The Regulation of Cbf1 by PAS Kinase Is a Pivotal Control Point for Lipogenesis Versus Respiration in Saccharomyces cerevisiae

PAS kinase 1 (Psk1) is a key regulator of respiration in Saccharomyces cerevisiae. Herein the molecular mechanisms of this regulation are explored through the characterization of its substrate, Centromere binding factor 1 (Cbf1). CBF1-deficient yeast displayed a significant decrease in cellular respiration, while PAS kinase-deficient yeast, or yeast harboring a Cbf1 phosphosite mutant (T211A) displayed a significant increase. Transmission electron micrographs showed an increased number of mitochondria in PAS kinase-deficient yeast consistent with the increase in respiration. Although the CBF1-deficient yeast did not appear to have an altered number of mitochondria, a mitochondrial proteomics study revealed significant differences in the mitochondrial composition of CBF1-deficient yeast including altered Atp3 levels, a subunit of the mitochondrial F₁-ATP synthase complex. Both beta-galactosidase reporter assays and western blot analysis confirmed direct transcriptional control of ATP3 by Cbf1. In addition, we confirmed the regulation of yeast lipid genes LAC1 and LAG1 by Cbf1. The human homolog of Cbf1, Upstream transcription factor 1 (USF1), is also known to be involved in lipid biogenesis. Herein, we provide the first evidence for a role of USF1 in respiration since it appeared to complement Cbf1 in vivo as determined by respiration phenotypes. In addition, we confirmed USF1 as a substrate of human PAS kinase (hPASK) in vitro. Combined, our data supports a model in which Cbf1/USF1 functions to partition glucose towards respiration and away from lipid biogenesis, while PAS kinase inhibits respiration in part through the inhibition of Cbf1/USF1.

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Broadening the operative field: the extent of surgery beyond the patient`s informed consent (the so-called therapeutic exception)

W artykule omówiono przesłanki tzw. wyjątku terapeutycznego, uregulowanego w art. 35 ustawy z dnia 5 grudnia 1996 r. o zawodach lekarza i lekarza dentysty. Konstrukcja ta pozwala lekarzowi, w trakcie operacji, na zmianę zakresu zabiegu ponad zgodę wyrażoną przez pacjenta. Ponadto poruszono kwestię tzw. zgody antycypacyjnej oraz warunki jej skuteczności oraz wyjaśniono, czy w wypadku realizacji przesłanek wyjątku terapeutycznego lekarz jedynie może dokonać odpowiedniej modyfikacji czynności operacyjnych, czy też jest to jego obowiązek. Wskazano również, że w omawianej sytuacji lekarz nie może powoływać się na tzw. stan wyższej konieczności. Prezentowane treści zostały wzbogacone o przedstawienie konkretnych spraw sądowych i ich rozstrzygnięć.

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Inter-arm differences in blood pressure among subjects with disseminated atherosclerosis scheduled for vascular surgery

Background: The measurement of blood pressure (BP) is routinely performed in perioperative care. The reliability of results is essential for the implementation of treatment ensuring haemodynamic stability. The aim of the present study was to assess the prevalence and basic determinants of inter-arm BP differences among patients with advanced peripheral atherosclerosis undergoing vascular surgical procedures of the lower limbs. Methods: The prospective study was carried out in patients scheduled for elective lower limb vascular surgery. One-time non-invasive BP measurements were performed sequentially on the brachial arteries of both upper extremities before the induction of anaesthesia, maintaining the shortest possible interval between measurements. The systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded. Results: The results of 173 patients (including 123 men aged 67 ± 8 years) were analysed. In 16 (9.3%) patients, an inter-arm difference in BP was already observed during the preoperative examination. SBP and DBP was higher in the right limb in 86 (49.7%) an 80 (46.3%) patients, respectively. Moreover, the medians of inter-arm differences in SBP, DBP and MAP were 9 (IQR 4–17), 5 (IQR 3–10) and 7 mm Hg (IQR 3–12), respectively. An evaluation of the determinants of BP differences related to the presence of additional diseases demonstrated that patients with arterial hypertension were characterised by higher SBP and MAP disproportions (P = 0.04 and P = 0.01). Conclusions: In the population of patients with disseminated atherosclerosis, the inter-arm differences in BP substantially exceed the measurement error limits and are likely to be associated with arterial hypertension. If in doubt about BP disproportions, intraoperative monitoring of BP should be recommended using an invasive method on the limb presenting higher non-invasively measured values.

