Πέμπτη 2 Νοεμβρίου 2017

Prediction of Multiple-Trait and Multiple-Environment Genomic Data Using Recommender Systems

In genomic-enabled prediction, the task of improving the accuracy of the prediction of lines in environments is difficult because the available information is generally sparse and usually has low correlations between traits. In current genomic selection, while researchers have a large amount of information and appropriate statistical models to process it, there is still limited computing efficiency to do so. Although statistical models are usually mathematically elegant, they are also computationally inefficient, and they are impractical for many traits, lines, environments, and years because they need to sample from huge normal multivariate distributions. For these reasons, this study explores two recommender systems: a) item-based collaborative filtering (IBCF) and b) the matrix factorization algorithm (MF) in the context of multiple traits and multiple environments. The IBCF and matrix factorization methods were compared with two conventional methods on simulated and real data. Results of the simulated and real data sets show that the IBCF technique was slightly better in terms of prediction accuracy than the two conventional methods and the matrix factorization method when the correlation was moderately high. The IBCF technique is very attractive because it produces good predictions when there is high correlation between items (environment-trait combinations) and its implementation is computationally feasible, which can be useful for plant breeders who deal with very large data sets.



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Early obesity leads to increases in hepatic arginase I and related systemic changes in nitric oxide and l -arginine metabolism in mice

Abstract

Obesity is a risk factor for vascular endothelial cell dysfunction characterized by low-grade, chronic inflammation. Increased levels of arginase I and concomitant decreases in l-arginine bioavailability are known to play a role in the pathogenesis of vascular endothelial cell dysfunction. In the present study, we focused on changes in the systemic expression of arginase I as well as l-arginine metabolism in the pre-disease state of early obesity prior to the onset of atherosclerosis. C57BL/6 mice were fed a control diet (CD; 10% fat) or high-fat diet (HFD; 60% fat) for 8 weeks. The mRNA expression of arginase I in the liver, adipose tissue, aorta, and muscle; protein expression of arginase I in the liver and plasma; and systemic levels of l-arginine bioavailability and NO2 were assessed. HFD-fed mice showed early obesity without severe disease symptoms. Arginase I mRNA and protein expression levels in the liver were significantly higher in HFD-fed obese mice than in CD-fed mice. Arginase I levels were slightly increased, whereas l-arginine levels were significantly reduced, and these changes were followed by reductions in NO2 levels. Furthermore, hepatic arginase I levels positively correlated with plasma arginase I levels and negatively correlated with l-arginine bioavailability in plasma. These results suggested that increases in the expression of hepatic arginase I and reductions in plasma l-arginine and NO2 levels might lead to vascular endothelial dysfunction in the pre-disease state of early obesity.



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Effects of Endothelin-related Gene Polymorphisms and Aerobic Exercise Habit on Age-Related Arterial Stiffening: A 10-year Longitudinal Study

Increased arterial stiffness has emerged as a strong predictor of future cardiovascular events and all-cause mortality. The aim of this study was to elucidate influences of endothelin (ET)-related genetic polymorphisms and regular physical activity on age-related arterial stiffening through a 10-year longitudinal study. A decadal change in brachial-ankle pulse wave velocity (baPWV), an index of arterial stiffness, was evaluated retrospectively among 92 volunteers (63 ± 14yrs, 51 men). The targeted single-nucleotide polymorphisms were ET-A receptor SNP rs5333 (ET-A) and ET-B receptor SNP rs5351 (ET-B). Subjects with either ET-A TC or CC genotypes exhibited significantly greater increases in baPWV (+15.3 ± 11.7 and +16.6 ± 15.7%/dec, respectively) than ET-A TT genotype holders (+9.2 ± 9.0%/dec), while subjects with the ET-B GG genotype showed a significantly greater increase in baPWV (+17.7 ± 14.1%/dec) than other ET-B genotype holders (AA: +9.5 ± 10.0%/dec; AG: +11.2 ± 9.6%/dec). The combination of these ET-related genetic risks was associated with a 2.4 times greater decadal increase in baPWV compared with no genetic risk (+8.1 ± 8.4 vs. 19.5 ± 16.0%/dec). In contrast, individuals engaging in >15 METs·hours/week of aerobic exercise showed substantially smaller increases in baPWV (+5.0 ± 9.7%/dec) compared with their physically-inactive peers (+13%/dec). These differences remained significant after adjusting for confounding factors, including baseline baPWV and ET-related genotype risk. Our current longitudinal study found that ET-related gene polymorphisms contribute to diverse age-related changes in arterial stiffness, and that regular sufficient aerobic exercise attenuates the age-related arterial stiffening independently of ET-related gene polymorphisms.



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Improvements in Force Variability and Structure from Vision- to Memory-Guided Submaximal Isometric Knee Extension in Subacute Stroke

We examined changes in variability, accuracy, frequency composition, and temporal regularity of force signal from vision-guided to memory-guided force-matching tasks in 17 subacute stroke and 17 age-matched healthy subjects. Subjects performed a unilateral isometric knee extension at 10%, 30%, and 50% of peak torque (MVC) for 10 s (3 trials each). Visual feedback was removed at the 5s-mark in the first 2 trials (feedback withdrawal), and 30 s after the second trial the subjects were asked to produce the target force without visual feedback (force recall). The coefficient of variation and constant error were used to quantify force variability and accuracy. Force structure was assessed by the median frequency, relative spectral power in the 0-3 Hz band, and sample entropy of the force signal. At 10% MVC, the force signal in subacute stroke subjects became steadier, more broadband, and temporally more irregular after the withdrawal of visual feedback, with progressively larger error at higher contraction levels. Also, the lack of modulation in the spectral frequency at higher force levels with visual feedback persisted in both the withdrawal and recall conditions. In terms of changes from the visual feedback condition, the feedback withdrawal produced a greater difference between the paretic, non-paretic, and control legs than the force recall. The overall results suggest improvements in force variability and structure from vision- to memory-guided force control in subacute stroke despite decreased accuracy. Different sensory-motor memory retrieval mechanisms seem to be involved in the feedback withdrawal and force recall conditions, which deserves further studies.



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Emerging Wearable Physiological Monitoring Technologies and Decision Aids for Health & Performance

N/A



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Chronic exposure to electronic cigarette (E-cig) results in impaired cardiovascular function in mice

Proponents for electronic cigarettes(E-cigs) claim they are a safe alternative to smoking tobacco-based cigarettes,however little is known about the long-term effects of E-cig vapor exposure on vascular function.The purpose of this study was to determine the cardiovascular consequences of chronic E-cig exposure. Female mice (C57Bl/6 background strain)were randomly assigned to chronic daily exposure of E-cig vapor, standard cigarette smoke(using 3R4F-reference-cigarette), or filtered-air(N=15/group). Respective whole-body exposures consisted of 4 x 1-hour exposure blocks, separated by 30-minute intervals of fresh air breaks, resulting in intermittent daily exposure for a total of 4h/day, 5days/week for 8-months. Non-invasive ultrasonography was used to assess cardiac function and aortic stiffness (pulse wave velocity)at 3 times points (before, during, after chronic exposure). Upon completion of the 8-month exposure, ex-vivo wire tension myograph and force transduction measured changes in aortic tension in response to vasoactive inducing compounds. Aortic stiffness increased 2.5- and 2.8-times greater in E-cig and conventional tobacco-cigarettes,respectively, compared to filtered-air exposed control mice(p<0.05). The maximal aortic relaxation achieved to methacholine was 24% and 33% lower in E-cig and 3R4F-exposed mice,respectively, compared to controls(p<0.05). No differences were noted in sodium-nitroprusside dilation between the groups. 3R4F exposure altered cardiac function by reducing fractional shortening and ejection fraction after 8-months exposure(p<0.05). A similar tendency, though not statistically significant,was also observed with E-cig exposure(p<0.10). Chronic exposure to E-cig vapor accelerates aortic stiffness,significantly impairs aortic endothelial function,and may lead to impaired cardiac function. The clinical implications from this study are, even at relatively low exposure levels,chronic use of E-cig induces cardiovascular dysfunction.



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Increased respiratory neural drive and work of breathing in exercise-induced laryngeal obstruction

Rationale: Exercise induced laryngeal obstruction (EILO), a phenomenon in which the larynx closes inappropriately during physical activity, is a prevalent cause of exertional dyspnea in young individuals. The physiological ventilatory impact of EILO and its relationship to dyspnea are poorly understood. Objectives: To evaluate exercise related changes in laryngeal aperture on ventilation, pulmonary mechanics and respiratory neural drive. Methods: We prospectively evaluated 12 subjects (six with EILO and six healthy age- and gender-matched controls). Subjects underwent baseline spirometry and a symptom-limited incremental exercise test with simultaneous and synchronized recording of endoscopic video, gastric-, esophageal- and transdiaphragmatic pressures, diaphragm electromyography and respiratory airflow. Results: The EILO and control groups had similar peak work rates and minute ventilation (VE) (work rate: 227±35 vs. 237±35W; VE: 103±20 vs. 98±23 L/min; p>0.05). At submaximal work rates (140-240W) subjects with EILO demonstrated increased work of breathing (p<0.05) and respiratory neural drive (p<0.05), developing in close temporal association with onset of endoscopic evidence of laryngeal closure (p<0.05). Unexpectedly, a ventilatory increase (p<0.05), driven by augmented tidal volume (p<0.05), was seen in subjects with EILO, before the onset of laryngeal closure; there were however no differences in dyspnea intensity between groups. Conclusion: Using simultaneous measurements of respiratory mechanics and diaphragm electromyography with endoscopic video we demonstrate, for the first time, increased work of breathing and respiratory neural drive in association with the development of EILO. Future detailed investigations are now needed to understand the role of upper airway closure in causing exertional dyspnea and exercise limitation.



