Segmentation of Whole-Body Images into Two Compartments in Model for Bone Marrow Dosimetry Increases the Correlation with Hematological Response in 177Lu-DOTATATE Treatments

Cancer Biotherapy & Radiopharmaceuticals , Vol. 0, No. 0.


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Gender, power and leadership: the effect of a superior's gender on respiratory therapists' ability to challenge leadership during a life-threatening emergency.

Gender, power and leadership: the effect of a superior's gender on respiratory therapists' ability to challenge leadership during a life-threatening emergency.

Br J Anaesth. 2017 Oct 01;119(4):697-702

Authors: Pattni N, Bould MD, Hayter MA, McLuckie D, Noble LMK, Malavade A, Friedman Z

Abstract
Background: Effective communication within teams is crucial, especially in crisis situations. Hierarchy gradients between team members can contribute to communication failures and are influenced by many factors. The effect of gender on team performance has not been well studied. The objective of this study was to examine the effect of the physician's gender on respiratory therapists' ability to effectively challenge clearly incorrect clinical decisions during a life-threatening crisis.
Methods: Respiratory therapists were recruited to take part in a high-fidelity simulation of can't-intubate can't-oxygenate scenarios. They were randomized into two groups, either assisting a male or a female anaesthetist in managing an airway crisis during which the anaesthetist made incorrect clinical decisions. Two independent raters scored the performances using the modified Advocacy-Inquiry Score (min 1, max 6).
Results: Twenty-nine subjects completed the study. The median best challenge score when the staff anaesthetist was female was 4 (3-5 IQR [2-6 range]) compared with 3 (3-3[0-3]) for challenges to a male anaesthetist (P=0.017). The median of the total challenges against a female staff member 11 (7.3-14.8 [2-18]) was significantly higher compared with 4 (3.5-7 [2-11.5]) for a male staff (P=0.006).
Conclusions: The study showed a significant effect of superiors' gender on a respiratory therapist's ability to challenge leadership. A female staff anaesthetist was challenged more often and with greater assertiveness and effectiveness. This has implications for an educational intervention targeting the ability to challenge a wrong decision by a supervisor and emphasizing the effect of gender on the willingness to speak up.

PMID: 29121299 [PubMed - in process]

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77. Altered H-reflex following pulsed radiofrequency in patients with lumbosacral radicular pain

Pulsed radiofrequency (PRF) short-lasting bursts allow pain modulation with no tissue necrosis. Neurophysiological evaluation of PRF possible effects has not been described yet. Objective of this study was to investigate the effects of PRF on sensory nerve conduction and H-reflex in patients with lumbosacral radicular pain.We evaluated 23 patients with unilateral L5-S1 root pain who underwent PRF at the corresponding level of radicular symptoms. PRF was applied through a multifunctional electrode introduced via trans-sacral access for 240s.

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76. Vestibular evoked myogenic potentials (c-VEMPS AND o-VEMPS) in the diagnosis of vestibular neuritis

Vestibular neuritis (VN) is a common neuro-otologic syndrome characterized by acute prolonged vertigo lasting several days, nausea, vomiting. Vestibular-evoked myogenic potentials (VEMPs) are becoming the better diagnostic tool in this pathology. VEMPs can be recorded from tonically contracted neck muscles by acoustic and galvanic stimulation or forehead tap (cervical VEMPs, c-VEMPs) or from extraocular muscles, using the same stimuli. (ocular VEMPs, o-VEMPs). The aim of our study was to assess the reliability of c-VEMPs and o-VEMPs in the diagnosis of VN.

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88. The sympathetic skin response as a predictor of recovery of ulnar nerve lesion at wrist

The aim of the study was to evaluate, in the ulnar nerve injuries, distally to the elbow, the role of monitoring the function of sudomotor fibers assessed by Sympathetic Skin Response (SSR) during recovery after surgical treatment and rehabilitation.We recruited 31 patients admitted for rehabilitation after traumatic wrist injury with ulnar nerve and artery lesions. Patients with other nerves or artery involved were excluded. All patients underwent surgical primary nerve repair within 72h and the same rehabilitative program.

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46. Somatosensory evoked potentials in neonatal hypoxic-ischemic encephalopathy

Somatosensory evoked potentials (SEPs) are considered a useful exam for the prognosis of newborns with hypoxic-ischemic encephalopathy (HIE) treated with hypothermia. We examined our data in respect to the MRI, considering the repetitivity of the abnormalities of the SEPs in the time. Of a large number of newborns evaluated with HIE treated with hypothermia in both centers we considered a group of patients with SEPs and MRI just after the completion of hypothermia. 10 patients with abnormal SEPs have repeated the exam after a period ranging from 4days to 7months: in 7 cases the SEPs were normalized (in 3 newborns just after few weeks).

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1. Laser evoked potential in clinical practice: The diagnostic field in small fiber neuropathy

Small fiber neuropathy (SFN) is frequently encountered in clinical practice. Due to the small nerve fiber characteristics, the diagnosis requires the use of not conventional tests like skin biopsy, Quantitative sensory testing (QST) and Laser Evoked Potentials (LEPs). The aim of this study was to evaluate the diagnostic value of A-delta LEPs in clinical practice in a large cohort of patients with diagnosis of "definite" SFN.We screened 296 patients evaluated in our institution with confirmed diagnosis of sensory neuropathy.