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Risk factors for occurrence of failed interscalene brachial plexus blocks for shoulder arthroscopy using 20 mL 0.5% ropivacaine: a randomised trial

Background: The red blood cell distribution width index (RDW) is one of several parameters routinely analysed in peripheral blood counts. The aim of the study was to assess the usefulness of RDW in the prediction of in-hospital mortality in patients undergoing high-risk gastroenterological surgery. Methods: Prospective observation covered 229 patients who underwent surgery, for whom the risk of cardiovascular complications was high due to the type of procedure. The patient's individual risk was assessed using the criteria of the American Society of Anesthesiologists (ASA-PS). Peripheral blood for morphological examination was collected preoperatively. The following parameters of the red blood cell system were evaluated: red blood cell count (RBC), haemoglobin (Hgb), haematocrit (Hct), mean corpuscular volume (MCV), RDW expressed as a standard deviation (SD) and a coefficient of variation (CV). The occurrence of hospital death was the main endpoint. Results: Patients who died had had statistically significantly lower RBC, Hgb and Hct values, as well as higher RDW-SD and RDW-CV values. Both the preoperative RDW-SD and RDW-CV values predicted the outcome, respectively: AUC_RDW-SD = 0.744 (95% CI: 0.683–0.799; P RDW-CV = 0.762 (95% CI: 0.702–0.816; P RDW-SD = 1.21; P RDW-CV = 1.62; P = 0.01), even after adjustment for individual risk and other erythrocyte parameters. Conclusion: RDW is a valuable screening predictor of in-hospital mortality in patients undergoing high-risk gastroenterological surgery, regardless of the estimated individual risk and the value of other erythrocyte parameters. Evaluation of the RDW may be helpful in the identification of patients requiring correction of haematological disorders in the pre-operative period, as well as, in particular, surveillance in the perioperative period.

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Use of noninvasive mechanical ventilation with pressure support guaranteed with average volume in de novo hypoxaemic respiratory failure. A pilot study

Background: This study was designed to determine the results associated with the use of noninvasive mechanical ventilation (NIV) using the BiPAP S/T-AVAPS ventilation strategy in subjects with mild to moderate de novo hypoxaemic respiratory failure. Methods: This is a prospective study that includes subjects with de novo hypoxaemic respiratory failure (not produced by acute exacerbations of COPD, chronic lung disease, or congestive heart failure) with mild to moderate PaO₂/FiO₂, who were admitted to the Intensive Care Unit (ICU) of Santa Maria Clinic in Guayaquil, Ecuador. Subjects were divided into two groups and compared according to their PaO₂/FiO₂: higher than 100 and up to 200 mm Hg (moderate ARDS) or between 200 and 300 mm Hg (mild ARDS) (both groups were ventilated with the BiPAP S/T-AVAPS strategy). A value of P Results: A total of 38 subjects were analysed in this study. The total rate of intubation was 34.2% while the mortality rate was 28.9%. Significant differences were observed when comparing success versus failure in exhaled tidal volumes (P = 0.04), peak inspired pressure (P 2 (P 2 (P 2/FiO₂ (P P P = 0.029) measured at baseline and at 12-hour, 24-hour and 48-hour intervals. Conclusion: The BiPAP S/T-AVAPS ventilatory mode can be used in subjects with de novo hypoxaemic respiratory failure with special vigilance concerning exhaled tidal volumes and inspired pressure.

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Peri-anaesthetic cardiac arrest with administration of enalapril, spironolactone and β-blocker

none

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Postoperative pain after spinal surgery in the paediatric population

Introduction: Postoperative pain is a major aftereffect of surgery. Especially severe occurs after extensive operations within the spine. The goal of the study was to investigate the laboratory predictive factors of intensive postoperative pain in children undergoing extensive surgery Patients and methods: We recruited 41 children, age median 13 years (IQR:10-15 years) undergoing extensive spine surgery. The subjects were divided into two groups based on the intensity of postoperative pain measured using the 10-point numerical rating scale (NRS), visual analog scale (VAS) or faces pain scale-revised (FPS-R). Patients with a score of 5 or higher were included in the study group and those with NRS of less than 5 were included in the control group. We collected detailed clinical and laboratory data before, during and after surgery. Results: The highest intensity of pain was observed in the first 6 hours after surgery. The postoperative pain was associated with a higher drop in hemoglobin concentration and hematocrit level in peri-operative period (p=0.006 and p=0.019 respectively) as well as higher changes in mean arterial pressure during surgery. Additionally, we found that children with intensive pain had higher total protein concentration after surgery. Conclusions: We reported that the drop in hemoglobin and hematocrit level, fluctuation in mean arterial pressure as well as total protein concentration could be useful prognostic factors of early postoperative pain.