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Morphological and functional properties of the conducting human airways investigated by in vivo CT and in vitro MRI

The accurate representation of the human airway anatomy is crucial for understanding and modeling the structure-function relationship in both healthy and diseased lungs. The present knowledge in this area is based on morphometric studies of excised lung casts, partially complemented by in vivo studies in which computed tomography (CT) was used on a small number of subjects. In the present study, we analyze CT scans of a cohort of healthy subjects and obtain comprehensive morphometric information down to the seventh generation of bronchial branching, including airway diameter, length, branching angle, and rotation angle. While some of the geometrical parameters (such as the child-to-parent branch diameter ratio) are found to be in line with accepted values, for others (such as the branch length-to-diameter ratio) our findings challenge the common assumptions. We also evaluate several metrics of self-similarity, including the fractal dimension of the airway tree. Additionally, we use phase-contrast magnetic resonance imaging (MRI) to obtain the volumetric flow field in the 3D printed airway model of one of the subjects during steady inhalation. This is used to relate structural and functional parameters and, in particular, to close the power-law relationship between branch flow rate and diameter. The diameter exponent is found to be significantly lower than in the usually assumed Poiseuille regime, which we attribute to the strong secondary (i.e. transverse) velocity component. The strength of the secondary velocity with respect to the axial component exceeds the levels found in idealized airway models, and persists within the first seven generations.



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Copyright

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4





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Contributors

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4





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Contents

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4





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Forthcoming Issues

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4





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Anesthesia Outside of the Operating Room: The Wild West or the New Frontier?

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Lee A. Fleisher




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Anesthesia Outside the Operating Room

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Mark S. Weiss, Wendy L. Gross




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Anesthesia Outside the Operating Room

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Mark S. Weiss, Wendy L. Gross




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Demands of Integrated Care Delivery in Interventional Medicine and Anesthesiology

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Wendy L. Gross, Lebron Cooper, Steven Boggs

Teaser

Evolving financial and medical constraints fueled by the increasing repertoire of nonoperating room cases and widening scope of patient comorbidities are discussed. The need to integrate finances and care approaches is detailed, and strategic suggestions for broader collaborative practice are suggested.


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Building and Maintaining Organizational Infrastructure to Attain Clinical Excellence

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Kelly Lebak, Jason Lane, Richard Taus, Hansol Kim, Michael S. Stecker, Michael Hall, Meghan B. Lane-Fall, Mark S. Weiss

Teaser

Active maintenance of highly functional teams is critical to ensuring safe, efficient patient care in the non–operating room anesthesia (NORA) suite. In addition to developing collaborative relationships and patient care protocols, individual and team training is needed. For anesthesiologists, this training must begin during residency. The training should be supplemented with continuing education in this field for providers who find themselves working in the NORA space. As NORA continues to grow, robust NORA-specific quality assurance and improvement programs will empower anesthesiologists with the tools they need to best care for these patients.


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Safety of Non–Operating Room Anesthesia

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Zachary G. Woodward, Richard D. Urman, Karen B. Domino

Teaser

Malpractice claims for non–operating room anesthesia care (NORA) had a higher proportion of claims for death than claims in operating rooms (ORs). NORA claims most frequently involved monitored anesthesia care. Inadequate oxygenation/ventilation was responsible for one-third of NORA claims, often judged probably preventable by better monitoring. Fewer malpractice claims for NORA occurred than for OR anesthesia as assessed by the relative numbers of in NORA versus OR procedures. The proportion of claims in cardiology and radiology NORA locations were increased compared with estimates of cases in these locations. Although NORA is safe, adherence to safe clinical practice is important.


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Implementation and Use of Anesthesia Information Management Systems for Non–operating Room Locations

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Jason T. Bouhenguel, David A. Preiss, Richard D. Urman

Teaser

Non–operating room anesthesia (NORA) encounters comprise a significant fraction of contemporary anesthesia practice. With the implemention of an aneshtesia information management system (AIMS), anesthesia practitioners can better streamline preoperative assessment, intraoperative automated documentation, real-time decision support, and remote surveillance. Despite the large personal and financial commitments involved in adoption and implementation of AIMS and other electronic health records in these settings, the benefits to safety, efficacy, and efficiency are far too great to be ignored. Continued future innovation of AIMS technology only promises to further improve on our NORA experience and improve care quality and safety.


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Monitoring for Nonoperating Room Anesthesia

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Stylianos Voulgarelis, John P. Scott

Teaser

Procedures requiring nonoperating room anesthesia (NORA) continue to increase in quantity and complexity. The roles of anesthesiologists as members of care teams in nonoperating room locations continue to evolve. The safe provision of NORA requires strict adherence to standardized monitoring guidelines including pulse oximetry, capnography, electrocardiogram, and noninvasive blood pressure ampliflier. Body temperature should also be measured in appropriate scenarios. High-risk anesthetics require advanced preparation and monitoring.


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Use of Anesthesiology Services in Radiology

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Hansol Kim, Jason Lane, Rolf Schlichter, Michael S. Stecker, Richard Taus

Teaser

In the setting of technological advancements in imaging and intervention with concomitant rise in the use of non–operating room anesthesia (NORA) care, it has become even more critical for anesthesiologists to be aware of the needs and limitations of interventional procedures performed outside of the operating room. This article addresses the use of NORA services from the interventional radiologist's point of view and provides specific examples of preprocedural, intraprocedural, and postprocedural care patients may need for optimal outcome.


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An Anesthesiologist’s View of Tumor Ablation in the Radiology Suite

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Annie Amin, Jason Lane, Thomas Cutter

Teaser

The advent of radiology image–guided tumor ablation procedures has opened up a new era in minimally invasive procedures. Using CT, MRI, ultrasound, and other modalities, radiologists and surgeons can now ablate a tumor through percutaneous entry sites. What traditionally was done in an operating room via large open incisions, with multiple days in the hospital recovering, is now becoming an outpatient procedure via these new techniques. Anesthesiologists play a critical role in optimizing outcome in these patients. Knowledge by anesthesiologists of procedural goals, technology used, and inherit safety concerns of anesthetizing patients in the radiology suite are all critical to patients and proceduralists.


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A Radiologist’s View of Tumor Ablation in the Radiology Suite

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Sharath K. Bhagavatula, Jason Lane, Paul Shyn

Teaser

Image-guided percutaneous, minimally invasive ablation techniques offer a wide variety of new modalities to treat tumors in some of the most medically complicated patients coming to our hospitals. The use of computed tomography, PET, ultrasound imaging, and MRI to guide radiofrequency ablation, microwave ablation, and cryoablation techniques now makes it possible to treat patients on a short stay or outpatient basis with very good immediate outcomes. This rapid expansion of new tumor ablation techniques often presents challenges for the non–operating room anesthesia team. Collaboration and communication between the radiologist and anesthesiologist are key to safety and excellent patient outcomes.


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Catheterization Laboratory

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Paul N. Fiorilli, Saif Anwaruddin, Elizabeth Zhou, Ronak Shah

Teaser

The cardiac catheterization laboratory is advancing medicine by performing procedures on patients who would usually require sternotomy and cardiopulmonary bypass. These procedures are done percutaneously, allowing them to be performed on patients considered inoperable. Patients have compromised cardiovascular function or advanced age. An anesthesiologist is essential for these procedures in case of hemodynamic compromise. Interventionalists are becoming more familiar with transcatheter aortic valve replacement and the device has become smaller, both contributing to less complications. Left atrial occlusion and the endovascular edge-to-edge mitral valve repair devices were approved. Although these devices require general anesthesia, an invasive surgery and cardiopulmonary bypass machine are not necessary for deployment.


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Anesthesia in the Electrophysiology Laboratory

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Jeff E. Mandel, William G. Stevenson, David S. Frankel

Teaser

The electrophysiology suite is a foreign location to many anesthesiologists. The initial experience was with shorter procedures under conscious sedation, and the value of greater tailoring of the sedation/anesthesia by anesthesiologists was not perceived until practice patterns had already been established. Although better control of ventilation with general anesthesia may be expected, suppression of arrhythmias, blunting of the hemodynamic adaptation to induced arrhythmias, and interference by muscle relaxants with identification of the phrenic nerve may be seen. We review a range of electrophysiology procedures and discuss anesthetic approaches that balance patient safety and favorable outcomes.


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Cardioversions and Transthoracic Echocardiography

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Ronak Shah, Elizabeth Zhou

Teaser

Patients with atrial fibrillation and flutter routinely require transesophageal echocardiography with cardioversion. It is not uncommon to encounter patients with reduced ejection fractions, coronary artery disease, prior cardiac surgery, or obstructive sleep apnea. The anesthesiologist must carefully evaluate the patient and any available laboratory and study findings to assess for potential complications after anesthesia. Appropriate anesthetics must be chosen based on the preoperative evaluation. Additionally, because most of these cases are done without a secured airway, emergency medications and airway equipment must be readily available.


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Anesthesia for Routine and Advanced Upper Gastrointestinal Endoscopic Procedures

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): Christopher D. Sharp, Ezekiel Tayler, Gregory G. Ginsberg

Teaser

This article aims to detail the breadth and depth of advanced upper gastrointestinal endoscopic procedures. It will focus on sedation and airway management concerns pertaining to this emerged and emerging class of minimally invasive interventions. The article will also cover endoscopic hemostasis, endoscopic resection, stenting and Barrett eradication therapy plus endoscopic ultrasound. It additionally will address the nuances of endoscopic retrograde cholangiopancreatography and new natural orifice transluminal endoscopic surgery procedures including endoscopic cystgastrostomy and the per-oral endoscopic myotomy procedure.


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Anesthesia for Colonoscopy and Lower Endoscopic Procedures

Publication date: December 2017
Source:Anesthesiology Clinics, Volume 35, Issue 4
Author(s): John Michael Trummel, Vinay Chandrasekhara, Michael L. Kochman

Teaser

Demand for anesthesiologist-assisted sedation is expanding for gastrointestinal lower endoscopic procedures and may add to the cost of these procedures. Most lower endoscopy can be accomplished with either no, moderate, or deep sedation; general anesthesia and active airway management are rarely needed. Propofol-based sedation has advantages in terms of satisfaction and recovery over other modalities, but moderate sedation using benzodiazepines and opiates work well for low-risk patients and procedures. No sedation for routine colonoscopy works well for selected patients and eliminates sedation-related risks. There is no difference in outcome measures based on sedation received.


