Παρασκευή, 17 Νοεμβρίου 2017

Spanish Translated Abstracts



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Copyright Page



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Information for Authors



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Editorial Board



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Physical Medicine and Rehabilitation Value in Bundled Payment for Total Joint Replacement and Cardiac Surgery: The Rusk Experience

"Change is the law of life. And those who look only to the past or the present are certain to miss the future."—John F. Kennedy, June 26, 1963Physiatry is at a crossroads. We may shortly find that we cannot rely on traditional care structures such as inpatient units, consultancies, and interventional procedures if we are to thrive in a world of value-based care. Pressures on costs, centralization of patient flow, outcomes reporting, and systemic consolidation will all necessitate a new approach.

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Table of Contents



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Academy News – November PM&R Journal

As the primary medical society for the specialty of PM&R, your Academy is focused on moving the specialty and you forward. Academy membership supports initiatives to assist our members with:

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Characterization of Cefotaxime- and Ciprofloxacin-Resistant Commensal Escherichia coli Originating from Belgian Farm Animals Indicates High Antibiotic Resistance Transfer Rates

Microbial Drug Resistance , Vol. 0, No. 0.


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Expanding the neurodevelopmental phenotype of PURA syndrome

PURA syndrome is a recently described developmental encephalopathy presenting with neonatal hypotonia, feeding difficulties, global developmental delay, severe intellectual disability, and frequent apnea and epilepsy. We describe 18 new individuals with heterozygous sequence variations in PURA. A neuromotor disorder starting with neonatal hyptonia, but ultimately allowing delayed progression to walking, was present in nearly all individuals. Congenital apnea was present in 56% during infancy, but all cases in this cohort resolved during the first year of life. Feeding difficulties were frequently reported, with gastrostomy tube placement required in 28%. Epilepsy was present in 50% of the subjects, including infantile spasms and Lennox–Gastaut syndrome. Skeletal complications were found in 39%. Disorders of gastrointestinal motility and nystagmus were also recurrent features. Autism was diagnosed in one individual, potentially expanding the neurodevelopmental phenotype associated with this syndrome. However, we did not find additional PURA sequence variations in a cohort of 120 subjects with autism. We also present the first neuropathologic studies of PURA syndrome, and describe chronic inflammatory changes around the arterioles within the deep white matter. We did not find significant correlations between mutational class and severity, nor between location of the sequence variation in PUR repeat domains. Further studies are required in larger cohorts of subjects with PURA syndrome to clarify these genotype–phenotype associations.



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Wieacker–Wolff syndrome with associated cleft palate in a female case

Wieacker–Wolff syndrome is a rare congenital syndrome with few reported cases in the current literature. It is traditionally described in males as an X-linked recessive disorder associated with congenital contractures of the feet, progressive neurologic muscular atrophy, and intellectual delay caused by ZC4H2 mutations. The purpose of this paper is to present a female individual with a classic phenotype and cleft palate, a previously undescribed finding in this syndrome. Recent reports have demonstrated that females are rarely severely affected and phenotypic expression is difficult to predict [Zanzottera et al. (); American Journal of Medical Genetics Part A 173A: 1358–1363]. This case supports the unpredictability of Wieacker–Wolff syndrome severity and prompts future questions regarding female mutations and phenotypic expression.



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Unique association of hypochondroplasia with craniosynostosis and cleft palate in a Mexican family

Hypochondroplasia (HCH) is a skeletal dysplasia caused by an abnormal function of the fibroblast growth factor receptor 3. Although believed to be relatively common, its prevalence and phenotype are not well established owing to its clinical, radiological, and genetic heterogeneity. Here we report on a molecularly proven HCH family with an affected father and two children. The siblings (male and female) with HCH also had craniosynostosis and cleft palate, respectively. The present report supports the conclusion that the full clinical spectrum of HCH is not completely delineated. It also suggests that secondary, as yet unknown, modifying factors can influence the final phenotype.



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p.Arg69Trp in RNASEH2C is a founder variant in three Indian families with Aicardi–Goutières syndrome

Aicardi–Goutières syndrome is an early-onset severe neurological disorder characterized by intracranial calcification, white matter abnormalities, hepatosplenomegaly, cerebrospinal fluid lymphocytosis, and elevated interferon-α levels, thus mimicking congenital viral infections. It is a genetically heterogeneous condition and autosomal recessive and autosomal dominant forms with variations in seven genes known till date. Variations in RNASEH2C cause an autosomal recessive form of AGS. Here we report three Indian families with variant, c.205C>T (NM_032193.3, p.Arg69Trp) in RNASEH2C gene identified by whole-exome sequencing and targeted molecular testing of the variant. Review of literature and our data suggest this is likely to be a founder variant in Asians and it would be a good initial variant to screen in patients with Aicardi–Goutières syndrome in Indians.



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A model to characterize psychopathological features in adults with Prader-Willi syndrome

High prevalence of behavioral and psychiatric disorders in adults with Prader-Willi Syndrome (PWS) has been reported in last few years. However, data are confusing and often contradictory. In this article, we propose a model to achieve a better understanding of the psychopathological features in adults with PWS. The study is based on clinical observations of 150 adult inpatients, males and females. Non-parametric statistics were performed to analyse the association of psychopathological profiles with genotype, gender and age. We propose a model of psychiatric disorders in adults with PWS based on cognitive, emotional and behavioural issues. This model defines four psychopathological profiles: Basic, Impulsive, Compulsive, and Psychotic. The Basic profile is defined by traits and symptoms that are present in varying degrees in all persons with PWS. In our cohort, this Basic profile corresponds to 55% of the patients. The rest show, in addition to these characteristics, salient features of impulsivity (Impulsive profile, 19%), compulsivity (Compulsive profile, 7%), or psychosis (Psychotic profile, 19%). The analysis of factors associated with different profiles reveals an effect of genotype on Basic and Psychotic profiles (Deletion: 70% Basic, 9% Psychotic; Non-deletion: 23% Basic, 43% Psychotic) and a positive correlation between male sex and impulsivity, unmediated by sex hormone treatment. This is a clinical study, based on observation proposing an original model to understand the psychiatric and behavioural disorders in adults with PWS. Further studies are needed in order to test the validity of this model.



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The Influence of Genetic Stability on Aspergillus fumigatus Virulence and Azole Resistance

Genetic stability is extremely important for the survival of every living organism and a very complex set of genes have evolved to cope with DNA repair upon DNA damage. Here, we investigated the Aspergillus fumigatus AtmA (Ataxia-telangiectasia mutated) and AtrA kinases and how they impact virulence and the evolution of azole resistance. We demonstrated that A. fumigatus atmA and atrA null mutants are haploid and have a discrete chromosomal polymorphism. The atmA and atrA strains are sensitive to several DNA damaging agents but surprisingly both strains were more resistant than the wild-type strain to paraquat, menadione, and hydrogen peroxide. The atmA and atrA genes showed synthetic lethality emphasizing the cooperation between both enzymes and their consequent redundancy. The lack of atmA and atrA does not cause any significant virulence reduction in A. fumigatus in a neutropenic murine model of invasive pulmonary aspergillosis and in the invertebrate alternative model Galleria mellonela. Wild-type, atmA and atrA populations that were previously transferred 10 times in minimal medium in the absence of voriconazole have not shown any significant changes in drug resistance acquisition. In contrast, atmA and atrA populations similarly evolved in the presence of a subinhibitory concentration of voriconazole showed about 5 to 10-fold increase when compared to the original MIC values. There are discrete alterations in the voriconazole target Cyp51A/Erg11A or cyp51/erg11 and/or Cdr1B efflux transporter overexpression that do not seem to be the main mechanisms to explain voriconazole resistance in these evolved populations. Taken together, these results suggest that genetic instability caused by atmA and atrA mutations can confer an adaptive advantage mainly in the intensity of voriconazole resistance acquisition.



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Mating Design and Genetic Structure of a Multi-parent Advanced Generation Inter-cross (MAGIC) Population of Sorghum (Sorghum bicolor (L.) Moench)

MAGIC populations are powerful next generation mapping resources. We describe here the mating design and structure of the first MAGIC population in sorghum and test its utility for mapping. The population was developed by intercrossing 19 diverse founder lines, through a series of paired crosses with a genetic male sterile source, followed by 10 generations of random mating. At the final stage of random mating, one thousand random fertile plants in the population were identified and subjected to six generations of selfing to produce 1000 immortal MAGIC inbred lines. The development of this sorghum MAGIC population took over 15 years. Genotyping-by-sequencing of a subset of 200 MAGIC lines identified 79,728 SNPs, spanning high gene rich regions. Proportion of SNPs per chromosome ranged from 6% to 15%. Structure analyses produced no evidence of population stratification, portraying the desirability of this population for genome-wide association studies (GWAS). The 19 founders formed three clusters, each with considerable genetic diversity. Further analysis showed that 73% of founder alleles segregated in the MAGIC population. Linkage disequilibrium (LD) patterns depicted the MAGIC population to be highly recombined, with LD decaying to r2 ≤ 0.2 at 40kb and down to r2 ≤ 0.1 at 220kb. GWAS detected two known plant height genes: DWARF1 (Chr.9) and DWARF3 (Chr.7) and a potentially new plant height QTL (QTL-6) on Chromosome 6. The MAGIC population was found to be rich in allelic content with high fragmentation of its genome, making it fit for both gene mapping and effective marker-assisted breeding.



