Πέμπτη, 28 Δεκεμβρίου 2017

Reducing the Risk of Postpartum Depression in a Low-Income Community Through a Community Health Worker Intervention

Abstract

Objectives To clarify the effectiveness of perinatal social support interventions in reducing postpartum depression among minority, low-income women. Methods The Transdisciplinary Research Consortium for Gulf Resilience on Women's Health supported a community-based participatory research project to improve perinatal health among low-income, first-time pregnant women living in a vulnerable Gulf Coast region. Community health workers (CHWs) were partnered with recruited women, and used a mix of mobile technology and home visits to develop a supportive relationship during the perinatal period. Results Women enrolled in the CHW-led intervention had lower (F: 2.38, p = 0.04) average postpartum depression scores (EPDS) 6 months postpartum than a comparison population. The difference, however, was not seen among women in the intervention group who reported relatively poor relationships with their CHWs. Conclusions for Practice Results reinforce the evidence that perinatal social support can affect postpartum depression outcomes. CHWs are increasingly utilized by public programs to reach at-risk populations. We discuss the potential efficacy of CHW programs, but also, the need to pair outreach with effective monitoring and evaluation of the relationship development between CHW and clients.



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The Relationships Between Internal and External Measures of Training Load and Intensity in Team Sports: A Meta-Analysis

Abstract

Background

The associations between internal and external measures of training load and intensity are important in understanding the training process and the validity of specific internal measures.

Objectives

We aimed to provide meta-analytic estimates of the relationships, as determined by a correlation coefficient, between internal and external measures of load and intensity during team-sport training and competition. A further aim was to examine the moderating effects of training mode on these relationships.

Methods

We searched six electronic databases (Scopus, Web of Science, PubMed, MEDLINE, SPORTDiscus, CINAHL) for original research articles published up to September 2017. A Boolean search phrase was created to include search terms relevant to team-sport athletes (population; 37 keywords), internal load (dependent variable; 35 keywords), and external load (independent variable; 81 keywords). Articles were considered for meta-analysis when a correlation coefficient describing the association between at least one internal and one external measure of session load or intensity, measured in the time or frequency domain, was obtained from team-sport athletes during normal training or match-play (i.e., unstructured observational study). The final data sample included 122 estimates from 13 independent studies describing 15 unique relationships between three internal and nine external measures of load and intensity. This sample included 295 athletes and 10,418 individual session observations. Internal measures were session ratings of perceived exertion (sRPE), sRPE training load (sRPE-TL), and heart-rate-derived training impulse (TRIMP). External measures were total distance (TD), the distance covered at high and very high speeds (HSRD ≥ 13.1–15.0 km h−1 and VHSRD ≥ 16.9–19.8 km h−1, respectively), accelerometer load (AL), and the number of sustained impacts (Impacts > 2–5 G). Distinct training modes were identified as either mixed (reference condition), skills, metabolic, or neuromuscular. Separate random effects meta-analyses were conducted for each dataset (n = 15) to determine the pooled relationships between internal and external measures of load and intensity. The moderating effects of training mode were examined using random-effects meta-regression for datasets with at least ten estimates (n = 4). Magnitude-based inferences were used to interpret analyses outcomes.

Results

During all training modes combined, the external load relationships for sRPE-TL were possibly very large with TD [r = 0.79; 90% confidence interval (CI) 0.74 to 0.83], possibly large with AL (r = 0.63; 90% CI 0.54 to 0.70) and Impacts (r = 0.57; 90% CI 0.47 to 0.64), and likely moderate with HSRD (r = 0.47; 90% CI 0.32 to 0.59). The relationship between TRIMP and AL was possibly large (r = 0.54; 90% CI 0.40 to 0.66). All other relationships were unclear or not possible to infer (r range 0.17–0.74, n = 10 datasets). Between-estimate heterogeneity [standard deviations (SDs) representing unexplained variation; τ] in the pooled internal–external relationships were trivial to extremely large for sRPE (τ range = 0.00–0.47), small to large for sRPE-TL (τ range = 0.07–0.31), and trivial to moderate for TRIMP (τ range= 0.00–0.17). The internal–external load relationships during mixed training were possibly very large for sRPE-TL with TD (r = 0.82; 90% CI 0.75 to 0.87) and AL (r = 0.81; 90% CI 0.74 to 0.86), and TRIMP with AL (r = 0.72; 90% CI 0.55 to 0.84), and possibly large for sRPE-TL with HSRD (r = 0.65; 90% CI 0.44 to 0.80). A reduction in these correlation magnitudes was evident for all other training modes (range of the change in r when compared with mixed training − 0.08 to − 0.58), with these differences being unclear to possibly large. Training mode explained 24–100% of the between-estimate variance in the internal–external load relationships.

Conclusion

Measures of internal load derived from perceived exertion and heart rate show consistently positive associations with running- and accelerometer-derived external loads and intensity during team-sport training and competition, but the magnitude and uncertainty of these relationships are measure and training mode dependent.



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Balance Training Does Not Alter Reliance on Visual Information during Static Stance in Those with Chronic Ankle Instability: A Systematic Review with Meta-Analysis

Abstract

Background

Visual, vestibular, and somatosensory systems contribute to postural control. Chronic ankle instability (CAI) patients have been observed to have a reduced ability to dynamically shift their reliance among sources of sensory information and rely more heavily on visual information during a single-limb stance relative to uninjured controls. Balance training is proven to improve postural control but there is a lack of evidence regarding the ability of balance training programs to alter the reliance on visual information in CAI patients.

Objective

Our objective was to determine if balance training alters the reliance on visual information during static stance in CAI patients.

Methods

The PubMed, CINAHL, and SPORTDiscus databases were searched from their earliest available date to October 2017 using a combination of keywords. Study inclusion criteria consisted of (1) using participants with CAI; (2) use of a balance training intervention; and (3) calculation of an objective measure of static postural control during single-limb stance with eyes open and eyes closed. Sample sizes, means, and standard deviations of single-leg balance measures for eyes-open and eyes-closed testing conditions before and after balance training were extracted from the included studies. Eyes-open to eyes-closed effect sizes [Hedges' g and 95% confidence intervals (CI)] before and after balance training were calculated, and between-study variability for heterogeneity and potential risks of publication bias were examined.

Results

Six studies were identified. The overall eyes-open to eyes-closed effect size difference between pre- and post-intervention assessments was not significant (Hedges' g effect size = 0.151, 95% CI = − 0.151 to 0.453, p = 0.26). This result indicates that the utilization of visual information in individuals with CAI during the single-leg balance is not altered after balance training. Low heterogeneity (Q(5) = 2.96, p = 0.71, I 2 = 0%) of the included studies and no publication bias were found.

Conclusion

On the basis of our systematic review with meta-analysis, it appears that traditional balance training protocols do not alter the reliance on visual information used by CAI patients during a single-leg stance.



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Functional architecture of the somatosensory homunculus detected by electrostimulation

Abstract

In this prospective electrostimulation study, based on 50 operated patients with no sensory deficit and no brain lesion in the postcentral gyrus, we acquired coordinates in the standard MNI space of the functional areas of the somatosensory homunculus. The 3D brain volume of each patient was normalized to that space to obtain the MNI coordinates of the stimulation site locations. For 647 sites stimulated on Brodmann Area 1 (and 1025 in gyri nearby), 258 positive points for somatosensory response (40%) were found in the postcentral gyrus. In the contralateral BA1, the hand representation displayed not only medial-to-lateral, little-finger-to-thumb, but also rostral-to-caudal discrete somatotopy, with the tip of each finger located more caudally than the proximal phalanx. We detected a medial-to-lateral, tip-to-base tongue organization but no rostral-to-caudal functional organization. The analysis of the MNI body coordinates showed rare inter-individual variations in the medial-to-lateral somatotopic organization in these patients with intact somatosensory cortex. Positive stimulations were detected through the "on/off" outbreak effect and discriminative touch sensations were the sensations reported almost exclusively by all patients during stimulation. Mean hand (2.39 mA) and tongue (2.60 mA) positive intensity thresholds were lower (P < 0.05) than the intensities required to elicit sensations in the other parts of the body. Unlike Penfield et al., we detected no sensations such as sense of movement or desire to move, no somatosensory responses outside the postcentral gyrus, and no bilateral responses for face/tongue stimulations. We propose a rationalization of the standard drawing of the somatosensory homunculus according to MNI space.

This article is protected by copyright. All rights reserved



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Gut microbiota in the pathogenesis of inflammatory bowel disease

Abstract

Inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease, is a chronic and relapsing inflammatory disorder of the intestine. Although its incidence is increasing globally, the precise etiology remains unclear and a cure for IBD has yet to be discovered. The most accepted hypothesis of IBD pathogenesis is that complex interactions between genetics, environmental factors, and the host immune system lead to aberrant immune responses and chronic intestinal inflammation. The human gut harbors a complex and abundant aggregation of microbes, collectively referred to as the gut microbiota. The gut microbiota has physiological functions associated with nutrition, the immune system, and defense of the host. Recent advances in next-generation sequencing technology have identified alteration of the composition and function of the gut microbiota, which is referred to as dysbiosis, in IBD. Clinical and experimental data suggest dysbiosis may play a pivotal role in the pathogenesis of IBD. This review is focused on the physiological function of the gut microbiota and the association between the gut microbiota and pathogenesis in IBD. In addition, we review the therapeutic options for manipulating the altered gut microbiota, such as probiotics and fecal microbiota transplantation.



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Editorial Board



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Issue Information



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Role of ultrasound guided epidural anesthesia for lower limb surgery in children with previously repaired meningomyelocele

Summary

Background

Children that have had a meningomyelocele repair often present for hip and bilateral lower limb surgeries. Due to vertebral, epidural, and nerve root abnormalities, placement of epidural catheter is difficult.

Aims

We aim to describe the potential role of ultrasound in delineating the most appropriate intervertebral space for central neuroaxial blocks in these patients.