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Diagnostic Performance of Contrast-Enhanced Ultrasound for Pancreatic Neoplasms: A Systematic Review and Meta-Analysis

Early diagnosis of pancreatic cancer is essential to optimize treatment strategies.

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Diagnostic Performance of Contrast-Enhanced Ultrasound for Pancreatic Neoplasms: A Systematic Review and Meta-Analysis

Early diagnosis of pancreatic cancer is essential to optimize treatment strategies.

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The Use of Regional or Neuraxial Anesthesia for Below-Knee Amputations May Reduce the Need for Perioperative Blood Transfusions.

Background and Objectives: Amputations of the lower extremity remain a common procedure in a high-risk population. Perioperative morbidity and mortality reach as high as 14.1% in below-knee amputations. We aimed to determine whether regional, or neuraxial, anesthesia, when compared with general anesthesia (GA), would be associated with reduced perioperative morbidity and mortality. Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program data set. The study population was divided into 2 groups: patients undergoing regional anesthesia (RA) and those undergoing GA. The primary end point for our study was 30-day mortality. The secondary end points were return to the operating room, surgical site infections, pulmonary complications, acute kidney injury, urinary tract infection, cardiac arrest, myocardial infarction, perioperative transfusions, thromboembolisms, sepsis, composite measure of postoperative complications, and days from operation to discharge. Results: Twelve thousand seven hundred twenty-three patients were identified. Older patients, white patients, patients with a higher body mass index, patients without dyspnea, patients with independent functional status, smokers, patients with sepsis, and patients with bleeding disorders were associated with receiving GA. Hispanic patients, patients with chronic obstructive pulmonary disease, and patients with congestive heart failure were associated with receiving RA. Our study did not reveal a 30-day mortality difference between RA and GA. Regional anesthesia was associated with a significantly decreased need for perioperative blood transfusions (11.8% vs 16.5%, P

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Challenging Conventions to Make a Difference in Patient Care: The 2017 Gaston Labat Award Lecture.

No abstract available

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An app for patient education and self-audit within an enhanced recovery program for bowel surgery: a pilot study assessing validity and usability

Abstract

Introduction

While patient engagement and clinical audit are key components of successful enhanced recovery programs (ERPs), they require substantial resource allocation. The objective of this study was to assess the validity and usability of a novel mobile device application for education and self-reporting of adherence for patients undergoing bowel surgery within an established ERP.

Methods

Prospectively recruited patients undergoing bowel surgery within an ERP used a novel app specifically designed to provide daily recovery milestones and record adherence to 15 different ERP processes and six patient-reported outcomes (PROs). Validity was measured by the agreement index (Cohen's kappa coefficient for categorical, and interclass correlation coefficient (ICC) for continuous variables) between patient-reported data through the app and data recorded by a clinical auditor. Acceptability and usability of the app were measured by the System Usability Scale (SUS).

Results

Forty-five patients participated in the study (mean age 61, 64% male). Overall, patients completed 159 of 179 (89%) of the available questionnaires through the app. Median time to complete a questionnaire was 2 min 49 s (i.q.r. 2′32″–4′36″). Substantial (kappa > 0.6) or almost perfect agreement (kappa > 0.8) and strong correlation (ICC > 0.7) between data collected through the app and by the clinical auditor was found for 14 ERP processes and four PROs. Patient-reported usability was high; mean SUS score was 87 (95% CI 83–91). Only 6 (13%) patients needed technical support to use the app. Forty (89%) patients found the app was helpful to achieve their daily goals, and 34 (76%) thought it increased their motivation to recover after surgery.

Conclusions

This novel application provides a tool to record patient adherence to care processes and PROs, with high agreement with traditional clinical audit, high usability, and patient satisfaction. Future studies should investigate the use of mobile device apps as strategies to increase adherence to perioperative interventions.



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Effect of transanal total mesorectal excision for rectal cancer: comparison of short-term outcomes with laparoscopic and open surgeries

Abstract

Objective

To compare short-term results of total mesorectal excision (TME) for mid and low rectal cancer, achieved by transanal (TaTME), laparoscopic (LaTME), and open (OpTME) approaches.

Background

The impact of TaTME on the surgical treatment of mid and low rectal cancer has yet to be clarified.

Methods

This is a case-matched study, based on data from a prospectively maintained database of patients who underwent TaTME from May 2015 to March 2017, and a retrospective chart review of patients who underwent LaTME and OpTME in the previous period. Each patient in the TaTME group was matched to one LaTME and one OpTME based on sex, BMI, tumor status, and the height of the tumor from the anal verge. Primary end-points were rates of positive circumferential resection margin (CRM), distal resection margin, and the macroscopic quality of the surgical specimen. Composite of these outcomes was compared as an indication for successful surgery. Secondary end-points included intraoperative data and postoperative course and complications.

Results

Three hundred patients were included (TaTME = 100, LaTME = 100, OpTME = 100). The three groups were comparable in the baseline characteristics. TaTME resulted in lower rates of incomplete TME specimens than LaTME, but not OpTME (P = 0.016, P = 0.750, respectively). The rates of CRM involvement, mean CRM distance, and the percentages of successful surgery were comparable among the three groups (P = 0.368). The conversion to open surgery occurred only in the LaTME group. TaTME resulted in shorter operation time and less blood loss than the other two groups (P < 0.001 and P < 0.001). Hospital stay was shorter in the TaTME group (P = 0.002); complication rate and mortality were comparable among the groups.

Conclusions

TaTME had, in our hands, some obvious benefits over other approaches. The pathological results were not significantly superior to LaTME and OpTME. The procedure is however feasible and safe. Further studies are needed to evaluate the long-term oncological and quality of life outcomes.



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Endoscopic transmural management of abdominal fluid collection following gastrointestinal, bariatric, and hepato-bilio-pancreatic surgery

Abstract

Background

Post-operative collections are a recognized source of morbidity after abdominal surgery. Percutaneous drainage is currently considered the standard treatment but not all collections are accessible using this method. Since the adoption of EUS, endoscopic transmural drainage has become an attractive option in the management of such complications. The present study aimed to assess the efficacy, safety and modalities of endoscopic transmural drainage in the treatment of post-operative collections.

Methods

Data of all patients referred to our dedicated multidisciplinary facility from 2014 to 2017 for endoscopic drainage of symptomatic post-operative collections after failure of percutaneous drainage or when it was deemed impossible, were retrospectively analyzed.

Results

Thirty-two patients (17 males and 15 females) with a median age of 53 years old (range 31–74) were included. Collections resulted from pancreatic (n = 10), colorectal (n = 6), bariatric (n  = 5), and other type of surgery (n  = 11). Collection size was less than 5 cm in diameter in 10 (31%), between 5 and 10 cm in 17 (53%) ,and more than 10 cm in 5 (16%) patients. The median time from surgery to endoscopic drainage was 38 days (range 6–360). Eight (25%) patients underwent endoscopic guided drainage whereas 24 (75%) patients underwent EUS-guided drainage. Technical success was 100% and clinical success was achieved in 30 (93.4%) after a mean follow-up of 13.5 months (1.2–24.8). Overall complication was 12.5% including four patients who bled following trans-gastric drainage treated with conservative therapy.

Conclusions

The present series suggests that endoscopic transmural drainage represents an interesting alternative in the treatment of post-operative collection when percutaneous drainage is not possible or fails.



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Laparoscopy-assisted distal gastrectomy versus laparoscopy-assisted total gastrectomy with D2 lymph node dissection for middle-third advanced gastric cancer

Abstract

Background

There still remains controversy for the choice of resection extent for gastric cancer involving the middle-third of the stomach. The aim of this study was to compare the technical feasibility and long-term outcomes of laparoscopy-assisted distal gastrectomy (LADG) versus laparoscopy-assisted total gastrectomy (LATG) for middle-third advanced gastric cancer (AGC) and to determine which is the optimal surgical procedure.

Methods

For this study, clinical data for 379 patients who underwent LADG or LATG with D2 lymph node dissection between April 2005 and June 2014 were analyzed retrospectively. The short- and long-term outcomes were compared between the propensity score-matched groups.

Results

The LADG group had a significantly shorter operating time (212.74 vs. 241.79 min, P < 0.001), less estimated blood loss (114.38 vs. 181.51 ml, P = 0.000), shorter first flatus and postoperative hospital stay. Additionally, the total cost of hospitalization was significantly higher in the LATG group than LADG group (71187.58 vs. 65783.25 RMB, P = 0.000). There were no significant differences in postoperative complications rate between the LADG group and the LATG group. The 5-year overall survival (OS) rates were 64.4% in the LADG group and 61.0% in the LATG group (P = 0.548). The resection extent was not an independent prognostic factor for the OS.

Conclusions

LADG with D2 nodal dissection is a feasible treatment strategy for middle-third AGC with better short-term outcomes and similar long-term survival rates compared with LATG. We recommended that DG should be the optimal surgical procedure for middle one-third AGC under the premise of negative proximal resection margin.



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Clinical outcomes of deep invasive submucosal colorectal cancer after ESD

Abstract

Background and study aims

Endoscopic submucosal dissection (ESD) is a reliable method that can replace surgery under certain conditions. However, limited information is available on the clinical course of T1b colorectal cancer (CRC) after ESD. The aim of the study was to clarify the feasibility of ESD for T1b CRC.

Patients and methods

Three hundred and two patients with 312 T1 CRC were identified in this retrospective cohort study. All patients were treated with ESD, other endoscopic treatments, or surgery. In this study, we (I) investigated the en bloc resection rate of ESD and (II) compared the overall survival (OS) rate for patients who underwent ESD with additional surgery (Group A) and surgery without upfront endoscopic resection (Group B) for T1b CRC.

Results

No significant differences were observed in the en bloc resection rates between T1b and T1a CRC (100 vs. 98.7%), but the en bloc R0 resection rate was significantly lower in T1b CRC than in T1a CRC (64.7 vs. 97.4%). Regarding complications, perforations occurred in 2.9% of patients with T1b CRC, which was not significantly different from the rate of 5.3% in patients with T1a CRC. No significant differences were observed in the OS or recurrence-free survival (RFS) curves between Groups A and B (OS rates at 5 years: 92.3 vs. 88.9%, RFS rates at 5 years: 81.4 vs. 85.3%). Similarly, the 5-year disease-specific survival (DSS) rate of Group A was identical to that of Group B (both 100%).

