Retraction

'The association of hypotension with the insertion of an abdominal retractor during lower abdominal surgery in pediatric patients: a retrospective observational study' by Rika Nakayama, Takahiro Mihara, Yoshihisa Miyamoto & Koui Ka.¹

The above article from Pediatric Anesthesia, published online on July 7, 2015 in Wiley Online Library (http://ift.tt/1NnycQ7) has been retracted by agreement between the authors, the Journal Editor in Chief, Andrew Davidson, and John Wiley & Sons Ltd. The retraction has been agreed following a review of the study data by the authors, which found that cases not satisfying the inclusion criteria were included and that there were data collection errors with respect to the patients' ages and sexes. As a result, the authors judged that the reproducibility of the results could not be guaranteed and have requested retraction.

REFERENCE

Nakayama R, Mihara T, Miyamoto Y, Ka K. The association of hypotension with the insertion of an abdominal retractor during lower abdominal surgery in pediatric patients: a retrospective observational study. Pediatr Anesth. 2015;25:824-828. http://ift.tt/2DoEk8L.

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Signaling of vasodilatation across an exercise transient

Abstract

Historically, the mechanisms contributing to the local regulation of exercise blood flow (hyperaemia) and vasodilatation have been examined after a steady-state response has been achieved (e.g. a few minutes of constant rhythmic exercise).

This article is protected by copyright. All rights reserved

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Preeclampsia and Hypertension During Pregnancy in Areas with Relatively Low Levels of Traffic Air Pollution

Abstract

Objectives Air pollution exposure may contribute to the development of preeclampsia and hypertension during pregnancy. However, the evidence for such a relation is still limited. We investigated the associations between exposure for moderate to low levels of air pollution during pregnancy and preeclampsia and gestational hypertension in selected urban and county areas of Norway. Methods This study used a sub-group of 17,533 women in the Norwegian Mother and Child Cohort Study. Air pollution levels at residential addresses were estimated using land use regression models and back-extrapolated to the period of each pregnancy. Information on preeclampsia and gestational hypertension were obtained from the Medical Birth Registry of Norway and information on lifestyle factors was collected from questionnaires completed by the women during pregnancy. Results Moderate mean levels of NO₂ (13.6 ± 6.9 µg/m³) at residential address during pregnancy were not associated with preeclampsia and pregnancy hypertension. We found no statistically significant associations per 10 µg/m³ change in NO₂ exposure and preeclampsia (adjusted OR 0.89, 95% CI 0.74, 1.08) or hypertension during pregnancy (adjusted OR 0.91, 95% CI 0.78, 1.06). Conclusions for Practice In this large Norwegian pregnancy cohort, we found no statistically significant associations for moderate to low levels of pregnancy NO₂ exposure and preeclampsia or hypertension during pregnancy.

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Are Randomized Control Trials the Best Method to Assess the Effectiveness of Community Treatment Orders?

Abstract

Many jurisdictions have enacted community treatment order (CTO) legislation that requires a person, who suffers from a severe mental disorder, to follow a treatment plan when living in the community. CTOs have been a source of debate because of controversies on whether evidence of effectiveness should only be considered from randomized controlled trials (RCTs). RCTs are considered the "gold standard" method to evaluate effectiveness of simple therapeutic interventions such as medication, but they are problematic for evaluation of complex interventions because valid attribution of causation in complex interventions is not guaranteed with RCTs. CTOs are complex interventions that require the interaction of many individuals and organizations to achieve their effects and effectiveness research must measure these complexities of delivery and outcomes. This paper examines conceptual, methodological and analytical challenges of CTO research within the context of RCTs and other research designs. It also discusses the current state of knowledge on effectiveness of CTOs. Finally, we suggest a way forward by presenting alternative causal inference approaches and potential models for evaluation complex interventions, such as CTOs. We propose that these approaches should be used alongside other research designs in a nuanced approach that may involve using findings from initial studies to refine the intervention and/or its implementation.

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Uranium time series analysis: A new methodological approach for event screening categorisation

Publication date: March 2018
Source:Journal of Environmental Radioactivity, Volume 183
Author(s): Stefano Bianchi, Wolfango Plastino
Uranium (U) groundwater anomalies, detected before the L'Aquila earthquake (April 6th, 2009), represent a key geochemical signal of a progressive increase of deep fluids fluxes at middle–lower crustal levels associated with the geodynamics of the earthquake. Although the analyses performed in association with the seismic pattern around Gran Sasso National Laboratory and the geophysical and geochemical patterns of the Gran Sasso aquifer supported this hypothesis, a new approach for time series analysis has been developed for event screening categorisation and to highlight U as possible strain meter in geodynamical processes, particularly those which characterise active normal faulting.



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Homozygous TMEM127-mutations in two patients with bilateral pheochromocytomas

Abstract

Pheochromocytoma (PCC) and paraganglioma (PGL) are rare neuroendocrine tumors that are hereditary in up to 50% of patients. The gene encoding transmembrane-protein-127 (TMEM127) is one of the PCC/PGL susceptibility genes with an autosomal dominant inheritance pattern. Here we report two patients with bilateral PCC who both harbored a homozygous TMEM127-mutation. In a 31-year old mentally retarded patient the homozygous c.410-2A>G mutation was discovered during an update of DNA-analysis. A 26-year old mentally retarded patient was found to have a homozygous c.3G>A mutation. The parents of both patients were consanguineous. We reviewed previously reported clinical features of TMEM127-mutation carriers and compared our findings with case descriptions of homozygous mutations in other PGL/PCC susceptibility genes. Homozygosity for an autosomal dominant inherited disorder is an extremely rare phenomenon and has, to our knowledge, not been reported before for the gene encoding TMEM127. In the present cases, the clinical picture does not seem to be very different from heterozygous TMEM127-mutation carriers, except for a relatively large tumor size and more pronounced plasma metanephrines concentration. It is unclear whether the mental retardation is causally related to homozygosity of the TMEM127-mutations. Updating genetic screening in patients in whom PCC/PGL has been diagnosed in the past should be considered as it might provide clinically relevant information.

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[Ca2+]i modulation of cAMP-stimulated ciliary beat frequency via PDE1 in airway ciliary cells of mice

Abstract

Intracellular Ca²⁺ concentration ([Ca²⁺]_i) plays crucial roles in the regulation of ciliary beat frequency (CBF) and ciliary bend angle (CBA) of airway cilia. Moreover, Ca²⁺-dependent PDE1A exists in the CBF regulating metabolon of cilia. This study demonstrated that CBF is regulated by a direct and an indirect action of [Ca²⁺]_i; the direct action changes CBF mediated via [Ca²⁺]_i and the indirect action changes CBF mediated via cAMP, accumulation of which is controlled by the PDE1 activity. Upon reducing [Ca²⁺]_i to various levels, the direct action decreases CBF and the indirect action increases CBF. The final CBF is determined by extents of cAMP accumulation, which are determined by PDE1 activities inhibited dependent on [Ca²⁺]_i decreases; a slight decrease induced by a nominally Ca²⁺-free solution (no cAMP accumulation via PDE1) decreases CBF and an extreme decrease induced by 50 μm BAPTA-AM increases CBF via cAMP accumulation via inhibiting PDE1 similarly to a PDE1 inhibitor (8MmIBMX). CBA increase in response to [Ca²⁺]_i decreases is smaller than CBF increase, because of no existence of PDE1A in the CBA regulating metabolon. Contrary, an [Ca²⁺]_i increased by ionomycin, which decreases cAMP accumulation by PDE1A activation, caused a slower procaterol-stimulated CBF increase than that decreased by a Ca²⁺-free solution. A decrease in [Ca²⁺]_i stimulates cAMP accumulation, while an increase in [Ca²⁺]_i inhibits cAMP accumulation in airway ciliary cells. Thus, changes in [Ca²⁺]_i modulate CBF and CBA via cAMP accumulation by controlling the PDE1 activity.

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Determinants, analysis and interpretation of the muscle compound action potential (M wave) in humans: implications for the study of muscle fatigue

Abstract

The compound muscle action potential (M wave) has been commonly used to assess the peripheral properties of the neuromuscular system. More specifically, changes in the M-wave features are used to examine alterations in neuromuscular propagation that can occur during fatiguing contractions. The utility of the M wave is based on the assumption that impaired neuromuscular propagation results in a decrease in M-wave size. However, there remains controversy on whether the size of the M wave is increased or decreased during and/or after high-intensity exercise. The controversy partly arises from the fact that previous authors have considered the M wave as a whole, i.e., without analyzing separately its first and second phases. However, in a series of studies we have demonstrated that the first and second phases of the M wave behave in a different manner during and after fatiguing contractions. The present review is aimed at five main objectives: (1) to describe the mechanistic factors that determine the M-wave shape; (2) to analyze the various factors influencing M-wave properties; (3) to emphasize the need to analyze separately the first and second M-wave phases to adequately identify and interpret changes in muscle fiber membrane properties; (4) to advance the hypothesis that it is an increase (and not a decrease) of the M-wave first phase which reflects impaired sarcolemmal membrane excitability; and (5) to revisit the involvement of impaired sarcolemmal membrane excitability in the reduction of the force generating capacity.

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High Incidence of Recurrent Crohn’s Disease Following Colectomy for Ulcerative Colitis Revealed with Long Follow-Up

Abstract

Background and Aims

Ulcerative colitis (UC) patients with progression of their disease despite optimized medical therapy may warrant "curative" proctocolectomy with end ileostomy or ileo-anal pouch (IPAA) anastomosis. The aim of our study was to assess the incidence of later recurrent ileitis that lead to altering the initial diagnosis to Crohn's disease (CD).

Methods

A retrospective analysis was conducted on the inflammatory bowel disease database at Lenox Hill Hospital. The database consisted of patients that were diagnosed with UC or CD based on clinical assessment, endoscopic appearance, gross and histological examination, and imaging between 1960 and 2015. The post-colectomy follow-up period was at least 10 years. Recurrent disease was classified by evidence of transmural inflammation in the distal ileum, fistulizing disease, or stricturing disease.