Method

Twelve children with previous meningomyelocele repair, in the age group of 6-12 years posted for hip or bilateral lower limb surgeries were included. After induction of anesthesia, an ultrasound scan was done with the patient in the left lateral position. The central neuroaxial block was performed in the most appropriate intervertebral space seen on transverse scan of spine. These patients were studied with regard to visibility of the osseous framework of the spine, the anterior and posterior dural complexes, ease of insertion of catheter, evidence of dural puncture, and possibility of identification of the extent of peri-incisional fibrosis.

Results

One case required 2 attempts. There was no evidence of dural puncture. We could confirm the soft tissue shadow, the osseous framework, and the anterior and posterior dural complexes in all 12 patients. Ultrasonography guided in selecting the most appropriate space for epidural catheter placement.

Conclusion

Ultrasound guidance aids in identification of normal intervertebral space and explicitly shows the abnormal space. It can be used as an aid to differentiate between normal and abnormal space in post-meningomyelocele repair.



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Evidence for increased use of the Society of Pediatric Anesthesia Critical Events Checklist in resource-limited environments: A retrospective observational study of app data

Summary

Background

Electronic decision support tools in anesthesiology practice have great value, including the potential for mobile applications to simplify delivery of best-practice guidelines.

Aims

We sought to combine demographics with usage information to elucidate important patterns in the rate of use of the Society of Pediatric Anesthesia Critical Events Checklist, as measured by in-app accesses of the checklist via the freely available anesthesia calculator app anesthesiologist.

Methods

We performed a retrospective analytic observational case-control study using analytics and survey data collected from the app. Users of the app were classified on the basis of whether or not they had accessed the checklist. This classification was used to perform logistic regression against a number of independent variables, including frequency of app use, country income level, professional role, rating of app importance, length of time in practice, group size, practice model, community served, and primary practice environment.

Results

Individual app users practicing in low- and middle-income countries have a significantly higher rate of Society for Pediatric Anesthesia Critical Events Checklist utilization as compared with high-income countries. Rural practitioners had higher utilization of the checklist. Practice size did not affect the utilization of the checklist. The checklist was used for both provider learning and for just-in-time patient care.

Conclusion

mHealth apps are invaluable resource in everyday clinical practice. Mobile app analytics and in-app survey data reveal variable penetration and applicability of such technology worldwide. mHealth apps may be particularly impactful in limited-resource areas, such as lower-income environments and rural communities.



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Editorial Board



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Founder mutation in IKBKAP gene causes vestibular impairment in familial dysautonomia

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Publication date: February 2018
Source:Clinical Neurophysiology, Volume 129, Issue 2
Author(s): Joel V. Gutiérrez, Horacio Kaufmann, Jose-Alberto Palma, Carlos Mendoza-Santiesteban, Vaughan G. Macefield, Lucy Norcliffe-Kaufmann
ObjectiveTo assess vestibular function in patients with familial dysautonomia (FD), a hereditary sensory and autonomic neuropathy – caused by a mutation in the IKBKAP gene (c.2204 + 6 T>C) – and characterized by marked gait ataxia.MethodsCervical and vestibular evoked myogenic potentials (cVEMPs and oVEMPs) were recorded from the sternocleidomastoid (SCM) and extraocular muscles in 14 homozygous patients, 2 heterozygous patients, and 15 healthy controls during percussion of the forehead.ResultscVEMP and oVEMP amplitudes were significantly lower, and peak latencies significantly delayed, in the FD patients. There were no differences in overall EMG during attempted maximal voluntary contractions of the SCM muscle, suggesting intact efferent function. The two heterozygotes with a minor haplotype missense (R696P) mutation in exon 19 of the IKBKAP gene had cVEMP responses less affected than the homozygous.ConclusionsThe founder mutation in the IKBKAP gene affects the development of vestibular afferent pathways, leading to attenuated cVEMPs.SignificanceVestibular abnormalities may contribute to the gait ataxia in FD.



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Interhemispheric motor interactions in hemiparetic children with perinatal stroke: Clinical correlates and effects of neuromodulation therapy

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Publication date: February 2018
Source:Clinical Neurophysiology, Volume 129, Issue 2
Author(s): Derek Eng, Ephrem Zewdie, Patrick Ciechanski, Omar Damji, Adam Kirton
ObjectiveBrain stimulation and constraint therapy may enhance function after perinatal stroke but mechanisms are unknown. We characterized interhemispheric interactions (IHI) in hemiparetic children and explored their relationship to motor function and neuromodulation.MethodsForty-five hemiparetic perinatal stroke subjects aged 6–19 years completed a clinical trial of repetitive-transcranial magnetic stimulation (rTMS) and constraint therapy. Paired-pulse TMS measured IHI in cases and normal controls. Suprathreshold conditioning stimuli preceded contralateral test stimuli bidirectionally: stroke to non-stroke (SNS) and non-stroke to stroke (NSS). Primary outcome was the interhemispheric ratio (IHR) between conditioned and test only MEP amplitudes X100 (<100 implied inhibition). Motor outcomes at baseline and post-intervention were compared to IHR.ResultsProcedures were well tolerated. IHI occurred bidirectionally in controls. Eighteen stroke participants had complete data. IHR were increased in stroke participants in both directions. SNS IHR was >100 (facilitation) in 39% of measurements and correlated with better motor function. NSS IHR correlated with poorer motor function. Intervention-induced clinical change was not associated with IHR.ConclusionsInterhemispheric interactions are altered and related to clinical function, but not necessarily neuromodulation, in children with perinatal stroke.SignificanceAdding interhemispheric interactions to evolving models of developmental plasticity following early injury may advance neuromodulation strategies.



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Ambulation and survival following surgery in elderly patients with metastatic epidural spinal cord compression

Metastatic epidural spinal cord compression (MESCC) is a disabling consequence of disease progression. Surgery can restore/preserve physical function, improving access to treatments that increase duration of survival; however, advanced patient age may deter oncologists and surgeons from considering surgical management.

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Reply to “Prospective advances in fetal biomagnetometry - challenges remain”

Our recent simulation paper on fetal-maternal biomagnetic scanner (FM scanner) (Lew et al., 2017) demonstrated that it should be possible to develop a new type of instrument that can provide the online real-time information useful for advancing prenatal medicine on the electrophysiology of the maternal uterus and fetal heart and brain. Although the authors of the accompanying Letter to the Editor (Popescu and Gustafson, 2018), who have made significant contributions to the field of fetal monitoring, largely agree with this main point, they are not fully convinced that our FM scanner can detect the electrophysiological activity of the fetal brain in real time.

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Oxaliplatin and neuropathy: A role for sodium channels

Ensuring long-term quality of life in cancer survivors following treatment is critically important, particularly given the increasing effectiveness of treatments. Chemotherapy-induced peripheral neuropathy (CIPN) remains a major side effect of cancer therapy, with many commonly used chemotherapies, leading to early cessation and long-lasting disability (Park et al., 2013).

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Observations on muscle activity in REM sleep behavior disorder assessed with a semi-automated scoring algorithm

Rapid eye movement (REM) sleep behavior disorder (RBD) is a disorder defined by inappropriate muscle activity and enactment of dream content during REM sleep. RBD is closely connected with diseases pathologically characterized by abnormal aggregation of α-synuclein, including Parkinson's disease (PD), dementia with Lewy bodies and multiple system atrophy (St Louis et al., 2017). RBD often precedes overt motor symptoms of α-synucleinopathies by years (Postuma et al., 2015b; St Louis et al., 2017), providing a window to study their early pre-motor and prodromal disease stages.

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Prospective advances in fetal biomagnetometry – challenges remain

We were very enthused to find in the latest issue of Clinical Neurophysiology this simulation study (Lew et al., 2017) introducing a novel fetal biomagnetometer concept with a sensor array distributed all around the pregnant woman's torso. We applaud the authors' initiative to challenge the fetal biomagnetometry field by putting forward such an economical compact device for in-utero measurements of the fetal electrophysiology as well as maternal uterine activity. The claim is that this modern design will ensure full coverage of the fetal head and body for any position of the fetus and at any stage of the pregnancy without the need of an expensive magnetically shielded room and using advanced miniature optically-pumped magnetometers that do not require cryogenics.

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Development, validation and utility of a simulation model of the nociceptive flexion reflex threshold

The nociceptive flexion reflex (NFR) is a spinal withdrawal reflex of the leg typically assessed by the biceps femoris muscle electromyogram after electrocutaneous stimulation of the sural nerve (Skljarevski and Ramadan 2002; Sandrini et al. 2005). Clinical and scientific interest in the NFR is primarily founded on the correlation of the reflex amplitude with the subjective pain magnitude (Willer et al. 1979; Chan and Dallaire 1989; Dowman 1991) and the correlation of the threshold of the NFR with the subjective pain threshold (Willer 1977; Rhudy et al.

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Sorafenib and fluvastatin synergistically alleviate hepatic fibrosis via inhibiting the TGFβ1/Smad3 pathway

Effective strategies for the treatment of hepatic fibrosis are urgently in need.

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Differences in pain thresholds elicited by intraoral electrical stimuli between individuals with and without diabetes mellitus

Abstract

There is little evidence about sensation in individuals with diabetes mellitus (DM) in the dental research field. We investigated whether pain thresholds (PTs) differ between individuals with and without DM (non-DM; NDM). To this end, we assessed whether PTs obtained from the oral cavity, hands, and feet differed from each other and across groups, and whether PTs differed for the three current frequencies used for testing (2000 Hz, 250 Hz, and 5 Hz). PT measurements were obtained from the oral mucosa and the tips of the fingers and toes of 56 volunteers, including 21 individuals with DM (12 men and 9 women, average age: 72.1 ± 4.7 years) and 35 NDM individuals (17 males and 18 females, average age: 51.2 ± 23.9 years) using the Neurometer CPT/C® device to deliver electrical stimulation. A single operator obtained PT measurements from around the left greater palatine foramen and from the tip of the left first finger and of the left great toe. Individuals with DM had significantly lower PT values than those without DM. The PT values for the oral cavity, hands, and feet differed significantly from each other (foot > hand, foot > oral cavity, hand > oral cavity). Moreover, there was a significant difference in the PT values for 5 Hz and 2000 Hz, as well as for 250 Hz and 2000 Hz. This study concluded that PT values derived from DM participants are lower than those from NDM participants, although PT measurements varied across regions and with current frequency.