Conclusions

ESD for T1b CRC before surgery is a possible strategy because of the low rate of complications and favorable long-term outcomes.



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Resection outcomes and recurrence rates of endoscopic submucosal dissection (ESD) and hybrid ESD for colorectal tumors in a single Italian center

Abstract

Background

Endoscopic submucosal dissection (ESD) and hybrid-ESD techniques are treatment modalities for colorectal neoplasia, although mostly used in the Eastern hemisphere. Only few data on ESD for colorectal neoplasia have been published in the West. We report the outcomes of colorectal ESD and hybrid ESD in a single Italian center.

Methods

We retrospectively evaluated the outcomes of all ESD and hybrid-ESD procedures for colorectal neoplasia performed over the first 2-year experience from a prospectively recorded database. Neuroendocrine tumors and adenocarcinoma with submucosal infiltration through the submucosal (SM) 2 layer or deeper were excluded. The primary outcome was the recurrence rate at the 6- to 12-month follow-up.

Results

Fifty-two patients were included in the study, of which 23 underwent ESD and 29 hybrid ESD. The mean lesion sizes for ESD and hybrid ESD were similar (25.8 vs. 25.4 mm, p = 0.940), while median procedure length was significantly longer for ESD (120 vs. 60 min, p < 0.001). ESD and hybrid ESD yielded similar en-bloc resection rate (82.6 vs. 82.8%) and R0 resection rate (34.8 vs. 31%). ESD had a lower neoplasia recurrence rate than hybrid ESD (11.7 vs. 20%) and a lower bleeding rate (0 vs. 8.7%). One perforation occurred in the hybrid-ESD cohort and two perforations in the ESD cohort, of which one required surgical intervention. Non-recurrence at follow-up was associated with R0 status, en-bloc resection, and lesion size ≤ 20 mm.

Conclusion

Our outcomes are comparable with other studies in Western series. Studies addressing the cost effectiveness of ESD and comparing its long-term outcome with endoscopic mucosal resection in the West are needed.



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Low-impact laparoscopic cholecystectomy is associated with decreased postoperative morbidity in patients with sickle cell disease

Abstract

Background

Laparoscopic cholecystectomy (LC) is one of the most frequent surgeries performed in patients with sickle cell disease (SCD). LC in SCD patients is associated with a particularly high postoperative morbidity. The aim of the present study is to assess the safety and feasibility of cholecystectomy performed by mini-laparoscopy with low- and stable-pressure pneumoperitoneum (MLC + LSPP) and to compare the rate of postoperative SCD-related morbidity with standard LC.

Methods

Thirty-five consecutive SCD patients admitted between November 2015 and March 2017 for cholelithiasis requiring surgery were compared with an historical cohort of 126 SCD patients who underwent LC for the same indication. Operative variables, postoperative outcomes, patient and surgeon satisfaction, and costs were evaluated.

Results

MLC + LSPP exhibited a mean operative time comparable to LC (p = 0.169). Operative blood loss was significantly reduced in the MLC + LSPP group, and the suction device was rarely used (p = 0.036). SCD-related morbidity (including acute chest syndrome) was significantly higher in the LC group compared with the MLC + LSPP group (18.3 vs. 2.9%; p = 0.029). The mean times to resume ambulation (p = 0.018) and regular diet (p = 0.045) were significantly reduced in the MLC + LSPP group. The mean incision length (all trocars combined) was 28.22 mm for MLC + LSPP and 49.64 mm for LC patients (p < 0.0001). Multivariate regression analysis demonstrated that the only significant predictor of postoperative SCD-related morbidity was the surgical approach (odds ratio: 9.24). Patient and surgeon satisfaction were very high for MLC + LSPP. The mean total cost per patient (surgery and hospitalization) was not different between groups (p = 0.084).

Conclusion

MLC + LSPP in SCD patients appears to be safe and feasible. Compared with LC, MLC + LSPP in SCD patients is associated with a significantly reduced incidence of postoperative SCD-related morbidity and more rapid ambulation and return to regular diet without increasing the total costs per patient.



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The influence of the different forms of appendix base closure on patient outcome in laparoscopic appendectomy: a randomized trial

Abstract

Background

During laparoscopic appendectomy, the base of the appendix is usually secured by loop ligature or stapling device. Hem-o-lok and DS clips have been shown as alternative techniques. The aim of this study was to compare the clinical outcomes of various forms of securing the base of the appendix, in order to find the most suitable method.

Patients and methods

The study included 120 patients with acute appendicitis randomly divided into four groups with 30 patients in each. In the first group, the base of the appendix was secured using an Endoloop, in the second group using a stapling device, in the third group using Hem-o-lok, and in the fourth group using a DS clip. The primary outcome was overall morbidity following securing the base of the appendix. Secondary outcomes were time of application and operative procedure, total length of stay, and surgical outcome.

Results

No morbidity was recorded in any group. The time of application was significantly longer in the Endoloop group than in the Stapler (P < 0.0001), Hem-o-lok (P < 0.0001), and DS clips (P < 0.0001) groups. The time of application in the Stapler group was significantly shorter than in the Hem-o-lok (P < 0.0001) and the DS clips (P < 0.0001) groups. The time of the operative procedure was significantly longer in the Endoloop than in the Stapler group (P < 0.0001). The time of the operative procedure in the Stapler group was significantly shorter than in the DS clips group (P < 0.0001) but did not differ significantly from the Hem-o-lok group (P = 0.199). The time of the operative procedure in the Hem-o-lok group was significantly shorter than in the DS clips group (P = 0.044).

Conclusion

All forms of closure of the appendix base are acceptable, but Hem-o-lok and DS clips have the best potential for further development, and will probably become the method of choice in securing the base of the appendix.



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Internal dosimetry of inhaled iodine-131

Publication date: January 2018
Source:Journal of Environmental Radioactivity, Volume 181
Author(s): Mitra Kiani Nasab, Laleh Rafat Motavalli, Hashem Miri Hakimabad
In this paper, the dose assessment for the iodine inhalation exposure in 19 aerosol sizes and three gas/vapor forms at three levels of thyroid uptake, was performed. Two different modes of work (light vs. heavy) and breathing (nose vs. mouth) for aerosol inhalation were investigated. In order to calculate the cumulated activities per unit of inhaled activity, a combined model which included the latest models of both human respiratory and alimentary tract was developed. The S values for 131I were computed based on the ICRP adult male and female reference voxel phantoms by the Monte Carlo method. Then, the committed equivalent and committed effective dose coefficients were obtained (The data are available at http://ift.tt/2zgPtKh). In general, for the nonzero thyroid uptakes, the maximum cumulated activity was found in the thyroid. When the thyroid is blocked, however, the maximum depends on the work and breathing mode and radioisotope form. Overall, the maximum CED coefficient was evaluated for the inhalation of elemental iodine at thyroid uptake of ∼27% (2.8 × 10−8 Sv/Bq). As for the particle inhalation per se, mouth breathing of 0.6 nm and 0.2 μm AMTD particles showed to have the maximum (2.8 × 10−8 Sv/Bq) and minimum (6.4 × 10−9 Sv/Bq) CED coefficients, respectively. Compared to the reference CED coefficients, the authors found an increase of about 58% for inhalation of the aerosols with AMAD of 1 μm and 70% for 5 μm.



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Assessment of the calibration of gamma spectrometry systems in forest environments

Publication date: January 2018
Source:Journal of Environmental Radioactivity, Volume 181
Author(s): Alan J. Cresswell, David C.W. Sanderson, Katsuhiko Yamaguchi
A Monte Carlo simulation was used to develop a model of the response of a portable gamma spectrometry system in forest environments. This model was used to evaluate any corrections needed to measurements of 137Cs activity per unit area calibrated assuming an open field geometry. These were shown to be less than 20% for most forest environments. The model was also used to assess the impact of activity in the canopy on ground level measurements. For similar activity per unit area in the lower parts of the canopy as on the ground, 10-25% of the ground based measurement would be due to activity in the canopy, depending on the depth profile in the soil. The model verifies that an optional collimator cap can assess activity in the canopy by repeat survey.



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Trunk exercises improve gait symmetry in Parkinson disease: A blind phase II randomised-controlled trial.

Objective: Deficits in step-to-step symmetry and trunk muscle activations have been linked to falls in Parkinson's disease (PD). Given such symptoms are poorly managed with anti-parkinsonian medications, alternate therapies are needed. This blind phase II randomised-controlled trial sought to establish whether exercise can improve step-to-step symmetry in PD. Design: Twenty-four PD patients with a falls history completed baseline assessments of symptom severity, balance confidence, mobility and quality of life. Step-to-step symmetry was assessed by deriving harmonic ratios from three-dimensional accelerations collected for the head and trunk. Patients were randomly assigned to either 12-weeks of exercise and falls prevention education or falls prevention education only. Both groups repeated the baseline tests 12- and 24-weeks following the initial assessment. The Australian and New Zealand Clinical Trials Registry number is ACTRN12613001175763. Results: At 12-weeks, the Exercise group had statistically significant and clinically relevant improvements in anterior-posterior step-to-step trunk symmetry. In contrast, the Education group recorded statistically significant and clinically meaningful reductions in medial-lateral and vertical step-to-step trunk symmetry at 12-weeks. Conclusion: Given that step-to-step symmetry improved for the Exercise group and declined for the Education group post-intervention, active interventions appear more suited to increasing independence and quality of life for people with PD. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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EMS scheduling software: Going strong since 2005

In March 2005, eCore was the fortunate recipient of an article write up in JEMS magazine and web site about our products. Prior to re branding to ePro Scheduler, the original product name was Net Scheduler Pro. Even back in 2005, the eCore team was offering top of the line EMS Scheduling Software to the industry JEMS serves. Where Scheduling Software has Been to Where We Are Now It is very exciting ...