Results

From our IBD database, we identified 128 patients who underwent elective or urgent colectomy with the preoperative diagnosis of UC. Thirty-two (25%) had either an IPAA or end ileostomy with documented recurrence of inflammation in the small bowel mucosa consistent with CD. There was no significant difference between the type of surgical approach and the chance of recurrent disease (p = .20). The average time to clinically significant recurrence was 5 years.

Conclusion

The incidence of recurrent CD following colectomy for ulcerative colitis, when followed postoperatively for an average of 20 years, was 25%, considerably more than previously reported. Patients who come to colectomy for ulcerative colitis and are followed for at least 10 years show a high incidence of recurrent Crohn's disease in the ileostomy or ileo-anal pouch. Extended follow-up should be included in patients coming to colectomy for ulcerative colitis before they should be considered cured of their disease.

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Chronic deep brain stimulation normalizes scalp EEG activity in isolated dystonia

Publication date: February 2018
Source:Clinical Neurophysiology, Volume 129, Issue 2
Author(s): Svjetlana Miocinovic, Andrew Miller, Nicole C. Swann, Jill L. Ostrem, Philip A. Starr
ObjectiveTo investigate cortical activity using scalp EEG in patients with isolated dystonia treated with chronic deep brain stimulation (DBS), on and off stimulation.MethodsWe analyzed 64-channel scalp EEG in 12 isolated dystonia patients treated with chronic DBS (7 generalized, 5 cervical/segmental; 7 globus pallidus (GP), 5 subthalamic nucleus (STN)), and 20 healthy age-matched controls. Recordings during rest and movement task, and clinical motor scores, were collected with DBS-on and during a 90-min DBS washout.ResultsResting state alpha power in the dominant (or contralateral to more dystonic side) motor cortex channel during DBS was comparable to healthy controls, but it increased when DBS was stopped. Resting state and movement-related alpha coherence between bilateral motor cortex channels was increased off DBS.ConclusionsChronic DBS reduces exaggerated alpha oscillations and interhemispheric alpha coherence in the motor cortex of patients with isolated dystonia.SignificanceThese findings complement related studies in Parkinson's disease and support the view that network desynchronization is a prominent mechanism of DBS in movement disorders.



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The effect of increased intracranial EEG sampling rates in clinical practice

Publication date: February 2018
Source:Clinical Neurophysiology, Volume 129, Issue 2
Author(s): Kathryn A. Davis, Seth P. Devries, Abba Krieger, Temenuzhka Mihaylova, Daniela Minecan, Brian Litt, Joost B. Wagenaar, William C. Stacey
ObjectiveRecent research suggests that high frequency intracranial EEG (iEEG) may improve localization of epileptic networks. This study aims to determine whether recording macroelectrode iEEG with higher sampling rates improves seizure localization in clinical practice.Methods14 iEEG seizures from 10 patients recorded with >2000 Hz sampling rate were downsampled to four sampling rates: 100, 200, 500, 1000 Hz. In the 56 seizures, seizure onset time and location was marked by 5 independent, blinded EEG experts.ResultsWhen reading iEEG under clinical conditions, there was no consistent difference in time or localization of seizure onset or number of electrodes involved in the seizure onset zone with sampling rates varying from 100 to 1000 Hz. Stratification of patients by outcome did not improve with higher sampling rate.ConclusionWhen utilizing standard clinical protocols, there was no benefit to acquiring iEEGs with sampling rate >100 Hz. Significant variability was noted in EEG marking both within and between individual expert EEG readers.SignificanceAlthough commercial equipment is capable of sampling much faster than 100 Hz, tools allowing visualization of subtle high frequency activity such as HFOs will be required to improve patient care. Quantitative methods may decrease reader variability, and potentially improve patient outcomes.



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Fasciculation potentials and decremental responses in amyotrophic lateral sclerosis

Publication date: February 2018
Source:Clinical Neurophysiology, Volume 129, Issue 2
Author(s): Yosuke Miyaji, Yuki Hatanaka, Mana Higashihara, Takamichi Kanbayashi, Fumiaki Tanaka, Masahiro Sonoo
ObjectiveThe positive correlation between fasciculation potentials (FPs) and decremental responses in repetitive nerve stimulation test (RNS) in amyotrophic lateral sclerosis (ALS) patients has been described based on only one past study. We revisited this issue.MethodsSubjects consisted of 30 prospectively-enrolled ALS patients on whom both needle EMG and RNS were conducted in the same trapezius muscle. Fasciculation potentials (FPs) were identified off-line from the restored 3-min signal. Firing rate of FPs (FR-FP) per minute was calculated from the total count of FPs of different origins. Correlations between FR-FP, decremental percentage (Decr%) and the amplitude of the initial compound muscle action potential (CMAPamp) in RNS were investigated.ResultsThere was no correlation between FR-FP and Decr% (r = 0.03) or between FR-FP and CMAPamp (r = 0.04). A significant negative correlation was observed between CMAPamp and Decr% (r = −0.56, P < .005).ConclusionFPs are not correlated with the decremental response in RNS.SignificanceThe underlying mechanism for FPs and decremental responses in ALS must be different and unrelated to each other.



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Nerve ultrasound in neurofibromatosis type 1: A follow-up study

Publication date: February 2018
Source:Clinical Neurophysiology, Volume 129, Issue 2
Author(s): Johan A. Telleman, Menno D. Stellingwerff, Geert J. Brekelmans, Leo H. Visser
ObjectiveTo investigate development of sonographic abnormalities and applications of high-resolution ultrasonography (HRUS) in neurofibromatosis type 1 (NF1).MethodsSixteen asymptomatic or minimally symptomatic NF1 patients underwent HRUS at inclusion and 1 year follow-up. Upper and lower extremity nerves were investigated. Peripheral nerve involvement was graded.ResultsPlexiform neurofibromas (PNFs) were found in 7 patients (43.8%) at inclusion and 10 (62.5%) at follow-up. All initially identified PNFs were also found at follow-up; additional PNFs were found by extended longitudinal assessment at follow-up. All 3 patients with minor and 7 patients with severe peripheral nerve involvement had similar involvement at follow-up. Mean nerve size change was −0.2 mm² (±1.6) and 0.3 mm² (±6.2) in patients with minor and severe involvement. Mean PNF size change was −0.1 mm² (±9.9).ConclusionsHRUS allows qualitative assessment of peripheral nerves, which makes it advantageous as initial imaging technique in suspected neuropathy. Patients with minimal nerve involvement remained so, and might therefore require less follow-up for malignant peripheral nerve sheath tumor (MPNSTs) development. Measured change in PNF size was highly variable. Repeating an extensive standardized HRUS protocol during follow-up thus seems less useful to screen for MPNSTs.SignificanceHRUS has potential applications as diagnostic and screening tool in NF1.



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Correlations between MUNIX and adapted multiple point stimulation MUNE methods

Publication date: February 2018
Source:Clinical Neurophysiology, Volume 129, Issue 2
Author(s): Karim Benmouna, Christophe Milants, François Charles Wang
ObjectiveThe aim of this study was to evaluate how the motor unit number index (MUNIX) is related to the adapted multiple point stimulation (AMPS) technique.MethodsMUNIX and AMPS technique were prospectively performed on thenar muscles in 20 consecutive patients referred to our neurophysiological laboratory with the clinical diagnosis of a possible motoneurone disorder (MND). The clinical and paraclinical assessment confirmed the diagnosis of MND in 13 out of 20 patients, amyotrophic lateral sclerosis (ALS) in 9 (with MND group). In the other 7 patients, there were neither evidence of MND, nor of any peripheral nervous system disease (without MND group).ResultsAMPS and MUNIX data were significantly (p < 0.001) lower in patients with MND than in patients without MND. There was a strong significant positive linear correlation between AMPS and MUNIX values (n = 20; R = 0.83; p < 0.01).ConclusionBoth MUNIX and AMPS methods could serve as a reliable marker to document the motor unit loss.SignificanceThe present paper constitutes one more clue of MUNIX reliability.



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Detecting sub-second changes in brain activation patterns during interictal epileptic spike using simultaneous EEG-fMRI

Publication date: February 2018
Source:Clinical Neurophysiology, Volume 129, Issue 2
Author(s): Epifanio Bagarinao, Satoshi Maesawa, Yuji Ito, Naotaka Usui, Jun Natsume, Hirohisa Watanabe, Minoru Hoshiyama, Toshihiko Wakabayashi, Gen Sobue, Shinji Naganawa, Haruo Isoda
ObjectiveEpileptic spikes are associated with rapidly changing brain activation involving the epileptic foci and other brain regions in the "epileptic network". We aim to resolve these activation changes using simultaneous electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) recordings.MethodsSimultaneous EEG-fMRI recordings from 9 patients with epilepsy were used in the analysis. Our method employed the whole scalp EEG data to generate regressors for the analysis of fMRI data using the general linear model.ResultsWe were able to resolve, with milliseconds temporal resolution, changes in activation patterns involving suspected epileptic foci and other brain regions in the epileptic network during spike and slow wave. Using summary maps (called SSWAS maps) which show the activation frequency of voxels, we found that suspected epileptic foci tend to be significantly active during this interval. SSWAS maps also enabled the detection of the epileptic foci in 4 of 5 patients where the conventional event-timing-based analysis failed to identify.ConclusionThese findings demonstrated the efficacy of the method and the potential application of SSWAS maps to identify epileptic foci.SignificanceThe method could help resolve activation changes during epileptic spike and could provide insights into the underlying pathophysiology of these changes.



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Wound protectors in reducing surgical site infections in lower gastrointestinal surgery: an updated meta-analysis

Abstract

Background

Surgical site infection (SSI) is a common complication in gastrointestinal surgery. Wound protection devices are being increasingly used in the attempt to reduce infection rates. We performed a meta-analysis to determine if wound protectors reduce the incidence of SSIs in lower gastrointestinal surgery.

Methods

MEDLINE and EMBASE databases were searched between 1946 and 2016. Randomized controlled trials comparing wound protector versus no wound protector in lower gastrointestinal surgery were included. Our primary outcome was surgical site infection. Subgroup analysis was conducted comparing single-ring versus dual-ring wound protectors.