This article is protected by copyright. All rights reserved.



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Cybathlon experiences of the Graz BCI racing team Mirage91 in the brain-computer interface discipline

In this work, we share our experiences made at the world-wide first CYBATHLON, an event organized by the Eidgenössische Technische Hochschule Zürich (ETH Zürich), which took place in Zurich in October 2016. It...

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Pulmonary Emboli and Deep Venous Thrombosis during Adolescence

Pulmonary emboli (PE) and deep venous thrombus (DVT) are two conditions considered to affect primarily adults. These conditions, however, can and do affect neonates, toddlers, school-age children, and adolescents. Factors contributing to the development of PE and DVT are often associated with genetic mutations in Antithrombin III, Protein C, and Protein S. This article presents a primary care case study of an adolescent who was diagnosed with and underwent treatment for bilateral PE and a DVT, and reviews the underlying primary genetic mutations, diagnostic workup, and management of his clinical condition.

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Depressive Symptoms in the Young Athlete after Injury: Recommendations for Research

It has been well documented that a serious injury to an athlete can cause psychological symptoms such as depression. However, much of the literature focuses on the collegiate athlete. Little is known about the prevalence of depressive symptoms in the young athlete who experiences an injury that adversely affects the ability to compete in his/her selected sport or may end athletic participation altogether. As sports specialization becomes increasingly widespread and age of participation becomes younger, depressive symptoms may be found in child and adolescent athletes.

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An Integrated Nurse Practitioner–Run Subspecialty Referral Program for Incontinent Children

Evidence suggests that urinary and fecal incontinence and abnormal voiding and defecation dynamics are different manifestations of the same syndrome. This article reports the success of an innovative program for care of children with incontinence and dysfunctional elimination. This program is innovative because it is the first to combine subspecialty services (urology, gastroenterology, and psychiatry) in a single point of care for this population and the first reported independent nurse practitioner–run specialty referral practice in a free-standing pediatric ambulatory subspecialty setting.

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Transitional Care for Young Adults With Congenital Heart Disease: A Case Study

Congenital heart defects, any of myriad innate problems with the structure and function of the heart, affect nearly 1% of births in the United States annually (Centers for Disease Control and Prevention, 2016). Historically, a congenital heart defect was regarded as an inevitable fatality. However, immense strides in diagnosis, operative techniques, and critical care over the past 60 years have increased an infant's chance of survival into adulthood to 85% to 90% (Gurvitz et al., 2016). In fact, adults account for two-thirds of the overall congenital heart disease (CHD) population (Jacobs et al., 2015).

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Expanding Access to Clinical Services for Toddlers with Autism Spectrum Disorders

Autism spectrum disorder (ASD) is a neurodevelopmental disorder typically diagnosed in the toddler and preschool years. Intensive early intervention (EI) using applied behavior analytic procedures is the evidenced-based intervention most effective in improving developmental outcomes. Unfortunately, there are numerous barriers to accessing EI services for toddlers with ASD. This article addresses (a) the process of developing an EI program using primarily applied behavior analytic services with multidisciplinary health care providers, (b) a description of the service delivery provided, (c) educational and training programs to increase qualified staff, and (d) advocacy efforts to improve community capacity.

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Non-invasive Markers of Portal Hypertension: Appraisal of Adult Experience and Potential Utilisation in Children

Portal Hypertension (PHT) is a significant cause of morbidity and mortality in children with chronic liver disease (CLD) and portal vein obstruction. Increased portal pressure results in variceal formation along the gastrointestinal (GI) tract resulting in major bleeding. Identifying children with significant PHT who are more likely to suffer GI bleeding has been challenging and the role of surveillance upper GI endoscopy has been debated. This review analyses research done on serum biomarkers and imaging techniques as possible predictors of significant PHT. We evaluated the research performed on adult population, as well as the limited work done on children, to identify promising areas for future research. A literature search was conducted on 'PubMed'. Several search terms were used including "portal hypertension", "paediatric portal hypertension", "non-invasive markers of portal hypertension", "spleen stiffness", "liver stiffness", "elastography" and "endothelial damage". The articles included were selected based on their relevance to the purpose of our review. The research suggests a combination of several biomarkers, in addition to an imaging technique such as transient elastography (TE) or magnetic resonance elastography (MRE), would allow for the best prediction of significant varices. The most promising indicators would be those that are applicable in both intra- and extra-hepatic causes of PHT. Further research on these predictors in children with PHT is required to determine their potential role as selection criteria for PHT and stratification of surveillance GI endoscopies. Address correspondence and reprint requests to Dr Tassos Grammatikopoulos, Paediatric Liver, Gastroenterology & Nutrition Centre, King's College Hospital, Denmark Hill, London, SE5 9RS, UK (e-mail: t.grammatikopoulos@nhs.net). Received 24 September, 2017 Accepted 16 December, 2017 Disclosures: none. Conflicts of interest: none. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. © 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Polycystic Pancreas Disease

No abstract available

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Hyperadiponectinemia During Infliximab Induction Therapy in Pediatric Crohn's Disease

ABSTRACTObjectives:The inflammatory process in Crohn's disease (CD) involves the visceral fat, characterized by adipocyte hyperplasia and altered adipose tissue and serum concentrations of TNF, leptin, adiponectin and resistin. We investigated the effect of anti-TNF therapy with infliximab (IFX) on serum adipokine levels in pediatric CD.Methods:Serum concentrations of resistin (ng/ml), leptin (ng/ml), and total adiponectin (μg/ml) were assessed by ELISA in 18 pediatric CD patients (mean age 15.0 ± 1.5 years) before 1st, 2nd and 4th IFX infusion (week 0, 2 and 14) and compared with baseline values from sex- and BMI-matched healthy controls (HC, mean age 13.4 ± 1.6 years).Results:At baseline CD patients (mean age 15.0 ± 1.5 years, 10/18 males) compared to HC (13.4 ± 1.6 years, 7/15 males) had higher resistin levels (median 14.7 ng/ml, range 5.1–50.5 vs. 7.3 ng/ml, 0.5–14.5) (p = 0.0002). At week 2 and 14 resistin decreased to 6.9 ng/ml (2.9–16.8) (p 

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Bone Mineral Density of Very Long-term Survivors After Childhood Liver Transplantation

ABSTRACTObjectives:Liver transplant patients are at risk of osteopenia and fractures but limited information is available in long-term survivors after childhood transplantation. This study aimed to assess bone mineral density (BMD) of very long-term, >5 years, survivors after liver transplantation in childhood.Methods:Patients aged 5 years after transplant were potentially eligible but only those with ongoing review in our state were included. Dual-energy absorptiometry (DXA) was used to measure BMD. Patients aged 5 years, survivors after liver transplantation in childhood. Methods: Patients aged 5 years after transplant were potentially eligible but only those with ongoing review in our state were included. Dual-energy absorptiometry (DXA) was used to measure BMD. Patients aged

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Prevalence of Anti-tissue Transglutaminase (tTG) Antibodies and Celiac Disease in Children with IBD

ABSTRACTIntroduction:Celiac disease can occur in children with Inflammatory bowel disease (IBD) and poses a diagnostic challenge. We evaluated the presence of anti-tissue transglutaminase (tTG) antibodies and celiac disease among children with IBD.Methods:In a retrospective chart review, we assessed the prevalence of tTG antibodies and celiac disease and compared with a control group of children with gastrointestinal symptoms without IBD.Results:Study population included 130 children with IBD and 257 in the control group. Abnormal tTG levels were found in 6 and 20 patients, respectively (4.6% vs. 7.8%, p = 0.24). One patient with IBD and 12 in the control group had celiac disease (0.8% vs. 4.7%, p = 0.07).Conclusion:False positive tTG can occur in children with IBD. The prevalence of celiac disease is not increased in children with IBD compared with non-IBD children with gastrointestinal symptoms and is similar to that in the general population. Introduction: Celiac disease can occur in children with Inflammatory bowel disease (IBD) and poses a diagnostic challenge. We evaluated the presence of anti-tissue transglutaminase (tTG) antibodies and celiac disease among children with IBD. Methods: In a retrospective chart review, we assessed the prevalence of tTG antibodies and celiac disease and compared with a control group of children with gastrointestinal symptoms without IBD. Results: Study population included 130 children with IBD and 257 in the control group. Abnormal tTG levels were found in 6 and 20 patients, respectively (4.6% vs. 7.8%, p = 0.24). One patient with IBD and 12 in the control group had celiac disease (0.8% vs. 4.7%, p = 0.07). Conclusion: False positive tTG can occur in children with IBD. The prevalence of celiac disease is not increased in children with IBD compared with non-IBD children with gastrointestinal symptoms and is similar to that in the general population. Address correspondence and reprint requests to Dinesh S. Pashankar, MD, MRCP (UK), Associate Professor of Pediatrics, Division of Gastroenterology. Yale University, School of medicine, 333 Cedar street, PO box 208064, LMP 4109, New Haven, CT 06520 (e-mail: Dinesh.pashankar@yale.edu). Received 7 June, 2017 Accepted 1 December, 2017 We report no conflict of interest. The other authors report no conflicts of interest. © 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Adherence to the gluten free diet and health related quality of life in an ethnically diverse pediatric population with Celiac Disease