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38. Different behavior of cerebrospinal fluid amyloid-β and tau levels in patients with post-traumatic disorders of consciousness

Traumatic brain injury (TBI) is a major risk factor for Alzheimer disease (AD). Although the mechanisms that lead to AD after a TBI are largely unknown, changes in amyloid- (A metabolism and abnormal tau phosphorylation are probably involved. In this study, we evaluated A, total tau (t-tau), and phosphorylated tau (p-tau) levels in the cerebrospinal fluid (CSF) of 15 patients who developed a prolonged disorder of consciousness after a severe TBI (mean time from TBI 271.6±176.5days; range 92–578days).

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2. Pain catastrophizing and features of cortical response to painful stimuli in fibromyalgia

Gamma Band Oscillations (GBO) after laser stimuli are currently considered a correlate of subjective pain perception. Habituation of laser evoked potentials (LEPs) is reduced in patients with central amplification of pain stimuli.To correlate LEPs habituation and GBO induced by laser stimulation with subjective pain rating and pain catastrophizing in patients with Fibromyalgia (FM) and controls.We recorded LEPs in 30 FM patients and 15 healthy controls by stimulating the dorsum of the right hand.

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Announcement

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3. Immunofluorescence characterization of skin nerve misfolded α-synuclein in different synucleinopathies: A confocal study

Intraneural misfolded α-synuclein (syn) characterized different synucleinopathies such as pure autonomic failure (PAF), idiopathic Parkinson disease (IPD) and dementia with Lewy Bodies (DLB). The aim of this study is to characterize by immunofluorescence the skin intraneural α-synuclein (syn) deposits in PAF, IPD and DLB to ascertain conformation-specific differences which may justify a different clinical phenotype.We identified a total of 21 skin intraneural abnormal syn deposits in PAF (3 patients), 22 in IPD (8 patients) and 40 in DLB (7 patients).

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80. Small fiber neuropathy in Amyotrophic Lateral Sclerosis: Contribution of laser-evoked potentials and skin biopsy

Increasing evidence suggests that amyotrophic lateral sclerosis (ALS) is a multisystem neurodegenerative disorder, also determining a small fiber neuropathy (SFN) as recognized by skin biopsy studies in distal legs, irrespective of the disease duration. This study aimed at evaluating the performance of a battery of neurophysiological and morphological tests assessing the small fiber loss occurring in ALS.We recruited 10 consecutive ALS patients (5M, age 64.9±7.3, duration of symptoms 29.1±20.7months).

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4. Does small fiber pathology in PD change over time?

Small fiber pathology is part of the clinical picture of PD. Cross-sectional studies have shown no correlation between intraepidermal nerve fiber (IENF) density and patient disease duration and severity. However, it is not known whether IENF density changes over time. We aimed to assess the progression of small fiber pathology in PD patients along the disease course.We assessed epidermal innervation at time 0 and after 1–9years (mean 3.5) in 17 PD patients (M/F=11/6, age=64.4±15.3) leg on punch biopsies.

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42. Functional Tremor: When neurophysiology makes the difference

Functional tremor (FT) still remains a challenge for clinicians; here, we propose a simple and fast test battery for an early diagnosis of FT.We enrolled ten patients with probable FT and compared them with patients with essential tremor (ET) or tremor-dominant Parkinson's Disease (PD). Surface polymyography was bilaterally performed with arms relaxed, with arms outstretched at shoulder level without or with a 500-g mass attached to the wrist ("mass loading"), during voluntary contralateral motor activation and while performing ballistic movements.

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5. Vocal cord paralysis in children: A new neurophysiological approach for diagnosis and functional prognosis

To establish the possibility to use the methodology of recording corticobulbar motor evoked potentials (CoMEPs) from cricothyroid muscles (CTHY) and vocal cord elicited by transcranial electrical stimulation (TES), as diagnostic tool for predicting function recovery in children with vocal fold immobility (VFI).We included six children (mean age: 4.7years; range: 2–9years) with diagnosis of cord immobility that underwent video-fibro-endoscopy procedure. Under general anaesthesia, we used TES by stimulation over C3/Cz or C4/Cz to elicit CoMEPs.

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50. Inter hemispheric comparison of PAS-induced cortical plasticity: A pilot study in healthy subjects

Dystonia is considered a "network" disease with an abnormal cortical plasticity induced by by paired-associated-stimulation. In this study, we applied the PAS-TMS paradigm in healthy subjects, with the aim to collect reliable data from both hemispheres in order to put the basis to future application in focal dystonia.We studied 7 healthy subjects (4 females; mean age 32.33±6.79years). We applied electrical stimulatrion of median nerve electrical and MEPs from both abductor pollicis brevis (APB) and first dorsal interosseous (FDI) muscles (2), following Stefan et al.

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6. Trigeminal neuralgia typical and atypical. A disease or two?

Trigeminal Neuralgia (TN) is a clinical condition characterized by a sudden, usually unilateral, brief, stabbing, recurrent pain with a distribution consistent with one or more divisions of the fifth cranial nerve. In the classical form, the genesis of paroxysmal pain has been attributed to areas of focal demyelination due to vascular compression on the nerve. The 20–50% of patients with TN have an atypical form characterized by the presence of constant pain, often described as burning continuous or sub-continuous, as well as paroxysmal pain.

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92. Myogenic vestibular-evoked potentials: An extension of the assessment protocol

Vestibular-Evoked-Myogenic-Potentials (VEMPs) represent a muscular response following an intense acoustic stimulation. The cVEMPs explore a reflex arc (from saccule to the neck musculature) and usually are only recorded from sternocleidomastoideus (SCM).1 They are non-invasive, well-tolerated, simple-to-perform and very useful in several diseases. The normal response is a biphasic complex P13/N23. We propose a more extensive protocol. We recruited 31 subjects (mean age±SD:50.8±19.0). VEMPs were recorded symmetrically and simultaneously through surface electromyography from SCM, splenius (SPL), trapezius (TRP) and orbicularis oculi (OO).