Results

Twelve RCTs with 3029 participants were included. There was a significant decrease in the odds of developing SSI in the wound protector group (OR 0.64, 95% CI 0.45–0.90, P < 0.01, I ² = 55%). There was evidence of a subgroup effect (P = 0.01) with dual-ring wound protectors associated with significantly lower incidence of SSIs (OR 0.31, 95% CI 0.18–0.52, P < 0.0001, I ² = 12%), which was not appreciated in the single-ring group (OR 0.84, 95% CI 0.67–1.04, P = 0.11, I ² = 0%).

Conclusions

Wound protector use is associated with decreased odds of developing SSI in patients undergoing lower gastrointestinal surgery. There was a subgroup effect when comparing dual-ring to single-ring devices.

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Irritable bowel syndrome and Endometriosis: new insights for old diseases

Irritable bowel syndrome and endometriosis are two diseases affecting a significant part of the female population, either together or individually, with remarkable consequences in the quality of life. Several studies suggest an epidemiological association between them. Their association may not be just an epidemiological phenomenon, but the manifestation of a pathophysiological correlation, which probably generates a mutual promotion phenomenon. In particular, both clinical entities share the presence of a chronic low-grade inflammatory state at the basis of the disease persistence.

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Nonalcoholic fatty liver disease as a sentinel marker for the development of diabetes mellitus in non-obese subjects

Non-alcoholic fatty liver disease (NAFLD) is associated with substantial cardiometabolic morbidity.

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Paradigms for Restoration of Somatosensory Feedback via Stimulation of the Peripheral Nervous System

Obtaining feedback from our environment and estimating the internal states of our body is essential for decision making and survival. Humans constantly integrate inputs from multiple sensory sources in an unconscious fashion over all available channels. Millions of sensors located in the eye, ear, and skin collect hundreds of thousands of bits per second (Küpfmüller, 1974). Unconscious sensory integration and processing is necessary to prevent information overload from these sensory inputs. This intrinsic mechanism is essential to function, yet, overlooked under normal physiological conditions.

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Arterioportal shunting, splanchnic capillary perfusion, and the effects of colloids during capnoperitoneum in neonatal and adolescent pigs

Abstract

Background

Clinical and experimental data indicate that neonates are sensitive to the CO₂ pneumoperitoneum. An impaired splanchnic perfusion during laparoscopy in adults has been reported. We recently confirmed that intravenous colloids improve macrocirculatory function in neonates. We aimed to determine the impact of CO₂ pneumoperitoneum on the perfusion of splanchnic organs in the young including effects of colloid application.

Methods

Male piglets (n = 25) were divided into four groups: (1) neonatal controls, (2) neonates with crystalloid restitution, (3) neonates with colloidal restitution, and (4) adolescents with crystalloid restitution. Animals were ventilated and subjected to a 3-h, 10 mmHg CO₂ pneumoperitoneum followed by 2 h resuscitation. Hepatic, splanchnic, and arteriovenous shunt perfusion was assessed via central and portal venous catheters. Capillary organ flow was detected by fluorescent microspheres. The rate of bile flow was measured.

Results

The neonatal crystalloid group showed a significant decrease in the intestinal capillary perfusion at the end of the recovery period. This was not detectable in the adolescent and colloid group. There was a significant increase in microcirculatory arterioportal shunt flow during the CO₂ pneumoperitoneum in both neonatal groups but not in the sham and adolescent groups (p < 0.05). Hepatic arterial perfusion increased after insufflation in all groups and dropped during capnoperitoneum to levels of about 70% baseline. There was no significant impairment of splanchnic perfusion or bile flow as a result of the pneumoperitoneum in all groups.

Conclusions

Capillary perfusion of the abdominal organs was stable during capnoperitoneum and recovery in adolescents and neonates with colloid restitution, but not with crystalloid restitution. Significant arterioportal shunting during capnoperitoneum could affect hepatic microcirculation in neonates. Our data confirm that moderate pressure capnoperitoneum has no major effect on the perfusion of abdominal organs in neonates with adequate substitution.

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Factors influencing discharge disposition after colectomy

Abstract

Background

Factors associated with discharge destination after colectomy despite accounting for surgical morbidity have not previously been well characterized. This study aims to evaluate perioperative predictors for extended care after complicated and uncomplicated colectomy.

Methods

Patients admitted from home for elective colectomy were identified from the American College of Surgeons, National Surgical Quality Improvement Program, 2012–2013 general and colectomy-targeted datasets. Patients who were discharged home (DH) were compared to those discharged to facility (DF) for patient, disease, treatment, and pre-discharge postoperative adverse events. Patients without any 30-day postoperative complication were similarly compared.

Results

Of 19,527 patients undergoing elective colectomy, 18,128 (92.8%) were discharged home and 1399 (7.2%) patients to other facilities. When there was no postoperative complication, these rates were 96.3 and 3.7%, respectively. On multivariable analysis, factors associated with DF included female gender, functional dependence, weight loss, ASA class ≥ 3, open and stoma surgery, and development of postoperative complications. For patients without postoperative complications, increasing age, functional dependence, and ASA score ≥ 3 were associated with DF. Preoperative bowel preparation, albumin, a minimally invasive surgical approach, and length of stay < 5 days were significantly associated with reduced DF.

Conclusion

The majority of perioperative factors associated with extended care after colectomy are patient driven. The adoption of oral antibiotics as bowel preparation, minimally invasive surgery, and accelerated recovery protocols may reduce post-acute care placement after elective colectomy.

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Application of a simple, affordable quality metric tool to colorectal, upper gastrointestinal, hernia, and hepatobiliary surgery patients: the HARM score

Abstract

Background

Quality is the major driver for both clinical and financial assessment. There remains a need for simple, affordable, quality metric tools to evaluate patient outcomes, which led us to develop the HospitAl length of stay, Readmission and Mortality (HARM) score. We hypothesized that the HARM score would be a reliable tool to assess patient outcomes across various surgical specialties.

Methods

From 2011 to 2015, we identified colorectal, hepatobiliary, upper gastrointestinal, and hernia surgery admissions using the Vizient Clinical Database. Individual and hospital HARM scores were calculated from length of stay, 30-day readmission, and mortality rates. We evaluated the correlation of HARM scores with complication rates using the Clavien–Dindo classification.

Results

We identified 525,083 surgical patients: 206,981 colorectal, 164,691 hepatobiliary, 97,157 hernia, and 56,254 upper gastrointestinal. Overall, 53.8% of patients were admitted electively with a mean HARM score of 2.24; 46.2% were admitted emergently with a mean HARM score of 1.45 (p < 0.0001). All HARM components correlated with patient complications on logistic regression (p < 0.0001). The mean length of stay increased from 3.2 ± 1.8 days for a HARM score < 2 to 15.1 ± 12.2 days for a HARM score > 4 (p < 0.001). In elective admissions, for HARM categories of < 2, 2–< 3, 3–4, and > 4, complication rates were 9.3, 23.2, 38.8, and 71.6%, respectively. There was a similar trend for increasing HARM score in emergent admissions as well. For all surgical procedure categories, increasing HARM score, with and without risk adjustment, correlated with increasing severity of complications by Clavien–Dindo classification.

Conclusions

The HARM score is an easy-to-use quality metric that correlates with increasing complication rates and complication severity across multiple surgical disciplines when evaluated on a large administrative database. This inexpensive tool could be adopted across multiple institutions to compare the quality of surgical care.

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C-reactive protein in predicting major postoperative complications are there differences in open and minimally invasive colorectal surgery? Substudy from a randomized clinical trial

Abstract

Background

In search of improvement of patient assessment in the postoperative phase, C-reactive protein (CRP) is increasingly being studied as an early marker for postoperative complications following major abdominal surgery. Several studies reported an attenuated immune response in minimally invasive surgery, which might affect interpretation of postoperative CRP levels. The aim of the present study was to compare the value of CRP as a predictor for major postoperative complications in patients undergoing open versus laparoscopic colorectal surgery.

Methods

A subgroup analysis from a randomized clinical trial (LAFA-trial) was performed, including all patients with non-metastasized colorectal cancer. In the LAFA trial, patients were randomized to open or laparoscopic segmental colectomy. In a subgroup of 79 patients of the LAFA trial, postoperative assessment of CRP levels was conducted routinely preoperatively and 1, 2, 24 and 72 h after surgery.

Results

Thirty-seven patients were randomized to the open group and 42 patients to the laparoscopic group. Major complications occurred in 19% of laparoscopic procedures and 13.5% of open procedures (p = 0.776). CRP levels rise following surgical procedures. In uncomplicated cases, the rise in CRP levels was significantly lower at 24 and 72 h following laparoscopic resection in comparison to open resection. No differences in CRP levels were observed when comparing open and laparoscopic resection in patients with major complications.

Conclusion

In patients with an uncomplicated postoperative course, CRP levels were lower following minimally invasive resection, possibly due to decreased operative trauma. No differences in CRP were observed stratified for surgical technique in patients with major complications. These results suggest that CRP may be applied as a marker for major postoperative complications in both open and minimally invasive colorectal surgery. Future research should aim to assess the role of standardized postoperative CRP measurements.

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Endoscopic full-thickness resection of gastric and duodenal subepithelial lesions using a new, flat-based over-the-scope clip

Abstract

Background

Surgical resection of upper gastrointestinal (GI) subepithelial tumors (SETs) is associated with significant morbidity and mortality. A new over-the-scope (OTS) clip can be used for endoscopic full-thickness resection (eFTR). We aimed to prospectively evaluate feasibility and safety of upper GI eFTR with a new, flat-based OTS clip.

Methods

Consecutive patients with a gastric or duodenal SET < 20 mm were prospectively included. After identification of the lesion, the clip was placed and lesions were resected. Patients were followed for 1 month to assess severe adverse events (SAEs); 3–6 months after eFTR, endoscopy was performed.