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Rapid and Efficient CRISPR/Cas9-Based Mating-Type Switching of Saccharomyces cerevisiae

Rapid and highly efficient mating-type switching of Saccharomyces cerevisiae enables a wide variety of genetic manipulations such as the construction of strains, for instance isogenic haploid pairs of both mating-types, diploids and polyploids. We used the CRISPR/Cas9 system to generate a double-strand break (DSB) at the MAT locus, and in a single co-transformation, both haploid and diploid cells were switched to the specified mating-type at ~80% efficiency. The mating-type of strains carrying either rod or ring chromosome III were switched, including those lacking HMLα and HMRa cryptic mating loci.  Furthermore, we transplanted the synthetic yeast chromosome V to build a haploid poly-synthetic chromosome strain by using this method together with an endoreduplication intercross strategy. The CRISPR/Cas9 mating-type switching method will be useful in building the complete synthetic yeast (Sc2.0) genome. Importantly, it is a generally useful method to build polyploids of a defined genotype and generally expedites strain construction, for example in the construction of fully a/a/a/a isogenic tetraploids.



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Editorial Board



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Table of Contents



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Optimal blood pressure decreases acute kidney injury after gastrointestinal surgery in elderly hypertensive patients: A randomized study

To determine the appropriate mean arterial pressure (MAP) control level for elderly patients with hypertension during the perioperative period.

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Bi-orifice approach to nasal intubation in children: A case series of anticipated difficult airways undergoing orthognathic surgeries

Airway management of pediatric patients with craniofacial disorders can be challenging, especially when compounded by the surgical requirement for nasal intubation. Life-threatening complications can occur during induction of general anesthesia in patients with abnormal anatomy (laryngospasm, inability to mask ventilate due to obstruction, total loss of airway, death) [1,2,3]. Although awake nasal fiberoptic intubation (FOI) is a common method of securing adult difficult airways, it may not be appropriate for children due to emotional, physiological, and anatomical differences.

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The effect of sevoflurane compared to propofol maintenance on post-surgical quality of recovery in patients undergoing an ambulatory gynecological surgery: A prospective, randomized, double-blinded, controlled, clinical trial

The main objective of the current investigation was to evaluate the effect of propofol used as anesthetic maintenance compared to sevoflurane on global post-surgical quality of recovery in female patients undergoing ambulatory gynecological surgery.

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A case of midazolam anaphylaxis during a pediatric patient's first anesthetic

Perioperative anaphylaxis remains a relatively rare (with an estimated incidence 1:3,5000 to 1:20,000) but important cause of morbidity and mortality [1]. Common causes include neuromuscular blockers, antibiotics, and latex [1,2]. Diagnosis of perioperative anaphylaxis may be delayed, as general anesthesia may mask the characteristic symptoms of hypotension, rash, and airway swelling. Herein we present a case of midazolam anaphylaxis in a child's first anesthetic.

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Anesthetic management of a patient with benign tracheal tumor identified at induction of general anesthesia

Benign tumors of the tracheobronchial tree are quite rare [1] and are sometimes misdiagnosed as asthma or chronic obstructive pulmonary disease (COPD) when the symptoms are not severe [1,2,3]. Delayed diagnosis is common and these tumors may not be identified for a long time if they are slow growing [1,2,3]. In such cases, routine examinations such as chest radiography will not reveal the tumor before elective surgery [1,3] and it is possible that induction of general anesthesia will be initiated before the anesthetist recognizes that there is a tumor in the tracheobronchial tree.

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Intermittent bilateral anterior sub-costal quadratus lumborum block for effective analgesia in lower abdominal surgery

As one of new quadratus lumborum (QL) blocks, the anterior sub-costal QL block has been reported to be an effective analgesic in lower abdominal surgery [1]. However, there have been no reports on the efficacy of the anterior sub-costal QL block over the long postoperative period. In this article, we report two successful cases of intermittent anterior sub-costal QL block in lower abdominal surgery for pain management during the long postoperative period.

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A novel approach for performing ultrasound-guided maxillary nerve block

Maxillary nerve block has traditionally been performed using fluoroscopy. In recent years, ultrasonography has provided a useful method for needle guidance when performing maxillary nerve block, as well as other blocks [1–5]. The coronoid approach is popular for ultrasound guidance [1–4]. However, this approach is challenging due to some disadvantages of the technique.

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Combined spinal epidural in a parturient with tinea versicolor

Tinea versicolor is a benign condition with a prevalence of 2–8% in the United States [1]. The yeast, Malassezia globosa, a normal component of skin flora, can become pathogenic with exposure to heat and humidity and in immunosuppressive conditions such as pregnancy. Tinea versicolor responds to antifungal medications but recurrence is common. We present a case of a pregnant patient with a longstanding diagnosis of tinea versicolor in whom we performed a combined spinal technique for labor analgesia after exploring and discussing the theoretical risks.

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Postpartum tubal ligation: A retrospective review of anesthetic management at a single institution and a practice survey of academic institutions

The primary aim was to evaluate institutional anesthetic techniques utilized for postpartum tubal ligation (PPTL). Secondarily, academic institutions were surveyed on their clinical practice for PPTL.

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Surgeon assisted quadratus lumborum block – ‘Gaurav-Aditi’ technique case series

Quadratus lumborum block (QLB) is a new abdominal wall block which has been used successfully for the post operative pain management of patients undergoing abdominal surgeries [1,2]. Classically QLB can be given in four different approaches using ultrasound [3]. In many developing countries like India ultrasound is still not available at all centers. Many times in patients with central obesity it is difficult to perform this block using ultrasound [4]. So we present a new 'Gaurav-Aditi' technique of performing the QLB, wherein post-operative pain of six patients who were undergoing open radical nephrectomy was managed successfully.

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Anesthetic management for retrieval of a large aspirated denture in a patient with Parkinson's disease

Airway foreign body aspiration is uncommon in adults. It is particularly likely in patients with impaired cough reflexes and reduced sensorium due to drugs, alcohol, or neurological dysfunction. Dental prosthetics are the most common foreign bodies aspirated in patients with Parkinson's disease [1]. If a large denture is aspirated, the airway can become totally obstructed. Below, we describe the challenging anesthetic management of a patient with Parkinson's disease who required removal of a large intratracheal denture via rigid bronchoscopy.

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Reversal of trend in near infrared spectroscopy [NIRS] values in a patient with carotid artery stenosis

Near Infrared Spectroscopy (NIRS) monitors continuous non-invasive regional oxygen balance within the frontal cerebral cortex. Cerebral vasoneural coupling ensures that local brain metabolism increase is met normally with augmented regional blood flow [1]. Anaesthetics agents play a vital role and so rising doses of cortical suppressant anaesthetics may increase rSO2 as oxygen consumption is decreased [2].

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Strategies to prevent ischemic optic neuropathy following major spine surgery: A narrative review

Postoperative vision loss following a major spine operation is a rare but life-changing event. Most of reports have been linked to ischemic optic neuropathy, and patients undergoing surgery for scoliosis correction or posterior lumbar fusion seem to be at the highest risk. Despite that some key risk factors have been identified, much of the pathophysiology still remain unknown. In fact, whereas only a minority of patients at high risk will present this complication, others with similar risk factors undergoing different procedures may not develop it at all.

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Medicaid insurance as primary payer predicts increased mortality after total hip replacement in the state inpatient databases of California, Florida and New York

To confirm the relationship between primary payer status as a predictor of increased perioperative risks and post-operative outcomes after total hip replacements.

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Incidence of complications in the post-anesthesia care unit and associated healthcare utilization in patients undergoing non-cardiac surgery requiring neuromuscular blockade 2005–2013: A single center study

The use of neuromuscular blockade agents (NMBA), had been associated with significant residual post-operative paralysis and morbidity. There is a lack of clinical evidence on incidence of postoperative complications within the post-anesthesia care unit (PACU) in patients exposed to intraoperative NMBA's. This study aims to estimate the incidence of post-operative complications associated with use of NMBAs and assessing its association with healthcare resource utilization.

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Measuring satisfaction and anesthesia related outcomes in a surgical day care centre: A three-year single-centre observational study

To evaluate patient satisfaction and patient reported anaesthesia related outcome parameters after outpatient surgery.

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Paraneuraxial Nerve Blocks: A well-defined novel terminology that is clinically essential for regional anesthesia

We read with great interest the articles "Clinical Experiences of the Continuous Thoracolumbar Interfascial Plane (TLIP) Block" by Ueshima et al. [1]. We would like to share our thoughts regarding this study as we have performed several continuous (TLIP) Blocks in the past 2months.

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Emergency surgery in a newborn patient with severe congenital hypothyrodism

We aimed to discuss anaesthesia management in a newborn with severe hypothyroidism for whom we could not provide hypothyroidism treatment due to tracheoesophageal fistula and anal atresia.

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Increasing upper limb training intensity in chronic stroke using embodied virtual reality: a pilot study

Technology-mediated neurorehabilitation is suggested to enhance training intensity and therefore functional gains. Here, we used a novel virtual reality (VR) system for task-specific upper extremity training a...

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Setting the pace: insights and advancements gained while preparing for an FES bike race

The reduction in physical activity following a spinal cord injury often leads to a decline in mental and physical health. Developing an exercise program that is effective and enjoyable is paramount for this po...

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Mechanisms of propofol attenuation of ketamine-induced neonatal brain injury

OBJECTIVE: We studied the mechanisms of protective effects of propofol on ketamine-induced damage to neonatal cognitive function.

MATERIALS AND METHODS: We utilized a rat model of ketamine anaesthesia. Eighty neonatal rats (7 days after birth) were divided into four groups: normal saline group, ketamine group, and low- and high-dose propofol combined with ketamine groups. Six hours after anaesthesia, we obtained hippocampal tissue, and quantified apoptotic index and total protein concentration, and assessed global proteomics changes induced by two tested drugs. The latter changes were documented by two-dimensional electrophoresis and matrix-assisted laser desorption/ ionization time of flight mass spectrometry. To evaluate cognitive functions, water maze test was applied after animals grew for 21 days. We further repeated proteomics studies at 21 days post-anaesthesia.