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7. Cathodal transcranial direct current stimulation reduces seizure frequency and modulates brain functional connectivity with drug-resistant temporal lobe epilepsy: A sham controlled study

Cathodal transcranial direct current stimulation (ctDCS) is a technique able to non-invasively inhibit cortical excitability, which is abnormally increased in epilepsy, but its efficacy in reducing seizures and in modulating epileptic network is still under debate.We evaluated the efficacy of 20-min 1mA ctDCS vs sham-tDCS in reducing seizure frequency and in modulating the functional connectivity (FC) between epileptic focus (EF) and the other cortical areas, in 10 temporal drug-resistant epilepsy (DRE) patients.

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84. Atypical presentation of Guillain-Barré syndrome in childhood: A clinical case

A 31-months old child was admitted with a 4-day history of fever and weakness. The initial neurological examination revealed a meningeal syndrome with neck stiffness, without consciousness impairment. Head CT was normal. Analysis of CSF showed only increased level of proteins. Based on clinical manifestations, an empirical antibiotics and antiviral therapy was started. During the following 48h, a progressive flaccid tetraparesis occurred. An ENG/EMG study was performed to exclude a peripheral involvement that showed decreased CMAP amplitude, partial motor conduction blocks/pseudo-blocks signs in the forearm segment of median and ulnar nerves and absence of F-waves.

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8. Neurophysiological comparison among tonic, high frequency and burst spinal cord simulation: Novel insights into spinal and brain mechanisms of action

Spinal cord Stimulation (SCS) is an effective option for neuropathic pain treatment. New technological developments, as high-frequency (HF) and Theta Burst Stimulation (TBS), have shown promising results, although putative mechanisms of action are still debated.Twenty-five patients with lower back pain were enrolled and underwent LF, HF and TBS. LEPs were recorded by using a Nd:YAG laser: amplitudes and latencies of the main two components (N1, N2/P2) were compared among different experimental conditions.

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36. Bilateral loss of cortical SEPs predict severe MRI lesions in neonatal hypoxic ischemic encephalopathy treated with hypothermia

The introduction of therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy call for reevaluation of the prognostic role of SEPs. This study aimed to test the prognostic value of SEPs using as outcome measure MRI severity and patterns of injury.Neonates eligible for hypothermia were recruited from four Italian Centers if they performed SEP and MRI at 4–15days of life. SEPs were scored as: normal (bilaterally recorded/unilaterally absent N20) or altered (bilaterally absent N20). The severity of brain injury was measured using a validated MRI scoring system for acute and sub-acute signal abnormalities.

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Egg Case Silk Gene Sequences from Argiope Spiders: Evidence for Multiple Loci and a Loss of Function Between Paralogs

Spiders swath their eggs with silk to protect developing embryos and hatchlings. Egg case silks, like other fibrous spider silks, are primarily composed of proteins called spidroins (spidroin = spider-fibroin). Silks, and thus spidroins, are important throughout the lives of spiders, yet the evolution of spidroin genes has been relatively understudied. Spidroin genes are notoriously difficult to sequence because they are typically very long (10 or more kilobases of coding sequence) and highly repetitive. Here, we investigate the evolution of spider silk genes through long-read sequencing of BAC clones. We demonstrate that the silver garden spider Argiope argentata has multiple egg case spidroin loci with a loss of function at one locus. We also use degenerate PCR primers to search the genomic DNA of congeneric species and find evidence for multiple egg case spidroin loci in other Argiope spiders. Comparative analyses show that these multiple loci are more similar at the nucleotide level within a species than between species. This pattern is consistent with concerted evolution homogenizing gene copies within a genome. More complicated explanations include convergent evolution or recent independent gene duplications within each species.

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A Primer on the Use of Equivalence Testing for Evaluating Measurement Agreement.

Purpose: Statistical equivalence testing is more appropriate than conventional tests of difference to assess the validity of physical activity (PA) measures. This paper presents the underlying principles of equivalence testing and gives three examples from PA and fitness assessment research. Methods: The three examples illustrate different uses of equivalence tests. Example 1 uses PA data to evaluate an activity monitor's equivalence to a known criterion. Example 2 illustrates the equivalence of two field-based measures of physical fitness with no known reference method. Example 3 uses regression to evaluate an activity monitor's equivalence across a suite of 23 activities. Results: The examples illustrate the appropriate reporting and interpretation of results from equivalence tests. In the first example, the mean criterion measure is significantly within +/-15% of the mean PA monitor. The mean difference is 0.18 METs and the 90% confidence interval of [-0.15, 0.52] is inside the equivalence region of [-0.65, 0.65]. In the second example, we chose to define equivalence for these two measures as a ratio of mean values between 0.98 and 1.02. The estimated ratio of mean VO2 values is 0.99, which is significantly (p=0.007) inside the equivalence region. In the third example, the PA monitor is not equivalent to the criterion across the suite of activities. The estimated regression intercept and slope are -1.23 and 1.06. Neither confidence interval is within the suggested regression equivalence regions. Conclusions: When the study goal is to show similarity between methods, equivalence testing is more appropriate than traditional statistical tests of differences (e.g., ANOVA and t-tests). This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. (C) 2017 American College of Sports Medicine

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Dopaminergic Genetic Variants and Voluntary Externally Paced Exercise Behavior.