Results

eFTR was performed on 13 lesions in 12 patients: 7 gastric and 6 duodenal SETs. Technical success was achieved in 11 cases (85%). In all 11 cases, R0-resection was achieved. In all 6 duodenal cases and in one gastric case, FTR was achieved (64%). One SAE (pain) was observed after eFTR of a gastric SET. After eFTR of duodenal SETs, several SAEs were observed: perforation (n = 1), microperforation (n = 3), and hemorrhage (n = 1). During follow-up endoscopy, the clip was no longer in situ in most patients (7 of 10; 70%).

Conclusions

eFTR with this new flat-based OTS clip is feasible and effective. Although gastric eFTR was safe, eFTR in the duodenum was complicated by (micro)perforation in several patients. Therefore, the design of the clip or the technique of resection needs further refinement to improve safety of resection of SET in thin-walled areas such as the duodenum before being applied in clinical practice.

Dutch trial register: NTR5023.

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Kan. high schools now required to teach CPR

The new standard makes Kansas the 38th state in the country to have CPR training as a high school graduation requirement

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Local Anesthetic Systemic Toxicity in Total Joint Arthroplasty: Incidence and Risk Factors in the United States From the National Inpatient Sample 1998–2013

Background Local anesthetic systemic toxicity (LAST) is a rare and potentially devastating complication of regional anesthesia. Single-institution registries have reported a decreasing incidence, but these results have limited broad applicability. A recent study using a US database found a relatively high incidence of LAST. We used the National Inpatient Sample, a US database of inpatient admissions, to identify the national incidence and associated risk factors for LAST in total joint arthroplasties. Methods In this retrospective study, we studied patients undergoing hip, knee, or shoulder arthroplasty, from 1998 to 2013, with an adjunct peripheral nerve blockade. We used a multivariable logistic regression to identify patient conditions, hospital level variables, and procedure sites associated with LAST. Results A total of 710,327 discharges met inclusion criteria. The average adjusted incidence was 1.04 per 1000 peripheral nerve blocks, with decreasing trend over the 15-year study period (odds ratio [OR], 0.90; P = 0.002). Shoulder arthroplasty (OR, 4.35; P = 0.0001) compared with knee or hip arthroplasty and medium-size (OR, 3.34; P = 0.003) and large-size (OR, 2.40; P = 0.025) hospitals as compared with small hospitals were associated with increased odds of LAST. Conclusions The incidence of LAST nationally in total joint arthroplasty with adjunct nerve blocks is similar to recent estimates from academic centers, with a small decreasing trend through the study period. Despite an overall low incidence rate, practitioners should continue to maintain vigilance for manifestations of LAST, especially as the use of regional anesthesia continues to increase. Accepted for publication June 29, 2017. Address correspondence to: Daniel S. Rubin, MD, Department of Anesthesia and Critical Care, University of Chicago Medicine, 5841 S Maryland, Box MC 4028, Chicago, IL 60637 (e-mail: drubin@dacc.uchicago.edu). Funding was provided by National Institutes of Health (Bethesda, Maryland) grant UL1 RR024999 to the University of Chicago Institute for Translational Medicine. G.W. is an officer, director, shareholder and paid consultant of ResQ Pharma, Inc. He also created and maintains www.lipidrescue.org, an educational web site. The other authors declare no potential 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 Web site (www.rapm.org). Copyright © 2017 by American Society of Regional Anesthesia and Pain Medicine.

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Steven Knight becomes partner at Fitch & Associates

Knight will continue to lead the firm's growing fire service practice PLATTE CITY, Mo. — Fitch & Associates, a leading public safety and health care consulting firm, has named Steven Knight partner, effective January 1, 2018. For more than three years, Dr. Knight has served as the firm's Fire Service Practice Lead. In that role, he led numerous assessments of fire service operations ...

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EMS education needed: Overcoming the speed bumps of 2017

As 2017 draws to a close and 2018 approaches, I think it's appropriate to look back on the EMS events of the last year, and try to draw some lessons that will help us prepare for what is to come. And the lesson I think we can all draw is, "Thank goodness it's almost over." 2017 turned out to be like that fantasy date with a supermodel: she looked great from afar, but over dinner ...

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The development of skeletal muscle hypertrophy through resistance training: the role of muscle damage and muscle protein synthesis

Abstract

Resistance training (RT)-induced skeletal muscle hypertrophy is a highly intricate process. Despite substantial advances, we are far from understanding exactly how muscle hypertrophy develops during RT. The aim of the present review is to discuss new insights related to the role of skeletal muscle damage and muscle protein synthesis (MPS) in mediating RT-induced hypertrophy. Specifically, the thesis that in the early phase of RT (≤ 4 previous RT sessions) increases in muscle cross-sectional area are mostly attributable to muscle damage-induced muscle swelling; then (after ~ 10 sessions), a modest magnitude of muscle hypertrophy ensues; but only during a latter phase of RT (after ~ 18 sessions) is true muscle hypertrophy observed. We argue that the initial increases in MPS post-RT are likely directed to muscle repair and remodelling due to damage, and do not correlate with eventual muscle hypertrophy induced by several RT weeks. Increases in MPS post-RT session only contribute to muscle hypertrophy after a progressive attenuation of muscle damage, and even more significantly when damage is minimal. Furthermore, RT protocols that do not promote significant muscle damage still induce similar muscle hypertrophy and strength gains compared to conditions that do promote initial muscle damage. Thus, we conclude that muscle damage is not the process that mediates or potentiates RT-induced muscle hypertrophy.

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Vonoprazan: A Novel and Potent Alternative in the Treatment of Acid-Related Diseases

Abstract

Although proton pump inhibitors (PPIs) have been used widely, acid-related diseases are still associated with a huge burden on the health care system. Recently, the efficacy and safety of a new acid suppressant named vonoprazan in the treatment of acid-related diseases have been evaluated by a series of studies. As a novel potassium-competitive acid blocker, vonoprazan may provide reversible acid suppression by preventing K⁺ from binding to gastric H⁺/K⁺-ATPase. It has been clinically used for the short-term treatment of gastroesophageal reflux disease (GERD), peptic ulcer disease and Helicobacter pylori (H. pylori) infection in Japan. The healing rate of GERD and gastric ulcers by vonoprazan is more than 95 and 90%, respectively; also, it is effective in curing PPI-resistant GERD. It increases H. pylori eradication rate to more than 88% as part of both first-line and second-line therapy. It is also effective in the eradication of clarithromycin-resistant H. pylori strains. All of these short-term studies show vonoprazan is safe and well-tolerated. As a safe and effective acid inhibitor, vonoprazan might be a novel alternative in the treatment of acid-related diseases.

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Efficacy and Safety of Lumen-Apposing Metal Stents in Management of Pancreatic Fluid Collections: Are They Better Than Plastic Stents? A Systematic Review and Meta-Analysis

Abstract

Background and Aims

Endoscopic ultrasound (EUS)-guided transmural drainage has been increasingly utilized as a first-line therapeutic modality for drainage of pancreatic fluid collections (PFC). Recently, lumen-apposing metal stents (LAMS) have been utilized for management of PFCs. We conducted a systematic review and meta-analysis to evaluate the cumulative efficacy and safety of LAMS in the management of PFC (primary outcome). We also compared the efficacy and safety of LAMS with multiple plastic stents (MPS) in the management of PFC (secondary outcome).

Methods

We searched Medline, Embase and Cochrane databases from inception to November 5, 2016, to identify studies (with ≥ 10 patients) reporting technical success, clinical success, and adverse events (AE) of EUS-guided transmural drainage of PFC using LAMS. Weighted pooled rates (WPR) were calculated for technical success, clinical success and AE. Risk ratios (RR) were calculated and pooled to compare LAMS with MPS in terms of technical success, clinical success, and AE. Pooled mean difference (MD) was calculated to compare the number of endoscopic sessions required by each type of stent to achieve clinical success. All analyses were done using random effects model.

Results

Eleven studies with 688 patients were included in this meta-analysis. WPR for technical success of LAMS in PFC management was 98% (96, 99%), (I ² = 15%). WPR for clinical success was 93% (89, 96%) with moderate heterogeneity (I ² = 50%). There was no difference in clinical success for pseudocysts (PP) versus walled-off pancreatic necrosis (WON) (P = 0.51). WPR for AE was 13% (9, 20%), (I ² = 64%). AE were 10% more in WON as compared to PP (P = 0.009). Most common AE requiring intervention was stent migration (4.2%), followed by infection (3.8%), bleeding (2.4%), and stent occlusion (1.9%). Six studies with 504 patients compared the performance of LAMS with MPS. Pooled RR for technical success was 1.71 (0.38, 7.37). Pooled RR for clinical success was 0.37 (0.20, 0.67) in favor of LAMS. Pooled RR for AE was 0.39 (0.18, 0.84), (I ² = 50%). Pooled MD for number of endoscopic sessions was − 0.84 (− 1.69, 0.01).

Conclusions

LAMS seem to have excellent efficacy and safety in the management of PFCs. They may be preferred over plastic stents as they are associated with better clinical success and lesser adverse events.

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Changing Epidemiology of Upper Gastrointestinal Hemorrhage in the Last Decade: A Nationwide Analysis

Abstract

Background

Upper gastrointestinal hemorrhage (UGIH) is common and carries substantial mortality requiring frequent hospitalizations.

Aim

To investigate trends in etiology and outcome of UGIH in hospitalized patients in the USA.

Methods

Retrospective, observational cohort study of the Nationwide Inpatient Sample from 2002 to 2012 was carried out. UGIH was identified in hospitalizations with a principle ICD-9-CM diagnosis of UGIH or secondary diagnosis of UGIH with a principal diagnosis of hematemesis, blood in stool, or gastrointestinal bleeding. Age 18 years or older was required for inclusion, and elective admissions and transferred patients were excluded.