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A case report of inadvertent intranasal submucosal injection of concentrated epinephrine with no long-term sequelae

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Clinical and Molecular Characterization of Panton–Valentine Leukocidin-Positive Invasive Staphylococcus aureus Infections in Korea

Microbial Drug Resistance, Ahead of Print.


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First Detection of New Delhi Metallo-β-Lactamase-5-Producing Escherichia coli from Companion Animals in Korea

Microbial Drug Resistance, Ahead of Print.


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Genetic Analysis of p17S-208 Plasmid Encoding the Colistin Resistance mcr-3 Gene in Escherichia coli Isolated from Swine in South Korea

Microbial Drug Resistance, Ahead of Print.


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EMS Specialist Projects Supervisor - GAAA

Make A Difference in your community by being a leader of our Emergency Medical Service Team! Galveston County Health District is seeking a new EMS Special Projects Supervisor! The right candidate will be responsible for successfully managing daily operational aspects of non-emergency medical transport and emergency medical services provided by the Galveston County Health District's Galveston Area Ambulance ...

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FT/PT Paramedic - Med-Star Paramedic Ambulance, Inc.

MED-Star Paramedic Ambulance, Inc. located in Brandon, South Dakota is currently hiring full and part time Paramedics. We are a family owned and operated company. We respond to 911 calls in the southeast area of Minnehaha county and provide interfacility transports from area hospitals. We offer flexible scheduling with 12 and 24 hour shifts available and minimal call time. Pay starting at $36,500-$42,000/year ...

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Wash. responders, civilians honored for saving life of retired fire chief

Retired Chehalis Fire Department Chief Bill Nacht went into cardiac arrest while waiting for a friend so they could go on a motorcycle trip

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Deletion of IP 3 R1 by Pdgfrb-Cre in mice results in intestinal pseudo-obstruction and lethality

Abstract

Background

Inositol 1,4,5-trisphosphate receptors (IP₃Rs) are a family of intracellular Ca²⁺ release channels located on the membrane of endoplasmic reticulum, which have been shown to play critical roles in various cellular and physiological functions. However, their function in regulating gastrointestinal (GI) tract motility in vivo remains unknown. Here, we investigated the physiological function of IP₃R1 in the GI tract using genetically engineered mouse models.

Methods

Pdgfrb-Cre mice were bred with homozygous Itpr1 floxed (Itpr1^f/f) mice to generate conditional IP₃R1 knockout (pcR1KO) mice. Cell lineage tracing was used to determine where Pdgfrb-Cre-mediated gene deletion occurred in the GI tract. Isometric tension recording was used to measure the effects of IP₃R1 deletion on muscle contraction.

Results

In the mouse GI tract, Itpr1 gene deletion by Pdgfrb-Cre occurred in smooth muscle cells, enteric neurons, and interstitial cells of Cajal. pcR1KO mice developed impaired GI motility, with prolonged whole-gut transit time and abdominal distention. pcR1KO mice also exhibited lethality as early as 8 weeks of age and 50% of pcR1KO mice were dead by 40 weeks after birth. The frequency of spontaneous contractions in colonic circular muscles was dramatically decreased and the amplitude of spontaneous contractions was increased in pcR1KO mice. Deletion of IP₃R1 in the GI tract also reduced the contractile response to the muscarinic agonist, carbachol, as well as to electrical field stimulation. However, KCl-induced contraction and expression of smooth muscle-specific contractile genes were not significantly altered in pcR1KO mice.

Conclusions

Here, we provided a novel mouse model for impaired GI motility and demonstrated that IP₃R1 plays a critical role in regulating physiological function of GI tract in vivo.

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Halloween: Is it the most dangerous day for kids?

Analysis of the 56 million ePCR records in the NEMSIS national dataset shows days with the most traumatic pediatric cardiac arrests in 2013 and 2014

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CoTCCC Chair Dr. Frank Butler Receives NAEMT’s Most Prestigious 2018 Rocco V. Morando Lifetime Achievement Award

CLINTON, Miss. — Captain Frank K. Butler, Jr., (USN ret), MD was presented with the 2018 Rocco V. Morando Lifetime Achievement Award, recognizing a lifetime of commitment, contributions and leadership to Emergency Medical Services (EMS). The award is NAEMT's most prestigious and is generously sponsored by the National Registry of Emergency Medical Technicians (NREMT). The presentation...

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“Gardner and Sutherland’s chromosome abnormalities and genetic counseling” by R.J. McKinlay Gardner, David J. Amor. Oxford University Press

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Halloween: Is it the most dangerous day for kids?