Purpose: Most candidate gene studies on the neurobiology of voluntary exercise behavior have focused on the dopaminergic signaling pathway and its role in the mesolimbic reward system. We hypothesized that dopaminergic candidate genes may influence exercise behavior through additional effects on executive functioning and that these effects are only detected when the types of exercise activity are taken into account. Methods: Data on voluntary exercise behavior and at least one SNP/VNTR were available for 12,929 participants of the Netherlands Twin Registry. Exercise activity was classified as externally paced if a high level of executive function skill was required. The total volume of voluntary exercise (minutes per week) as well as the volume specifically spent on externally paced activities were tested for association with nine functional dopaminergic polymorphisms (DRD1: rs265981, DRD2/ANKK1: rs1800497, DRD3: rs6280, DRD4: VNTR 48bp, DRD5: VNTR 130-166bp, DBH: rs2519152, DAT1: VNTR 40bp, COMT: rs4680, MAOA: VNTR 30bp), a polygenic score (PGS) based on nine alleles leading to lower dopamine responsiveness, and a PGS based on three alleles associated with both higher reward sensitivity and better executive functioning (DRD2/ANKK1: 'G' allele, COMT: Met allele, DAT1: 440bp allele). Results: No association with total exercise volume or externally paced exercise volume was found for individual alleles or the nine-allele polygenic score. The volume of externally paced exercise behavior was significantly associated with the reward and executive function congruent PGS. This association was driven by the DAT1 440bp and COMT Met allele which acted as increaser alleles for externally paced exercise behavior. Conclusion: Taking into account the types of exercise activity may increase the success of identifying genetic variants and unraveling the neurobiology of voluntary exercise behavior. Key words: candidate gene, exercise behavior, reward sensitivity, executive functioning (C) 2017 American College of Sports Medicine

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Cramps frequency and severity are correlated with small and large nerve fiber measures in type 1 diabetes

Muscle cramps are defined as sudden sustained and painful contraction of a muscle or muscle group. Muscle cramps are common, with a higher prevalence in the elderly(Abdulla et al. 1999) and in patients with neuropathic conditions,(Katzberg 2015) and are often underreported.(Naylor and Young 1994) The pathogenesis of muscle cramps involves spontaneous discharges of motor nerves, but the exact site of origin of these discharges, and their physiological mechanism remain uncertain.(Layzer 1994) Although the prevailing hypothesis is that muscle cramps originate and are propagated at motor nerves,(Layzer 1994) muscle cramps have also been described in sensory and pure small fiber neuropathies.(Lopate et al.

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Cognitive reserve modulates attention processes in healthy elderly and amnestic mild cognitive impairment: an event-related potential study

Cognitive reserve (CR) is a concept that was proposed to explain susceptibility heterogeneities of different individuals to cognitive impairment while confronting same neural pathology (Barulli et al., 2013). In addition, CR might be associated with lifetime intellectual activities and some other environmental factors including Intelligence Quotient (IQ), education, occupation level and participation in leisure activities, et al (Barulli et al., 2013). There is extensive epidemiological and experimental evidence to support the existence of CR: education, occupation level and participation in leisure activities have been demonstrated to be related to risk for developing dementia (Smith et al., 2010; Stern, 2012; Xu et al., 2015), cognitive impairment while aging (Barulli et al., 2013), and clinical changes in several other neurological and psychiatric disorders (Barnett et al., 2006; Sumowski et al., 2013; Hindle et al., 2014; Nunnari et al., 2014; Mathias et al., 2015).

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A novel protocol for contact isolation for multi-drug resistant organisms (MDROs) in children on inpatient rehabilitation and effects on functional outcomes: A Noninferiority study

The incidence of contact isolation for multidrug resistant organisms is increasing in acute hospitals and inpatient rehabilitation units alike. There is limited evidence on the effect of contact isolation on functional outcomes during inpatient rehabilitation.

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Squatting re-education with lumbo-pelvic-thigh muscles cocontraction improves functional performance in patellofemoral pain syndrome: a case report

Anterior knee pain with or without joint crepitus during squatting is the common clinical feature in the individuals with patellofemoral pain syndrome (PFPS). Altered lower extremity alignment and lumbo-pelvic-thigh muscles motor control is often associated with PFPS. Although current interventions recommend individual muscle activation and strength training exercises, the reported benefits of cocontraction based exercises in PFPS is limited. It might be due to the long standing hypothesis that the exercise induced cocontraction of thigh muscles may induce a negative effect by increasing the joint contact forces in individuals with knee osteoarthritis.

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Blood glucose concentrations in prehospital trauma patients with traumatic shock: A retrospective analysis

BACKGROUND Deranged glucose metabolism after moderate to severe trauma with either high or low concentrations of blood glucose is associated with poorer outcome. Data on prehospital blood glucose concentrations and trauma are scarce. OBJECTIVES The primary aim was to describe the relationship between traumatic shock and prehospital blood glucose concentrations. The secondary aim was to determine the additional predictive value of prehospital blood glucose concentration for traumatic shock when compared with vital parameters alone. DESIGN Retrospective analysis of the predefined, observational database of a nationwide Helicopter Emergency Medical Service (34 bases). SETTING Emergency trauma patients treated by Helicopter Emergency Medical Service between 2005 and 2013 were investigated. PATIENTS All adult trauma patients (≥18 years) with recorded blood glucose concentrations were enrolled. OUTCOMES Primary outcome: upper and lower thresholds of blood glucose concentration more commonly associated with traumatic shock. Secondary outcome: additional predictive value of prehospital blood glucose concentrations when compared with vital parameters alone. RESULTS Of 51 936 trauma patients, 20 177 were included. In total, 220 (1.1%) patients died on scene. Hypoglycaemia (blood glucose concentration 2.8 mmol l−1 or less) was observed in 132 (0.7%) patients, hyperglycaemia (blood glucose concentration exceeding 15 mmol l−1) was observed in 265 patients (1.3%). Blood glucose concentrations more than 10 mmol l−1 (n = 1308 (6.5%)) and 2.8 mmol l−1 or less were more common in patients with traumatic shock (P 