Results

The hospitalization rate of UGIH in the USA decreased by 21% from 2002 to 2012, from 81 to 67 cases per 100,000 population (p < 0.01). The greatest declines occurred for gastritis and PUD, which decreased by 55 and 30%, respectively (p < 0.01). There were increases in neoplasm, Dieulafoy lesions, angiodysplasia, and esophagitis, which increased by 50, 33, 32 and 20%, respectively (p < 0.01). The all-cause inpatient mortality rate of UGIH decreased 28% from 2.6 per 100 cases in 2002 to 1.9 in 2012 (p < 0.01). The greatest decline occurred for esophagitis, Mallory–Weiss tear, and neoplasm, which decreased by 39% (p < 0.01), 36% (p = 0.02), and 36% (p < 0.01), respectively. The rate of hospitalization for bleeding caused by esophageal varices remained constant and low (approximately 2%) throughout the study period; the mortality for esophageal varices also remained constant at 6–7%.

Conclusions

The epidemiology of UGIH hemorrhage appears to be shifting, with a decline in PUD and gastritis; an increase in hospitalization rate for neoplasm, Dieulafoy lesions, angiodysplasia, and esophagitis; and a reduction in overall mortality. The decreasing hospitalization rate and mortality rate of UGIH suggest population trends in use of treatments for PUD, improved hemostatic techniques, and overall care.

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Estrogen-Dependent Nrf2 Expression Protects Against Reflux-Induced Esophagitis

Abstract

Background

Gastroesophageal reflux disease is more common in males than in females. The enhanced antioxidative capacity of estrogen in females might account for the gender difference. Nuclear factor erythroid 2-related factor 2 (Nrf2) plays a pivotal role in the host defense mechanism against oxidative stress.

Aims

This study aimed to clarify the role of Nrf2 in reflux-induced esophageal inflammation, focusing on the gender difference and nitric oxide.

Methods

Gastroesophageal reflux was surgically induced in male and female rats. Nitrite and ascorbic acid were administered for 1 week to provoke nitric oxide in the esophageal lumen. Male rats with gastroesophageal reflux were supplemented with 17β-estradiol or tert-butylhydroquinone, an Nrf2-inducing reagent. Esophageal squamous cell carcinoma KYSE30 cells were treated with 17β-estradiol. Nrf2 expression was examined by Western blotting and quantitative real-time PCR. Antioxidant gene expression profiles were examined by a PCR array.

Results

In the presence of nitric oxide, reflux-induced esophageal damage was less evident, whereas esophageal expression of Nrf2 and its target genes such as Nqo1 was more evident in female or male rats supplemented with 17β-estradiol than in male rats. 17β-Estradiol increased nuclear Nrf2 expression in KYSE30 cells. tert-Butylhydroquinone increased tissue Nqo1 mRNA expression, leading to a reduction in reflux-induced esophageal damage.

Conclusions

Estrogen-dependent Nrf2 expression might contribute to protection against the development of gastroesophageal reflux disease in females.

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Early Botulinum Toxin Injections in Infants with Musculoskeletal Disorders: A Systematic Review of Safety and Effectiveness.

Publication date: Available online 27 December 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Jean-Sébastien Bourseul, Anais Molina, Mael Lintanf, Laetitia Houx, Emmanuelle Chaléat-Valayer, Christelle Pons, Sylvain Brochard
ObjectiveTo report current evidence regarding the safety of intramuscular BTI in children with orthopaedic- and neurological-related musculoskeletal disorders under the age of 2 years.Data SourcePUBMED, The Cochrane Library, and Science Direct, Google Scholar and Web of Science.Study SelectionTwo reviewers independently selected studies based on predetermined inclusion criteria.Data ExtractionData relating to the aim were extracted. Methodological quality was graded independently by 2 reviewers using the Physiotherapy Evidence Database assessment scale for randomized controlled trials (RCTs) and the Downs and Black evaluation tool for nonRCTs. Level of evidence was determined using the modified Sackett scale.Data SynthesisData of 473 infants were analysed. Fifty-five infants had cerebral palsy, 112 had obstetric brachial plexus palsy, 257 had clubfoot and 44 had congenital torticollis. No studies reported any severe adverse event that could be attributed to the BTI. The rate of mild to moderate adverse events reported varied from 5 to 25%. Results regarding efficacy were preliminary, dependant on the pathology and limited by the small number of studies and their low levels of evidence.ConclusionBTI is already widely used as an early treatment for this age group. The safety profile of BTI in infants appears similar to that of older children and risks appear more related to the severity of the pathology and the location of the injections than to the toxin itself. With regard to effectiveness, other studies with higher levels of evidence should be carried out for each specific pathology.



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Concise Commentary: Breathing New Life into Antisecretory Medications

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Endoscopic Submucosal Dissection of Early Gastric Cancer in Patients with Liver Cirrhosis

Abstract

Background and Objectives

Endoscopic submucosal dissection (ESD) has become widely accepted method for treating early gastric cancer (EGC), but little is known about its role in patients with liver cirrhosis (LC). The aims of this study were to evaluate the outcomes of ESD in treating EGC in patients with LC.

Methods

The multicenter retrospective study identified 43 patients with chronic hepatitis B (CHB)-related cirrhosis undergoing ESD for treating EGC. The patients (LC group) were subdivided into two groups based on their Child–Pugh classification (CP-class): 32 with CP-class A (LC-A) and 11 with CP-class B (LC-B). The patients were compared to 47 non-cirrhotic CHB patients who underwent ESD (CHB group). Eight patients had a past history of hepatocellular carcinoma (HCC) prior to ESD, but no patients had viable HCC when ESD was performed.

Results

Procedural outcomes (en bloc, lateral/basal margins resection) and post-procedural complications (bleeding or perforation) did not differ significantly between the LC and CHB groups or between the LC-A and LC-B groups. No patients experienced worsening of the Child–Pugh score 1 month after ESD compared with the baseline score. During a median observation period of 66 months, the recurrence rates of gastric cancers were similar between the LC and CHB groups (5-year recurrence rates: 2.4 vs. 2.3%, p = 0.925), and all recurrent gastric cancers were completely resected by additional ESD. The overall mortality rate was increased in the LC group (5-year mortality rates: 17.9 vs. 5.7%, p = 0.034), and 8 of 10 deaths were attributed to liver-related diseases (such as HCC, complications of portal hypertension, hepatic failure).

Conclusions

ESD is feasible in patients with EGC and comorbid LC, even those with CP-class B cirrhosis. Their prognosis depends on LC-related diseases and not recurrent EGC.

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Reasoning Abilities and Potential Correlates Among Jordanian School Children

Abstract

Objectives To investigate factors related to reasoning skills in 434 school children aged 5–9 years. Methods The Leiter International Performance Scale-Revised was used to assess reasoning skills. Demographic, work and family income data, information on child's daily behavior and school academic achievement were provided by the participating children's parents. Results Reasoning scores increased by 4.56 points with increasing subject's age, 1.71 points with increasing level of father's occupation, 1.86 points with each increase in the subject's GPA, 1.13 points with consumption of breakfast at home and 1.81 points when child slept more hours. Having a father who smoked and living in a rural area decreased scores in reasoning. Conclusions for Practice Screening of reasoning and associated factors is essential for a comprehensive and accurate understanding of the child's abilities and limitations. Understanding the child's reasoning abilities is critical for establishing intervention goals and planning therapeutic activities.

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Bidirectional modulation of glutamatergic synaptic transmission by mGlu7 receptors at SC-CA1 hippocampal synapses

Abstract

Neurotransmitter release is driven by Ca²⁺ influx at synaptic boutons that acts on synaptic vesicles ready to undergo exocytosis. Neurotransmitter release is inhibited when mGlu₇ receptors provoke a reduction in Ca²⁺ influx, although the reduced release from synapses lacking this receptor suggests that they may also prime synaptic vesicles for release. These mGlu₇ receptors activate phospholipase C (PLC) and generate inositol trisphosphate (IP₃), which in turn releases Ca²⁺ from intracellular stores and produces diacylglycerol (DAG), an activator of proteins containing DAG-binding domains like Munc13 and protein kinase C (PKC). However, the full effects of mGlu₇ receptor signalling on synaptic transmission are unclear. We found that prolonged activation of mGlu₇ receptors with the agonist L-AP4 first reduces and then enhances the amplitude of EPSCs, a presynaptic effect that changes the frequency but not the amplitude of the mEPSCs and the paired pulse ratio. Pertussis toxin blocks the inhibitory response, while the PLC inhibitor U73122, and the inhibitor of DAG binding calphostin C, prevent receptor mediated potentiation. Moreover, this DAG-dependent potentiation of the release machinery brings more synaptic vesicles closer to the active zone plasma membrane in a Munc13-2 and RIM1α dependent manner. Electrically evoked release of glutamate that activates mGlu₇ receptors also bi-directionally modulates synaptic transmission. In these conditions, potentiation now occurs rapidly and it overcomes any inhibition, such that potentiation prevails unless it is suppressed with the PLC inhibitor U73122.

This article is protected by copyright. All rights reserved

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Comparison of the outcomes of dynamic/static tests and palpation tests in TMD-pain patients

Summary

Background: In addition to palpation tests, dynamic/static tests have been proposed to complement temporomandibular disorders (TMD) patients' evaluation in the clinical setting. Objective: The aim of this study was to assess the intra- and inter-observer reliability of the palpation tests and of the dynamic/static tests, and to determine whether those tests would yield comparable outcomes in terms of pain diagnoses. Methods: Ninety-eight (N=98) consecutive adult patients were examined during two clinical sessions by two independent examiners, based on muscle and joint palpation techniques described in the Research Diagnostic Criteria of Temporomandibular Disorders (RDC/TMD). They also underwent dynamic/static tests. Results: The intra-observer reliability of palpation tests was generally poor, with fair-to-good to excellent ICC values only for the superior masseter and intra-oral sites. The inter-observer reliability of palpation was fair-to-good for muscles, but it was poor for the TMJ lateral pole. Both intra- and inter-observer reliability for the dynamic/static tests varied from fair-to-good to excellent. The intra-observer reliability for muscle pain diagnoses based on palpation tests was between poor and fair-to-good whereas the inter-observer reliability was excellent. The intra-observer reliability for pain diagnoses based on dynamic/static tests was fair-to-good, and the inter-observer reliability varied from fair-to-good to excellent. Conclusions: Some features of the dynamic/static tests make them potentially more useful than palpation tests for selected clinical purposes, such as discriminating between joint and muscle pain as well as monitoring symptoms course. Thus, findings from this investigation suggest that both tests should be included in the TMD diagnostic algorithms.