RESULTS: Ketamine markedly up-regulated apoptotic index and decreased total protein concentration. Propofol dose-dependently reverted these adverse changes. Six hours post-anaesthesia, combined propofol and ketamine administration up-regulated the following proteins in the hippocampus: PD1A3, NDUFB10, HSPA8, ATP5JD, and PSMA1. Furthermore, the following proteins were down-regulated: PPIA, PKM2, GFAP, NSE, PPIA, PKM2, and GFAP. After 21 days, animals treated with ketamine showed marked disturbances in cognitive function as demonstrated by increased time of the water maze test, whereas propofol diminished these changes. In addition, expression of proteins largely normalized in propofol-treated animals, with only two up-regulated proteins (FUBP3 and PRDX5) and three down-regulated proteins (GAPDH, AKR1A1, and VCP).

CONCLUSIONS: Adverse effects of ketamine on cognitive function are reverted by propofol, also through beneficial effects on protein expression in the hippocampus.

L'articolo Mechanisms of propofol attenuation of ketamine-induced neonatal brain injury sembra essere il primo su European Review.



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Lumbar Spine Anatomy in Women Sustaining Unintentional Dural Puncture During Labor Epidural Placement: A Descriptive Study Using Magnetic Resonance Imaging and Ultrasound.

Background and Objectives: Unintentional dural puncture is one of the most frequent complications of the epidural technique. One previous study suggested that atypical sonoanatomy of the ligamentum flavum/dura mater unit may be a risk factor for this complication. In this study, we describe the anatomy of the lumbar spine, assessed by magnetic resonance imaging (MRI) and ultrasound, in women sustaining unintentional dural puncture during epidural catheter placement for labor analgesia. Methods: We approached women who sustained a recognized unintentional dural puncture. Following consent, technical aspects of the epidural catheter placement were documented. Postpartum MRI of the lumbar spine and bedside spinal ultrasound were performed. Ultrasound images of the ligamentum flavum/dura mater unit in the transverse view were classified as typical, atypical, or inconclusive. Magnetic resonance imaging images were reviewed by a neuroradiologist, who was blinded to the level of the puncture. Results: We included 10 women with unintentional dural punctures in the study. In 5 of the 10 women, these dural punctures occurred despite epidural catheter insertion by experienced practitioners. These women had a mean body mass index of 28.5 kg/m2 (range, 24-38 kg/m2). Two women suffered dural punctures twice. Ultrasound imaging in the paramedian view produced typical images in all patients. In the transverse view, 7 of 10 women showed atypical or inconclusive images, with atypical images seen at either L4/5 or L5/S1. Magnetic resonance imaging results revealed no anatomical abnormalities, with the exception of 1 woman who showed a ligamentum flavum gap away from the puncture site. Conclusions: Our results suggest that unintentional dural punctures occur in likely anatomically normal women. Furthermore, the transverse ultrasound views may fail to demonstrate typical ligamentum flavum/dura mater unit at the lower lumbar levels despite its confirmed presence by MRI. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

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Repeatability and Meaningful Change of CPET Parameters in Normal Subjects.

Introduction/Purpose: Cardiopulmonary exercise testing (CPET) plays an important role in clinical medicine and research. Repeatability of CPET parameters has not been well characterized, but is important to assess variability and determine if there have been meaningful changes in a given CPET parameter. Methods: We recruited 45 healthy subjects and performed two symptom-limited CPETs within 30 days using a cycle ergometer. Differences in relevant CPET parameters between CPET-1 and CPET-2 were assessed using a paired t-test. Coefficient of variation (CoV) and Bland-Altman plots are reported. Factors that may be associated with variability were analyzed (sex, age, time of day, fitness level). The coefficient of repeatability was calculated for peak V[spacing dot above]O2 and V[spacing dot above]O2 at lactate threshold (LT) to establish a 95% threshold for meaningful change. Results: There were no significant differences between tests in the parameters reported. Specifically, we found overall low CoV in peak V[spacing dot above]O2 (4.9%), V[spacing dot above]O2@LT (10.4%), peak O2 pulse (4.6%), peak V[spacing dot above]E (7.4%), V[spacing dot above]E/V[spacing dot above]CO2@LT (4.0%) andV[spacing dot above]E/V[spacing dot above]O2@LT (4.8%). The CoV for RER@LT was significantly affected by diurnal factors; age, sex and fitness level did not impact variability. The 95% threshold for meaningful change in peak V[spacing dot above]O2 was 0.540 L/min and for V[spacing dot above]O2@LT was 0.520 L/min. Conclusions: Repeatability of CPET parameters is generally higher then previously reported. There were no significant differences in variability related to sex, age, fitness level; diurnal factors had a limited impact. The threshold for meaningful change in peak V[spacing dot above]O2 and for V[spacing dot above]O2@LT should be considered when gauging a response to therapies or training. (C) 2017 American College of Sports Medicine

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The Role of Airway Inflammation and Bronchial Hyperresponsiveness in Athlete's Asthma.

PURPOSE: Asthma is frequently reported in endurance athletes. The aim of the present study was to assess the long-term airway inflammatory response to endurance exercise in high-level athletes with and without asthma. METHODS: In a cross-sectional design, 20 asthmatic athletes (10 swimmers, 10 cross-country skiers), 19 athletes without asthma (10 swimmers, 9 cross-country skiers) and 24 healthy non-athletes completed methacholine bronchial challenge, lung function tests and sputum induction on two separate days. All athletes competed on a national or international level and exercised >=10 hours/week. The non-athletes exercised

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Validity of Wearable Activity Monitors during Cycling and Resistance Exercise.

Introduction: The use of wearable activity monitors has seen rapid growth; however, the mode and intensity of exercise could affect validity of heart rate (HR) and caloric (energy) expenditure (EE) readings. There is a lack of data regarding the validity of wearable activity monitors during graded cycling regimen and a standard resistance exercise. The present study determined the validity of eight monitors for HR compared to an ECG and seven monitors for EE compared to a metabolic analyzer during graded cycling and resistance exercise. Methods: Fifty subjects (28 women, 22 men) completed separate trials of graded cycling and three sets of four resistance exercises at a 10-repetition maximum (RM) load. Monitors included: Apple Watch Series 2 (AWS2), Fitbit Blaze, Fitbit Charge 2, Polar H7 (PH7), Polar A360, Garmin Vivosmart HR, TomTom Touch, and Bose SoundSport Headphones (BSP). HR was recorded after each cycling intensity and following each resistance exercise set. EE was recorded following both protocols. Validity was established as having a mean absolute percent error (MAPE) value of

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Intrapartum assessment of fetal well-being

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Treatment withdrawal and end-of-life care in the intensive care unit

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Prehabilitation

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Anaesthesia for head and neck cancer surgery

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Principles of resource allocation in critical care

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The Frequency of Mutations in Quinolone Resistance-Determining Regions and Plasmid-Mediated Quinolone Resistance in Shigella Isolates Recovered from Pediatric Patients in Tehran, Iran: An Overlooked Problem

Microbial Drug Resistance , Vol. 0, No. 0.


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You Will Never Walk Alone: A Simulation Experience for Caregiver’s Family and Friends

No abstract available

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Enhanced Recovery After Surgery: Current Controversies and Concerns

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Role of Urine Drug Testing in the Current Opioid Epidemic

imageWhile the evidence for urine drug testing for patients on chronic opioid therapy is weak, the guidelines created by numerous medical societies and state and federal regulatory agencies recommend that it be included as one of the tools used to monitor patients for compliance with chronic opioid therapy. To get the most comprehensive results, clinicians should order both an immunoassay screen and confirmatory urine drug test. The immunoassay screen, which can be performed as an in-office point-of-care test or as a laboratory-based test, is a cheap and convenient study to order. Limitations of an immunoassay screen, however, include having a high threshold of detectability and only providing qualitative information about a select number of drug classes. Because of these restrictions, clinicians should understand that immunoassay screens have high false-positive and false-negative rates. Despite these limitations, though, the results can assist the clinician with making preliminary treatment decisions. In comparison, a confirmatory urine drug test, which can only be performed as a laboratory-based test, has a lower threshold of detectability and provides both qualitative and quantitative information. A urine drug test's greater degree of specificity allows for a relatively low false-negative and false-positive rate in contrast to an immunoassay screen. Like any other diagnostic test, an immunoassay screen and a confirmatory urine drug test both possess limitations. Clinicians must keep this in mind when interpreting an unexpected test result and consult with their laboratory when in doubt about the meaning of the test result to avoid making erroneous decisions that negatively impact both the patient and clinician.

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Dr Ted Eger Obituary

imageNo abstract available

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The “Ear-Sternal Notch” Line—How Should You Lie?

imageNo abstract available

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The Search for the Optimal Tidal Volume: Why Do We Use Body Weight?

No abstract available

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General Anesthesia Imposes Negative Effects on Heart Rate and Blood Pressure Regulation in Patients With a History of Head and Neck Radiation Therapy

imageBACKGROUND: Head and neck radiation therapy (HNRT) impairs baroreflex sensitivity, and it may potentiate the effects of anesthetics on heart rate (HR) and blood pressure (BP) regulation. Currently, the impacts of HNRT on HR and BP under anesthesia remain unclear. METHODS: In this study, 472 patients with primary oral cavity or oropharyngeal cancer at all stages were examined. Half of the patients underwent HNRT plus surgery. The other half underwent surgery only and was matched with the treatment patients according to age, sex, and body mass index at a 1:1 ratio. The HRs and BPs in the 2 groups during anesthetic induction, skin incision, and emergence were compared retrospectively. A multivariable model of repeated measures with unstructured covariance structure was used to examine the associations of HNRT with intraoperative HRs and BPs after adjusting for baseline HR and BP, time, use of β-blockers, history of chemotherapy, and American Society of Anesthesiologists physical status score. BPs and HRs were collected every 5 minutes. The baseline HR and BP measurements were not included in the outcome vector and were only used as adjustment for baselines. RESULTS: Compared with corresponding baseline values in controls, the baseline HR was significantly higher (P = .0012) and the baseline systolic BP was lower (P

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When Is “Never Enough” (Data) … Enough?