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Chief Operations Officer - Huntsville Emergency Medical Services Inc

Summary: Directs, administers, and coordinates the activities of the organization in support of policies, goals, and objectives established by the Chief Executive Officer and the Board of Directors by performing the following duties personally or through subordinate managers. Essential Duties and Responsibilities: (Other duties may be assigned) · Manages 5 - 10 subordinate supervisors who supervise ...

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Emergency Medical Technician - Ready Responders

About The Role When you join our team as a Ready Responder, you will join a group of dedicated healthcare providers who are licensed, trained, and credentialed to respond at the EMT-Basic level of care. Our Responders provide two types of service: Acute care response, high priority calls for service Help to improve patient outcomes by arriving at the scene within minutes Provide on-scene triage and ...

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Motor cortex excitability in seizure-free STX1B mutation carriers with a history of epilepsy and febrile seizures

Publication date: December 2017
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): Maria-Ioanna Stefanou, Debora Desideri, Justus Marquetand, Paolo Belardinelli, Christoph Zrenner, Holger Lerche, Ulf Ziemann
ObjectiveMutations in STX1B encoding the presynaptic protein syntaxin-1B are associated with febrile seizures with or without epilepsy. It is unclear to what extent these mutations are linked to abnormalities of cortical glutamatergic or GABAergic neurotransmission. We explored this question using single- and paired-pulse transcranial magnetic stimulation (TMS) excitability markers.MethodsWe studied nine currently asymptomatic adult STX1B mutation carriers with history of epilepsy and febrile seizures, who had been seizure-free for at least eight years without antiepileptic drug treatment, and ten healthy age-matched controls. Resting motor threshold (RMT), and input-output curves of motor evoked potential (MEP) amplitude, short-interval intracortical inhibition (SICI, marker of GABAAergic excitability) and intracortical facilitation (ICF, marker of glutamatergic excitability) were tested.ResultsRMT, and input-output curves of MEP amplitude, SICI and ICF revealed no significant differences between STX1B mutation carriers and healthy controls.ConclusionsFindings suggest normal motor cortical GABAAergic and glutamatergic excitability in currently asymptomatic STX1B mutation carriers.SignificanceTMS measures of motor cortical excitability show utility in demonstrating normal excitability in adult STX1B mutation carriers with history of seizures.



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Early corticospinal tract damage in prodromal SCA2 revealed by EEG-EMG and EMG-EMG coherence

Publication date: December 2017
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): Luis Velázquez-Pérez, Johannes Tünnerhoff, Roberto Rodríguez-Labrada, Reidenis Torres-Vega, Yusely Ruiz-Gonzalez, Paolo Belardinelli, Jacqueline Medrano-Montero, Nalia Canales-Ochoa, Yanetza González-Zaldivar, Yaimeé Vazquez-Mojena, Georg Auburger, Ulf Ziemann
ObjectiveClinical data suggest early involvement of the corticospinal tract (CST) in spinocerebellar ataxia type 2 (SCA2). Here we tested if early CST degeneration can be detected in prodromal SCA2 mutation carriers by electrophysiological markers of CST integrity.MethodsCST integrity was tested in 15 prodromal SCA2 mutation carriers, 19 SCA2 patients and 25 age-matched healthy controls, using corticomuscular (EEG-EMG) and intermuscular (EMG-EMG) coherence measures in upper and lower limb muscles.ResultsSignificant reductions of EEG-EMG and EMG-EMG coherences were observed in the SCA2 patients, and to a similar extent in the prodromal SCA2 mutation carriers. In prodromal SCA2, EEG-EMG and EMG-EMG coherences correlated with the predicted time to ataxia onset.ConclusionsFindings indicate early CST neurodegeneration in SCA2. EEG-EMG and EMG-EMG coherence may serve as biomarkers of early CST neurodegeneration in prodromal SCA2 mutation carriers.SignificanceFindings are important for developing preclinical disease markers in the context of currently emerging disease-modifying therapies of neurodegenerative disorders.



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Single-unit activity of the anterior Globus pallidus internus in Tourette patients and posterior Globus pallidus internus in dystonic patients

Publication date: December 2017
Source:Clinical Neurophysiology, Volume 128, Issue 12
Author(s): Andrea Giorni, François Windels, Peter G. Stratton, Raymond Cook, Paul Silberstein, Terrence Coyne, Peter A. Silburn, Pankaj Sah
ObjectivesOur goal was to provide a detailed analysis of neurons' electrophysiological activity recorded in sub-territories of Globus pallidus internus (GPi) used as Deep Brain Stimulation (DBS) targets for these clinical conditions to potentially assist electrode targeting.MethodsWe used intra-operative microelectrode recording during stereotactic neurosurgery to guide implantation of DBS lead.ResultsUnits in the medial anterior part of GPi of 7 Tourette's syndrome patients under general anesthesia were firing at mean and median rate of 32.1 and 21 Hz respectively (n = 101), with 45% of spikes fired during bursts and 21.3 bursts per minute. In the latero-posterior part of GPi of 7 dystonic patients under local anesthesia the mean and median activity were 46.1 and 30.6 Hz respectively (n = 27), and a mean of 21.7 bursts per minute was observed, with 30% of all spikes occurring during these bursts.ConclusionUnits activity pattern – slow-regular, fast-irregular or fast-regular were present in different proportions between the two targets.SignificanceThe electrophysiological characteristics of the medial-anterior part of GPi and its latero-posterior portion can be used to assist DBS electrode targeting and also support the refinement of pathophysiological models of Tourette's syndrome and Dystonia.



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Paid Maternity Leave in the United States: Associations with Maternal and Infant Health

Abstract

Objectives The United States is one of only three countries worldwide with no national policy guaranteeing paid leave to employed women who give birth. While maternity leave has been linked to improved maternal and child outcomes in international contexts, up-to-date research evidence in the U.S. context is needed to inform current policy debates on paid family leave. Methods Using data from Listening to Mothers III, a national survey of women ages 18–45 who gave birth in 2011–2012, we conducted multivariate logistic regression to predict the likelihood of outcomes related to infant health, maternal physical and mental health, and maternal health behaviors by the use and duration of paid maternity leave. Results Use of paid and unpaid leave varied significantly by race/ethnicity and household income. Women who took paid maternity leave experienced a 47% decrease in the odds of re-hospitalizing their infants (95% CI 0.3, 1.0) and a 51% decrease in the odds of being re-hospitalized themselves (95% CI 0.3, 0.9) at 21 months postpartum, compared to women taking unpaid or no leave. They also had 1.8 times the odds of doing well with exercise (95% CI 1.1, 3.0) and stress management (95% CI 1.1, 2.8), compared to women taking only unpaid leave. Conclusions for Practice Paid maternity leave significantly predicts lower odds of maternal and infant re-hospitalization and higher odds of doing well with exercise and stress management. Policies aimed at expanding access to paid maternity and family leave may contribute toward reducing socio-demographic disparities in paid leave use and its associated health benefits.



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Title Page/Sections Editors

Publication date: November 2017
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms, Volume 1860, Issue 11





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Chicago paramedic has responded to calls in every single city ambulance

By EMS1 Staff CHICAGO — A paramedic accomplished a personal goal by handling emergencies in each of the city's ambulances. FOX32 reported that Terry Sullivan spent decades responding to at least one call in every one of the ambulances in Chicago, and Wednesday he responded to a call in ambulance number 75. To achieve this goal that he made for himself 20 years ago, Sullivan traded shifts ...

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Shift Supervisor – Vitalink - New Hanover Regional Medical Center

Shift Supervisor – Vitalink Full-Time, Nights New Hanover Regional Medical Center Wilmington, NC New Hanover Regional Medical Center's Emergency Transport Services (ETS) is a recognized leader at both state and national levels. Recent awards include: the 2016 American Heart Association Mission Lifeline Gold Award Recognition for EMS, AirLink, and VitaLink, the 2016 EMS National Association ...

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Altered resting-state functional connectivity in patients with obsessive–compulsive disorder: A magnetoencephalography study

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Publication date: Available online 28 October 2017
Source:International Journal of Psychophysiology
Author(s): Min Jung Koh, Jaeho Seol, Jee In Kang, Bong-Soo Kim, Kee Namkoong, Jin Woo Chang, Se Joo Kim
Aberrant cortical–striatal–thalamic–cortical circuits have been implicated in the pathophysiology of obsessive−compulsive disorder (OCD). However, the neurobiological basis of OCD remains unclear. We compared patterns of functional connectivity in patients with OCD and in healthy controls using resting-state magnetoencephalography (MEG). Participants comprised 24 patients with OCD (21 men, 3 women) and 22 age- and sex-matched healthy controls (19 men, 3 women). Resting-state measurements were obtained over a 6-min period using a 152-channel whole-head MEG system. We examined group differences in oscillatory activity and distribution of functional cortical hubs based on the nodal centrality of phase-locking value (PLV) maps. Differences in resting-state functional connectivity were examined through PLV analysis in selected regions of interest based on these two findings. Patients with OCD demonstrated significantly lower delta band activity in the cortical regions of the limbic lobe, insula, orbitofrontal, and temporal regions, and theta band activity in the parietal lobe regions than healthy controls. Patients with OCD exhibited fewer functional hubs in the insula and orbitofrontal cortex and additional hubs in the cingulate and temporo-parietal regions. The OCD group exhibited significantly lower phase synchronization among the insula, orbitofrontal cortex, and cortical regions of the limbic lobe in all band frequencies, except in the delta band. Altered functional networks in the resting state may be associated with the pathophysiology of OCD. These MEG findings indicate that OCD is associated with decreased functional connectivity in terms of phase synchrony, particularly in the insula, orbitofrontal cortex, and cortical regions of the limbic lobe.