This article is protected by copyright. All rights reserved.

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Startup testing motorcycle helmet that calls for help in crash

The GPS-enabled helmet will contact emergency services if the motorcyclist should fall off the bike

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Hospital steps up security after national increase in emergency room violence

A study revealed that 54.5 percent of 6,504 emergency nurses have experienced physical violence and/or verbal abuse from a patient or visitor

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EMS agency implements new CPR procedures

Chief Shane Lockard said the district is among the first in the U.S. to adopt a new combination, the ResQCPR System and the Lucas 3 chest compression system

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ESO Solutions Celebrates Upgrade of 1,000th EMS Agency to NEMSIS 3 Data Standard

Leading EMS ePCR Software Provider Continues Transition of Agencies to Meet New National and State EMS Data Requirements AUSTIN, TX — ESO Solutions, Inc., the leading data and software company serving emergency medical services, fire departments, and hospitals, announced that it recently upgraded its 1,000th customer to the new NEMSIS 3 data standard. Cape Fear Valley Mobile Integrated Healthcare ...

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Fire dept. offers no out-of-pocket transport costs for insured residents

The Charlottesville Fire Department purchased its first ambulance in over 60 years and said if you live in the city and have insurance you don't have to pay

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NIOSH safety engineer gets award for ambulance safety video series

James Green received the Digital Health Award for his ambulance crash test methods series

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Code 3® Announces First of its Kind Bacteria Killing Patient Compartment Light Powered By Vital Vio

ST. LOUIS, MO — Code 3®, Inc., a leading manufacturer and developer of light and sound emergency products, today announced the launch of its new germ killing Patient Compartment Light Powered by Vital Vio. Code 3's Patient Compartment Light powered by Vital Vio's VioSafe™ White Light Disinfection™ Technology multi-tasks by providing continuous disinfection of bacteria on objects and surfaces ...

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The New Exclusive Large Medical Service Backpack Features Superior Storage Options, Customization, and Comfort

The New Exclusive Large Medical Service Backpack Features Superior Storage Options, Customization, and Comfort COATESVILLE, Pa. — theEMSstore, a trusted, top supplier of critical supplies geared toward EMS professionals, is excited to offer one of the highest-quality EMS backpacks available today: the Exclusive Large Medical Service Backpack. "This is an ideal bag for first responders," ...

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Redivus Health Launches State of Kansas Initiative in Partnership With The University of Kansas Health System

Collaboration supports rural healthcare providers with the goal of improving patient outcomes across the state of Kansas OLATHE, KS & KANSAS CITY, KS — Redivus Health announced today it will partner with The University of Kansas Health System to roll out the Redivus mobile clinical decision support platform to Kansas hospitals and Emergency Medical Services (EMS) providers starting this month ...

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911 calls capture chaos, tragedy after Amtrak train derailment

Calls from the train's riders, freeway motorists and witnesses flooded the dispatch center as desperate voices explained a widespread disaster

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The importance of Monitoring etCO2 with Pediatric patients

Melissa Langhan, MD reviews the importance of capnography to monitor pediatric patients in the emergency medicine environment.

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Braun Ambulances: Join the Braun Family

This short video provides a high level overview of Braun Industries and what makes Braun ambulances unique. To learn more, visit our website at http://ift.tt/2g1BwaJ.

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Ambulance Crash Side Impact - Crash Testing by Braun

Partnering with an industry leader in commercial vehicle crash testing, Braun is continually evaluating their ambulance models for crashworthiness. This footage features a side impact test with a Ford F-150. For more information, visit www.BraunStrong.com.

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Braun Ambulance Order & Build Process

Take a look inside Braun Industries and learn how our custom ambulances are built. We go step by step from design and order review through manufacturing and delivery. See how each ambulance is "Built for Life". Visit our website at http://ift.tt/2g1BwaJ for more.

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Elk River Fire & Ambulance on Braun Ambulance

Braun Industries delivered custom ambulances to departments and organizations around the country. In this video, hear from Elk River about their experiences working with Braun to design and build a custom emergency vehicle.

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Ambulance Rollover Crash - Crash Testing by Braun

Partnering with an industry leader in commercial vehicle crash testing, Braun is continually evaluating their ambulance models for crashworthiness. This footage features a simulated ambulance rollover. For more information, visit http://ift.tt/2g1BwaJ.

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EMS1 Editorial Advisory Board reflects on 2017 and the year ahead

It was a big year for EMS, and for EMS1. EMS providers made big strides for patient care and promoting the profession in 2017. Community paramedic Lisa Cassidy with the St. Charles County Ambulance District launched the #StopHeroin campaign for opioid abuse prevention and treatment. Charles Avery, an EMS program director at Bainbridge State College, made it possible for a young woman with Down Syndrome ...

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NIOSH safety engineer gets award for ambulance safety video series

By EMS1 Staff WASHINGTON — A NIOSH safety engineer was awarded for his video series on ambulance safety. The Centers for Disease Control and Prevention reported that James Green won a Digital Health Award for his seven-part series on ambulance crash test methods. The video series highlighted new crash test methods that resulted from NIOSH research, as well as crash-tested product demos and ambulance ...

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5 top takeaways from EMS's 2017 year in review

2017 may very well be one of the most tumultuous years for EMS. Against the backdrop of a highly charged national political landscape, field care professionals saw an array of changes as well. While some of the events highlight the success of an industry on the cusp of change, others demonstrated that we continue to be dragged down by boorish behavior. Community paramedicine comes of age" Mobile integrated ...

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911 calls capture chaos, tragedy after Amtrak train derailment

Calls from the train's riders, freeway motorists and witnesses flooded the dispatch center as desperate voices explained a widespread disaster

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Effect of Longitudinal Changes of Body Fat on the Incidence and Regression of Nonalcoholic Fatty Liver Disease

To investigate the longitudinal association between changes in body fat amount and the incidence and regression of nonalcoholic fatty liver disease (NAFLD).

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Emergency double-balloon enteroscopy for retrieval of an ingested dental-bridge, partially embedded within the wall of the jejunum

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Endoscopic resection of a rare subepithelial esophageal hamartoma

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Patterns in use and costs of subsidising 5-aminosalicyclic acid compounds and biologic agents in the treatment of inflammatory bowel disease in Australia

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Stereotactic body radiotherapy (SBRT) for patients with locally advanced pancreatic cancer: a single center experience

Despite advances in treatment, notably in systemic therapy, the prognosis of pancreatic adenocarcinoma (PADC) remains dismal. Stereotactic body radiotherapy (SBRT) is an emerging tool in the complex management of PADC. We review outcomes of SBRT for PADC at our institution.

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Elective endoscopic variceal ligation is not a risk factor for bacterial infection in patients with liver cirrhosis

Patients with cirrhosis are at high risk of bacterial infections. Invasive procedures aregenerally believed to increase this susceptibility.

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Macro-Aspartate Aminotransferase: An Unusual Etiology of Liver Enzyme Elevation

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A novel mutation (c.855delG) in STK11 gene is associated with Peutz-Jeghers Syndrome in a Chinese family

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Serum amyloid A level correlated with endoscopic findings in patients with Crohn’s disease – possible biomarker for evaluating mucosal healing

Mucosal healing (MH) has been proposed as an essential therapeutic goal for treatment of Crohn's disease (CD) patients. The utility of serum amyloid A (SAA) for prediction of MH in CD patients is lacking.

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Serial C-reactive protein measurements in patients treated for suspected abdominal tuberculosis

Response to treatment is often used as a criterion for the diagnosis of abdominal tuberculosis.

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Recurrent biliary acute pancreatitis is frequent in a real-world setting

Data about recurrent acute pancreatitis (RAP) are limited.

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Gastrointestinal lymphomas: French Intergroup Clinical Practice Recommendations for diagnosis, treatment and follow-up (SNFG, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, SFH)

This document is a summary of the French Intergroup guidelines on the management of gastro-intestinal lymphomas, available on the web-site of the French Society of Gastroenterology, SNFGE (www.tncd.org), updated in September 2017.

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Distinct Expression of Phenotypic Markers in Placodes- and Neural Crest-Derived Afferent Neurons Innervating the Rat Stomach

Abstract

Background

Visceral pain is initiated by activation of primary afferent neurons among which the capsaicin-sensitive (TRPV1-positive) neurons play an important role. The stomach is a common source of visceral pain. Similar to other organs, the stomach receives dual spinal and vagal afferent innervation. Developmentally, spinal dorsal root ganglia (DRG) and vagal jugular neurons originate from embryonic neural crest and vagal nodose neurons originate from placodes. In thoracic organs the neural crest- and placodes-derived TRPV1-positive neurons have distinct phenotypes differing in activation profile, neurotrophic regulation and reflex responses. It is unknown to whether such distinction exists in the stomach.

Aims

We hypothesized that gastric neural crest- and placodes-derived TRPV1-positive neurons express phenotypic markers indicative of placodes and neural crest phenotypes.

Methods

Gastric DRG and vagal neurons were retrogradely traced by DiI injected into the rat stomach wall. Single-cell RT-PCR was performed on traced gastric neurons.

Results

Retrograde tracing demonstrated that vagal gastric neurons locate exclusively into the nodose portion of the rat jugular/petrosal/nodose complex. Gastric DRG TRPV1-positive neurons preferentially expressed markers PPT-A, TrkA and GFRα₃ typical for neural crest-derived TRPV1-positive visceral neurons. In contrast, gastric nodose TRPV1-positive neurons preferentially expressed markers P2X₂ and TrkB typical for placodes-derived TRPV1-positive visceral neurons. Differential expression of neural crest and placodes markers was less pronounced in TRPV1-negative DRG and nodose populations.

Conclusions

There are phenotypic distinctions between the neural crest-derived DRG and placodes-derived vagal nodose TRPV1-positive neurons innervating the rat stomach that are similar to those described in thoracic organs.