ABSTRACTObjectives:Celiac disease (CD) is an autoimmune disease that requires life-long adherence to a gluten-free diet (GFD). Adherence to the GFD in childhood may be poor and adversely influence health related quality of life (HRQOL). The study purpose was to determine socio-demographic and socio-economic factors influencing adherence to the GFD and HRQOL in a multi-ethnic cohort of youth with CD.Methods:A multi-site (Edmonton, Hamilton, Toronto) study examining child-parent HRQOL in youth with CD (n=243) and /or mild gastrointestinal complaints (GI-CON; n = 148) was conducted. Socio-demographic (age, child-parental age/education/ethnicity/place of birth), anthropometric (weight, height, BMI), disease (diagnosis, age at diagnosis, duration, Marsh score, serology), household characteristics (income, family size, region, number of children/total household size), HRQOL (Peds TM4.0/Kindl and CDDUX), GI Complaints (PedsQLTM:Gastrointestinal Symptom Scale [GSS]) and gluten intake were measured.Results:Younger age (

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Electrogastrography, Near-infrared Spectroscopy and Acoustics to Measure Gastrointestinal Development in Preterm Babies

ABSTRACTObjectives:To obtain objective measures indicative of gastrointestinal maturity using three non-invasive technologies.Methods:Electrogastrography (EGG), abdominal near-infrared spectroscopy (NIRS), and bowel sound/acoustics (AC) monitoring were used simultaneously to obtain physiologic measures of the gastrointestinal system of 18 preterm and 5 term neonates who were tolerating enteral feedings.Measures of EGG slow wave voltage (EGG dominant power) and AC signal amplitude (AC dominant power) were obtained after spectral density analysis. Mean abdominal regional saturations (A-rSO2) were obtained directly from NIRS. The relationship of these three measures with postmenstrual age (PMA) was assessed.Results:The results of the three methods differed depending on whether the measurements were pre-prandial or post-prandial. Post-prandial EGG dominant power increases with PMA (r = 0.67, p = 0.003), both pre- and post-prandial abdominal NIRS mean regional saturation increase with PMA (r = 0.73, p 

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Endoscopic Trans-Esophageal Drainage of Mediastinal Pseudocyst in A Child

No abstract available

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Magnetic Resonance Enterography Cannot Replace Upper Endoscopy in Pediatric Crohn's Disease: An Imagekids Sub-study

ABSTRACTObjectives:While magnetic resonance enterography (MRE) can accurately reflect ileal inflammation in pediatric Crohn's disease (CD), there are no pediatric data on the accuracy of MRE to detect upper gastrointestinal tract (UGI) lesions. We aimed to compare MRE and esophagogastroduodenoscopy (EGD) in detecting the spectrum and severity of UGI disease in children.Methods:This is an ancillary study of the prospective multi-center ImageKids study focusing on pediatric MRE. EGD was performed within 2 weeks of MRE (at disease onset or thereafter) and explicitly scored by SES-CD modified for the UGI and physician global assessment. Local and central radiologists scored the UGI region of the MRE blinded to the EGD. Accuracy of MRE compared to EGD was examined using correlational coefficients (r) and area under receiver operating characteristic curves (AUC).Results:One-hundred-and-eighty-eight patients were reviewed (mean age 14 ± 1 years, 103 (55%) males); 66/188 (35%) children had macroscopic ulcerations on EGD (esophagus, 13 (7%); stomach, 34 (18%); duodenum, 45 (24%)). Most children had aphthous ulcers, but 10 (5%) had larger ulcers (stomach, 2 (1%); duodenum, 8 (4%)). There was no agreement between local and central radiologists on the presence or absence of UGI inflammation on MRE (Kappa=−0.02, p=0.71). EGD findings were not accurately detected by MRE, read locally or centrally (r=−0.03 to 0.11, p = 0.18 to 0.88; AUC=0.47 to 0.55, p = 0.53 to 1.00).No fistulae or narrowings were identified on either EGD or MRE.Conclusions:MRE cannot reliably assess the UGI in pediatric CD and cannot replace EGD for this purpose. Objectives: While magnetic resonance enterography (MRE) can accurately reflect ileal inflammation in pediatric Crohn's disease (CD), there are no pediatric data on the accuracy of MRE to detect upper gastrointestinal tract (UGI) lesions. We aimed to compare MRE and esophagogastroduodenoscopy (EGD) in detecting the spectrum and severity of UGI disease in children. Methods: This is an ancillary study of the prospective multi-center ImageKids study focusing on pediatric MRE. EGD was performed within 2 weeks of MRE (at disease onset or thereafter) and explicitly scored by SES-CD modified for the UGI and physician global assessment. Local and central radiologists scored the UGI region of the MRE blinded to the EGD. Accuracy of MRE compared to EGD was examined using correlational coefficients (r) and area under receiver operating characteristic curves (AUC). Results: One-hundred-and-eighty-eight patients were reviewed (mean age 14 ± 1 years, 103 (55%) males); 66/188 (35%) children had macroscopic ulcerations on EGD (esophagus, 13 (7%); stomach, 34 (18%); duodenum, 45 (24%)). Most children had aphthous ulcers, but 10 (5%) had larger ulcers (stomach, 2 (1%); duodenum, 8 (4%)). There was no agreement between local and central radiologists on the presence or absence of UGI inflammation on MRE (Kappa=−0.02, p=0.71). EGD findings were not accurately detected by MRE, read locally or centrally (r=−0.03 to 0.11, p = 0.18 to 0.88; AUC=0.47 to 0.55, p = 0.53 to 1.00).No fistulae or narrowings were identified on either EGD or MRE. Conclusions: MRE cannot reliably assess the UGI in pediatric CD and cannot replace EGD for this purpose. Address correspondence and reprint requests to Peter C. Church, MD, FRCPC, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8 (e-mail: peterchurch@gmail.com). Received 12 May, 2017 Accepted 4 December, 2017 Conflicts of Interest and source of funding: No author had any conflict of interest in relation to the content of this manuscript. The ImageKids study (clinicaltrials.gov NCT01881490) was supported by a grant from AbbVie. ImageKids Study collaborators: George Alex, Michal M. Amitai, Sudha Anupindi, Elhamy Bekhit, Eric Benchimol, Laureline Berteloo, Eva Coppenrath, Jorge Davila, Lissy de Ridder, Lee A. Denson, Larisa Duchano, Hankje Escher, David Grand, Izabela Herman-Sucharska, Holger Hetterich, Jessie Hulst, Anat Ilivitzki, Judith Kelsen, Sibylle Koletzko, Osnat Konen, Karen Lambot, Neal LeLeiko, Daniel A. Lemberg, Maarten Lequin, David Mack, Javier Martin de Carpi, Maria Martínez-León, M. Luisa Mearin, Doug Moote, Daniel Moses, Kathy O'Brien, Lucia Riaza, Firas Rinawi, Frank Ruemmele, Richard Russell, Raanan Shamir, Ron Shaoul, Jared Silverstein, Emily Stenhouse, Alexander Towbin, Thomas D. Walters, Martin Wasser Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.jpgn.org). © 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Non-Invasive Assessment of Significant Dehydration In Infants Using The Inferior Vena Cava to Aortic Diameter Ratio: Is it Useful?

ABSTRACTObjective:To assess the accuracy of the inferior vena cava to aorta (IVC/Ao) diameter ratio for predicting significant dehydration in infants relative to their percentage weight change and the clinical diagnosis by a physician.Methods:A prospective observational study was performed on 200 infants with acute diarrhea presenting with clinical evidence of significant dehydration whose treatment required intravenous (IV) fluids as determined by the attending physician at a pediatric emergency department. Weight was recorded at admission before IV fluid treatment and at hospital discharge. The percentage of dehydration was determined using the following formula: (discharge weight − admission weight)/ discharge weight × 100%. Patients with a percentage weight change of  5% were considered significantly dehydrated. The IVC/Ao diameter ratio was measured for all patients before IV fluid rehydration and again at discharge.Results:Only 134 out of 200 dehydrated infants were found to be significantly dehydrated using the gold standard, percentage weight change. Receiver operating characteristics (ROC) curve analysis of the pre-hydration IVC/Ao ratio showed a sensitivity of 82%, a specificity of 91%, and an accuracy of 87% for predicting significant dehydration in infants at a cut-off point of less than 0.75. In contrast, physician clinical diagnosis showed a sensitivity of 70%, a specificity of 63% and an accuracy of 73%.Conclusion:The IVC/Ao diameter ratio can be used as a reliable predictor for diagnosing significant dehydration in infants. Objective: To assess the accuracy of the inferior vena cava to aorta (IVC/Ao) diameter ratio for predicting significant dehydration in infants relative to their percentage weight change and the clinical diagnosis by a physician. Methods: A prospective observational study was performed on 200 infants with acute diarrhea presenting with clinical evidence of significant dehydration whose treatment required intravenous (IV) fluids as determined by the attending physician at a pediatric emergency department. Weight was recorded at admission before IV fluid treatment and at hospital discharge. The percentage of dehydration was determined using the following formula: (discharge weight − admission weight)/ discharge weight × 100%. Patients with a percentage weight change of  5% were considered significantly dehydrated. The IVC/Ao diameter ratio was measured for all patients before IV fluid rehydration and again at discharge. Results: Only 134 out of 200 dehydrated infants were found to be significantly dehydrated using the gold standard, percentage weight change. Receiver operating characteristics (ROC) curve analysis of the pre-hydration IVC/Ao ratio showed a sensitivity of 82%, a specificity of 91%, and an accuracy of 87% for predicting significant dehydration in infants at a cut-off point of less than 0.75. In contrast, physician clinical diagnosis showed a sensitivity of 70%, a specificity of 63% and an accuracy of 73%. Conclusion: The IVC/Ao diameter ratio can be used as a reliable predictor for diagnosing significant dehydration in infants. Address correspondence and reprint requests to Prof. Doaa El Amrousy, MD Pediatrics, assistant professor of Pediatrics, Tanta University Hospital, Tanta, Egypt. Egypt, Tanta, El Motasem street No 6, (e-mail: doaamoha@yahoo.com). Received 21 August, 2017 Accepted 12 December, 2017 Funding: none to declare. Conflict of interest: all authors declare no conflict of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.jpgn.org). © 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Treatment of Chronic Hepatitis C Virus Infection in Children. A Position Paper by the Hepatology Committee of European Society of Paediatric Gastroenterology, Hepatology and Nutrition