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Extraversion and cardiovascular responses to recurrent social stress: Effect of stress intensity

Publication date: Available online 28 October 2017
Source:International Journal of Psychophysiology
Author(s): Wei Lü, Wanying Xing, Brian M. Hughes, Zhenhong Wang
The present study sought to establish whether the effects of extraversion on cardiovascular responses to recurrent social stress are contingent on stress intensity. A 2×5×1 mixed-factorial experiment was conducted, with social stress intensity as a between-subject variable, study phase as a within-subject variable, extraversion as a continuous independent variable, and cardiovascular parameter (HR, SBP, DBP, or RSA) as a dependent variable. Extraversion (NEO-FFI), subjective stress, and physiological stress were measured in 166 undergraduate students randomly assigned to undergo moderate (n=82) or high-intensity (n=84) social stress (a public speaking task with different levels of social evaluation). All participants underwent continuous physiological monitoring while facing two consecutive stress exposures distributed across five laboratory phases: baseline, stress exposure 1, post-stress 1, stress exposure 2, post-stress 2. Results indicated that under moderate-intensity social stress, participants higher on extraversion exhibited lesser HR reactivity to stress than participants lower on extraversion, while under high-intensity social stress, they exhibited greater HR, SBP, DBP and RSA reactivity. Under both moderate- and high-intensity social stress, participants higher on extraversion exhibited pronounced SBP and DBP response adaptation to repeated stress, and showed either better degree of HR recovery or greater amount of SBP and DBP recovery after stress. These findings suggest that individuals higher on extraversion exhibit physiological flexibility to cope with social challenges and benefit from adaptive cardiovascular responses.



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The application of reward learning in the real world: Changes in the reward positivity amplitude reflect learning in a medical education context

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Publication date: Available online 27 October 2017
Source:International Journal of Psychophysiology
Author(s): Chad C. Williams, Kent G. Hecker, Michael K. Paget, Sylvain P. Coderre, Kelly W. Burak, Bruce Wright, Olave E. Krigolson
Evidence ranging from behavioural adaptations to neurocognitive theories has made significant advances into our understanding of feedback-based learning. For instance, over the past twenty years research using electroencephalography has demonstrated that the amplitude of a component of the human event-related brain potential – the reward positivity – appears to change with learning in a manner predicted by reinforcement learning theory (Holroyd and Coles, 2002; Sutton and Barto, 1998). However, while the reward positivity (also known as the feedback related negativity) is well studied, whether the component reflects an underlying learning process or whether it is simply sensitive to feedback evaluation is still unclear. Here, we sought to provide support that the reward positivity is reflective of an underlying learning process and further we hoped to demonstrate this in a real-world medical education context. In the present study, students with no medical training viewed a series of patient cards that contained ten physiological readings relevant for diagnosing liver and biliary disease types, selected the most appropriate diagnostic classification, and received feedback as to whether their decisions were correct or incorrect. Our behavioural results revealed that our participants were able to learn to diagnose liver and biliary disease types. Importantly, we found that the amplitude of the reward positivity diminished in a concomitant manner with the aforementioned behavioural improvements. In sum, our data support theoretical predictions (e.g., Holroyd and Coles, 2002), suggest that the reward positivity is an index of a neural learning system, and further validate that this same system is involved in learning across a wide range of contexts.



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Electrophysiological correlates of near outcome and outcome sequence processing in problem gamblers and controls

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Publication date: Available online 27 October 2017
Source:International Journal of Psychophysiology
Author(s): Natalie Ulrich, Johannes Hewig
The magnification of skill component in gambling as well as the gambler's and hot hand fallacies are gambling-related cognitive distortions. The magnification of skill component refers to the belief that one's ability can be used to win in gambling and that there is a reliable way to do so. The gambler's fallacy refers to the belief that a given outcome is unlikely to follow a preceding run of the same outcome (e.g. a coin coming up heads following a run of heads), while the hot hand fallacy refers to the belief that a streak of wins is going to continue. The biopsychological basis of these cognitive distortions can be analyzed by examining the processing of near outcomes and outcome sequences in gambling. Near outcomes refer to close wins and losses that would have almost resulted in the other outcome. The current study aims to investigate the electrophysiological basis of said cognitive distortions as well as its modulation by gambling problems. In the current study a group of problem gamblers and matched controls gambled on a wheel of fortune and a coin toss paradigm. The processing of near outcomes and outcome sequences was analyzed using event-related potentials (FRN, P300). Near outcomes evoked smaller P300 amplitudes in both groups. Furthermore, previous wins were associated with increased P300 amplitudes. Outcome closeness and previous outcome sequences did not modulate the FRN amplitude. The processing of near outcomes and outcome sequences was not modulated by gambling problems. General differences between problem gamblers and controls were found, with problem gamblers showing reduced peak-to-peak FRN amplitudes. This might point towards a generally more favorable evaluation of gambling outcomes in problem gamblers while the electrophysiological correlates of the analyzed cognitive distortions do not differ from those of healthy controls.



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New methods to optimally detect episodes of non-metabolic heart rate variability reduction as an indicator of psychological stress in everyday life

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Publication date: Available online 18 October 2017
Source:International Journal of Psychophysiology
Author(s): Stephen B.R.E. Brown, Jos F. Brosschot, Anke Versluis, Julian F. Thayer, Bart Verkuil
Cardiovascular disease is the leading cause of death in the western world. Frequent or chronic reductions in heart rate variability (HRV) are a powerful predictor of cardiovascular disease. Psychological stress has been suggested to be an important factor in the development of reduced HRV. Recently, Verkuil et al. (2016) introduced a laboratory-based method to measure additional HRV reduction in everyday life, and reductions in HRV related to psychological stress. In the current paper, we discuss alternative methods to detect additional HRV reductions, in real life data sets without the necessity of laboratory-based calibration, and even in existing data sets. All of these methods use a subset of 24h' worth of HRV and movement data to do so: either the first 10min of every hour, the full 24h, a combination of 10min from three consecutive hours, or a classification of level of movement. We also present a method to visualize HRV and movement data to be able to detect episodes of reduced additional HRV optically. The method that used the full 24h' worth of data detected the largest percentage of episodes of reduced additional HRV that actually match with self-reported stress levels, making this method the most promising.



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Do sport-related concussions result in long-term cognitive impairment? A review of event-related potential research

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Publication date: Available online 18 October 2017
Source:International Journal of Psychophysiology
Author(s): Christopher J. Brush, Peter J. Ehmann, Ryan L. Olson, Walter R. Bixby, Brandon L. Alderman
Sport-related concussions have become a major public health concern although the long-term effects on cognitive function remain largely unknown. Event-related potentials (ERPs) are ideal for studying the long-term impact of sport-related concussions, as they have excellent temporal precision and provide insight that cannot be obtained from behavioral or neuropsychological measures alone. We reviewed all available published studies that have used stimulus or response-locked ERPs to document cognitive control processes in individuals with a history of concussion. Collectively, cross-sectional evidence suggests consistent reductions in P3 amplitude in previously concussed individuals, as well as a possible impairment in cognitive processing speed (P3 latency) and error monitoring processes (ERN). The persistent neurophysiological changes found may be related to the number of previous concussions sustained and the time since injury. Future studies incorporating prospective research designs are warranted before definitive statements can be offered regarding the long-term impact of sport-related concussions on cognitive control.



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A case-control study of skin conductance biofeedback on seizure frequency and emotion regulation in drug-resistant temporal lobe epilepsy

Publication date: Available online 16 October 2017
Source:International Journal of Psychophysiology
Author(s): Iliana Kotwas, Aileen McGonigal, Stéphanie Khalfa, Mireille Bastien-Toniazzo, Fabrice Bartolomei, Jean-Arthur Micoulaud-Franchi




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Homozygous Mutation in ELMO2 may cause Ramon syndrome

We report on a girl, born to first cousin Lebanese parents, with intellectual disability, seizures, repeated gingivorrhagia, enlarged lower and upper jaws, overgrowth of the gums, high arched and narrow palate, crowded teeth, hirsutism of the back, large abdomen and a small umbilical hernia. Cysts of the mandible, fibrous dysplasia of bones, and enlarged adenoids causing around 60% narrowing of the nasopharyngeal airways were noted at radiographic examination. Her brother presented with the same features in addition to a short stature, an ostium secundum, and more pronounced intellectual disability. He died at the age of 8 years from a severe pulmonary infection and repeated bleeding episodes. A clinical diagnosis of Ramon syndrome was made.

Whole exome sequencing studies performed on the family revealed the presence of a novel homozygous missense mutation in ELMO2 gene, p.I606S in the affected individuals. Loss of function mutations in ELMO2 have been recently described in another clinically distinct condition: Primary intraosseous vascular malformation or intraosseous hemangioma, called VMOS. Review of the literature and differential diagnoses are discussed.

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Biallelic mutations in FLNB cause a skeletal dysplasia with 46,XY gonadal dysgenesis by activating β-catenin

Filamin B (FLNB) functions as a switch that can affect chrondrocyte development and endochondral bone formation through a series of signaling molecules and transcription factors that also affect Sertoli cell development. Here, we report a subject with a novel skeletal dysplasia and co-existing 46,XY gonadal dysgenesis and biallelic mutations in FLNB.

Whole exome sequencing was performed to identify mutations. Quantitative qPCR and flow variant assays were performed to quantify RNA, proteins and phosphorylated proteins. The TOPFLASH reporter was performed to quantify β-catenin activity.

Mutations were identified in the FLNB gene (FLNB:p.F964L, FLNB:p.A1577V). These mutations increased binding of FLNB protein to the MAP3K1 and RAC1 signal transduction complex and activated β-catenin and had different effects on phosphorylation of MAP kinase pathway intermediates and SOX9 expression.

Direct activation of β-catenin through the FLNB-MAP3K1-RAC1 complex by FLNB mutations is a novel mechanism for causing 46,XY gonadal dysgenesis. The mechanism of action varies from those reported previously for loss-of-function mutations in SOX9 and gain-of-function mutations in MAP3K1.

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The GAS5/miR-222 Axis Regulates Proliferation of Gastric Cancer Cells Through the PTEN/Akt/mTOR Pathway

Abstract

Background

Several lines of evidence have indicated that growth arrest-specific transcript 5 (GAS5) functions as a tumor suppressor and is aberrantly expressed in multiple cancers. GAS5 was found to be downregulated in gastric cancer (GC) tissues, and ectopic expression of GAS5 inhibited GC cell proliferation.