Analysis of the 56 million ePCR records in the NEMSIS national dataset shows days with the most traumatic pediatric cardiac arrests in 2013 and 2014

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EMS World Expo Quick Take: Assessing, treating and transporting patients with special needs

Be aware patients with special needs may have comorbidities, and their conditions fall on a spectrum

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A Systematic Review of Traditional, Complementary and Alternative Medicine Use Amongst Ethnic Minority Populations: A Focus Upon Prevalence, Drivers, Integrative Use, Health Outcomes, Referrals and Use of Information Sources

Abstract

Ethnic minority populations have been identified as high users of traditional, complementary and alternative medicine (TCAM). This paper reports the systematic review of TCAM use amongst ethnic minorities. A comprehensive literature search was conducted in Ovid, PubMed and CINAHL. Included studies were original, peer-reviewed, English language articles with the primary focus on TCAM use amongst ethnic minority populations. A total of 17 articles met the inclusion criteria and were included in the systematic review. A considerable level of TCAM use was observed amongst ethnic minority populations usually attributed to its perceived safe and natural properties. Ethnic minority populations predominantly used TCAM concurrently with conventional medicine and primary TCAM referral sources were family and friends. A substantial level of TCAM integration with conventional medicine is common practice amongst these populations and the lack of disclosure about TCAM use raises an important area for further research inquiry.

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EMS World Expo Quick Take: Active assailant preparation, response for EMS

20-60-90 minute rule underscores the importance of rapidly accessing trauma patients and transporting patients to definitive surgical care

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Paramedic Inpatient, (NICU/PICU - Flex) FT; 36 hours per week 5p-5a with weekend rotation - Children's Hospital & Medical Center

The inpaitent paramedic serves a clinical resource on inpateint units (critical care or med surg). Working to the full scope of their license, the paramedic will complete assessments, perform procedures, administer meds, and respond to emergencies in the assigned unit or division. The paramedic will interact with patients and famillies and be part of the pediatric and neonatal care team.

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Functional validation of miRNAs targeting genes of DNA double-strand break repair to radiosensitize non-small lung cancer cells

Publication date: Available online 30 October 2018

Source: Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms

Author(s): Celeste Piotto, Alberto Biscontin, Caterina Millino, Maddalena Mognato

Abstract

DNA-Double strand breaks (DSBs) generated by radiation therapy represent the most efficient lesions to kill tumor cells, however, the inherent DSB repair efficiency of tumor cells can cause cellular radioresistance and impact on therapeutic outcome. Genes of DSB repair represent a target for cancer therapy since their down-regulation can impair the repair process making the cells more sensitive to radiation. In this study, we analyzed the combination of ionizing radiation (IR) along with microRNA-mediated targeting of genes involved in DSB repair to sensitize human non-small cell lung cancer (NSCLC) cells. MicroRNAs are natural occurring modulators of gene expression and therefore represent an attractive strategy to affect the expression of DSB repair genes. As possible IR-sensitizing targets genes we selected genes of homologous recombination (HR) and non-homologous end joining (NHEJ) pathway (i.e. RAD51, BRCA2, PRKDC, XRCC5, LIG1). We examined these genes to determine whether they may be real targets of selected miRNAs by functional and biological validation. The in vivo effectiveness of miRNA treatments has been examined in cells over-expressing miRNAs and treated with IR. Taken together, our results show that hsa-miR-96-5p and hsa-miR-874-3p can directly regulate the expression of target genes. When these miRNAs are combined with IR can decrease the survival of NSCLC cells to a higher extent than that exerted by radiation alone, and similarly to radiation combined with specific chemical inhibitors of HR and NHEJ repair pathway.

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Predictive factors of the treatment outcome in patients with advanced biliary tract cancer receiving gemcitabine plus cisplatin as first-line chemotherapy

Journal of Gastroenterology

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A multicenter observational study on the clinicopathological features of gastric cancer in young patients

Journal of Gastroenterology

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Oral metronidazole use and risk of acute pancreatitis: A population-based case-control study

Clinical Epidemiology

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Review of microbial resistance to chronic ionizing radiation exposure under environmental conditions