ABSTRACTObjectives:In 2017, the European Medicines Agency (EMA) and the Food and Drug Administration (FDA) approved the use of the fixed-dose combination of ledipasvir/sofosbuvir and of the combination of sofosbuvir and ribavirin for treatment of adolescents (12–17 years, weighing more than 35 kg) with chronic hepatitis C virus (HCV) genotype 1, 4, 5 and 6 and genotype 2 and 3 infections, respectively. Although trials with direct acting antivirals (DAAs) are ongoing for younger children, the only available treatment in US and Europe for those

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Diagnostic Tests in Pediatric Constipation

Constipation is one of the most common gastrointestinal symptoms in children. With a median reported prevalence of 12%, it accounts for about 25% of all pediatric gastroenterology consultations. The majority of children suffers functional constipation and do not usually require any diagnostic testing. For those children not responding to conventional medical treatment or in the presence of a more significant clinical picture, however, an accurate instrumental assessment is usually recommended to evaluate either the underlying pathophysiologic mechanisms or a possible organic etiology. The present review analyzes the possible diagnostic investigations for severely constipated children, focusing on their actual indications and their utility in clinical practice. Over the last decade, there has been a remarkable increase in our knowledge of normal and abnormal colonic and anorectal motility in children, and a number of different techniques to measure transit and motility have been developed and are discussed in this narrative review. Address correspondence and reprint requests to Renato Tambucci, MD, Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy (e-mails: renato.tambucci@gmail.com; renato.tambucci@opbg.net). Received 24 August, 2017 Accepted 13 December, 2017 Dr Tambucci and Dr Quitadamo equally contributed as First Authors. Supportive foundations: This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Conflict-of-interest statement: The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.jpgn.org). © 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Seasonal Association of Pediatric Functional Abdominal Pain Disorders and Anxiety

ABSTRACTObjectives:Abdominal pain related pediatric functional gastrointestinal disorders (AP-FGID) are defined by abdominal discomfort or pain that may provide obstacles to everyday activities, such as school attendance. It has been reported that AP-FGID symptoms may be reduced in summer, but it is unclear what drives this seasonal variation. This pilot study aimed to explore whether the seasonal variation in AP-FGID symptoms could be explained by various psychological and behavioral factors.Methods:Parents of children with AP-FGID symptoms completed online questionnaires on symptoms, anxiety, parental responses to pain, sleep, diet and physical activity once during spring months and again in the summer months.Results:In a sample of 34 participants who completed both questionnaires, 22 reported improvements during the summer months. These participants reported a significantly higher seasonal decrease in anxiety than participants whose children's symptoms did not improve from spring to summer (mean decrease 2.21 vs 0.08, P = 0.017). Both groups reported equal improvements in sleep and decreased stress from spring to summer. Neither group experienced statistically significant seasonal change in physical activity or fruit, vegetables, dairy, or caffeine consumption.Conclusions:This study suggests that amelioration of gastrointestinal symptoms in pediatric patients with AP-FGID during summer months is associated with amelioration of anxiety in the same time period. It is not yet clear whether decreased anxiety is the cause or effect of decreased AP-FGID symptoms. Objectives: Abdominal pain related pediatric functional gastrointestinal disorders (AP-FGID) are defined by abdominal discomfort or pain that may provide obstacles to everyday activities, such as school attendance. It has been reported that AP-FGID symptoms may be reduced in summer, but it is unclear what drives this seasonal variation. This pilot study aimed to explore whether the seasonal variation in AP-FGID symptoms could be explained by various psychological and behavioral factors. Methods: Parents of children with AP-FGID symptoms completed online questionnaires on symptoms, anxiety, parental responses to pain, sleep, diet and physical activity once during spring months and again in the summer months. Results: In a sample of 34 participants who completed both questionnaires, 22 reported improvements during the summer months. These participants reported a significantly higher seasonal decrease in anxiety than participants whose children's symptoms did not improve from spring to summer (mean decrease 2.21 vs 0.08, P = 0.017). Both groups reported equal improvements in sleep and decreased stress from spring to summer. Neither group experienced statistically significant seasonal change in physical activity or fruit, vegetables, dairy, or caffeine consumption. Conclusions: This study suggests that amelioration of gastrointestinal symptoms in pediatric patients with AP-FGID during summer months is associated with amelioration of anxiety in the same time period. It is not yet clear whether decreased anxiety is the cause or effect of decreased AP-FGID symptoms. Address correspondence and reprint requests to Miranda A.L. van Tilburg, Campbell University College of Pharmacy & Health Sciences, Buies Creek, NC 27506, PO Box 1090 (e-mail: vantilburg@campbell.edu). Received 11 August, 2017 Accepted 18 December, 2017 Supports: Partially funded by grant number T35-DK007386 from the National Institutes of Health. Website address and trial identification number: n/a. Funding for this work supported by: grant number T35-DK007386 from the National Institutes of Health. The authors report no conflicts of interest. Authors and Their Roles: Katharine L. Pollard- data collection, data analysis, and manuscript preparation. Christina Campbell- data collection and manuscript preparation. Megan Squires- data collection and manuscript preparation. Olafur Palsson- data collection and manuscript revision. Miranda van Tilburg- study creation, IRB approval, data analysis, and manuscript revision. © 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Seroimmunity to Hepatitis B Virus in Children With Inflammatory Bowel Disease: Effects of Booster Vaccination

No abstract available

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Hypercoagulation and Pediatric Inflammatory Bowel Disease- A Case Report

No abstract available

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Magnetic Resonance Imaging Findings in Neonatal Hemochromatosis

ABSTRACTBackground:There are limited data on utility of MRI in the assessment of suspected neonatal hemochromatosis (NH).Objectives:To present our experience with utilization of multi-echo sequences MRI technique in the evaluation of NH and to compare MRI findings in infants with and without NH.Methods:MRI performed for suspected NH were retrospectively reviewed to note the presence and severity of iron deposition (ID) in liver, spleen, pancreas and kidneys on multi-echo sequences. Findings were compared in infants with and without NH.Results:Of 20 infants (9 boys and 11 girls; median age of 12.5 days) included in the study, 7/20 had NH and 13/20 were assigned to the non-NH group. Higher degree of pancreatic ID was seen in the NH group (p = 0.001) with 4/7 evaluable pancreas showing moderate to severe degree and 1/7 showing mild degree of ID while none of the 13 infants in non-NH group showed moderate or severe degree of pancreatic ID. Even though the severity of hepatic ID was higher in NH group (p = 0.033) variable severity of hepatic ID was seen in both groups with most infants in both groups showing moderate to severe degree of ID. The severity of splenic ID was not particularly associated with any group (p = 0.774) but there was no moderate or severe degree of ID in NH. Renal ID was seen in two infants in non-NH group.Conclusions:A moderate to severe degree of pancreatic ID seen on MRI tends to be associated with NH and should be sought to establish a timely diagnosis of NH. Presence and severity of hepatic ID cannot be used for differentiation NH from other causes of neonatal liver failure. Background: There are limited data on utility of MRI in the assessment of suspected neonatal hemochromatosis (NH). Objectives: To present our experience with utilization of multi-echo sequences MRI technique in the evaluation of NH and to compare MRI findings in infants with and without NH. Methods: MRI performed for suspected NH were retrospectively reviewed to note the presence and severity of iron deposition (ID) in liver, spleen, pancreas and kidneys on multi-echo sequences. Findings were compared in infants with and without NH. Results: Of 20 infants (9 boys and 11 girls; median age of 12.5 days) included in the study, 7/20 had NH and 13/20 were assigned to the non-NH group. Higher degree of pancreatic ID was seen in the NH group (p = 0.001) with 4/7 evaluable pancreas showing moderate to severe degree and 1/7 showing mild degree of ID while none of the 13 infants in non-NH group showed moderate or severe degree of pancreatic ID. Even though the severity of hepatic ID was higher in NH group (p = 0.033) variable severity of hepatic ID was seen in both groups with most infants in both groups showing moderate to severe degree of ID. The severity of splenic ID was not particularly associated with any group (p = 0.774) but there was no moderate or severe degree of ID in NH. Renal ID was seen in two infants in non-NH group. Conclusions: A moderate to severe degree of pancreatic ID seen on MRI tends to be associated with NH and should be sought to establish a timely diagnosis of NH. Presence and severity of hepatic ID cannot be used for differentiation NH from other causes of neonatal liver failure. Address correspondence and reprint requests to Govind B. Chavhan, MD, DABR, The Hospital for Sick Children and University of Toronto Toronto, ON CANADA (e-mail: govind.chavhan@sickkids.ca). Received 11 October, 2017 Accepted 14 December, 2017 All authors have no funding to disclose. © 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Raw and Count Data Comparability of Hip-Worn ActiGraph GT3X+ and Link Accelerometers

ABSTRACTPURPOSETo enable inter- and intra-study comparisons it is important to ascertain comparability among accelerometer models. This study compared raw and count data between hip-worn ActiGraph GT3X+ and GT9X Link accelerometers.METHODSAdults (n=26 [n=15 women]; aged 49.1±20.0 years) wore GT3X+ and Link accelerometers over the right hip for an 80-min protocol involving 12-21 sedentary, household, and ambulatory/exercise activities lasting 2-15 min each. For each accelerometer, mean and variance of the raw (60 Hz) data for each axis and vector magnitude (VM) were extracted in 30-s epochs. A machine learning model (Montoye 2015) was used to predict energy expenditure in METs from the raw data. Raw data were also processed into activity counts in 30-s epochs for each axis and VM, with Freedson 1998 and 2011 count-based regression models used to predict METs. Time spent in sedentary, light, moderate, and vigorous intensities were derived from predicted METs from each model. Correlations were calculated to compare raw and count data between accelerometers, and percent (%) agreement was used to compare epoch-by-epoch activity intensity.RESULTSFor raw data, correlations for mean acceleration were 0.96±0.05, 0.89±0.16, 0.71±0.33, and 0.80±0.28 and for variance 0.98±0.02, 0.98±0.03, 0.91±0.06, and 1.00±0.00 in the X, Y, and Z axes and VM, respectively. For count data, corresponding correlations were 1.00±0.01, 0.98±0.02, 0.96±0.04, and 1.00±0.00, respectively. Freedson 1998 and 2011 count-based models had significantly higher %agreement for activity intensity (95.1±5.6% and 95.5±4.0%) than the Montoye 2015 raw data model (61.5±27.6%; p