Aims

The present study aimed to explore the underlying mechanisms of GAS5 involved in GC cell proliferation.

Methods

GAS5 and miR-222 expressions in GC cell lines were estimated by quantitative real-time polymerase chain reaction. The effects of GAS5 and miR-222 on GC cell proliferation were assessed by MTT assay and 5-bromo-2-deoxyuridine (BrdU) incorporation assays. The interaction between GAS5 and miR-222 was confirmed by luciferase reporter assay and RNA immunoprecipitation assay. The protein levels of the phosphatase and tensin homolog (PTEN), phosphorylated protein kinase B (Akt) (p-Akt), Akt, phosphorylated mammalian target of rapamycin (mTOR) (p-mTOR), and mTOR were determined by western blot.

Results

GAS5 was downregulated and miR-222 was upregulated in GC cells. GAS5 directly targeted and suppressed miR-222 expression. GAS5 overexpression and miR-222 inhibition suppressed cell proliferation, increased PTEN protein level and decreased p-Akt and p-mTOR protein levels in GC cells while GAS5 knockdown and miR-222 overexpression exhibited the opposite effects. Moreover, mechanistic analyses revealed that GAS5 regulated GC cell proliferation through the PTEN/Akt/mTOR pathway by negatively regulating miR-222.

Conclusions

GAS5/miR-222 axis regulated proliferation of GC cells through the PTEN/Akt/mTOR pathway, which facilitated the development of lncRNA-directed therapy against this deadly disease.



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BTG2 Is Down-Regulated and Inhibits Cancer Stem Cell-Like Features of Side Population Cells in Hepatocellular Carcinoma

Abstract

Background

Our previous study found that B cell translocation gene 2 (BTG2) was hyper-methylated and down-regulated in side population (SP) cells of hepatocellular carcinoma (HCC) cell line. However, its clinical significances and biological impacts on HCC SP cells remained unclear.

Aims

To investigate the prognostic value of BTG2 gene in HCC and its influences on cancer stem cells (CSCs)-like traits of HCC cell line SP cells.

Methods

BTG2 expression in human HCC and adjacent non-cancerous tissues was detected by immunohistochemical staining and quantitative real-time PCR, and also obtained from GEO and TCGA data. Its prognostic values were assessed. Its biological influences on HCC cell line SP cells were evaluated using cell viability, cell cycle, plate clone-forming assay, and chemoresistance in vitro and tumorigenicity in vivo.

Results

BTG2 expression was significantly suppressed in human HCC compared to adjacent non-cancerous tissues. BTG2 expression was correlated with TNM stage, tumor size and vascular invasion. Lower expression of BTG2 was associated with poorer overall survival and disease-free survival. In vitro, overexpression of BTG2 substantially suppressed cell proliferation and accumulation of HCC cell line SP cells in G0/G1 phase. Colony formation ability was markedly suppressed by BTG2 overexpression. Moreover, sensitivity of HCC cell line SP cells to 5-fluorouracil was substantially increased by overexpression of BTG2. Furthermore, tumorigenicity of HCC cell line SP cells transfected with BTG2 plasmids was significantly reduced in vivo.

Conclusions

BTG2 gene could regulate the CSC-like traits of HCC cell line SP cells, and it represented as a molecular prognostic marker for HCC.



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Enteric Glial Dysfunction Evoked by Apolipoprotein E Deficiency Contributes to Delayed Gastric Emptying

Abstract

Background and Aim

Diabetes is the main cause of gastroparesis accompanying decreased neuronal nitric oxide synthase (nNOS) in myenteric ganglia of the stomach. Decreased nNOS expression in the stomach also results from defects in apolipoprotein E (ApoE), which is secreted by astrocytes and has neuroprotective effects on the central nervous system. However, the roles of ApoE and enteric glial cells on gastric motility are uncertain. In this study, ApoE and enteric glial cell alterations in gastroparesis were investigated.

Methods

Type 2 diabetic (db/db) mice and ApoE-knockout mice were analyzed. Gastric emptying was measured using the 13C acetic acid breath test. Expression levels of the pan-neuronal marker, protein gene product 9.5 (PGP 9.5), and glial marker, glial fibrillary acidic protein (GFAP) were examined by immunohistochemistry. Neural stem cells (NSCs) were injected into the gastric antral wall of ApoE-knockout mice.

Results

Delayed gastric emptying was observed in 27% of db/db mice with significant decreases in serum ApoE levels and GFAP expression in the gastric antrum. Gastric emptying was also delayed in ApoE-knockout mice, with a significant decrease in GFAP expression, but no change in PGP 9.5 expression. Transplantation of NSCs improved gastric emptying in ApoE-knockout mice through supplementation of GFAP-positive cells.

Conclusions

Our results suggest that decreased enteric glial cells in ApoE-knockout mice are crucial for development of delayed gastric emptying, and NSC transplantation is effective in restoring myenteric ganglia and gastric motility.



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Ascites Neutrophil Gelatinase-Associated Lipocalin Identifies Spontaneous Bacterial Peritonitis and Predicts Mortality in Hospitalized Patients with Cirrhosis

Abstract

Background

Neutrophil gelatinase-associated lipocalin (NGAL) is a marker of both tissue injury and infection. Urine NGAL levels strongly predict acute kidney injury and mortality in patients with cirrhosis, but ascites NGAL is not well characterized. We hypothesized that ascites NGAL level is a marker of spontaneous bacterial peritonitis (SBP) and mortality risk in patients with cirrhosis.

Methods

Hospitalized patients with cirrhosis and ascites undergoing diagnostic paracentesis were prospectively enrolled and followed until death or discharge. Patients with secondary peritonitis, prior transplantation, or active colitis were excluded. NGAL was measured in the ascites and serum. Ascites NGAL level was evaluated as a marker of SBP (defined as ascites absolute neutrophil count > 250 cells/mm3) and predictor of in-patient mortality.

Results

A total of 146 patients were enrolled, and of these, 29 patients (20%) had SBP. Baseline characteristics were similar between subjects with and without SBP. Median (IQR) ascites NGAL was significantly higher in patients with SBP compared to those without SBP (221.3 [145.9–392.9] vs. 139.2 [73.9–237.2], p < 0.01). Sixteen (11%) patients died in the hospital. In the final multivariable model, ascites NGAL (OR 1.02 per 10 units, p < 0.01) remained predictive of in-hospital mortality, controlling for SBP (OR 9.76, p < 0.01) and MELD (OR 1.11, p = 0.01). In ROC analysis, ascites NGAL had an AUC of 0.79 for inhospital mortality, and the final model including ascites NGAL, MELD, and SBP had an AUC of 0.94.

Conclusions

Ascites NGAL level may be a biomarker of peritonitis in hospitalized patient with cirrhosis and an independent predictor of short-term in-hospital mortality, even controlling for SBP and MELD.



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Extra- and intracranial blood flow regulation during the cold pressor test: influence of age

We determined how the extra- and intracranial circulations respond to generalized sympathetic activation evoked by a cold pressor test (CPT) and whether this is affected by healthy aging. Ten young [23 ± 2 yr (means ± SD)] and nine older (66 ± 3 yr) individuals performed a 3-min CPT by immersing the left foot into 0.8 ± 0.3°C water. Common carotid artery (CCA) and internal carotid artery (ICA) diameter, velocity, and flow were simultaneously measured (duplex ultrasound) along with middle cerebral artery and posterior cerebral artery mean blood velocity (MCAvmean and PCAvmean) and cardiorespiratory variables. The increases in heart rate (~6 beats/min) and mean arterial blood pressure (~14 mmHg) were similar in young and older groups during the CPT (P < 0.01 vs. baseline). In the young group, the CPT elicited an ~5% increase in CCA diameter (P < 0.01 vs. baseline) and a tendency for an increase in CCA flow (~12%, P = 0.08); in contrast, both diameter and flow remained unchanged in the older group. Although ICA diameter was not changed during the CPT in either group, ICA flow increased (~8%, P = 0.02) during the first minute of the CPT in both groups. Whereas the CPT elicited an increase in MCAvmean and PCAvmean in the young group (by ~20 and ~10%, respectively, P < 0.01 vs. baseline), these intracranial velocities were unchanged in the older group. Collectively, during the CPT, these findings suggest a differential mechanism(s) of regulation between the ICA compared with the CCA in young individuals and a blunting of the CCA and intracranial responses in older individuals.

NEW & NOTEWORTHY Sympathetic activation evoked by a cold pressor test elicits heterogeneous extra- and intracranial blood vessel responses in young individuals that may serve an important protective role. The extra- and intracranial responses to the cold pressor test are blunted in older individuals.



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Functional assessment of the diaphragm by speckle tracking ultrasound during inspiratory loading

Assessment of diaphragmatic effort is challenging, especially in critically ill patients in the phase of weaning. Fractional thickening during inspiration assessed by ultrasound has been used to estimate diaphragm effort. It is unknown whether more sophisticated ultrasound techniques such as speckle tracking are superior in the quantification of inspiratory effort. This study evaluates the validity of speckle tracking ultrasound to quantify diaphragm contractility. Thirteen healthy volunteers underwent a randomized stepwise threshold loading protocol of 0–50% of the maximal inspiratory pressure. Electric activity of the diaphragm and transdiaphragmatic pressures were recorded. Speckle tracking ultrasound was used to assess strain and strain rate as measures of diaphragm tissue deformation and deformation velocity, respectively. Fractional thickening was assessed by measurement of diaphragm thickness at end-inspiration and end-expiration. Strain and strain rate increased with progressive loading of the diaphragm. Both strain and strain rate were highly correlated to transdiaphragmatic pressure (strain r2 = 0.72; strain rate r2 = 0.80) and diaphragm electric activity (strain r2 = 0.60; strain rate r2 = 0.66). We conclude that speckle tracking ultrasound is superior to conventional ultrasound techniques to estimate diaphragm contractility under inspiratory threshold loading.