No abstract available

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Noninfectious Fever in the Near-Term Pregnant Rat Induces Fetal Brain Inflammation: A Model for the Consequences of Epidural-Associated Maternal Fever

imageBACKGROUND: Women laboring with epidural analgesia experience fever much more frequently than do women who chose other forms of analgesia, and maternal intrapartum fever is associated with numerous adverse consequences, including brain injury in the fetus. We developed a model of noninfectious inflammatory fever in the near-term pregnant rat to simulate the pathophysiology of epidural-associated fever and hypothesized that it would produce fetal brain inflammation. METHODS: Twenty-four pregnant Sprague-Dawley rats were studied at 20 days gestation (term: 22 days). Dams were treated by injection of rat recombinant interleukin (IL)-6 or vehicle at 90-minute intervals, and temperature was monitored every 30 minutes. Eight hours after the first treatment, dams were delivered of fetuses and then killed. Maternal IL-6 was measured at delivery. Fetal brains (n = 24) were processed and stained for ED-1/CD68, a marker for activated microglia, and cell counts in the lateral septal and hippocampal brain regions were measured. Fetal brains were also stained for cyclooxygenase-2 (COX-2), a downstream marker of neuroinflammation. Eight fetal brains were further analyzed for quantitative forebrain COX-2 by Western blotting compared to a β-actin standard. Maternal temperature and IL-6 levels were compared between treatments, as were cell counts, COX-2 staining, and COX-2 levels by Mann-Whitney U test, repeated-measures analysis of variance, or Fisher exact test, as appropriate. RESULTS: Injection of rat IL-6 at 90-minute intervals produced an elevation of maternal temperature compared to vehicle (P

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Intraoperative Anemia Monitoring: Another Obstacle to Blood Conservation in the Surgical Patient

No abstract available

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Subcellular Energetics and Metabolism: A Cross-Species Framework

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The Aortocaval Compression Conundrum

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Understanding the Significance of Aerosolized Vasodilator Use in Pulmonary Hypertension: What Is Numerically, Statistically, and Clinically Meaningful?

No abstract available

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Do No Harm, Except Unto Thyself

No abstract available

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Do You Do What I Do? Cardiac Anesthesia Surveys From Around the Globe

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Effect of an Intravenous Dexamethasone Added to Caudal Local Anesthetics to Improve Postoperative Pain: A Systematic Review and Meta-analysis With Trial Sequential Analysis

imageBACKGROUND: Caudal anesthesia has been used for postoperative pain control in pediatric surgical patients, but the duration of the analgesic effect is occasionally unsatisfactory. Intravenous steroids have been shown to be effective for postsurgical pain management after certain surgeries. The aim of this meta-analysis with trial sequential analysis (TSA) was to evaluate the analgesic effect of steroids in patients administered with caudal anesthesia. METHODS: This study was a systematic review and meta-analysis. A search of published literature was conducted in the MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials databases and in trial registration sites. Randomized controlled trials that compared intravenous steroids with a placebo in pediatric patients who had received caudal anesthesia for surgery were included in the study. The primary outcomes from the present meta-analysis were the analgesic duration and the number of patients who required rescue analgesics. The analgesic duration and incidence of rescue use were summarized using mean difference or risk ratio with a 97.5% confidence interval (CI), respectively. If the 97.5% CI of the mean difference or risk ratio included a value of 0 or 1, respectively, we considered the difference not to be significant. We used the random effects model to combine the results. Heterogeneity was quantified with the I2 statistic. The quality of the trials was evaluated using the Cochrane methodology. Moreover, a TSA with a risk of type 1 error of 2.5% and power of 90% was performed. We established the minimum clinically meaningful difference of analgesic duration as 3 hours. The target sample size for meta-analysis was also calculated in the TSA. We also assessed adverse events. RESULTS: Six trials with 424 patients were included; 211 patients received intravenous steroids. All trials compared dexamethasone of at least 0.5 mg/kg dose with a placebo. Dexamethasone prolonged the duration of caudal analgesia (mean difference, 244 minutes; 97.5% CI, 188–300). Heterogeneity was considerable with an I2 value of 94.8%. Quality of evidence was very low. The TSA suggested that only 17.0% of the target sample size had been reached, but the cumulative Z score crossed the trial sequential monitoring boundary to indicate a benefit. Rescue use was reported in 4 studies with 260 patients. Rescue use was not significantly reduced in the dexamethasone group (risk ratio, 0.53; 97.5% CI, 0.09–3.30; I2, 98.7%). No increase in adverse events was reported. CONCLUSIONS: Intravenous dexamethasone prolongs the analgesic duration of caudal anesthesia. Trials to investigate the effectiveness of a lower dose of the dexamethasone in prolonging analgesic effects would be of interest. Further trials with a low risk of bias are necessary.

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Association of Surgery and Anesthesia With Mental Disorder Diagnoses: What Would Sir Austin Bradford Hill Say?

No abstract available

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Opioid Prescribing for the Treatment of Acute Pain in Children on Hospital Discharge

imageBACKGROUND: The epidemic of nonmedical use of prescription opioids has been fueled by the availability of legitimately prescribed unconsumed opioids. The aim of this study was to better understand the contribution of prescriptions written for pediatric patients to this problem by quantifying how much opioid is dispensed and consumed to manage pain after hospital discharge, and whether leftover opioid is appropriately disposed of. Our secondary aim was to explore the association of patient factors with opioid dispensing, consumption, and medication remaining on completion of therapy. METHODS: Using a scripted 10-minute interview, parents of 343 pediatric inpatients (98% postoperative) treated at a university children's hospital were questioned within 48 hours and 10 to 14 days after discharge to determine amount of opioid prescribed and consumed, duration of treatment, and disposition of unconsumed opioid. Multivariable linear regression was used to examine predictors of opioid prescribing, consumption, and doses remaining. RESULTS: Median number of opioid doses dispensed was 43 (interquartile range, 30–85 doses), and median duration of therapy was 4 days (interquartile range, 1–8 days). Children who underwent orthopedic or Nuss surgery consumed 25.42 (95% confidence interval, 19.16–31.68) more doses than those who underwent other types of surgery (P

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Being Mindful in Managing Pain: Integrative Medicine in Chronic Pain Management

imageNo abstract available

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Using Integrative Medicine in Pain Management: An Evaluation of Current Evidence

imageComplementary medicine therapies are frequently used to treat pain conditions such as headaches and neck, back, and joint pain. Chronic pain, described as pain lasting longer than 3–6 months, can be a debilitating condition that has a significant socioeconomic impact. Pharmacologic approaches are often used for alleviating chronic pain, but recently there has been a reluctance to prescribe opioids for chronic noncancer pain because of concerns about tolerance, dependence, and addiction. As a result, there has been increased interest in integrative medicine strategies to help manage pain and to reduce reliance on prescription opioids to manage pain. This article offers a brief critical review of integrative medical therapies used to treat chronic pain, including nutritional supplements, yoga, relaxation, tai chi, massage, spinal manipulation, and acupuncture. The goal of this article is to identify those treatments that show evidence of efficacy and to identify gaps in the literature where additional studies and controlled trials are needed. An electronic search of the databases of PubMed, The Cochrane Library, EMBASE, PsycINFO, and Science Citation Index Expanded was conducted. Overall, weak positive evidence was found for yoga, relaxation, tai chi, massage, and manipulation. Strong evidence for acupuncture as a complementary treatment for chronic pain that has been shown to decrease the usage of opioids was found. Few studies were found in which integrative medicine approaches were used to address opioid misuse and abuse among chronic pain patients. Additional controlled trials to address the use of integrative medicine approaches in pain management are needed.

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Massive Transfusion Protocols: When to Turn On, and Off, the Fire Hose

imageNo abstract available

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Initiation and Termination of Massive Transfusion Protocols: Current Strategies and Future Prospects

imageThe advent of massive transfusion protocols (MTP) has had a significant positive impact on hemorrhaging trauma patient morbidity and mortality. Nevertheless, societal MTP guidelines and individual MTPs at academic institutions continue to circulate opposing recommendations on topics critical to MTPs. This narrative review discusses up-to-date information on 2 such topics, the initiation and termination of an MTP. The discussion for each begins with a review of the recommendations and supporting literature presented by MTP guidelines from 3 prominent societies, the American Society of Anesthesiologists, the American College of Surgeons, and the task force for Advanced Bleeding Care in Trauma. This is followed by an in-depth analysis of the main components within those recommendations. Societal recommendations on MTP initiation in hemorrhaging trauma patients emphasize the use of retrospectively validated massive transfusion (MT) prediction score, specifically, the Assessment of Blood Consumption and Trauma-Associated Severe Hemorrhage scores. Validation studies have shown that both scoring systems perform similarly. Both scores reliably identify patients that will not require an MT, while simultaneously overpredicting MT requirements. However, each scoring system has its unique advantages and disadvantages, and this review discusses how specific aspects of each scoring system can affect widespread applicability and statistical performance. In addition, we discuss the often overlooked topic of initiating MT in nontrauma patients and the specific tools physicians have to guide the MT initiation decision in this unique setting. Despite the serious complications that can arise with transfusion of large volumes of blood products, there is considerably less research pertinent to the topic of MTP termination. Societal recommendations on MTP termination emphasize applying clinical reasoning to identify patients who have bleeding source control and are adequately resuscitated. This review, however, focuses primarily on the recommendations presented by the Advanced Bleeding Care in Trauma's MTP guidelines that call for prompt termination of the algorithm-guided model of resuscitation and rapidly transitioning into a resuscitation model guided by laboratory test results. We also discuss the evidence in support of laboratory result–guided resuscitation and how recent literature on viscoelastic hemostatic assays, although limited, highlights the potential to achieve additional benefits from this method of resuscitation.