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The Effects of Sex and Motoneuron Pool on Central Fatigue

AbstractPurposeIt is uncertain if sex influences central fatigue as the reduction in voluntary activation (VA) was not different between the sexes for elbow flexors (EFs) but greater in males compared to females for knee extensors. This disparity could result from the facilitatory and inhibitory effects of group III/IV muscle afferent effects on flexor vs. extensor motoneurons, respectively. The purpose of this study was to examine central fatigue and motoneuron responsiveness of EFs and elbow extensors (EEs) in males and females.MethodsTwenty-two participants (11 females) performed a 2-min isometric maximal voluntary contraction (MVC) of EFs and EEs (on separate days) followed by 2-min of recovery. Electromyographic potentials were recorded from biceps or triceps brachii in response to stimulation of the brachial plexus (Mmax), corticospinal tract (cervicomedullary motor evoked potential; CMEP), and motor cortex (motor evoked potential; MEP). Superimposed and resting doublets (for determining VA) were evoked via muscle belly stimulation of biceps or triceps brachii. Only CMEPs and superimposed doublets were recorded during fatigue.ResultsThere was no effect of sex on CMEP area for either muscle group during fatigue or recovery. During the 2-min after EE fatigue, mean normalized CMEP and MEP area were ~85% and ~141% of control, indicating inhibition and facilitation of the motoneurons and motor cortex, respectively. VA during recovery was significantly reduced in males but not females for the EFs, and unchanged in either sex for the EEs.ConclusionThe findings do not support the concept that equivocal findings regarding sex differences in central fatigue are related to augmented effects of group III/IV afferent feedback in males compared to females. Purpose It is uncertain if sex influences central fatigue as the reduction in voluntary activation (VA) was not different between the sexes for elbow flexors (EFs) but greater in males compared to females for knee extensors. This disparity could result from the facilitatory and inhibitory effects of group III/IV muscle afferent effects on flexor vs. extensor motoneurons, respectively. The purpose of this study was to examine central fatigue and motoneuron responsiveness of EFs and elbow extensors (EEs) in males and females. Methods Twenty-two participants (11 females) performed a 2-min isometric maximal voluntary contraction (MVC) of EFs and EEs (on separate days) followed by 2-min of recovery. Electromyographic potentials were recorded from biceps or triceps brachii in response to stimulation of the brachial plexus (Mmax), corticospinal tract (cervicomedullary motor evoked potential; CMEP), and motor cortex (motor evoked potential; MEP). Superimposed and resting doublets (for determining VA) were evoked via muscle belly stimulation of biceps or triceps brachii. Only CMEPs and superimposed doublets were recorded during fatigue. Results There was no effect of sex on CMEP area for either muscle group during fatigue or recovery. During the 2-min after EE fatigue, mean normalized CMEP and MEP area were ~85% and ~141% of control, indicating inhibition and facilitation of the motoneurons and motor cortex, respectively. VA during recovery was significantly reduced in males but not females for the EFs, and unchanged in either sex for the EEs. Conclusion The findings do not support the concept that equivocal findings regarding sex differences in central fatigue are related to augmented effects of group III/IV afferent feedback in males compared to females. Correspondence: Dr. Chris J. McNeil, School of Health and Exercise Sciences, Faculty of Health and Social Development, The University of British Columbia – Okanagan Campus, 1147 Research Road, Kelowna, British Columbia, Canada, V1V 1V7, E-mail: chris.mcneil@ubc.ca This study was supported by the Natural Sciences and Engineering Research Council of Canada and the Canadian Foundation for Innovation/British Columbia Knowledge Development Fund. The authors declare they have no conflict of interest. The results of this study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation and do not constitute endorsement by the American College of Sports Medicine. Accepted for Publication: 19 December 2017 © 2017 American College of Sports Medicine

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A Preventive Model for Muscle Injuries: A Novel Approach based on Learning Algorithms

ABSTRACTIntroductionThe application of contemporary statistical approaches coming from Machine Learning and Data Mining environments to build more robust predictive models to identify athletes at high risk of injury might support injury prevention strategies of the future.PurposeThe purpose was to analyse and compare the behaviour of numerous machine learning methods in order to select the best performing injury risk factor model to identify athlete at risk of lower extremity muscle injuries (MUSINJ).MethodsA total of 132 male professional soccer and handball players underwent a pre-season screening evaluation which included personal, psychological and neuromuscular measures. Furthermore, injury surveillance was employed to capture all the MUSINJ occurring in the 2013/2014 seasons. The predictive ability of several models built by applying a range of learning techniques were analysed and compared.ResultsThere were 32 MUSINJ over the follow up period, 21 (65.6%) of which corresponded to the hamstrings, three to the quadriceps (9.3%), four to the adductors (12.5%) and four to the triceps surae (12.5%). A total of 13 injures occurred during training and 19 during competition. Three players were injured twice during the observation period so the first injury was used leaving 29 MUSINJ that were used to develop the predictive models. The model generated by the SmooteBoost technique with a cost-sensitive ADTree as the base classifier reported the best evaluation criteria (area under the receiver operating characteristic curve score = 0.747, true positive rate = 65.9%, true negative rate = 79.1) and hence was considered the best for predicting MUSINJ.ConclusionsThe prediction model showed moderate accuracy for identifying professional soccer and handball players at risk of MUSINJ. Therefore, the model developed might help in the decision-making process for injury prevention. Introduction The application of contemporary statistical approaches coming from Machine Learning and Data Mining environments to build more robust predictive models to identify athletes at high risk of injury might support injury prevention strategies of the future. Purpose The purpose was to analyse and compare the behaviour of numerous machine learning methods in order to select the best performing injury risk factor model to identify athlete at risk of lower extremity muscle injuries (MUSINJ). Methods A total of 132 male professional soccer and handball players underwent a pre-season screening evaluation which included personal, psychological and neuromuscular measures. Furthermore, injury surveillance was employed to capture all the MUSINJ occurring in the 2013/2014 seasons. The predictive ability of several models built by applying a range of learning techniques were analysed and compared. Results There were 32 MUSINJ over the follow up period, 21 (65.6%) of which corresponded to the hamstrings, three to the quadriceps (9.3%), four to the adductors (12.5%) and four to the triceps surae (12.5%). A total of 13 injures occurred during training and 19 during competition. Three players were injured twice during the observation period so the first injury was used leaving 29 MUSINJ that were used to develop the predictive models. The model generated by the SmooteBoost technique with a cost-sensitive ADTree as the base classifier reported the best evaluation criteria (area under the receiver operating characteristic curve score = 0.747, true positive rate = 65.9%, true negative rate = 79.1) and hence was considered the best for predicting MUSINJ. Conclusions The prediction model showed moderate accuracy for identifying professional soccer and handball players at risk of MUSINJ. Therefore, the model developed might help in the decision-making process for injury prevention. Corresponding Author. Francisco Ayala. Sports Research Centre, Miguel Hernandez University of Elche. Avda. de la Universidad s/n. 03202 Elche, Alicante, Spain. Email address: fayala@umh.es, Fax: +0034965222409. Alejandro López-Valenciano were supported by predoctoral grant given by Ministerio de Educación, Cultura y Deporte (FPU) from Spain. We certify that no party having a direct interest in the results of the research supporting this article has or will confer a benefit on us or on any organization which we are associated, do not constitute endorsement by ACSM and they are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 14 December 2017 © 2017 American College of Sports Medicine

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Infant Health and Future Childhood Adversity

Abstract

Objective To investigate the extent to which disabling infant health conditions are associated with adverse childhood experiences at age 5. Methods We conducted a secondary analysis of data from the Fragile Families and Child Wellbeing Study, a national urban birth cohort. We estimated logistic regression models of associations between the presence of a disabling infant health condition and the child's ACE exposures at age 5, controlling for factors that preceded the child's birth, including the mother's sociodemographic characteristics, physical health, mental illness, and substance abuse and the parents' criminal justice system involvement and domestic violence or sexual abuse. ACEs included 4 categories of child maltreatment (physical, sexual, psychological abuse, neglect) and 5 categories of household dysfunction (father absence, substance use, mental illness, caregiver treated violently, incarceration). Results 3.3% of the children were characterized as having a disabling health condition that was likely present at birth. Logistic regression estimates indicate that having a disabling infant health condition was associated with 83% higher odds of the child experiencing 2 or more ACEs (AOR 1.83, CI 1.14–2.94) and 73% higher odds of the child experiencing 3 or more ACEs (AOR 1.73, CI 1.07–2.77) at age 5. Conclusions for Practice The finding of strong links between disabling infant health conditions and ACEs at age 5 suggests that child health and ACEs play intertwining and mutually reinforcing roles during the early lifecourse and highlights the critical importance of investing in systems that simultaneously promote optimal child development and address childhood adversity.