Publication date: January 2019

Source: Journal of Environmental Radioactivity, Volume 196

Author(s): Igor Shuryak

Abstract

Ionizing radiation (IR) produces multiple types of damage to nucleic acids, proteins and other crucial cellular components. Nevertheless, various microorganisms from phylogenetically distant taxa (bacteria, archaea, fungi) can resist IR levels many orders of magnitude above natural background. This intriguing phenomenon of radioresistance probably arose independently many times throughout evolution as a byproduct of selective pressures from other stresses (e.g. desiccation, UV radiation, chemical oxidants). Most of the literature on microbial radioresistance is based on acute γ-irradiation experiments performed in the laboratory, typically involving pure cultures grown under near-optimal conditions. There is much less information about the upper limits of radioresistance in the field, such as in radioactively-contaminated areas, where several radiation types (e.g. α and β, as well as γ) and other stressors (e.g. non-optimal temperature and nutrient levels, toxic chemicals, interspecific competition) act over multiple generations. Here we discuss several examples of radioresistant microbes isolated from extremely radioactive locations (e.g. Chernobyl and Mayak nuclear plant sites) and estimate the radiation dose rates they were able to tolerate. Some of these organisms (e.g. the fungus Cladosporium cladosporioides, the cyanobacterium Geitlerinema amphibium) are widely-distributed and colonize a variety of habitats. These examples suggest that resistance to chronic IR and chemical contamination is not limited to rare specialized strains from extreme environments, but can occur among common microbial taxa, perhaps due to overlap between mechanisms of resistance to IR and other stressors.

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Fibromyalgia: increased reactivity of the muscle membrane and a role of central regulation

Publication date: Available online 31 October 2018

Source: Clinical Neurophysiology

Author(s): E.G. Klaver-Krol, J.J. Rasker, M.M. Klaver, P.M. ten Klooster, M.J. Zwarts

Abstract

Objective

Fibromyalgia (FM) is characterized by widespread muscle pain and central neural deregulation. Previous studies showed increased muscle fiber conduction velocity (CV) in non-painful muscles of FM patients. This study investigates the relationship between central activation and the CV in FM.

Methods

Twenty-two females with primary FM and 21 controls underwent surface electromyography of the non-painful biceps brachii. Mean CVs were calculated from the motor unit potential velocities (CV-MUPs), and the CV-MUPs' statistical distributions were presented as histograms. The amount of muscle activity (average rectified voltage, ARV) was measured.

Results

The CV was higher in the FM-group than in the controls (P=0.021), with CV-MUPs generally shifted to higher values, indicative of increased muscle membrane propagation speeds. The largest increase in the CV of the FM-group occurred when adopting and maintaining a limb position at only 5% of maximum strength (P<0.001); the CV did not, as normal, increase with greater force. However, the ARV in both groups similarly increased with force.

Conclusions

In fibromyalgia patients, the muscle membrane propagation speed increases independently of the force load or amount of muscle activity produced. When adopting a limb position, the patients show an augmented muscle membrane reaction, suggesting deregulation from higher neural centers.

Significance

These findings contribute to understanding fibromyalgia.

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Electrophysiological evidence for changes in attentional orienting and selection in functional somatic symptoms

Publication date: Available online 30 October 2018

Source: Clinical Neurophysiology

Author(s): Maayan Karlinski, Alexander Jones, Bettina Forster

Abstract

Objective

We investigated changes in attention mechanisms in people who report a high number of somatic symptoms which cannot be associated with a physical cause.

Method

Based on scores on the Somatoform Disorder Questionnaire (SDQ-20; Nijenhuis et al., 1996) we compared two non-clinical groups, one with high symptoms on the SDQ-20 and a control group with low or no symptoms. We recorded EEG whilst participants performed an exogenous tactile attention task where they had to discriminate between tactile targets following a tactile cue to the same or opposite hand.

Results

The neural marker of attentional orienting to the body, the Late Somatosensory Negativity (LSN), was diminished in the high symptoms group and attentional modulation of touch processing was prolonged at mid and enhanced at later latency stages in this group.

Conclusion

These results confirm that attentional processes are altered in people with somatic symptoms, even in a non-clinical group. Furthermore, the observed pattern fits explanations of changes in prior beliefs or expectations leading to diminished amplitudes of the marker of attentional orienting to the body (i.e. the LSN) and enhanced attentional gain of touch processing.

Significance

This study shows that high somatic symptoms are associated with neurocognitive attention changes.

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Predictive Value of Intraoperative Bulbocavernosus Reflex during Untethering Surgery for Post-operative Voiding Function

Publication date: Available online 30 October 2018

Source: Clinical Neurophysiology

Author(s): Seungwoo Cha, Kyu-Chang Wang, Kwanjin Park, Hyung-Ik Shin, Ji Yeoun Lee, Sangjoon Chong, Keewon Kim

Abstract

Objective

To evaluate the clinical significance of intraoperative bulbocavernosus reflex (BCR) during untethering surgery in predicting post-operative voiding function.

Methods

We conducted a retrospective review of pediatric patients who underwent untethering surgery with available intraoperative baseline BCR. BCR response during surgery was classified into loss or maintenance. Post-operative voiding function was determined as worsened or maintained based on history, postvoid residual urine measurement, and urodynamic study (UDS). Data regarding demographics, diagnosis, pre-operative voiding difficulty, re-untethering, syrinx, and abnormalities in electromyography were collected for analysis.