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The natural history of idiopathic scoliosis during growth: a meta-analysis

Objective To provide a meta-analysis of current literature concerning the natural history of idiopathic scoliosis during growth. Design A comprehensive search of MEDLINE, EMBASE, and SCOPUS databases was conducted up to November 2016. Eligible works were prospective or retrospective studies that enrolled patients with infantile (IIS), juvenile (JIS), or adolescent idiopathic scoliosis (AIS), followed up without any treatment from the time of detection. A meta-analysis for proportion was performed. The studies were grouped per diagnosis: IIS, JIS, and AIS. Results Of the 1797 citations screened, we assessed 61 full-text articles and included 13 of these (2301 participants). Three studies included IIS patients (347 participants), five studies included a mixed population of JIS and AIS (1330 participants), and five studies included AIS patients only (624 participants). The random pooled estimated progression rate was 49% (95% CI: 1–97%) for IIS; 49% in a mixed group of patients affected by JIS or AIS (95% CI: 19–79%), and 42% in AIS (95% CI: 11–73%). Conclusions During growth, idiopathic scoliosis tends to progress in a high percentage of cases. The progression rate varies according to the age at diagnosis, with infantile scoliosis being the most unpredictable. There are many confounders, such as age, Risser sign and baseline Cobb angles that were not consistent among studies, making the data very heterogeneous. Address correspondence to: Francesca Di Felice, ISICO (Italian Scientific Spine Institute), Via Bellarmino 13/1, Milan, 20141 +393492682688 ORCID iD 0000-0002-9553-4499 Funding Source: No funding was secured for this study. Financial Disclosure: The authors have no financial relationships relevant to this article to disclose. Conflict of Interest: The authors have no conflicts of interest to disclose. Previous presentation at scientific meetings: SOSORT 2017 Lyon, ISSLS 2017 Athens. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Graduate Medical Education Funding & Curriculum in PM&R: A Survey of Physical Medicine & Rehabilitation Department Chairs

Abstract This national survey highlights graduate medical education funding sources for PM&R residency programs as well as: perceived funding stability; alignment of the current funding and educational model; the need of further education in post-acute care settings; and the practice of contemporary PM&R graduates as perceived by PM&R department/division chairs. About half of the reported PM&R residency positions appear to be funded by Centers of Medicare and Medicaid Services (CMS); over 40% of PM&R chairs believe their residency program is undersized and nearly a quarter feel at risk for losing positions. A total of 30% of respondents report PM&R resident experiences in home health, 15% in long-term acute care, and 52.5% in a skilled nursing facility/subacute rehabilitation facility. In programs that do not offer these experiences, a majority of chairs feel this training should be included. In addition, study results suggest that a majority of PM&R graduates work in an outpatient setting. Based on the results that chairs strongly feel the need for resident education in post-acute care settings and that a majority of graduates go on to practice in outpatient settings, there is a potential discordance for our current CMS GME funding model being linked to the acute care setting. Author Disclosures: All authors state no competing interests, funding, grants or equipment provided for the project from any source; nor financial benefits to the authors. There are no previous presentations or submissions of this research. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Contralateral involvement of congenital muscular torticollis and clavicular fracture

ABSTRACT Congenital muscular torticollis (CMT) is known to concur with some conditions such as developmental dysplasia of the hip or brachial plexus injury, which gives us some insights for pathogenesis of CMT. While clavicular fracture is the most common fracture in newborns, little is known about concurrence of CMT and clavicular fracture. Our clinical experience led us to realize that concurrence of CMT and clavicular fracture tended to occur on the contralateral side for each other rather than the ipsilateral side. This study aimed to verify contralateral concurrence of CMT and clavicular fracture. This is a retrospective cohort study in a tertiary hospital, including 996 subjects with CMT. Concurrent clavicular fracture was found in 20 of 996 subjects with CMT, with the concurrence rate being 2.01%. CMT and clavicular fracture occurred on the contralateral side for each other in 18 subjects (90%) rather than the ipsilateral side. This contralateral concurrence between side of CMT and clavicular fracture was significant (P=0.001), with an odds ratio of 81 (P=0.0032). CMT and clavicular fracture seem to occur significantly more on the contralateral side for each other. Underlying mechanism for consistent contralateral concurrence needs to be verified in the near future. Correspondence: All correspondence and requests for reprints should be addressed to: Shin-Young Yim, MD, PhD, The Center for Torticollis, Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon 16499, Republic of Korea. Tel: +82-31-219-5284, Fax: +82-31-219-5209. E-mail address: syyim@ajou.ac.kr Author Disclosures: No conflicts of interest have been reported by the authors or by any individuals in control of the content of this article. No funding or grants or equipment provided for the project from any source have been reported by the authors. Funding/Support: This work was supported by the grants through the National Research Foundation of Korea (NRF) funded by the Ministry Science, ICT and Future Planning, Republic of Korea (2016R1A2B1010654). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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The Joint Effects of Antenatal Steroids and Gestational Age on Improved Outcomes in Neonates

Abstract

Objectives

Antenatal corticosteroids are standard of care for women at risk of a preterm birth and demonstrated to be protective against poor outcomes in neonates including respiratory disorders, mortality and intraventricular hemorrhage (IVH). Its benefits may vary by gestational age, and accurate estimation is needed in a single-center population to account for practice variation.

