arrest, accidental death, or thermal injury were recorded. Compared with cardiovascular monitoring, patient respiratory status was poorly recorded. Conclusions: In terms of anesthesia, concurrent use of iMRI for awake craniotomy is clinically acceptable providing potential intraoperative complications can be controlled. Further, the configuration of the iMRI scanner as well as the reduced exposure from the lower magnetic field strength was found to impact patient safety management. Therefore when a conscious patient is left in the gantry without airway support, it is advisable that levels of oxygenation and ventilation should be monitored at all times. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved

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Pneumothorax Following Rib Graft: An Atypical Presentation.

No abstract available

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Intraoperative Spinal Cord Pulsations: A Good Sign or a Disaster Waiting to Happen?.

No abstract available

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Radiographic Predictors of Difficult Laryngoscopy in Acromegaly Patients.

Background: Patients with acromegaly have a high risk of difficult laryngoscopy. However, clinical predictors, such as upper lip bite test or modified Mallampati class, show limited predictive performance for difficult laryngoscopy in such patients. In this retrospective study, we evaluated radiographic indices obtained from skull lateral x-ray and ostiomeatal unit computed tomography images to predict difficult laryngoscopy in acromegaly patients. Materials and Methods: Data on demographics, preoperative serum levels of pituitary hormones, and radiographic indices were collected from 90 acromegaly patients that underwent transsphenoidal removal for pituitary tumor from January 2010 to December 2016. Difficult laryngoscopy was defined as Cormack-Lehane grade >=III. Results: Difficult laryngoscopy occurred in 21 (23%) patients. In univariate analysis, age and radiographic indices indicating tongue size, such as tongue area (TA) on ostiomeatal unit computed tomography, linear distance from the alveolar line of the mandible to the hyoid bone, and linear distance from the interior border of the mandible to the hyoid bone on skull lateral x-ray, were associated with difficult laryngoscopy. In multivariate analysis, age (odds ratio [95% confidence interval], 1.084 [1.037-1.190]; P=0.002) and TA (1.002 [1.000-1.003], P=0.014) were independent risk factors for difficult laryngoscopy. The area under the curve of the combined model of age and TA was 0.80. Conclusions: Old age and radiographic predictors indicating large tongue size (large TA, long alveolar line of the mandible to the hyoid bone and mandible to the hyoid bone) were associated with an increased rate of difficult laryngoscopy in acromegaly patients. Preoperative radiographic measurements of tongue size can be helpful for safe airway management in such patients. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved

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The Microbiome That Shapes Us: Can It Cause Obesity?

Abstract

Purpose of Review

We sought to examine the effects of the gut microbial makeup on weight gain and obesity. We wanted to find out what the current research on this topic was and what the effect of the gut microbiota on energy metabolism is, as well the effects of diet on the microbiome and what effect the microbiome has on metabolic syndrome.

Recent Findings

Obesity is thought to be due to greater calorie intake than expenditure. Recently, research has looked into the effects of the microbiome on obesity. Our gut flora is made up of trillions of microbes and there is evidence to suggest that even from the earliest stages of life, altering that flora can affect human's ability to gain and lose weight, which can lead to obesity and ultimately other disease such as cardiovascular disease, diabetes mellitus, and liver disease.

Summary

Obesity can affect the human body in profound ways and lead to a multitude of comorbidities. We found that the obesity pandemic appears to parallel the increased use of antibiotics seen across the US. In addition, the use of antibiotics can alter the gut flora even from the earliest stages of life and the altered microbiome can alter our body habitus and energy metabolism through antibiotics, diet, and bariatric surgery.

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