Results

We included 106 patients, with a mean age of 3.3 years, and 49 patients were male. BCR was lost in 15 patients during surgery and voiding function worsened in 14 patients after surgery. Lumbosacral lipoma was the most common diagnosis, and 16 patients were diagnosed with lipomyelomeningocele (LMMC). The sensitivity and specificity of intraoperative BCR for post-operative worsening of voiding function were 35.7%, and 88.5% at 6 months, respectively. The diagnosis of LMMC was statistically significant in a logistic regression analysis. The specificity of BCR at 6 months in patients with diagnosis other than LMMC was 93.4%, and intraoperative BCR was significant in a logistic regression analysis.

Conclusions

Intraoperative BCR during untethering could predict bladder function 6 months post-operatively with high specificity (88.5%), particularly in cases other than LMMC (93.4%), indicating that voiding function deterioration will not occur if intraoperative BCR is preserved.

Significance

Intraoperative BCR during untethering surgery is a useful tool to predict post-operative voiding outcome.

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Resting frontal EEG asymmetry in adolescents with major depression: impact of disease state and comorbid anxiety disorder

Publication date: Available online 30 October 2018

Source: Clinical Neurophysiology

Author(s): Lisa Feldmann, Charlotte E. Piechaczek, Barbara D. Grünewald, Verena Pehl, Jürgen Bartling, Michael Frey, Gerd Schulte-Körne, Ellen Greimel

Abstract

Objective

Greater relative right- than left-frontal cortical activity has been frequently found in adults with major depression (MD). As the few studies in adolescents with MD have been inconclusive, the aim of this study was to assess frontal alpha asymmetry (FAA) in an adolescent sample with MD whilst taking into account possible confounding variables such as disease state and comorbid anxiety disorder.

Methods

An 8-minute resting frontal EEG was assessed in 34 healthy controls (HCs), 16 adolescents with MD in remission without comorbid anxiety disorder (rMDa-), 22 adolescents with acute depression without comorbid anxiety disorder (MDa-), and 23 adolescents with acute depression and comorbid anxiety disorder (MDa+). Alpha power was analyzed over corresponding frontal Regions of Interests.

Results

Compared to HCs, MDa+ adolescents demonstrated more left- than right-sided EEG alpha power, indicating greater right-than left-frontal cortical activity. No other group differences emerged.

Conclusions

The results suggest that greater relative right-frontal cortical activity in adolescent MD is not a result of disease state but can be attributed to comorbid anxiety disorder.

Significance

Results suggest that FAA is not linked to adolescent depression per se and highlight the importance of considering comorbid disorders when examining asymmetry patterns in adolescent MD.

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Perceived Functional Social Support and Self-Rated Health: The Health Promoting Effects of Instrumental Support for the Irish Community in London

Abstract

Background

Despite an increasing volume of research on Irish migrants to the UK, limited scientific data exists on the main effects of social support on the health of this community.

Methods

A sample of Irish migrants in London was purposefully recruited (n = 790). Linear regression was used to predict social support. Logistic regression examined the independent association between functional social support and self-rated health (SRH) controlling for low risk covariates.

Results

Older age, economic factors and better SRH precited stronger social support. Irish migrants who reported being able to rely on at least three people in times of crisis and those who perceived stronger emotional support were more likely to report good SRH when adjusted for demography and socio-economic factors. As risks increased only perceived support in times of crisis predicted SRH.

Discussion

Interventions which build reliable and trusted social networks may have a direct effect on migrant health.

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TLL1 variant associated with development of hepatocellular carcinoma after eradication of hepatitis C virus by interferon-free therapy

Abstract

Background

The aim of this study is to ascertain whether the TLL1 variant at rs17047200 is associated with the development of HCC after achieving sustained virological response (SVR) by interferon (IFN)-free therapy for chronic hepatitis C (CHC).

Methods

A total of 1029 Japanese CHC patients with the following inclusion criteria were enrolled: (i) achieved SVR by IFN-free therapy, (ii) followed up at least 1 year from the end of treatment (EOT) (median 104 weeks), (iii) no history of hepatocellular carcinoma (HCC) by 1 year from the EOT.