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Old and New Lymphocyte Players in Inflammatory Bowel Disease

Abstract

Inflammatory bowel disease (IBD), encompassing Crohn's disease and ulcerative colitis, is a chronic intestinal inflammatory disorder characterized by diffuse accumulation of lymphocytes in the gut mucosa as a consequence of over-expression of endothelial adhesion molecules. The infiltrating lymphocytes have been identified as subsets of T cells, including T helper (Th)1 cells, Th17 cells, and regulatory T cells. The function of these lymphocyte subpopulations in the development of IBD is well-known, since they produce a number of pro-inflammatory cytokines, such as interferon-γ and interleukin-17A, which in turn activate mucosal proteases, thus leading to the development of intestinal lesions, i.e., ulcers, fistulas, abscesses, and strictures. However, the immune mechanisms underlying IBD are not yet fully understood, and knowledge about the function of newly discovered lymphocytes, including Th9 cells, innate lymphoid cells, mucosal-associated invariant T cells, and natural killer T cells, might add new pieces to the complex puzzle of IBD pathogenesis. This review summarizes the recent advances in the understanding of the role of mucosal lymphocytes in chronic intestinal inflammation and deals with the therapeutic potential of lymphocyte-targeting drugs in IBD patients.

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The Impact of Race on Survival After Hepatocellular Carcinoma in a Diverse American Population

Abstract

Background and Aims

Hepatocellular carcinoma (HCC) incidence is increasing at differential rates depending on race. We aimed to identify associations between race and survival after HCC diagnosis in a diverse American population.

Methods

Using the cancer registry from Sylvester Comprehensive Cancer Center, University of Miami and Jackson Memorial Hospitals, we performed retrospective analysis of 999 patients diagnosed with HCC between 9/24/2004 and 12/19/2014. We identified clinical characteristics by reviewing available electronic medical records. The association between race and survival was analyzed using Cox proportional hazards regression.

Results

Median survival in days was 425 in Blacks, 904.5 in non-Hispanic Whites, 652 in Hispanics, 570 in Asians, and 928 in others, p < 0.01. Blacks and Asians presented at more advanced stages with larger tumors. Although Whites had increased severity of liver disease at diagnosis compared to other races, they had 36% reduced rate of death compared to Blacks, [hazard ratio (HR) 0.64, 95% confidence interval (CI) 0.51–0.8, p < 0.01]. After adjusting for significant covariates, Whites had 22% (HR 0.78, 95% CI 0.61–0.99, p 0.04) reduced risk of death, compared to Blacks. Transplant significantly reduced rate of death; however, only 13.3% of Blacks had liver transplant, compared to 40.1% of Whites, p < 0.01.

Conclusions

In this diverse sample of patients, survival among Blacks is the shortest after HCC diagnosis. Survival differences reflect a more advanced tumor stage at presentation rather than severity of underlying liver disease precluding treatment. Improving survival in minority populations, in whom HCC incidence is rapidly increasing, requires identification and modification of factors contributing to late-stage presentation.

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Redox Imbalance in Intestinal Fibrosis: Beware of the TGFβ-1, ROS, and Nrf2 Connection

Abstract

Intestinal fibrosis, a common complication of inflammatory bowel diseases, becomes clinically apparent in ~ 40% of patients with Crohn's disease and ~ 5% of those with ulcerative colitis. Fibrosis, a consequence of local chronic inflammation, is characterized by excessive deposition of extracellular matrix (ECM) proteins by activated myofibroblasts, which are modulated by pro-fibrotic and anti-fibrotic factors. Fibrosis depends on the balance between production and degradation of ECM proteins. Although the transforming growth factor (TGF)-β1/Smad pathway is the major driving force of fibrosis, several pro-fibrogenic and anti-fibrogenic endogenous factors appear to interact directly with this pathway such as reactive oxygen species (ROS) and nuclear factor-erythroid 2-related factor 2 (Nrf2), which are connected with TGF-β1 during fibrosis development in several organs, including the intestine. Nrf2 is a ubiquitous master transcription factor that upregulates the expression of antioxidant enzymes and cytoprotective proteins mediated by antioxidant response elements (AREs). Here, I describe and discuss the links among TGF-β1, ROS, and Nrf2–AREs in the pathogenesis of intestinal fibrosis.

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Helicobacter pylori Antimicrobial Susceptibility Testing-Guided Salvage Therapy in the USA: A Real Life Experience

Abstracts

Background

The current practice guidelines recommend that Helicobacter pylori (H. pylori) culture and antimicrobial susceptibility testing (AST) be considered after patients failed the second course of H. pylori eradication therapy.

Aims

Here we report the real life experience of following this recommendation in the USA.

Methods

We established an in-house H. pylori culture protocol for AST and identified retrospectively patients who previously failed ≥ 2 courses of anti-H. pylori therapy and underwent esophagogastroduodenoscopy with AST at University of Michigan from 2010 to 2017. We determined the rate of H. pylori antibiotic resistance, the success rates of AST-guided tailored therapy, and the risk factors associated with treatment failure.

Results

Forty-seven patients were identified and 34 (72.3%) had successful cultures and AST. The most common antibiotic resistance was to metronidazole (79.4%), followed by clarithromycin (70.6%) and ciprofloxacin (42.9%). None of the patients were resistant to amoxicillin or tetracycline. The overall success rate of AST-guided tailored therapy was low (44.4%, 12/27). In patients infected with metronidazole-resistant H. pylori, bismuth quadruple therapy appears to be superior compared to non-bismuth quadruple therapy (6/8 or 75.0% vs. 3/14 or 21.4%, P = 0.03). High body mass index was significantly associated with tailored therapy failure (OR 1.24, 95% CI 1.00–1.54, P = 0.049).

Conclusions

The success rate of AST-guided salvage therapy in the USA is low particularly in those with high BMI. Bismuth-based therapy appears to be better than non-bismuth-based regimens.

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Concise Commentary: Is Nrf2 a Master Regulator of Intestinal Fibrosis?

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Speckle-Type POZ Protein Down-Regulates Matrix Metalloproteinase 2 Expression via Sp1/PI3K/Akt Signaling Pathway in Colorectal Cancer

Abstract

Background

Elevated expression of matrix metalloproteinases (MMPs) is correlated with invasion and metastasis of colorectal cancer (CRC). Recently, a previous study has suggested that speckle-type POZ protein (SPOP) could inhibit cancer cell proliferation and migration through down-regulation of MMP2 and MMP7, with a mechanism remaining unknown.

Aim

In this study, we, by using both CRC cells and normal colorectal cells, aimed to investigate the causal relationship between SPOP and MMP2, as well as the potential signaling pathways.

Methods

The causal relationship between SPOP and MMP2 was determined by both RT-PCR and Western blot in cells with SPOP expression or siRNA interference. The signaling pathway involved in MMP2 down-regulation by SPOP was subsequently identified by determination on the expression and phosphorylation of key signaling pathway proteins. Transcription factor involving in this MMP2 regulation was identified by determination on expression, phosphorylation, and nuclear translocation of key transcription factors.

Results

SPOP overexpression could significantly decrease MMP2 expression, while the knockdown of SPOP, in contrast, resulted in enhanced MMP2 level. Measurement of expression and phosphorylation of key signaling pathway proteins revealed that SPOP could inhibit PI3K and p-Akt level. Further tests on transcription factors showed that SPOP could inhibit SP1 phosphorylation and nuclear translocation.

Conclusions

SPOP could down-regulate MMP2 expression in CRC, and this regulation is mediated by inhibiting SP1 phosphorylation and nuclear translocation through PI3K/Akt signaling pathway. Our findings in this study provide understanding of MMP2 regulation in CRC and may also shed lights on the development of anti-CRC treatments.

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Esophageal Stents for Acute Variceal Bleeding: Expanding the Possibilities

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Functional Reach, Depression Scores and Number of Medications are Associated with Number of Falls in People with Chronic Stroke

Falls are a common adverse event among people with stroke. Previous studies investigating risk of falls after stroke have relied primarily on retrospective fall history ranging from 6-12 months recall, with inconsistent findings.

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Patient-Reported Outcome Measures: Utility for Predicting Spinal Surgery in an Integrated Spine Practice

For the majority of patients, spinal surgery is an elective treatment. The decision as to when and if to pursue surgery is complicated and influenced by a myriad of factors including pain intensity and duration, impact on functional activities, referring physician recommendation and surgeon preference. By understanding the factors that lead a patient to choose surgery we may better understand the decision making process, improve outcomes, and provide more effective care.

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Challenging diagnosis and inpatient rehabilitation of acute bilateral neuralgic amyotrophy possibly attributed to Lyme disease-A case report

Neuralgic amyotrophy (NA) is a neurological syndrome of unknown etiology primarily affecting the brachial plexus. We are reporting an unusual case of acute bilateral NA that was possibly secondary to Lyme disease. The patient demonstrated significant functional gains and was discharged home after 2 weeks of inpatient rehabilitation, supporting the role of inpatient rehabilitation in acute NA. In this report, we discussed the diagnosis, electrodiagnostic progression, pain management, goals for inpatient rehabilitation and overall prognosis of NA.

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Information for Authors

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Table of Contents

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A Tale of Two Treatments for Patellofemoral Pain

A 23-year-old female competitive runner presents with bilateral retropatellar pain. She has been evaluated by a physician previously and diagnosed with patellofemoral pain (PFP). Treatment to date has included physical therapy, which has been focused on quadriceps strengthening and passive modalities. She reports the treatment to be of minimal benefit.

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Musculoskeletal and Sports Medicine Physical Medicine and Rehabilitation Curriculum Guidelines

The following Musculoskeletal and Sports Medicine Physical Medicine and Rehabilitation (PM&R) Curriculum Guidelines were developed to define a recommended training strategy for PM&R residents in the realm of musculoskeletal and sports medicine. This document has been endorsed by the American Medical Society for Sports Medicine, the American Academy of Physical Medicine and Rehabilitation, and the Association of Academic Physiatrists. There are other published educational resources for sports medicine faculty that provide direction in improving the quality of sports medicine fellowship programs [1].