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Anesthetic Management and Procedural Outcomes of Patients Undergoing Off-Pump Transapical Implantation of Artificial Chordae to Correct Mitral Regurgitation: Case Series of 76 Patients

BACKGROUND: Transapical implantation of artificial chordae using the NeoChord system (NeoChord Inc, Minneapolis, MN) is an emerging beating-heart technique for correction of mitral regurgitation (MR) through a minimally invasive left minithoracotomy. The purpose of the study was to describe the anesthetic management and procedural success of patients undergoing this procedure. METHODS: All patients (n = 76) who underwent mitral valve repair with the NeoChord system in our institution from December 2011 to December 2016 were included in this observational prospective study. Balanced anesthesia with a combination of fentanyl, propofol, and sevoflurane was used in all patients. Each patient's core temperature was maintained at >36°C whenever possible. Two- and 3-dimensional transesophageal echocardiography was used in all patients to navigate the device to the posterior mitral valve leaflet (68 of 76 patients), anterior mitral valve leaflet (3 of 76 patients), or both leaflets (5 of 76 patients). After effective leaflet capture, the artificial chordae were deployed. Position and function of the artificial chordae were assessed by evaluating the degree of MR when the neochordae were tensed. After surgery, all patients were transferred to the intensive care unit. RESULTS: The mean age of the patients was 60 ± 13 years (range, 33–87 years), and the male/female ratio was 52/24. Most patients had severe MR (grade 4+ in 25 [33%] patients, grade 3+ in 51 [67%] patients). The average preoperative EuroSCORE II was 1.23% ± 1.16% (range, 0.46%–4.23%). The median duration of the procedure was 120 minutes (interquartile range [IQR] 115–145 minutes). After the procedure, 42 (56%) patients had trivial MR, 27 (36%) had grade 1+ MR, 4 (5%) had grade 2+ MR, and 2 (3%) had >2+ MR. One patient underwent conversion to conventional mitral valve repair due to perforation of the posterior mitral valve leaflet. The whole procedure was well tolerated by the patients, with hemodynamics remaining stable in the majority of the cases. Only 20 (26%) patients needed low-dose inotropic support perioperatively. All patients had an uneventful postoperative course. The median time to extubation was 4 hours (IQR, 2.6–6), and the length of intensive care unit stay was 22 hours (IQR, 21–24). Five (6.6%) patients required allogeneic blood products. CONCLUSIONS: Anesthesia for transapical NeoChord implantation can be safely performed under beating-heart conditions, with low perioperative morbidity and rare blood transfusions. Transesophageal echocardiography is crucial for the guidance, safety, and effectiveness of the procedure. Accepted for publication November 13, 2017. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). Institutional review board: Vilnius Regional Bioethics Committee, M. K. Ciurlionio St 21/27, LT 03101, Vilnius, Lithuania. E-mail: rbtek@mf.vu.lt. Reprints will not be available from the authors. Address correspondence to Arturas Lipnevicius, MD, Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, Santariskiu 2, Vilnius, LT 08661 Lithuania. Address e-mail to artaslip@yahoo.com. © 2017 International Anesthesia Research Society

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Clinical Utility of Intraoperative Motor-Evoked Potential Monitoring to Prevent Postoperative Spinal Cord Injury in Thoracic and Thoracoabdominal Aneurysm Repair: An Audit of the Japanese Association of Spinal Cord Protection in Aortic Surgery Database

BACKGROUND: Spinal cord ischemic injury is the most devastating sequela of descending and thoracoabdominal aortic surgery. Motor-evoked potentials (MEPs) have been used to intraoperatively assess motor tract function, but it remains unclear whether MEP monitoring can decrease the incidence of postoperative motor deficits. Therefore, we reviewed multicenter medical records of patients who had undergone descending and thoracoabdominal aortic repair (both open surgery and endovascular repair) to assess the association of MEP monitoring with postoperative motor deficits. METHODS: Patients included in the study underwent descending or thoracoabdominal aortic repair at 12 hospitals belonging to the Japanese Association of Spinal Cord Protection in Aortic Surgery between 2000 and 2013. Using multivariable mixed-effects logistic regression analysis, we investigated whether intraoperative MEP monitoring was associated with postoperative motor deficits at discharge after open and endovascular aortic repair. RESULTS: We reviewed data from 1214 patients (open surgery, 601 [49.5%]; endovascular repair, 613 [50.5%]). MEP monitoring was performed in 631 patients and not performed in the remaining 583 patients. Postoperative motor deficits were observed in 75 (6.2%) patients at discharge. Multivariable logistic regression analysis revealed that postoperative motor deficits at discharge did not have a significant association with MEP monitoring (adjusted odds ratio [OR], 1.13; 95% confidence interval [CI], 0.69–1.88; P = .624), but with other factors: history of neural deficits (adjusted OR, 6.08; 95% CI, 3.10–11.91; P

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Exploring Beyond the Duration of Analgesia: Can Adjuncts Improve More Meaningful Outcomes in Obstetric Patients?

No abstract available

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Does Lactate Affect the Association of Early Hyperglycemia and Multiple Organ Failure in Severely Injured Blunt Trauma Patients?

BACKGROUND: Early hyperglycemia is associated with multiple organ failure (MOF) after traumatic injury; however, few studies have considered the contribution of depth of clinical shock. We hypothesize that when considered simultaneously, glucose and lactate are associated with MOF in severely injured blunt trauma patients. METHODS: We performed a retrospective investigation at a single tertiary care trauma center. Inclusion criteria were patient age ≥18 years, injury severity score (ISS) >15, blunt mechanism of injury, and an intensive care unit length of stay >48 hours. Patients with a history of diabetes or who did not survive the initial 48 hours were excluded. Demographics, injury severity, and physiologic data were recorded. Blood glucose and lactate values were collected from admission through the initial 24 hours of hospitalization. Multiple metrics of glucose and lactate were calculated: the first glucose (Glucadm, mg/dL) and lactate (Lacadm, mmol/L) at hospital admission, the mean initial 24-hour glucose (Gluc24hMean, mg/dL) and lactate (Lac24hMean, mmol/L), and the time-weighted initial 24-hour glucose (Gluc24hTW) and lactate (Lac24hTW). These metrics were divided into quartiles. The primary outcome was MOF. Separate Cox proportional hazard models were generated to assess the association of each individual glucose and lactate metric on MOF, after controlling for ISS, admission shock index, and disposition to the operating room after hospital admission. We assessed the interaction between glucose and lactate metrics in the multivariable models. Results are reported as hazard ratios (HRs) for an increase in the quartile level of glucose and lactate measurements, with 95% confidence intervals (CIs). RESULTS: A total of 507 severely injured blunt trauma patients were evaluated. MOF occurred in 46 of 507 (9.1%) patients and was associated with a greater median ISS (33.5, interquartile range [IQR]: 22–41 vs 27, IQR: 21–34; P

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A Simulation Study to Evaluate Improvements in Anesthesia Work Environment Contamination After Implementation of an Infection Prevention Bundle

BACKGROUND: Microbiological contamination of the anesthesia work environment (AWE) is a potential source of health care–associated infections. Medication syringes, stopcocks, and many other areas are routinely contaminated during anesthetic care, and adherence to hand hygiene recommendations is poor. Using a simulation model, we investigated whether AWE contamination could be reduced by implementing an intervention bundle focused on infection prevention. METHODS: Twenty-five anesthesia providers were enrolled in this nonrandomized simulation scenario crossover design study. Subjects were asked to complete 2 general anesthesia scenarios in a mock operating room: a baseline scenario and an intervention scenario in which the bundle was implemented. The bundle included: double gloving before intubation, confining all airway equipment to 1 area, and performing hand hygiene before touching the anesthesia cart. Before each scenario, a manikin's oropharynx and face were marked with ultraviolet fluorescent tracers. After each scenario, the AWE was inspected with a ultraviolet light source to detect contaminant, and all sites were photographed. A blinded observer scored the images for the presence or absence of tracer at 20 sites. Videos of the scenarios were analyzed for duration and number of hand hygiene and glove removal events. Data were analyzed using a mixed effects model. Subjects completed a survey about their experience and the value of the scenarios. RESULTS: The intervention was associated with a decreased subject contamination score of 4.0 (95% confidence interval, 2.2–5.6; P

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In Response

No abstract available

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The Syringe Driver: Continuous Subcutaneous Infusions in Palliative Care, 4th ed.

No abstract available

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“Effects of Mat Pilates on Physical Functional Performance of Older Adults: a Meta-analysis of Randomized Controlled Trials.”

ABSTRACTObjectiveThe present meta-analysis aimed to examine evidence from randomized controlled trials in order to determine the effects of mat Pilates on measures of physical functional performance in the elderly.DesignA search was conducted in the MEDLINE/PubMed, Scopus, Scielo and PEDro databases between February and March 2017. Only RCTs that were written in English; included subjects 60 years-old; utilized mat Pilates exercises; included a comparison (control) group; and reported performance-based measures of physical function (balance, flexibility, muscle strength and cardiorespiratory fitness) were included. The methodological quality of the studies was analyzed according to the PEDro scale and the best-evidence synthesis. The meta-analysis was conducted with the Review Manager 5.3 software.ResultsThe search retrieved 518 articles, nine of which fulfilled the inclusion criteria. High methodological quality was found in five of these studies. Meta-analysis indicated a large effect of mat Pilates on dynamic balance (SMD=1.10, 95%CI=0.29-1.90), muscle strength (SMD=1.13, 95%CI=0.30-1.96), flexibility (SMD=1.22, 95%CI=0.39-2.04) and cardiorespiratory fitness (SMD=1.48, 95%CI=0.42-2.54) of elderly subjects.ConclusionThere is evidence that mat Pilates improves dynamic balance, lower limb strength, hip and lower back flexibility and cardiovascular endurance in elderly individuals. Further high-quality studies are necessary to clarify the effects of mat Pilates on other physical functional measurements among older adults. Objective The present meta-analysis aimed to examine evidence from randomized controlled trials in order to determine the effects of mat Pilates on measures of physical functional performance in the elderly. Design A search was conducted in the MEDLINE/PubMed, Scopus, Scielo and PEDro databases between February and March 2017. Only RCTs that were written in English; included subjects 60 years-old; utilized mat Pilates exercises; included a comparison (control) group; and reported performance-based measures of physical function (balance, flexibility, muscle strength and cardiorespiratory fitness) were included. The methodological quality of the studies was analyzed according to the PEDro scale and the best-evidence synthesis. The meta-analysis was conducted with the Review Manager 5.3 software. Results The search retrieved 518 articles, nine of which fulfilled the inclusion criteria. High methodological quality was found in five of these studies. Meta-analysis indicated a large effect of mat Pilates on dynamic balance (SMD=1.10, 95%CI=0.29-1.90), muscle strength (SMD=1.13, 95%CI=0.30-1.96), flexibility (SMD=1.22, 95%CI=0.39-2.04) and cardiorespiratory fitness (SMD=1.48, 95%CI=0.42-2.54) of elderly subjects. Conclusion There is evidence that mat Pilates improves dynamic balance, lower limb strength, hip and lower back flexibility and cardiovascular endurance in elderly individuals. Further high-quality studies are necessary to clarify the effects of mat Pilates on other physical functional measurements among older adults. Correspondence: Ruth Caldeira de Melo. School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, SP, Brazil. Av. Arlindo Béttio, 1000 - Ermelino Matarazzo - São Paulo - SP - Brazil. ZIP Code: 03828-000. e-mail: ruth.melo@usp.br Author Disclosures: The authors declare no conflict of interest. Neither the study nor the authors received financial support from any source. The study was not presented at a scientific meeting or was considered for publication in proceedings or similar format. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Inner tooth morphology of Homo erectus from Zhoukoudian. New evidence from an old collection housed at Uppsala University, Sweden