Results

Nineteen patients developed HCC (HCC group) and 1010 did not (non-HCC group). The proportion of rs17047200 AT/TT was significantly higher in the HCC group than the non-HCC group (47.4% vs. 20.1%, P = 0.008). Multivariate analysis showed that higher levels of α-fetoprotein, FIB-4 and rs17047200 AT/TT were independent risk factors for developing HCC (HR = 3.22, P = 0.021 for α-fetoprotein > 4.6 ng/ml; HR = 3.89, P = 0.036 for FIB-4 > 2.67; HR = 2.80, P = 0.026 for rs17047200 AT/TT). Cumulative incidence of HCC was significantly higher in patients with rs17047200 AT/TT than in those with AA (P = 0.006). Comparing clinical characteristics according to the TLL1 genotypes, patients with rs17047200 AT/TT had significantly lower platelet counts and higher levels of FIB-4 than those with AA (P = 0.011 and 0.032, respectively).

Conclusions

The TLL1 variant was independently associated with HCC development after HCV eradication by IFN-free regimen. It might be involved in hepatic fibrogenesis and thereby carcinogenesis.

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Associations of Resistance Exercise with Cardiovascular Disease Morbidity and Mortality

Purpose Resistance exercise (RE) can improve many cardiovascular disease (CVD) risk factors, but specific data on the effects on CVD events and mortality are lacking. We investigated the associations of RE with CVD and all-cause mortality, and further examined the mediation effect of body mass index between RE and CVD outcomes. Methods We included 12,591 participants (mean age 47 years) who received at least two clinical examinations 1987-2006. RE was assessed by a self-reported medical history questionnaire. Results During a mean follow-up of 5.4 and 10.5 years, 205 total CVD events (morbidity and mortality combined) and 276 all-cause deaths occurred, respectively. Compared with no RE, weekly RE frequencies of one, two, three times or total amount of 1-59 minutes were associated with approximately 40-70% decreased risk of total CVD events, independent of aerobic exercise (AE) (all p-values

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Associations between Distance and Loading Symmetry during Return to Sport Hop Testing

Purpose Hop tests are widely used to quantify recovery from anterior cruciate ligament reconstruction (ACLR) surgery. However, there is evidence that simply measuring hop distance may not be indicative of the quality of movement or representative of potential limitations in hopping mechanics, particularly during landing. The first purpose of the present study was to compare hop distance and loading symmetry between ACLR athletes and healthy uninjured recreational athletes. The second was to determine the association between hop distance and loading symmetry. Methods Twenty-five ACLR patients and 30 healthy controls completed the single hop, triple hop, and crossover hop test on each limb while the loadsol®, a single-sensor force insole, collected impact forces (100 Hz). A limb symmetry index was calculated for hop distance, peak impact force, loading rate, and impulse from the final landing of each trial. LSIs were compared between groups using Mann-Whitney U-Tests and distance and loading LSIs were compared using Spearman rank correlations. Results ACLR patients had reduced symmetry in hop distance and loading relative to healthy controls for every hop test and outcome measure (p

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The Role of Aerobic Exercise in Reducing Persistent Sport-related Concussion Symptoms

Aerobic exercise has received increasing attention in the scientific literature as a component of management for individuals who sustain a concussion. Since exercise training has been reported to reduce symptoms and improve function for those experiencing persistent postconcussion symptoms, it represents a potentially useful and clinically pragmatic rehabilitation technique. However, the specific exercise parameters that best facilitate recovery from concussion remain poorly defined and unclear. This review will provide a brief summary of the current understanding of the role of sub-symptom exercise to improve outcomes after a concussion and will describe the exercise parameters that appear to be important. This latter will take into account the three pillars of exercise dose – frequency, duration, and intensity – to examine what is currently known. In addition, we identify important gaps in our knowledge of exercise as a treatment for those who develop persistent symptoms of concussion. Corresponding author: David R. Howell, Children's Hospital Colorado, Sports Medicine Center, 13123 East 16th Avenue, Box 060, Aurora, Colorado 80045, UNITED STATES, 720-777-4869. David.Howell@ucdenver.edu This work was funded by The Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (R03HD094560) and The National Institute of Neurological Disorders and Stroke of the National Institutes of Health (R03NS106444). The results of the present study do not constitute endorsement by ACSM. Our work is presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for publication October 2018. © 2018 American College of Sports Medicine

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Effect of Ice Slurry Ingestion on Cardiovascular Drift and V[Combining Dot Above]O2max during Heat Stress