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An Introduction to Bayesian Data Analysis for Correlations

Bayesian approaches to data analysis can be a good alternative or supplement to traditional hypothesis testing. Unlike P values, simple Bayesian analyses can provide a direct measure of the strength of evidence both for and against a study hypothesis, which can be helpful for researchers for interpreting and making decisions about their results. This article provides an introduction to Bayesian methods for exploring the relationship between 2 quantitative variables, illustrated with a dataset from the literature and analyzed with free, easy-to-use software.

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Editorial Board

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Spanish Translated Abstracts

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Academy News – December 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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Copyright Page

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A Multinational Cluster Randomised Controlled Trial to Assess the Efficacy of ‘11+ Kids’: A Warm-Up Programme to Prevent Injuries in Children’s Football

Abstract

Objective

The objective of this study was to assess the efficacy of a newly developed warm-up programme ('11+ Kids') regarding its potential to reduce injuries in children's football.

Methods

Children's football teams (under 9 years, under 11 years, and under 13 years age groups) from Switzerland, Germany, the Czech Republic and the Netherlands were invited. Clubs were randomised to an intervention group and a control group, and followed for one season. The intervention group replaced their usual warm-up by '11+ Kids', while the control group warmed up as usual. The primary outcome was the overall risk of football-related injuries. Secondary outcomes were the risks of severe and lower extremity injuries. We calculated hazard ratios using extended Cox models, and performed a compliance analysis.

Results

In total, 292,749 h of football exposure of 3895 players were recorded. The mean age of players was 10.8 (standard deviation 1.4) years. During the study period, 374 (intervention group = 139; control group = 235) injuries occurred. The overall injury rate in the intervention group was reduced by 48% compared with the control group (hazard ratio 0.52; 95% confidence interval 0.32–0.86). Severe (74% reduction, hazard ratio 0.26; 95% confidence interval 0.10–0.64) and lower extremity injuries (55% reduction, hazard ratio 0.45; 95% confidence interval 0.24–0.84) were also reduced. Injury incidence decreased with increasing compliance.

Conclusion

'11+ Kids' is efficacious in reducing injuries in children's football. We observed considerable effects for overall, severe and lower extremity injuries. The programme should be performed at least once per week to profit from an injury preventive effect. However, two sessions per week can be recommended to further increase the protective benefit.

Trial Registration

ClinicalTrials.gov identifier: NCT02222025.

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Endurance Performance is Influenced by Perceptions of Pain and Temperature: Theory, Applications and Safety Considerations

Abstract

Models of endurance performance now recognise input from the brain, including an athlete's ability to cope with various non-pleasurable perceptions during exercise, such as pain and temperature. Exercise training can reduce perceptions of both pain and temperature over time, partly explaining why athletes generally have a higher pain tolerance, despite a similar pain threshold, compared with active controls. Several strategies with varying efficacy may ameliorate the perceptions of pain (e.g. acetaminophen, transcranial direct current stimulation and transcutaneous electrical stimulation) and temperature (e.g. menthol beverages, topical menthol products and other cooling strategies, especially those targeting the head) during exercise to improve athletic performance. This review describes both the theory and practical applications of these interventions in the endurance sport setting, as well as the potentially harmful health consequences of their use.

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The Effectiveness of Dance Interventions on Physical Health Outcomes Compared to Other Forms of Physical Activity: A Systematic Review and Meta-Analysis

Abstract

Background

Physical inactivity is one of the key global health challenges as it is associated with adverse effects related to ageing, weight control, physical function, longevity, and quality of life. Dancing is a form of physical activity associated with health benefits across the lifespan, even at amateur levels of participation. However, it is unclear whether dance interventions are equally as effective as other forms of physical activity.

Objective

The aim was to systematically review the literature on the effectiveness of structured dance interventions, in comparison to structured exercise programmes, on physical health outcome measures.

Methods

Seven databases were searched from earliest records to 4 August 2017. Studies investigating dance interventions lasting > 4 weeks that included physical health outcomes and had a structured exercise comparison group were included in the study. Screening and data extraction were performed by two reviewers, with all disagreements resolved by the primary author. Where appropriate, meta-analysis was performed or an effect size estimate generated.

Results

Of 11,434 studies identified, 28 (total sample size 1276 participants) met the inclusion criteria. A variety of dance genres and structured exercise interventions were compared. Meta-analyses showed dance interventions significantly improved body composition, blood biomarkers, and musculoskeletal function. The effect of either intervention on cardiovascular function and self-perceived mobility was equivalent.

Conclusion

Undertaking structured dance of any genre is equally and occasionally more effective than other types of structured exercise for improving a range of health outcome measures. Health practitioners can recommend structured dance as a safe and effective exercise alternative.

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Addition of Selenium to Methimazole Does Not Alter the Response to Therapy in Graves’ Hyperthyroidism

Clinical Thyroidology Dec 2017, Vol. 29, No. 12: 475-477.


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Higher Serum FT4 Level Within the Reference Range, but Not Serum TSH, Is Associated With the Development of Atrial Fibrillation

Clinical Thyroidology Dec 2017, Vol. 29, No. 12: 454-456.


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Second Radioactive Iodine Treatment Alone Is of Little Benefit in Treating Patients with Locoregional Persistent Differentiated Thyroid Carcinoma Who Previously Have Been Treated with Total Thyroidectomy and Ablative Radioactive Iodine

Clinical Thyroidology Dec 2017, Vol. 29, No. 12: 468-471.


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Shear-Wave Elastography in Thyroid Nodules Fails to Discriminate Between Benign and Malignant Tumors

Clinical Thyroidology Dec 2017, Vol. 29, No. 12: 457-460.


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Does Having Exophthalmic Graves’ Disease Increase a Patient's Risk of Suicide?

Clinical Thyroidology Dec 2017, Vol. 29, No. 12: 450-453.


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FDG-Avid Thyroid Incidentalomas on PET–CT Ordered for Other Malignancies Have No Prognostic Significance in a Large Retrospective Cohort

Clinical Thyroidology Dec 2017, Vol. 29, No. 12: 461-464.


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What Are the New Features of the 2017 Bethesda System for Thyroid Cytopathology?

Clinical Thyroidology Dec 2017, Vol. 29, No. 12: 472-474.


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Rate of Nodule Growth on Surveillance Ultrasound Predicts Risk of Malignancy

Clinical Thyroidology Dec 2017, Vol. 29, No. 12: 465-467.


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Lymphovascular Invasion Is a Predictor of Prognosis for Patients with Well-Differentiated Papillary Thyroid Carcinoma

Clinical Thyroidology Dec 2017, Vol. 29, No. 12: 478-481.


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Current Targeted Therapies in HER2-Positive Gastric Adenocarcinoma

Cancer Biotherapy & Radiopharmaceuticals Dec 2017, Vol. 32, No. 10: 351-363.


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Retraction of: Tumor Protein D52-Like 2 Contributes to Proliferation of Breast Cancer Cells; 10.1089/cbr.2014.1723

Cancer Biotherapy & Radiopharmaceuticals Dec 2017, Vol. 32, No. 10: 387-387.


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Preparation of Radioactive Skin Patches Using Polyhydroxamic Acid-Grafted Cellulose Films Toward Applications in Treatment of Superficial Tumors

Cancer Biotherapy & Radiopharmaceuticals Dec 2017, Vol. 32, No. 10: 364-370.


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Complex of TNF-α and Modified Fe3O4 Nanoparticles Suppresses Tumor Growth by Magnetic Induction Hyperthermia

Cancer Biotherapy & Radiopharmaceuticals Dec 2017, Vol. 32, No. 10: 379-386.


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MicroRNA-497-5p Suppresses Tumor Cell Growth of Osteosarcoma by Targeting ADP Ribosylation Factor-Like Protein 2

Cancer Biotherapy & Radiopharmaceuticals Dec 2017, Vol. 32, No. 10: 371-378.


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Retraction of: Tumor Protein D52-Like 2 Accelerates Gastric Cancer Cell Proliferation; 10.1089/cbr.2014.1766

Cancer Biotherapy & Radiopharmaceuticals Dec 2017, Vol. 32, No. 10: 388-388.


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The Development of the External Granular Layer of the Cerebellum and Neurobehavioral Correlates in Neonatal Rats Following Intrauterine and Postnatal Exposure to Caffeine

Journal of Caffeine Research , Vol. 0, No. 0.


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Kinetic and Dynamic Description of Caffeine

Journal of Caffeine Research , Vol. 0, No. 0.


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A Randomized, Two-Way Crossover Study to Evaluate the Pharmacokinetics of Caffeine Delivered Using Caffeinated Chewing Gum Versus a Marketed Caffeinated Beverage in Healthy Adult Volunteers

Journal of Caffeine Research Dec 2017, Vol. 7, No. 4: 125-132.


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Current Targeted Therapies in HER2-Positive Gastric Adenocarcinoma

Cancer Biotherapy & Radiopharmaceuticals Dec 2017, Vol. 32, No. 10: 351-363.


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Preparation of Radioactive Skin Patches Using Polyhydroxamic Acid-Grafted Cellulose Films Toward Applications in Treatment of Superficial Tumors

Cancer Biotherapy & Radiopharmaceuticals Dec 2017, Vol. 32, No. 10: 364-370.


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Nuclear receptors in cancer — uncovering new and evolving roles through genomic analysis

Nuclear receptors in cancer — uncovering new and evolving roles through genomic analysis

Nuclear receptors in cancer — uncovering new and evolving roles through genomic analysis, Published online: 27 December 2017; doi:10.1038/nrg.2017.102

Genomic technologies are providing a clearer picture of how nuclear receptors (NRs) regulate complex transcriptional networks and contribute to the development and progression of cancer. This deeper understanding of NRs will hopefully lead to improved prognostic tools and new therapeutic targets.

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Technique: Single-cell transcriptomes in space

Technique: Single-cell transcriptomes in space

Technique: Single-cell transcriptomes in space, Published online: 27 December 2017; doi:10.1038/nrg.2017.114

Technique: Single-cell transcriptomes in space

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