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In Response

No abstract available

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Risk of Cognitive Impairment by Sleep-Disordered Breathing

No abstract available

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Comparison of Transcranial Doppler and Ultrasound-Tagged Near Infrared Spectroscopy for Measuring Relative Changes in Cerebral Blood Flow in Human Subjects

BACKGROUND: Currently, no reliable method exists for continuous, noninvasive measurements of absolute cerebral blood flow (CBF). We sought to determine how changes measured by ultrasound-tagged near-infrared spectroscopy (UT-NIRS) compare with changes in CBF as measured by transcranial Doppler (TCD) in healthy volunteers during profound hypocapnia and hypercapnia. METHODS: Ten healthy volunteers were monitored with a combination of TCD, UT-NIRS (c-FLOW, Ornim Medical), as well as heart rate, blood pressure, end-tidal PCO2 (PEtCO2), end-tidal O2, and inspired O2. Inspired CO2 and minute ventilation were controlled to achieve 5 stable plateau goals of EtCO2 at 15–20, 25–30, 35–40, 45–50, and 55–60 mm Hg, for a total of 7 measurements per subject. CBF was assessed at a steady state, with the TCD designated as the reference standard. The primary analysis was a linear mixed-effect model of TCD and UT-NIRS flow with PEtCO2, which accounts for repeated measures. Receiver operating characteristic curves were determined for detection of changes in CBF. RESULTS: Hyperventilation (nadir PEtCO2 17.1 ± 2.4) resulted in significantly decreased mean flow velocity of the middle cerebral artery from baseline (to 79% ± 22%), but not a consistent decrease in UT-NIRS cerebral flow velocity index (n = 10; 101% ± 6% of baseline). Hypercapnia (peak PEtCO2 59.3 ± 3.3) resulted in a significant increase from baseline in both mean flow velocity of the middle cerebral artery (153% ± 25%) and UT-NIRS (119% ± 11%). Comparing slopes versus PEtCO2 as a percent of baseline for the TCD (1.7% [1.5%–2%]) and UT-NIRS (0.4% [0.3%–0.5%]) shows that the UT-NIRS slope is significantly flatter, P

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Not All Calcium Formulations Are Alike

No abstract available

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Unadjusted Bivariate Two-Group Comparisons: When Simpler is Better

Hypothesis testing involves posing both a null hypothesis and an alternative hypothesis. This basic statistical tutorial discusses the appropriate use, including their so-called assumptions, of the common unadjusted bivariate tests for hypothesis testing and thus comparing study sample data for a difference or association. The appropriate choice of a statistical test is predicated on the type of data being analyzed and compared. The unpaired or independent samples t test is used to test the null hypothesis that the 2 population means are equal, thereby accepting the alternative hypothesis that the 2 population means are not equal. The unpaired t test is intended for comparing dependent continuous (interval or ratio) data from 2 study groups. A common mistake is to apply several unpaired t tests when comparing data from 3 or more study groups. In this situation, an analysis of variance with post hoc (posttest) intragroup comparisons should instead be applied. Another common mistake is to apply a series of unpaired t tests when comparing sequentially collected data from 2 study groups. In this situation, a repeated-measures analysis of variance, with tests for group-by-time interaction, and post hoc comparisons, as appropriate, should instead be applied in analyzing data from sequential collection points. The paired t test is used to assess the difference in the means of 2 study groups when the sample observations have been obtained in pairs, often before and after an intervention in each study subject. The Pearson chi-square test is widely used to test the null hypothesis that 2 unpaired categorical variables, each with 2 or more nominal levels (values), are independent of each other. When the null hypothesis is rejected, 1 concludes that there is a probable association between the 2 unpaired categorical variables. When comparing 2 groups on an ordinal or nonnormally distributed continuous outcome variable, the 2-sample t test is usually not appropriate. The Wilcoxon-Mann-Whitney test is instead preferred. When making paired comparisons on data that are ordinal, or continuous but nonnormally distributed, the Wilcoxon signed-rank test can be used. In analyzing their data, researchers should consider the continued merits of these simple yet equally valid unadjusted bivariate statistical tests. However, the appropriate use of an unadjusted bivariate test still requires a solid understanding of its utility, assumptions (requirements), and limitations. This understanding will mitigate the risk of misleading findings, interpretations, and conclusions. Accepted for publication October 4, 2017. Funding: None. The authors declare no conflicts of interest. Address correspondence to Thomas R. Vetter, MD, MPH, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Health Discovery Bldg, Room 6.812, 1701 Trinity St, Austin, TX 78712. Address e-mail to thomas.vetter@austin.utexas.edu. © 2017 International Anesthesia Research Society

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Low- Versus High-Chloride Content Intravenous Solutions for Critically Ill and Perioperative Adult Patients: A Systematic Review and Meta-analysis

BACKGROUND: To assess whether use of low-chloride solutions in unselected critically ill or perioperative adult patients for maintenance or resuscitation reduces mortality and renal replacement therapy (RRT) use when compared to high-chloride fluids. METHODS: Systematic review and meta-analysis with random-effects inverse variance model. PubMed, Cochrane library, EMBASE, LILACS, and Web of Science were searched from inception to October 2016. Published and unpublished randomized controlled trials in any language that enrolled critically ill and/or perioperative adult patients and compared a low- to a highchloride solution for volume maintenance or resuscitation. The primary outcomes were mortality and RRT use. We conducted trial sequential analyses and assessed risk of bias of individual trials and the overall quality of evidence. Fifteen trials with 4067 patients, most at low risk of bias, were identified. Of those, only 11 and 10 trials had data on mortality and RRT use, respectively. A total of 3710 patients were included in the mortality analysis and 3724 in the RRT analysis. RESULTS: No statistically significant impact on mortality (odds ratio, 0.90; 95% confidence interval, 0.69–1.17; P = .44; I2 = 0%) or RRT use (odds ratio, 1.12; 95% confidence interval, 0.80–1.58; P = .52; I2 = 0%) was found. Overall quality of evidence was low for both primary outcomes. Trial sequential analyses highlighted that the sample size needed was much larger than that available for properly powered outcome assessment. CONCLUSIONS: The current evidence on low- versus high-chloride solutions for unselected critically ill or perioperative adult patients demonstrates no benefit, but suffers from considerable imprecision. We noted a limited exposure volume for study fluids and a relatively low risk of the populations in each study. Together with the relatively small pooled sample size, these data leave us underpowered to detect potentially important differences. Results from well-conducted, adequately powered randomized controlled trials examining sufficiently large fluid exposure are necessary. Accepted for publication October 6, 2017. Funding: This meta-analysis was supported by the Brazilian Ministry of Health. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Leticia Kawano-Dourado, MD, Research Institute - Hospital do Coracao (HCor), Rua Abilio Soares 250, 12o andar, cep: 04005-000, São Paulo-SP, Brazil. Address e-mail to ldourado@hcor.com.br. © 2017 International Anesthesia Research Society

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In Response

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Increased Hyperalgesia and Proinflammatory Cytokines in the Spinal Cord and Dorsal Root Ganglion After Surgery and/or Fentanyl Administration in Rats

BACKGROUND: Perioperative fentanyl has been reported to induce hyperalgesia and increase postoperative pain. In this study, we tried to investigate behavioral hyperalgesia, the expression of proinflammatory cytokines, such as interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α), and the activation of microglia in the spinal cord and dorsal root ganglion (DRG) in a rat model of surgical plantar incision with or without perioperative fentanyl. METHODS: Four groups of rats (n = 32 for each group) were subcutaneously injected with fentanyl at 60 μg/kg or normal saline for 4 times with 15-minute intervals. Plantar incisions were made to rats in 2 groups after the second drug injection. Mechanical and thermal nociceptive thresholds were assessed by the tail pressure test and paw withdrawal test on the day before, at 1, 2, 3, 4 hours, and on the days 1–7 after drug injection. The lumbar spinal cord, bilateral DRG, and cerebrospinal fluid of 4 rats in each group were collected to measure IL-1β, IL-6, and TNF-α on the day before, at the fourth hour, and on the days 1, 3, 5, and 7 after drug injection. The lumbar spinal cord and bilateral DRG were removed to detect the ionized calcium-binding adapter molecule 1 on the day before and on the days 1 and 7 after drug injection. RESULTS: Rats injected with normal saline only demonstrated no significant mechanical or thermal hyperalgesia or any increases of IL-1β, IL-6, and TNF-α in the spinal cord or DRG. However, injection of fentanyl induced analgesia within as early as 4 hours and a significant delayed tail mechanical and bilateral plantar thermal hyperalgesia after injections lasting for 2 days, while surgical plantar incision induced a significant mechanical and thermal hyperalgesia lasting for 1–4 days. The combination of fentanyl and incision further aggravated the hyperalgesia and prolonged the duration of hyperalgesia. The fentanyl or surgical incision upregulated the expression of IL-1β, IL-6, and TNF-α in the spinal cord and bilateral DRG for more than 7 days and increase of ionized calcium-binding adapter molecule 1 in the spinal cord. The combination of fentanyl and incision resulted in higher increase of IL-1β, IL-6, and TNF-α in the spinal cord and bilateral DRG. CONCLUSIONS: The surgical plantar incision with or without perioperative fentanyl induced significant mechanical and thermal hyperalgesia, an increased expression of IL-1β, IL-6, TNF-α in the spinal cord and DRG, and activation of microglia in the spinal cord. 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. Accepted for publication September 19, 2017. Funding: This study was supported by National Natural Science Foundation of China (Project No. 81571071) and Guangdong Provincial Natural Science Foundation of China (Project No. 2014A030313203). The authors declare no conflicts of interest. The authors Chang and Ye contributed equally to this study. Reprints will not be available from the authors. Address correspondence to Haihua Shu, MD, PhD, Department of Anesthesiology, Guangdong Second Provincial General Hospital, 466# Xingang Middle Rd, Guangzhou, Guangdong 510317, China. Address e-mail to shuhaihua@hotmail.com. © 2017 International Anesthesia Research Society

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Chest Pain From Hypermobility Responding to Physical Therapy in an Adolescent

imageAbstract Hypermobility syndrome usually causes pain in limbs from extension type injuries. The authors report on a 16-yr-old female adolescent with incapacitating chest pain secondary to extreme hypermobility of the chest. This pain led the patient to see multiple specialists without improvement or diagnosis. Physical examination results revealed a very hypermobile patient who was able to internally rotate her shoulders inward until her elbows touched. This unusual hyperextension maneuver was achieved by holding the shoulders in anteversion with her hands on her hips (see figures in the article). Currently, there is no literature reporting hypermobility as a cause for chronic chest pain. Pain medication including opioids did not reduce the patient's chronic chest pain. Specific physical therapy to strengthen core and chest wall muscles in addition to working on proper breathing techniques with the diaphragm decreased pain and resulted in a resolution of this condition. We report that hypermobility can cause significant chest pain and may require creative physical therapy to strengthen the specific musculature.