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Publication date: March 2018
Source:Journal of Human Evolution, Volume 116
Author(s): Clément Zanolli, Lei Pan, Jean Dumoncel, Ottmar Kullmer, Martin Kundrát, Wu Liu, Roberto Macchiarelli, Lucia Mancini, Friedemann Schrenk, Claudio Tuniz
Locality 1, in the Lower Cave of the Zhoukoudian cave complex, China, is one of the most important Middle Pleistocene paleoanthropological and archaeological sites worldwide, with the remains of c. 45 Homo erectus individuals, 98 mammalian taxa, and thousands of lithic tools recovered. Most of the material collected before World War II was lost. However, besides two postcranial elements rediscovered in China in 1951, four human permanent teeth from the 'Dragon Bone Hill,' collected by O. Zdansky between 1921 and 1923, were at the time brought to the Paleontological Institute of Uppsala University, Sweden, where they are still stored. This small sample consists of an upper canine (PMU 25719), an upper third molar (PMU M3550), a lower third premolar crown (PMU M3549), and a lower fourth premolar (PMU M3887). Some researchers have noted the existence of morpho-dimensional differences between the Zhoukoudian and the H. erectus dental assemblage from Sangiran, Java. However, compared to its chrono-geographical distribution, the Early to Middle Pleistocene dental material currently forming the Chinese-Indonesian H. erectus hypodigm is quantitatively meager and still poorly characterized for the extent of its endostructural variation. We used micro-focus X-ray tomography techniques of virtual imaging coupled with geometric morphometrics for comparatively investigating the endostructural conformation (tissue proportions, enamel thickness distribution, enamel-dentine junction morphology, pulp cavity shape) of the four specimens stored in Uppsala, all previously reported for their outer features. The results suggest the existence of time-related differences between continental and insular Southeast Asian dental assemblages, the Middle Pleistocene Chinese teeth apparently retaining an inner signature closer to the likely primitive condition represented by the Early Pleistocene remains from Java, while the Indonesian stock evolved toward tooth structural simplification.



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Pancreatoblastoma: an unusual diagnosis in an adult patient

Abstract

The authors describe a 31-year-old man admitted due to progressive weight loss, diarrhea and massive hepatomegaly. Laboratory data showed anemia (haemoglobin 11.7 g/dl), abnormal liver tests (total bilirubin 1.4 g/dl, aspartate aminotransferase 70 U/l, alanine aminotransferase 37 U/l and alkaline phosphatase 520 U/l). Abdominal ultrasound (US) displayed a large heterogeneous liver with a segment IV 25 mm nodule. Magnetic resonance revealed a 4 cm pancreatic tail mass and several liver nodules consistent with metastasis. The patient underwent an endoscopic ultrasound (EUS) with fine needle aspiration (FNA) from the pancreatic mass and liver metastasis with cytological evaluation consistent with a pancreatoblastoma, later confirmed through a percutaneous US-guided liver biopsy. During the inpatient period, liver function deteriorated and acute kidney injury developed. Severe progressive cachexia was observed. The patient was discharged on renal replacement therapy and palliative care. Death occurred 3 months after diagnosis. Pancreatoblastoma is an uncommon pancreatic malignant epithelial cancer of the pancreas, typically occurring in the paediatric population. Adult pancreatoblastoma is extremely rare, with about 40 cases reported in the literature and generally presenting a more aggressive biologic and clinical behaviour. Surgical resection is the treatment of choice, but most cases are detected in advanced stages. This case underlines the ability to establish a pancreatoblastoma cytology-based diagnosis with EUS-FNA, and confirms the associated poor outcome.



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President Trump visits Fla. fire department after golf trip

By Wayne Washington The Palm Beach Post WEST PALM BEACH, Fla. — President Donald Trump capped a day spent largely at one of his golf clubs Wednesday with a brief visit to a West Palm Beach Fire Rescue station. Firefighters and paramedics at Fire Station 2 on Dixie Highway south of Southern Boulevard formed a semi-circle around the president as he took pictures with them, shook hands with them ...

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eCore with ePro Scheduling

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Do you have continuous challenges with balancing work hours, minimize overtime and keep everything updated? Are you looking for a way to take control of this process and improve workflows? eCore's ePro Scheduler is an automated scheduling process that is built for the EMS industry. http://ift.tt/2Dq3EeE

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eCore with ePro Scheduling

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Do you have continuous challenges with balancing work hours, minimize overtime and keep everything updated? Are you looking for a way to take control of this process and improve workflows? eCore's ePro Scheduler is an automated scheduling process that is built for the EMS industry. http://ift.tt/2Dq3EeE

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eCore with ePro Scheduling

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Do you have continuous challenges with balancing work hours, minimize overtime and keep everything updated? Are you looking for a way to take control of this process and improve workflows? eCore's ePro Scheduler is an automated scheduling process that is built for the EMS industry. http://ift.tt/2Dq3EeE

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Editorial Board

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Publication date: January 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 1





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Table of Contents

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Publication date: January 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 1





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Editors' Selections From This Issue: Volume 99 / Number 1 / January 2018

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Publication date: January 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 1





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Masthead

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Publication date: January 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 1





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Rasch Analyses of the Wheelchair Use Confidence Scale for Power Wheelchair Users

Publication date: January 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 1
Author(s): Brodie M. Sakakibara, William C. Miller, Paula W. Rushton, Jan Miller Polgar
ObjectivesTo examine the dimensionality of the Wheelchair Use Confidence Scale for power wheelchair users (WheelCon-P), to identify items that do not fit the Rasch rating scale model as well as redundant items for elimination, and to determine the SEMs and reliability estimates for the entire range of measurements.DesignSecondary analysis of cross-sectional data.SettingCommunity.ParticipantsVolunteer participants (N=189) using wheelchairs (mean age of the sample, 56.7±13.0y; mean years of wheelchair use experience, 20.4±16.4).InterventionsNot applicable.Main Outcome Measures59-Item WheelCon-P.ResultsPrincipal component analyses confirmed the presence of 2 self-efficacy dimensions: mobility and social situation. Eleven mobility items and 5 social situation items fit the Rasch rating scale model. Three items misfit the model using all 16 items (ie, WheelCon-P short form). In each of the mobility, social situation, and WheelCon-P short form range of measurements, the 2 lowest and 2 highest measures had internal consistency reliability estimates below .70; all other measures had reliability estimates above .70.ConclusionsThe WheelCon-P is composed of 2 self-efficacy dimensions related to mobility and social situations. The scores from the WheelCon-P short form and the 11-item mobility and 5-item social situation dimensions using a 0 to 10 response scale have good reliability.



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Correction

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Publication date: January 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 1





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Archives of Physical Medicine and Rehabilitation Supplements

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Publication date: January 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 1





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Comparison of Ultrasonography and Short-Segment Nerve Conduction Study in Ulnar Neuropathy at the Elbow

Publication date: January 2018
Source:Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 1
Author(s): Rana Terlemez, Figen Yilmaz, Beril Dogu, Banu Kuran
ObjectiveTo assess the correlation between ultrasonographic and electrodiagnostic findings to determine the localization of the ulnar trapping at the elbow.DesignCross-sectional and noninterventional trial.SettingPhysical medicine and rehabilitation department of a teaching hospital.ParticipantsPatients (N=14) diagnosed with ulnar nerve entrapment using short-segment nerve conduction study.InterventionsThe elbow area was divided into 4 segments with 2-cm intervals. All patients underwent ultrasonographic and electrodiagnostic examinations.Main Outcome MeasuresThe nerve conduction velocity (NCV) of each segment was measured. The cross-sectional area (CSA) of the ulnar nerve was measured at 5 levels. The proximal CSA/distal CSA ratio (PDR) was calculated by proportioning the CSA values for each segment. The highest PDR was accepted as a trapping segment, whereas the segment with the lowest NCV was accepted electrophysiologically (provided it was <50m/s).ResultsA total of 80 PDR and NCV measurements were taken from 20 elbows. A statistically significant negative correlation (r=−.554; P<.001) was found between general PDR and NCV values. When we assumed that the NCV value <50m/s as the criterion standard for diagnosis, the cutoff value for the PDR was found to be 1.08, with a sensitivity of 70% and a specificity of 92.5%. The minimum NCV value and the maximum PDR value were mostly seen in the third segment compatible with the cubital tunnel.ConclusionsUltrasonography seems to be advantageous because it is more comfortable for the patient and requires shorter time than does electroneuromyography. To our knowledge, this is the first study to detect ulnar nerve entrapment by using not only CSA but also PDR as a ratio method with ultrasound.



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