Methods

A retrospective cohort of infants admitted to the hospital's neonatal intensive care unit, 1997–2015. Using Poisson regression, we separately modeled the incidence rate ratio of death, grade III or IV intraventricular hemorrhage (IVH), and moderate to severe bronchopulmonary dysplasia (BPD) testing the moderating effects of gestation on antenatal steroids, controlling for potential confounding.

Results

Among 5314 infants admitted, death occurred in 298 (6%), severe IVH in 244 (5%), and BPD in 527 (10%). Antenatal steroids were protective of death and BPD in the adjusted analysis, and there was multiplicative interaction where each week increase in gestational age combined with steroid therapy resulted in 13% reduced incidence for each outcome.

Conclusions for Practice

Antenatal steroids are protective against severe IVH and moderate to severe BPD, and when combined with gestational age, steroids are associated with greater protective benefits in older neonates. There is likely an ideal window to maximize the benefits of antenatal steroids, and future etiologic research should consider the joint effects with gestational age.

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Mini-implants and narrow diameter implants as mandibular overdenture retainers: A systematic review and meta-analysis of clinical and radiographic outcomes

Summary

This study reviews the clinical and radiographic outcomes of Mini-implants (MI) and Narrow Diameter Implants (NDI) as mandibular overdenture (MO) retainers. Six databases were consulted for clinical studies that evaluated implants with diameter ≤ 3.5 mm. Data on the MI and NDI for survival and success rate and peri-implant bone loss and were collected and submitted to meta-analysis. Thirty-six studies were included, 24 reporting MI performance and 12 describing NDI results. The MI group comprised data from 1 cross-sectional clinical study, 3 retrospective longitudinal (RL) clinical studies, 13 prospective longitudinal (PL) clinical studies and 7 randomized clinical trials (RCT) with follow-up periods ranging from 1 day to 7 years. Eight studies used conventional loading, thirteen used immediate loading, two studies used both loading types and one study did not report. The NDI group comprised data from 3 RL clinical studies, 6 PL clinical studies and 3 RCT with follow-up ranging from 6 months to 10 years. Ten studies used conventional loading, 1 study used immediate loading and 1 study did not report. The average survival rates of MI and NDI studies were 98% and 98%, respectively, while the average success rates were 93% and 96%, respectively. The average peri-implant bone loss after 12, 24, and 36 months was 0.89, 1.18, and 1.02 mm for MI and 0.18, 0.12, and -0.32 mm for NDI. Both MI and NDI showed adequate clinical behavior as overdenture retainers. The NDI showed a better long-term predictability to retain OM with most studies adopting conventional loading.

This article is protected by copyright. All rights reserved.

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Radon and NO2 levels and related environmental factors in 100 underground subway platforms over two-year period

Publication date: January 2018
Source:Journal of Environmental Radioactivity, Volume 181
Author(s): Sung Ho Hwang, Jae Bum Park, Wha Me Park
In this study, the environmental factors that affect radon (Rn) and nitrogen dioxide (NO2) levels in subway-station underground platforms are evaluated, and the outdoor NO2 levels are compared with those obtained for the underground platforms. The Rn and NO2 levels from May 2013 to September 2015 are determined for lines 1–4 of the Seoul Metro, via calculation of the arithmetic means of the Rn and NO2 levels with their standard deviations (SDs). The underground Rn levels in 2013 are found to be significantly higher than those recorded in 2015 for the Seoul Metro. In addition, the Rn levels are related to the station depth and construction year. Further, the underground NO2 levels are shown to be significantly higher than the outdoor levels for all four Seoul Metro subway lines. The Rn levels are also found to vary significantly between months, and are shown to increase gradually with depth from 8 to 20 m. The Rn levels are also higher for stations constructed in the 1980s. Therefore, stricter monitoring of Rn level may be required for stations constructed in the 1980s and/or having platform depths within the 8–20 m range. Island-type platform stations based on granite areas may also require careful attention.



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Effect of High-Intensity Interval Training on Total, Abdominal and Visceral Fat Mass: A Meta-Analysis

Abstract

Background

High-intensity interval training (HIIT) is promoted as a time-efficient strategy to improve body composition.

Objective

The aim of this meta-analysis was to assess the efficacy of HIIT in reducing total, abdominal, and visceral fat mass in normal-weight and overweight/obese adults.

Methods

Electronic databases were searched to identify all related articles on HIIT and fat mass. Stratified analysis was performed using the nature of HIIT (cycling versus running, target intensity), sex and/or body weight, and the methods of measuring body composition. Heterogeneity was also determined

Results

A total of 39 studies involving 617 subjects were included (mean age 38.8 years ± 14.4, 52% females). HIIT significantly reduced total (p = 0.003), abdominal (p = 0.007), and visceral (p = 0.018) fat mass, with no differences between the sexes. A comparison showed that running was more effective than cycling in reducing total and visceral fat mass. High-intensity (above 90% peak heart rate) training was more successful in reducing whole body adiposity, while lower intensities had a greater effect on changes in abdominal and visceral fat mass. Our analysis also indicated that only computed tomography scan or magnetic resonance imaging showed significant abdominal and/or visceral fat-mass loss after HIIT interventions.

Conclusion

HIIT is a time-efficient strategy to decrease fat-mass deposits, including those of abdominal and visceral fat mass. There was some evidence of the greater effectiveness of HIIT running versus cycling, but owing to the wide variety of protocols used and the lack of full details about cycling training, further comparisons need to be made. Large, multicenter, prospective studies are required to establish the best HIIT protocols for reducing fat mass according to subject characteristics.

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How Well is the Medical Home Working for Latino and Black Children?