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Standard and Amputation-Adjusted Body Mass Index Measures: Comparison and Relevance to Functional Measures, Weight-Related Comorbidities, and Dieting

imageAbstract People with limb loss may misjudge weight-related health when not adjusting body mass index (BMI) for amputation level. This cross-sectional, community-based study compared BMI and amputation-adjusted BMI (A-BMI) and evaluated relationships among BMI categories, function, and dieting. Subjects provided self-reported demographic, functional, and medical/prosthetic data including height and weight and completed performance-based balance and gait measures. A Web-based A-BMI calculator adjusted for amputation levels. Results for 294 subjects from 11 states (68.4% men; 76.5% white; average age, 55.6 [15.1] y) were reported, with vascular (49.7%) and unilateral transtibial (40.8%) amputations as the most common. Body mass index and A-BMI were closely correlated (Pearson r = 0.99), but a BMI of 28.6 (6.7) was less than an A-BMI of 30.3 (6.2) (t test, P 0.05). A larger than random proportion categorized as overweight by BMI dieted (χ2, P 0.05). People with limb loss using BMI may underestimate weight-related health; a Web-based A-BMI calculator may help monitor weight to make dieting decisions.

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Health-Related Quality of Life and Cancer-Related Symptoms During Interdisciplinary Outpatient Rehabilitation for Malignant Brain Tumor

imageObjective The aim of the study was to determine the relationships between functional outcomes, clinical symptoms, and health-related quality of life among patients with malignant brain tumors receiving interdisciplinary outpatient rehabilitation. Design A prospective study of 49 adults with malignant brain tumors participating in outpatient therapies was performed. Outcome measures included the Functional Assessment of Cancer Therapy-Brain (FACT-Br) for health-related quality of life and the Patient-Reported Outcome Measures Instrument Survey (PROMIS) Depression and Pain Behavior scales measured at admission, discharge, 1 and 3 mos after discharge. Day Rehabilitation Outcome Scale (DayROS), a functional measure, was measured at admission and discharge. Results The FACT-Br scores, PROMIS pain, and PROMIS depression scores did not significantly change. There were many negative associations seen between FACT-Br and PROMIS depression (all P

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Effects of Participation in Sports Programs on Walking Ability and Endurance Over Time in Children With Cerebral Palsy

imageObjective Children with cerebral palsy may benefit from maintaining a high level of physical fitness similar to typically developing children especially in terms of long-term physical performance, although in practice this is often difficult. The purpose of this study was to determine the effect of participation in sports programs on walking ability and endurance over time. Design A retrospective cohort study included participants with cerebral palsy, aged 6 to 20 yrs, who attended a summer sports program from 2004 to 2012. There were 256 participant sessions with pre/post data recorded. The participants consisted of a total of 97 children (mean age [SD] = 11.4 [3.1] yrs), many of whom attended multiple programs throughout the years. Programs were held 6 hrs/d, 5 d/wk for up to 4 wks. Outcome measures included the Timed Up and Go, modified 6-min walk, and 25-ft walk/run. Results The results showed significant improvements in the Timed Up and Go, modified 6-min walk distance and 25-ft walk/run over time. Children in Gross Motor Classification System level III made the largest gains. Conclusions Walking ability and endurance seem to improve after participation in an intensive summer sports programs. Higher frequency of program attendance resulted in significant improvements in the Timed Up and Go. To Claim CME Credits Complete the self-assessment activity and evaluation online at http://ift.tt/1l80W45 CME Objectives Upon completion of this article, the reader should be able to: (1) Discuss the importance of physical activity at the participation level (sports programs) for children with cerebral palsy; (2) Contrast the changes in walking ability and endurance for children in Gross Motor Function Classification System level I, II, and III after sports programs; and (3) Identify the impact of higher frequency of sports program attendance over time on walking ability. Level Advanced Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.75 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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Surface Electromyographic Activity of the Upper Trapezius Before and After a Single Dry Needling Session in Female Office Workers With Trapezius Myalgia

imageObjective Myofascial pain can be accompanied by a disturbed surface electromyographic (sEMG) activity. Nevertheless, the effect of myofascial treatment techniques, such as dry needling (DN), on the sEMG activity is poorly investigated. Several DN studies also emphasize the importance of eliciting local twitch responses (LTRs) during treatment. However, studies investigating the added value of LTRs are scarce. Therefore, the aims of this study were first to evaluate the effect of DN on the sEMG activity of myalgic muscle tissue, compared with no intervention (rest), and secondly to identify whether this effect is dependent of eliciting LTRs during DN. Methods Twenty-four female office workers with work-related trapezius myalgia were included. After completion of a typing task, changes in sEMG activity were evaluated after a DN treatment of the upper trapezius, compared with rest. Results The sEMG activity increased after rest and after DN, but this increase was significantly smaller 10 minutes after DN, compared with rest. These differences were independent whether LTRs were elicited or not. Conclusions Dry needling leads to a significantly lower increase in sEMG activity of the upper trapezius, compared with no intervention, after a typing task. This difference was independent of eliciting LTRs.

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Ultrasound Anatomy of the Transverse Carpal Ligament

imageNo abstract available

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Comparison of Inching Electrodiagnosis Method and Ultrasonographic Findings in the Determination of Median Nerve Entrapment Site in Carpal Tunnel Syndrome

imageObjective The purpose of the study was to evaluate the diagnostic value of both inching method through the electrodiagnostic test and ultrasonographic assay in localizing the site of entrapment in patients with symptoms and signs of carpal tunnel syndrome. Design Thirty-two hands with confirmed carpal tunnel syndrome through electrodiagnostic test and 30 hands as control group were enrolled. For both groups, sensory and motor latencies by inching technique and cross-sectional area by ultrasonography were measured at the inching points. The statistical analysis was performed by SPSS software, and mean difference with 95% confidence interval was calculated. Results Mean of sensory peak latency with inching method and cross-sectional area by the ultrasonography was greater in case group compared with the control group (P

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Hip Ganglion Cyst Causing Femoral Nerve Dysesthesia

imageNo abstract available

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Are Ultrasonographic Measures of Cervical Flexor Muscles Correlated With Flexion Endurance in Chronic Neck Pain and Asymptomatic Participants?

imageObjective This study compared the relationship between some clinical factors and the size of neck flexors in participants with or without chronic neck pain. Design In this case-control study, the correlation between flexor endurance capacity as well as thickness, cross-section area, and shape ratio of longus colli/capitis and sternocleidomastoid muscles were examined in 30 patients with chronic neck pain and 30 asymptomatic participants. Results The patients showed lower flexor endurance (P = 0.02), smaller thickness (P = 0.03), and cross-section area (P

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Role of Breathing Conditions During Exercise Testing on Training Prescription in Chronic Obstructive Pulmonary Disease

imageAbstract This study investigated whether different breathing conditions during exercise testing will influence measures of exercise capacity commonly used for training prescription in chronic obstructive pulmonary disease. Twenty-seven patients with chronic obstructive pulmonary disease (forced expiratory volume in 1 sec = 45.6 [9.4]%) performed three maximal exercise tests within 8 days, but at least 48 hrs apart. Subjects were thereby breathing either room air through a tightly fitting face mask like during any cardiopulmonary exercise test (MASK), room air without mask (No-MASK), or 10 l/min of oxygen via nasal cannula (No-MASK + O2). Cycling protocols were identical for all tests (start = 20 watts, increment = 10 males/5 females watts/min). Maximal work rate (90.4 [33.8], 100.3 [34.8], 107.4 [35.9] watts, P

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Patient Registry of Spasticity Care World: Data Analysis Based on Physician Experience

imageObjective The aim of the study was to report physician experience–based "real-world" treatment patterns with botulinum toxin type A in patients with stroke and traumatic brain injury. Design A prospective, multicenter, international observational registry design was used. Results Six hundred twenty-seven participants with stroke and 132 participants with traumatic brain injury were assessed and treated by 17 more experienced physicians and 12 less experienced physicians. Due to the limited usage of abobotulinumtoxinA Dysport and incobotulinumtoxinA Xeomin, data were reported on onabotulinumtoxinA BOTOX only. Based on physician experience, onabotulinumtoxinA doses were statistically different with larger mean doses injected by more experienced physicians in the upper limb (59.9 [39.0], P = 0.001) and in the lower limb (101.8 [69.2], P

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Second-Order Peer Reviews of Clinically Relevant Articles for the Physiatrist: Additional Weekend Therapy May Reduce Length of Rehabilitation Stay After Stroke A Meta-analysis of Individual Patient Data

No abstract available

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What Is the Effect of Strength Training on Pain and Sleep in Patients With Fibromyalgia?