NEW & NOTEWORTHY Transdiaphragmatic pressure using esophageal and gastric balloons is the gold standard to assess diaphragm effort. However, this technique is invasive and requires expertise, and the interpretation may be complex. We report that speckle tracking ultrasound can be used to detect stepwise increases in diaphragmatic effort. Strain and strain rate were highly correlated with transdiaphragmatic pressure, and therefore, diaphragm electric activity and speckle tracking might serve as reliable tools to quantify diaphragm effort in the future.



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Green tea epigallocatechin gallate enhances cardiac function restoration through survival signaling expression in diabetes mellitus rats with autologous adipose tissue-derived stem cells

The present study tests a hypothesis that cardioprotective effects mediated by autologous adipose-derived stem cells (ADSC) in rats afflicted with insulin-dependent diabetes mellitus (IDDM) may be synergistically enhanced by oral treatment with green tea epigallocatechin gallate (EGCG). Wistar rats were divided into sham, DM, DM+ADSC (autologous transplanted 1 x 106 cells per rat), and DM+ADSC+E (E, green tea oral administration EGCG). Heart tissues were isolated from all rats, and investigations were performed after 2-mo treatment. In the sham, DM, and DM+ADSC groups, we found that DM induced cardiac dysfunction (sham and DM) and autologous ADSC transplantation could partially recover cardiac functions (DM and DM+ADSC) in DM rats. Compared with DM+ADSC, significant improvement in cardiac functions can be observed in DM+ADSC+E in echocardiographic data, histological observations, and even cellular protein expression. Oral green tea EGCG administration and autologous ADSC transplantation show synergistically beneficial effects on diabetic cardiac myopathy in DM rats.

NEW & NOTEWORTHY Cardiomyopathy can be induced in rats with diabetes mellitus (DM). Heart function can be restored in DM rats with adipose-derived stem cell treatment. Oral epigallocatechin gallate (EGCG) administration synergistically enhances cardiac function in DM rats with stem cell treatment. The EGCG and stem cell treatment cross-effect occurs via survival protein expression.



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An assessment of the autonomic nervous system in the electrohypersensitive population: a heart rate variability and skin conductance study

The aim of the study was twofold: first, to compare the activity of the autonomic nervous system (ANS) between the population self-declared as electrohypersensitive (EHS) and their matched control individuals without intended exposure to electromagnetic fields (EMF). The second objective was to determine whether acute exposure to different radiofrequency signals modifies ANS activity in EHS. For that purpose, two different experiments were undertaken, in which ANS activity was assessed through heart rate variability (HRV) and skin conductance (SC). In the first experiment, a comparison between the EHS group (n = 30) and the control group (n = 25) showed that the EHS has an increased number of responses to auditory stimuli as measured by skin conductance activity, and that none of the short-term heart rate variability parameters differ between the two matched study groups. The second experiment, performed in a shielded chamber, involved 10 EHS from the first experiment. The volunteers participated in two different sessions (sham and exposure). The participants were consecutively exposed to four EMF signals (GSM 900, GSM 1800, DECT, and Wi-Fi) at environmental level (1 V/m). The experiment was double blinded and counterbalanced. The HRV variables studied did not differ between the two sessions. Concerning electrodermal activity, the data issued from skin conductance and tonic activity did not differ between the sessions, but showed a time variability. In conclusion, the HRV and SC profiles did not significantly differ between the EHS and control populations under no exposure. Exposure did not have an effect on the ANS parameters we have explored.

NEW & NOTEWORTHY This study provided analysis on the skin conductance parameters using a newly developed method (peak/min, extraction of skin conductance responses) that had not been performed previously. Additionally, the skin conductance signal was decomposed, considering tonic and phasic activities to be a distinct compound. Moreover, this is the first time a study has been designed into two steps to understand whether the autonomic nervous system is disturbed in the EHS population.



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Intraoperative administration of dexmedetomidine reduced the postoperative catheter-related bladder discomfort and pain in patients undergoing lumbar microdiscectomy

Abstract

Purpose

We aimed to evaluate the effect of the intraoperative dexmedetomidine (DEX) on the incidence and severity of catheter-related bladder discomfort (CRBD) after non-urologic surgery. The secondary aim was to find the correlation between the levels of CRBD and postoperative pain sensation.

Methods

Adult male patients undergoing lumbar microdiscectomy were enrolled. Patients were randomized into two groups. After propofol administration, group D (n = 35) received DEX at a loading dose of 1 μg/kg over 10 min, followed by a continuous infusion of 0.3–0.5 μg/kg/h until the end of surgery. In group C (n = 35), an identical volume of 0.9% saline was infused in the same manner. Induction and maintenance of anesthesia were standardized. The incidence and severity of CRBD, postoperative pain, and adverse effects were assessed at 1, 3, and 6 h after surgery.

Results

The incidence of CRBD was significantly lower in group D than in group C at 1 h (34.3 vs. 62.9%, P = 0.017), 3 h (25.7 vs. 60%, P = 0.004), and 6 h (17.1 vs. 54.3%. P = 0.001) postoperatively. The severity of CRBD at 1, 3, and 6 h postoperatively was less in group D than in group C. Postoperative pain score was significantly lower in group D than in group C at 3 and 6 h postoperatively. Adverse events were comparable between two groups. There was a significant correlation between the severity of CRBD and postoperative pain score.

Conclusions

Intraoperative administration of DEX is a safe and effective practice for the prevention of CRBD after lumbar microdiscectomy and can reduce postoperative pain.



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Racial Residential Segregation and STI Diagnosis Among Non-Hispanic Blacks, 2006–2010

Abstract

Sexually transmitted infections (STI) disproportionately impact non-Hispanic blacks. Racial residential segregation has been associated with negative socioeconomic outcomes. We sought to examine the association between segregation and STI diagnosis among blacks. The National Survey of Family Growth and US Census served as data sources. Five distinct dimensions represent segregation. The association between STI diagnosis and each segregation dimension was assessed with multilevel logistic regression modeling. 305 (7.4%) blacks reported STI diagnosis during the past 12 months. Depending on the dimension, segregation was a risk factor [dissimilarity aOR 2.41 (95% CI 2.38–2.43)] and a protective factor [isolation aOR 0.90 (95% CI 0.89–0.91)] for STI diagnosis. Findings suggest that STI diagnosis among blacks is associated with segregation. Additional research is needed to identify mechanisms for how segregation affects STI diagnosis and to aid in the development of interventions to decrease STIs.



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Delayed Copying of Unfamiliar Outline Images: Analysis of Stimulus Presentation-Related Potentials

High-density EEG recordings were made during performance of tasks consisting of delayed motor reproduction of unfamiliar trajectory outline images, with evaluation of event-related potentials (ERP) associated with presentation of these images and a command sound signal (a short sound). A total of 22 right-handed adult subjects took part in the study, which consisted of five blocks of trials with different delays T between the command sound signal and the end of presentation of trajectory outlines (T = 0, 500, 1000, 2000, and 4000 msec). analysis of ERP showed that in contrast to potentials associated with trajectory outline presentation, potentials linked with presentation of the command signals depended on delay duration T. Analysis of the cortical sources of these potentials showed that the changes seen in the sensor space corresponded to a marked monotonic increase in the reactivity of the orbital cortex of the right hemisphere and bilaterally symmetrical increases in the reactivity of the dorsal areas of the sensorimotor cortex. These data are assessed in the framework of the hypothesis of transformations of the internal representation of the trajectory from a sensory-specific format to an abstract sensory- and motor-nonspecific format occurring during the period of holding in working memory.



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Total intravenous anesthesia vs single pharmacological prophylaxis to prevent postoperative vomiting in children: A systematic review and meta-analysis

Summary

Background

Postoperative nausea and postoperative vomiting are frequent but often missed complications after general anesthesia in pediatric patients. Because inhaled anesthetics are known to trigger postoperative vomiting, total intravenous anesthesia is often administered in high-risk children to avoid the use of inhalational anesthesia. Since inhalational anesthesia might be advantageous in some situations, the question is raised whether administration of pharmacological prophylaxis offers equal protection from postoperative vomiting compared with total intravenous anesthesia alone.

Aim

The aim of this systematic review was to compare total intravenous anesthesia with single-drug pharmacological prophylaxis for the protection of postoperative vomiting in pediatric patients.

Methods

We conducted a systematic review (EMBASE, MEDLINE, and CENTRAL) with meta-analysis on randomized controlled trials including patients <18 years of age undergoing general anesthesia, with one group receiving propofol-based total intravenous anesthesia and another group receiving inhalational anesthesia with single pharmacological prophylaxis. Primary outcome was the overall incidence for postoperative vomiting. Secondary outcomes included early and late postoperative vomiting, the need for postoperative antiemetic medication, time to first oral intake, duration of stay in the postanesthesia care unit, and any adverse events defined as such by the respective authors. Risk ratios (RR) or mean differences (MD) with 95% confidence intervals (95% CI) were calculated using a random effects model with inverse variance weighting.

Results

Four randomized controlled trials including 558 children were included in the final analysis. All patients underwent strabismus surgery. Total intravenous anesthesia and single pharmacological prophylaxis were equally effective in preventing overall postoperative vomiting (RR 0.99 [95% CI 0.77; 1.27]; 4 trials), as well as vomiting in the early (1.48 [0.78; 2.83]; 4 trials) and late (0.89 [0.56;1.42]; 2 trials) postoperative period. There was no difference in the need for postoperative antiemetic medication. Although patients resumed drinking and eating significantly earlier following total intravenous anesthesia (MD −1.40 hours [−2.01; −0.80], P < .001), the duration of PACU stay did not differ between groups. The incidence of intraoperative oculocardiac reflex was the only reported adverse event, which was more likely to occur after total intravenous anesthesia (1.86 [1.01; 3.41]).

Conclusion

Single pharmacological prophylaxis appears equally effective compared with total intravenous anesthesia in preventing postoperative vomiting in pediatric patients. However, during strabismus surgery, total intravenous anesthesia increases the risk for bradycardia due to oculocardiac reflex. Thus, when anesthesia is maintained with inhalational anesthetics, its emetogenic effects can sufficiently be compensated by the addition of a single prophylactic antiemetic medication.



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