Abstract

Objective To examine the benefits of having a medical home among Latino and Black school-aged children, both with and without special health care needs (CSHCN). Methods Data from the 2011–2012 National Survey of Children's Health (NSCH) were analyzed to examine the associations of preventive dental and medical care, unmet dental or medical care, or missed school days with having a medical home among Latino and Black children compared to White children. Multivariate logistic regression with survey weights was used to adjust for child, parent, home, and geographic characteristics and an interaction term to estimate differences in outcomes among Black or Latino children receiving care in a medical home compared to White children with a medical home. Results Approximately 35% of Latino CSHCN and Latino non-CSHCN ages 6–17 years of age had a medical home. In the adjusted model comparing the effectiveness of the medical home by race and ethnicity, Latino non-CSHCN compared to White non-CSHCN were associated with lower odds of having one or more preventive dental visit in the last 12 months (OR 0.66; 95% CI 0.46–0.95) and no other associations between having a medical home and outcomes were found among Latinos compared to Whites regardless of non-CSHCN or CHSCN status. Meanwhile, having a medical home among Black non-CHSCN and CHSCN, compared to their White counterparts, showed potential benefits in regards to unmet medical care needs after adjusting for covariates, (OR 0.15; 95% CI 0.06–0.35; OR 0.16; 95% CI 0.05–0.55). Conclusions Medical homes may not be effective in delivering health services to the majority of Latino children but provide some benefit to Black children with and without CSHCN. Alternatively, the medical home may function differently for Latinos due to the specific medical home components measured by NSCH.

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Lax Prophylaxis: Vaccinating the Inflammatory Bowel Disease Patient

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Cut and Paste: Endoscopic Management of a Perforating Biliary Stent Utilizing Scissors and Clips

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Gender-Based Differences in a Population-Based Cohort with Celiac Disease: More Alike than Unalike

Abstract

Background

There is a gap in research focused on gender-based differences in non-referral populations with celiac disease.

Aims

The aim of this study was to estimate those differences in a unique population-based cohort of patients with celiac disease with respect to (1) presenting symptoms, (2) associated autoimmune disorders, and (3) survival.

Methods

Clinical data were systematically abstracted from the electronic medical record of a population-based incident cohort of patients with celiac disease. Logistic regression was used to assess the strength of the association of presenting symptoms and gender. Survival differences between genders were evaluated with Cox regression.

Results

We included 282 patients (females 65%, median age 39 years) diagnosed between 1990 and 2015. The female to male ratio was 1.85:1. Men and women presented similarly. Women were more likely to present with constipation (OR 2.33; 95% CI 1.06–5.12; p = 0.035). Anemia and abdominal distention or bloating were more frequently seen in women, but not on a statistically significant level. Overall autoimmune diseases were equally prevalent (31.6%) in males (30.2%) and females (32.2%) (p = 0.74). Hypothyroidism predominated in women. Age-adjusted survival was lower among men than women (HR 3.00; 95% CI 1.26–7.21, p = 0.014), but not more so than in the general population. Cancer was the most common cause of death, and there were two possible celiac disease-related deaths.

Conclusions

This study showed that men and women are more alike than unalike when it comes to celiac disease presentation and prevalence of concurrent autoimmune disease.

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Recovery following a marathon: a comparison of cold water immersion, whole body cryotherapy and a placebo control

Abstract

Purpose

Cryotherapy is an increasingly popular recovery strategy used in an attempt to attenuate the negative impact of strenuous physical activity on subsequent exercise. Therefore, this study aimed to assess the effects of whole body cryotherapy (WBC) and cold water immersion (CWI) on markers of recovery following a marathon.

Methods

Thirty-one endurance trained males completed a marathon. Participants were randomly assigned to a CWI, WBC or placebo group. Perceptions of muscle soreness, training stress and markers of muscle function were recorded before the marathon and at 24 and 48 h post exercise. Blood samples were taken at baseline, post intervention and 24 and 48 h post intervention to assess inflammation and muscle damage.

Results

WBC had a harmful effect on muscle function compared to CWI post marathon. WBC positively influenced perceptions of training stress compared to CWI. With the exception of C-reactive protein (CRP) at 24 and 48 h, neither cryotherapy intervention positively influenced blood borne markers of inflammation or structural damage compared to placebo.

Conclusion

The findings show WBC has a negative impact on muscle function, perceptions of soreness and a number of blood parameters compared to CWI, contradicting the suggestion that WBC may be a superior recovery strategy. Further, cryotherapy is no more effective than a placebo intervention at improving functional recovery or perceptions of training stress following a marathon. These findings lend further evidence to suggest that treatment belief and the placebo effect may be largely responsible for the beneficial effects of cryotherapy on recovery following a marathon.

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Heart rate variability and plasma nephrines in the evaluation of heat acclimatisation status

Abstract

Purpose

Heat adaptation (HA) is critical to performance and health in a hot environment. Transition from short-term heat acclimatisation (STHA) to long-term heat acclimatisation (LTHA) is characterised by decreased autonomic disturbance and increased protection from thermal injury. A standard heat tolerance test (HTT) is recommended for validating exercise performance status, but any role in distinguishing STHA from LTHA is unreported. The aims of this study were to (1) define performance status by serial HTT during structured natural HA, (2) evaluate surrogate markers of autonomic activation, including heart rate variability (HRV), in relation to HA status.

Methods

Participants (n = 13) were assessed by HTT (60-min block-stepping, 50% VO₂peak) during STHA (Day 2, 6 and 9) and LTHA (Day 23). Core temperature (Tc) and heart rate (HR) were measured every 5 min. Sampling for HRV indices (RMSSD, LF:HF) and sympathoadrenal blood measures (cortisol, nephrines) was undertaken before and after (POST) each HTT.