imageObjective The study aimed to investigate the effect of an 8-wk structured strength training program on pain and sleep quality in patients with fibromyalgia. Design Fifty-two patients with fibromyalgia were evaluated; 31 submitted to strength training and 21 comprised the control group. The instruments used were the Fibromyalgia Impact Questionnaire and The Pittsburgh Sleep Quality Index. The questionnaires were applied before the first training session, at 12 sessions, and after 24 sessions. Descriptive statistics (mean, SD, and frequency) and inferential tests were used. Results After 8 wks of intervention, significant differences were found between groups in subjective quality of sleep (P = 0.03), sleep disturbance (P = 0.02), daytime dysfunction (P = 0.04), and total sleep score (P

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Response to the Letter to the Editor on “Ultrasound Anatomy of the Transverse Carpal Ligament”

No abstract available

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Walking Aids for Enabling Activity and Participation: A Systematic Review

imageAbstract In this systematic literature review, we examined whether and how walking aids (i.e., canes, crutches, walkers, and rollators) enable activity and participation among adults with physical disabilities. Medline, Embase, all EBM reviews, PsychInfo, CINAHL, and Web of Science databases were used to identify studies published since 2008. Quantitative and qualitative designs were included. Data regarding participants, assistive device use, outcome measures, and domains of participation were extracted. Two reviewers independently rated the level of evidence and methodological quality of the studies. Outcomes were categorized per types of walking aids and activity and participation domains. Thirteen studies were included. Two studies involved canes, four pertained to rollators, and seven dealt with multiple types of walking aids. Mobility was the most frequently examined domain of activity and participation. Both negative and positive results were found. Negative outcomes were linked to the physical characteristics of the device, the use, environment, and personal reluctance. When incorporated in daily life, walking aids were found to enable several domains of activity and participation. Whether walking aids facilitate activity and participation may depend on the user's ability to overcome obstacles and integrate them in daily life. More high-quality research is needed to draw conclusions about their effectiveness.

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Hypercapnia Caused by a Therapeutic Dosage of Pregabalin in a Tetraplegic Patient With Cervical Spinal Cord Injury

imageAbstract Pregabalin is often used for the treatment of neuropathic pain in patients with spinal cord injury (SCI). We reported a patient with C5 [S(C5/C6)] ASIA Impairment Scale C SCI due to cervical myelopathy who presented CO2 retention when taking a therapeutic dosage of pregabalin. An 88-year-old patient with cervical SCI was transferred to the department of physical medicine and rehabilitation. When he had transferred, his neuropathic pain had been treated with 150-mg pregabalin per day (75 mg twice a day); however, he still exhibited severe neuropathic pain with a Numeric Pain Rating Scale score of 7 to 8. Dosage for the pregabalin increased from 150 mg/d (75 mg twice a day) to 225 mg/d (150 mg at morning and 75 mg at dinner). That afternoon, he presented drowsiness and confusion, and arterial blood gas analysis (ABGA) demonstrated respiratory acidosis with CO2 retention; pH, 7.312; PaCO2, 62.8 mm Hg; PaO2,58.9 mm Hg; HCO3 concentration, 30.8 mmol/L; base excess, 3.2 mmol/L; and oxygen saturation, 90.4%. Finally, he required tracheal intubation and ventilation. After 6 weeks, the patient was transferred to a general ward, and the follow-up ABGA and end-tidal CO2 showed normal range with the discontinuation of pregabalin. We demonstrated CO2 retention via ABGA in a patient with SCI due to cervical myelopathy who developed hypercapnia after taking a therapeutic dose of pregabalin. Physicians should pay particular attention to CO2 retention when prescribing a therapeutic dosage of pregabalin in a patient with cervical SCI.

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Ultrasound-Guided Steroid Injection of the Pisotriquetral Joint: A Multidisciplinary Effort

imageAbstract From the perspective of a multidisciplinary team, the authors describe the first reported use of ultrasound guidance for steroid injection into the pisotriquetral joint to relieve wrist pain of a person with spinal cord injury undergoing acute inpatient rehabilitation. Musculoskeletal ultrasound guidance was used to improve the accuracy of a corticosteroid injection of the pisotriquetral joint and the basal thumb in a 70-year-old man with paraplegia experiencing multifocal degenerative wrist pain. There was no bleeding or bruising after the injections, and the patient reported complete pain resolution 1 wk after the injections, which continued for over 1 yr. A multidisciplinary team was key in diagnosis, selection of treatment, and evaluation of treatment effect. Corticosteroid injection of the pisotriquetral joint under ultrasound guidance can be used as a treatment modality for managing wrist pain stemming from that joint. Further investigation and studies evaluating the use of ultrasound versus other imaging modalities for injection of the wrist are indicated.

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A Tip for Differentiating Between Sensory and Muscle Action Potentials

imageNo abstract available

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Triple Aim Initiative makes measuring patient satisfaction a key step for accreditation

The Institute for Healthcare Improvement's Triple Aim Initiative establishes patient satisfaction as an important benchmark for accreditation

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Pharmacological considerations in the elderly

Purpose of review This review discusses the pharmacology of contemporary anesthetic medications in geriatric patients, neurophysiological changes with aging, current recommendations for dosing anesthetic drugs. It also addresses current practice patterns and ongoing studies, which are likely to affect future anesthetic drug management in the elderly. Recent findings Potency of anesthetic drugs is increased in the elderly. In addition to changes at the receptor level, neurophysiological changes in functional connectivity with aging contributes to increased sensitivity of anesthetic drugs. However, the extent of reduction is underappreciated by the practitioners and dose adjustment is not uniformly applied in practice. Large database studies demonstrate association of short-term intraoperative hypotension and CNS depression, to poor perioperative outcomes. These perturbations are probably of greater consequence in frail, elderly patients with reduced reserves. Summary Anesthetic dosing should be more closely age-adjusted to prevent anesthetic-induced hypotension and increased depth of anesthesia in the elderly. Pharmacologic studies are required in the elderly population (>80 years). Correspondence to Shamsuddin Akhtar, Associate Professor, Anesthesiology and Pharmacology, Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, TMP # 3, PO Box 208051, New Haven, CT 06520-8051, USA. Tel: +1 203 785 2802; fax: +1 203 785 6664; e-mail: shamsuddin.akhtar@yale.edu Copyright © 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Dexmedetomidine promotes biomimetic non-rapid eye movement stage 3 sleep in humans: A pilot study

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Publication date: January 2018
Source:Clinical Neurophysiology, Volume 129, Issue 1
Author(s): Oluwaseun Akeju, Lauren E. Hobbs, Lei Gao, Sara M. Burns, Kara J. Pavone, George S. Plummer, Elisa C. Walsh, Tim T. Houle, Seong-Eun Kim, Matt T. Bianchi, Jeffrey M. Ellenbogen, Emery N. Brown
ObjectivesSleep, which comprises of rapid eye movement (REM) and non-REM stages 1–3 (N1–N3), is a natural occurring state of decreased arousal that is crucial for normal cardiovascular, immune and cognitive function. The principal sedative drugs produce electroencephalogram beta oscillations, which have been associated with neurocognitive dysfunction. Pharmacological induction of altered arousal states that neurophysiologically approximate natural sleep, termed biomimetic sleep, may eliminate drug-induced neurocognitive dysfunction.MethodsWe performed a prospective, single-site, three-arm, randomized-controlled, crossover polysomnography pilot study (n = 10) comparing natural, intravenous dexmedetomidine- (1-μg/kg over 10 min [n = 7] or 0.5-μg/kg over 10 min [n = 3]), and zolpidem-induced sleep in healthy volunteers. Sleep quality and psychomotor performance were assessed with polysomnography and the psychomotor vigilance test, respectively. Sleep quality questionnaires were also administered.ResultsWe found that dexmedetomidine promoted N3 sleep in a dose dependent manner, and did not impair performance on the psychomotor vigilance test. In contrast, zolpidem extended release was associated with decreased theta (∼5–8 Hz; N2 and N3) and increased beta oscillations (∼13–25 Hz; N2 and REM). Zolpidem extended release was also associated with increased lapses on the psychomotor vigilance test. No serious adverse events occurred.ConclusionsPharmacological induction of biomimetic N3 sleep with psychomotor sparing benefits is feasible.SignificanceThese results suggest that α2a adrenergic agonists may be developed as a new class of sleep enhancing medications with neurocognitive sparing benefits.



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Cytosolic aminoacyl-tRNA synthetases: unanticipated relocations for unexpected functions

Publication date: Available online 16 November 2017
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms
Author(s): Nathaniel Yakobov, Sylvain Debard, Frédéric Fischer, Bruno Senger, Hubert Dominique Becker
AbstractProkaryotic and eukaryotic cytosolic aminoacyl-tRNA synthetases (aaRSs) are essentially known for their conventional function of generating the full set of aminoacyl-tRNA species that are needed to incorporate each organism's repertoire of genetically-encoded amino acids during ribosomal translation of messenger RNAs. However, bacterial and eukaryotic cytosolic aaRSs have been shown to exhibit other essential nonconventional functions. Here we review all the subcellular compartments that prokaryotic and eukaryotic cytosolic aaRSs can reach to exert either a conventional or nontranslational role. We describe the physiological and stress conditions, the mechanisms and the signalling pathways that trigger their relocation and the new functions associated with these relocating cytosolic aaRS. Finally, given that these relocating pools of cytosolic aaRSs participate to a wide range of cellular pathways beyond translation, but equally important for cellular homeostasis, we mention some of the pathologies and diseases associated with the dis-regulation or malfunctioning of these nontranslational functions.