Results

Significant (P < 0.05) interactions existed for Tc, logLF:HF, cortisol and nephrines (two-way ANOVA; HTT by Day). Relative to LTHA, POST results differed significantly for Tc (Day 2, 6 and 9), HR (Day 2), logRMSSD (Day 2 and Day 6), logLF:HF (Day 2 and Day 6), cortisol (Day 2) and nephrines (Day 2 and Day 9). POST differences in HRV (Day 6 vs. 23) were + 9.9% (logRMSSD) and − 18.6% (logLF:HF).

Conclusions

Early reductions in HR and cortisol characterised STHA, whereas LTHA showed diminished excitability by Tc, HRV and nephrine measures. Measurement of HRV may have potential to aid real-time assessment of readiness for activity in the heat.

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Interpreting Adaptation to Concurrent Compared with Single-Mode Exercise Training: Some Methodological Considerations

Abstract

Incorporating both endurance and resistance training into an exercise regime is termed concurrent training. While there is evidence that concurrent training can attenuate resistance training-induced improvements in maximal strength and muscle hypertrophy, research findings are often equivocal, with some suggesting short-term concurrent training may instead further enhance muscle hypertrophy versus resistance training alone. These observations have questioned the validity of the purported 'interference effect' on muscle hypertrophy with concurrent versus single-mode resistance training. This article aims to highlight some methodological considerations when interpreting the concurrent training literature, and, in particular, the degree of changes in strength and muscle hypertrophy observed with concurrent versus single-mode resistance training. Individual training status clearly influences the relative magnitude and specificity of both training adaptation and post-exercise molecular responses in skeletal muscle. The training status of participants is therefore likely a key modulator of the degree of adaptation and interference seen with concurrent training interventions. The divergent magnitudes of strength gain versus muscle hypertrophy induced by resistance training also suggests most concurrent training studies are likely to observe more substantial changes in (and in turn, any potential interference to) strength compared with muscle hypertrophy. Both the specificity and sensitivity of measures used to assess training-induced changes in strength and muscle hypertrophy also likely influence the interpretation of concurrent training outcomes. Finally, the relative importance of any modulation of hypertrophic versus strength adaptation with concurrent training should be considered in context with the relevance of training-induced changes in these variables for enhancing athletic performance and/or functional capacity. Taken together, these observations suggest that aside from various training-related factors, additional non-training-related variables, including participant training status and the measures used to assess changes in strength and muscle hypertrophy, are important considerations when interpreting the outcomes of concurrent training interventions.

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Wls Expression Correlates with Tumor Differentiation and TNM Stage in Hepatocellular Carcinoma

Abstract

Background

Hepatocellular carcinoma (HCC) is an aggressive cancer with a poor prognosis. Effective biomarkers are necessary to predict the clinical course and outcome of patients with HCC. Wntless (Wls) is a key modulator of Wnt protein secretion and is overexpressed in various human cancers. However, the mechanism and alteration of Wls expression in HCC have not been clarified.

Aims

The aim of this study was to evaluate expression level of Wls in HCC and its clinical significance.

Methods

The levels of Wls expression were investigated in 84 HCC tissues using immunohistochemistry.

Results

Wls was negatively expressed in normal liver tissue and was negatively or weakly (score 0) expressed in liver cirrhosis. Twenty-eight out of 84 samples (33.3%) were negative or weakly (score 0) expressed Wls, 38 out of 84 (45.2%) moderately (1+) expressed Wls, and 18 out of 84 (21.4%) strongly (2+) expressed Wls. Wls expression was positively associated with tumor size (P = 0.005, r = 0.302), tumor TNM stage (P = 0.017, r = 0.261), AFP (P = 0.051), and HBV infection (P = 0.009, r = 0.283), and was negatively associated with differentiation (P < 0.001, r = − 0.552). No significant relationship between Wls expression and liver cirrhosis, ALT, GGT, age, sex, or tumor focality was found.

Conclusions

Our data showed that Wls was differentially expressed in HCC. Statistical analysis results suggest that Wls expression might increase as HCC progresses.

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Active and passive recovery influence responses of luteinizing hormone and testosterone to a fatiguing strength loading

Abstract

The purpose of this study was to examine the acute hormonal and muscular responses to a strenuous strength loading [bilateral leg press (LP) 10 × 10 1RM] followed by loading-specific active (AR, n = 7, LP 10 × 10 × 30% 1RM) or passive (PR, n = 11, seated) recovery. The subjects were men age: 26 ± 4 years, height: 174 ± 8 cm, body mass: 75 ± 13 kg. After control measurements, experimental measurements were conducted at pre- and post-loading as well as post-recovery and next morning. A significantly higher absolute concentration (p < 0.05) of serum luteinizing hormone (LH) was observed in AR than PR at next morning while no differences were observed in serum testosterone (T), cortisol (C) or sex hormone binding globulin (SHBG). Significant differences in relative hormonal responses to the loading were observed at next morning with greater responses observed in AR than in PR in terms of LH, and T (p < 0.05). Maximal bilateral isometric force (MVC) and countermovement jump height (CMJ) decreased significantly (p < 0.001) from the control measurements in both AR and PR but returned to control levels by next morning. No between-group differences were observed in mean absolute or relative changes in MVC or CMJ. From a hormonal perspective, the present AR method appears to have had some favorable effects following the strenuous strength loading; however, acute decreases in muscular force production did not significantly differ between groups. These results provide insight into the development of training programs that may help to support the performance of individuals involved in strenuous tasks.

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