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The impact of social exclusion on anticipatory attentional processing

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Publication date: Available online 15 November 2017
Source:International Journal of Psychophysiology
Author(s): John E. Kiat, Jacob E. Cheadle, Bridget J. Goosby
The importance of understanding how we anticipate and prepare for social rejection is underscored by the mental and physical toll of continual social vigilance. In this study, we investigate the impact of social rejection on anticipatory attentional processes using the well-known Cyberball task, a paradigm in which participants engage in a game of catch with virtual avatars who after an initial period of fair-play (inclusion condition) then exclude the participant from the game (exclusion condition). The degree of anticipatory attention allocated by subjects towards the avatars was assessed by measuring P3b responses towards the avatars' preparatory actions (i.e. the phase preceding their exclusionary actions) using high density EEG. The results of the study show that relative to the inclusion, participants exhibit elevated levels of anticipatory attentional allocation towards the avatars during the exclusion block. This shift was however significantly moderated by participants' self-reported cognitive regulation tendencies. Participants with higher levels of self-reported cognitive reappraisal tendencies showed larger anticipatory P3b increases from the inclusion to exclusion block relative to participants with reduced levels of reappraisal tendencies. These results highlight the impact of social exclusion on anticipatory neural processing and the moderating role of cognitive reappraisal on these effects.



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Wernicke–Korsakov Syndrome

Objective. To study the characteristics of the diagnosis and treatment of non-alcoholic-related Wernicke–Korsakov syndrome (WKS). Materials and methods. Eight patients (five men and three women) with mean age 38.9 ± 1.4 years with WKS were observed; WKS in three patients developed on the background of acute and two on the background of exacerbations of chronic gastrointestinal tract diseases with malabsorption, and in three after surgery to the upper segments of the gastrointestinal tract Results. Illness debuted with impaired consciousness. Symptoms of ataxia, oculomotor disorders, and bulbar syndrome started after 24–48 h. One patient developed a treatment-resistant state of tonic-clonic seizures. The brain MRI picture was characterized by the presence of hyperintense foci on T2-weighted images in the areas of the hypothalamus, mammillary bodies, brainstem, and cerebellum, with accumulation of contrast in the mammillary bodies. Patients received treatment with a complex of group B vitamins (Neurobion) and thiamine, with positive results Conclusions. Patients with gastrointestinal tract diseases accompanied by malabsorption are at risk of developing WKS. The appearance of changes in consciousness, ataxia, and oculomotor disorders in these patients is an indication to start thiamine therapy, thus preventing the development of stable cognitive deficit.



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Effects of Russian-Language Word Frequency on Mismatch Negativity in Auditory Event-Related Potentials

We report here our studied on the influence of the lexical frequency of Russian words on the latency and amplitude of mismatch negativity (MMN) in auditory event-related potentials (ERP). ERP were recorded in a multideviant oddball paradigm by presenting different-frequency Russian words and pseudowords. These experiments showed that the pattern of intrinsic MMN differed significantly between words with different lexical frequencies (p = 0.001) – the higher the frequency, the greater the amplitude and the shorter the latent period of the intrinsic MMN of the words. It is suggested that the greater amplitude and shorter latency of MMN for high-frequency words as compared with the pattern of MMN for low-frequency words is due to activation of memory traces for these words, these being stored in the cerebral cortex as distributed neuron populations. The suggestion that there is superfast access to lexical information during speech perception is confirmed, with access being possible 100–200 msec after presentation of a word. The ratio of MMN amplitudes for different pseudowords was somewhat reminiscent of data on MMN for words (analogs of high-frequency words produced higher-amplitude responses, while analogs of low-frequency words produced weaker responses, with no significant difference between low- and intermediate-frequency analogs), though MMN amplitudes for pseudowords were significantly greater and latent periods were significantly longer. Increases in the amplitude and latency of MMN to pseudowords as compared with MMN to words is associated with later and uncertain recognition of rarely encountered low-frequency words and completely unfamiliar stimuli, which are later classified as signals of a different category.



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25 Years of the Amyloid Hypothesis of the Origin of Alzheimer’s Disease: Advances, Failures, and New Perspectives

The amyloid hypothesis of the development of Alzheimer's disease (AD) continues to dominate, though the concept has changed significantly during its 25-year history. The accumulation of β-amyloid has been found to be linked not only with increase in its production (as found after elucidation of the genetic mechanisms of some familial cases of AD), but also with impairments to its clearance from brain tissues, which is mediated by the microcirculatory system. The most significant pathogenetic role in brain substance is played not by the senile plaques themselves, described by Alois Alzheimer almost 110 years ago and consisting of insoluble conjugates, but by soluble β-amyloid oligomers. The relationship between the vascular and degenerative processes in AD is supported by the common risk factors and by clinical, neuroimaging, pathomorphological, and experimental data. One component linking degenerative and vascular processes in AD is insulin resistance. Challenges of new multimodal therapeutic strategies for AD are discussed in relation to the current status of the amyloid hypothesis.



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Dallas fire dept. rolls out new 911 system

The new system cuts out the practice of "over triaging calls" and uses an algorithm to suggest to dispatchers what resources are needed

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Differential processing in modality-specific Mauthner cell dendrites

Abstract

Animals process multimodal information for adaptive behavioural decisions. In fish, evasion of a diving bird that breaks the water surface depends on integrating visual and auditory stimuli with very different characteristics. How do neurons process such differential sensory inputs at the dendritic level? For that we studied the Mauthner-cells (M-cells) in the goldfish startle circuit, which receive visual and auditory inputs via two separate dendrites, both accessible for in vivo recordings. We asked if electrophysiological membrane properties and dendrite morphology, studied in vivo, play a role in selective sensory processing in the M-cell. Our results show that anatomical and electrophysiological differences between the dendrites combine to produce stronger attenuation of visually evoked post synaptic potentials (PSPs) than to auditory evoked PSPs. Interestingly, our recordings showed also cross-modal dendritic interaction, as auditory evoked PSPs invade the ventral dendrite (VD) as well as the opposite, visual PSPs invade the lateral dendrite (LD). However, these interactions were asymmetrical with auditory PSPs being more prominent in the VD than visual PSPs in the LD. Modelling experiments imply that this asymmetry is caused by active conductances expressed in the proximal segments of the VD. Our results suggest modality-dependent membrane specialization in M-cell dendrites suited for processing stimuli of different time domains and more broadly provide a compelling example of information processing in single neurons.

This article is protected by copyright. All rights reserved



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Localization of α-Synuclein in the Rat Brain and Its Relationship with Dopaminergic Structures

Immunocytochemical studies of the brain in intact Wistar rats (n = 5) addressed the localization of α-synuclein (α-Syn), which is a protein presented in Lewy bodies in Parkinson's disease (PD), and tyrosine hydroxylase, a marker of dopaminergic and noradrenergic neurons, in comparison with data obtained after lesioning of the substantia nigra (n = 3). The localization of α-Syn in synaptic structures in the basal nuclei corresponded to corticostriate and strionigral projections, which was confirmed experimentally. The bodies of dopaminergic and noradrenergic neurons in the substantia nigra, locus ceruleus, and dorsal nucleus of the vagus nerve were found to contain α-Syn – these are structures which undergo neurodegeneration in PD. Sensory olfactory neurons and glomeruli in the olfactory bulbs also had high α-Syn contents.



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Molecular characterization and expression analysis of WRKY family genes in Dendrobium officinale

Abstract

The WRKY family of transcription factors is one of the most important families of plant transcriptional regulators, and the members regulate multiple biological processes. However, there is limited information on WRKYs in Dendrobium officinale. In this study, 52 WRKY family genes of D. officinale were surveyed for the first time. Conserved domain, phylogenetic, exon–intron construction, and expression analyses were performed for the DoWRKY genes. Two major types of intron splicing (PR and VQR introns) were found, and the intron insertion position was observed to be relatively conserved in the conserved DoWRKY domains. The expression profiles of nine DoWRKYs were analyzed in cold- and methyl jasmonate (MeJA)-treated D. officinale seedlings; the DoWRKYs showed significant expression changes at different levels, which suggested their vital roles in stress tolerance. Moreover, the expression trends of most of the DoWRKYs after the simultaneous cold stress and MeJA treatment were the opposite of those of DoWRKYs after the individual cold stress and MeJA treatments, suggesting that the two stresses might have antagonistic effects and affect the adaptive capacity of the plants to stresses. Twelve DoWRKY genes were differentially expressed between symbiotic and asymbiotic germinated seeds; all were upregulated in the symbiotic germinated seeds except DoWRKY16. These differences in expression of DoWRKYs might be involved in promoting in vitro symbiotic germination of seeds with Tulasnella-like fungi. Our findings will be useful for further studies on the WRKY family genes in orchids.



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New excavations at the HWK EE site: Archaeology, paleoenvironment and site formation processes during late Oldowan times at Olduvai Gorge, Tanzania

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Publication date: Available online 15 November 2017
Source:Journal of Human Evolution
Author(s): Ignacio de la Torre, Rosa M. Albert, Adrián Arroyo, Richard Macphail, Lindsay J. McHenry, Rafael Mora, Jackson K. Njau, Michael C. Pante, Carlos A. Rivera-Rondón, Ágata Rodríguez-Cintas, Ian G. Stanistreet, Harald Stollhofen, Karol Wehr
This paper reports the results of renewed fieldwork at the HWK EE site (Olduvai Gorge, Tanzania). HWK EE is positioned across the boundary between Lower and Middle Bed II, a crucial interval for studying the emergence of the Acheulean at Olduvai Gorge. Our excavations at HWK EE have produced one of the largest collections of fossils and artefacts from any Oldowan site, distributed across several archaeological units and a large excavation surface in four separate trenches that can be stratigraphically correlated. Here we present the main stratigraphic and archaeological units and discuss site formation processes. Results show a great density of fossils and stone tools vertically through two stratigraphic intervals (Lemuta and Lower Augitic Sandstone) and laterally across an area of around 300 m2, and highlight the confluence of biotic and abiotic agents in the formation of the assemblage. The large size and diversity of the assemblage, as well as its good preservation, qualify HWK EE as a reference site for the study of the late Oldowan at Olduvai Gorge and elsewhere in Africa. In addition, the description of the stratigraphic and archaeological sequence of HWK EE presented in this paper constitutes the foundation for further studies on hominin behavior and paleoecology in Lower and Middle Bed II.



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