External body cooling by fan airflow mitigates the decrease in maximal oxygen uptake (V[Combining Dot Above]O2max) associated with cardiovascular (CV) drift during cycling in hot conditions. It remains unknown whether internal body cooling via ice slurry ingestion elicits a similar response. Purpose To test the hypothesis that ice slurry ingestion attenuates the magnitude of CV drift and accompanying decrement in V[Combining Dot Above]O2max during heat stress. Methods Eight men completed a graded exercise test on a cycle ergometer in 22 °C to measure V[Combining Dot Above]O2max. Then on 3 separate occasions (in randomly assigned counterbalanced treatment orders), they cycled at 60%V[Combining Dot Above]O2max in hot conditions (35 °C, 40% RH) for either 15 min, 45 min with tepid (23 °C) fluid ingestion (45FL), or 45 min with ice (-1° C) slurry ingestion (45ICE), followed immediately by measurement of V[Combining Dot Above]O2max. The purpose of the separate 15- and 45-min trials was to measure CV drift and V[Combining Dot Above]O2max over the same time interval. Results The increase in HR between 15 and 45 min was twice as large in 45FL (8.6%) compared to 45ICE (4.6%; P=0.02). SV declined by 6.2% in 45FL but was maintained with 45ICE (P=0.02). V[Combining Dot Above]O2peak decreased from 15 to 45 min by 8.6% and 9.0% in 45FL and 45ICE, respectively, but was not different between conditions (P=0.79). Conclusion While ice slurry ingestion attenuated CV drift more than fluid ingestion, it did not mitigate the decline in V[Combining Dot Above]O2max. Contrary to previous findings, when ice slurry is ingested, changes in HR may not reflect changes in relative metabolic intensity during prolonged exercise in the heat. Corresponding Author: Jason Ng, Ph.D., CSCS, 5500 University Parkway, San Bernardino, CA 92407-2393, Phone: (909) 537-5412, Fax: (909) 537-7085. Email: jason.ng@csusb.edu CSUSB Faculty Center for Excellence for supporting the publication of this paper with funded writing time. The authors declare no conflict of interest. The results of the present study do not constitute endorsement by the American College of Sports Medicine. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 25 September 2018 © 2018 American College of Sports Medicine

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Physical Activity, Television Viewing Time, and DNA Methylation in Peripheral Blood

Introduction Physical activity may affect health via DNA methylation. The epigenetic influences of sedentary behaviours such as television viewing are unknown. We performed a genome-wide study of DNA methylation in peripheral blood in relation to physical activity and television viewing time. Methods DNA methylation was measured using the Illumina Infinium HumanMethylation450K BeadChip array in blood samples collected at baseline (N=5,513) and follow-up (N=1,249) from participants in the Melbourne Collaborative Cohort Study. At baseline, times/week of leisure-time physical activity was self-reported. At follow-up, the International Physical Activity Questionnaire was used to assess MET-hours/week of total and leisure-time physical activity, and hours/day of television viewing time. Linear mixed models were used to assess associations between the physical activity and television viewing measures and DNA methylation at individual CpG sites, adjusted for potential confounders and batch effects. Results At follow-up, total physical activity was associated with DNA methylation at cg10266336 (P=6.0x10-9), annotated to the SAA2 gene. Weaker evidence of associations (P

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Upregulation of Circular RNA VPS13C-has-circ-001567 Promotes Ovarian Cancer Cell Proliferation and Invasion

Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.


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Upregulation of Circular RNA VPS13C-has-circ-001567 Promotes Ovarian Cancer Cell Proliferation and Invasion

Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.


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Integrative Analysis of Transcriptomic and Methylomic Data in Photoperiod-Dependent Regulation of Cucumber Sex Expression

The cucumber (Cucumis sativus) is characterized by its diversity and seasonal plasticity in sexual type. A long day length condition significantly decreased the cucumber female flower ratio by 17.7%-52.9%, and the effect of photoperiod treatment is more significant under low temperature than under high temperature. Transcriptome analysis indicates that the photoperiod treatment preferentially significantly influenced flower development processes, particularly MADS-box genes in shoot apices. The long-day treatment resulted in predominantly transposable element (TE)- and gene-associated CHH-types of DNA methylation changes. Nevertheless, there was significant enrichment of CG- and CHG-types of DNA methylation changes nearing transcription start sites (TSSs)/transcription end sites (TESs) and gene bodies, respectively. Predominantly negative association between differentially methylated regions (DMRs) and differentially expressed genes (DEGs) were observed which implied epiregulation of DEGs. Two MADS-box genes that were significantly downregulated by long photoperiod showed significant hypermethylation in promoter regions that is essentially TE-rich. This study indicates MADS-box genes which are partially regulated by promoter methylation state may mediate photoperiod-dependent regulation of cucumber sex expression.

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The Yeast DNA Damage Checkpoint Kinase Rad53 Targets the Exoribonuclease, Xrn1

The highly conserved DNA damage response (DDR) pathway monitors the genomic integrity of the cell and protects against genotoxic stresses. The apical kinases, Mec1 and Tel1 (ATR and ATM in human, respectively), initiate the DNA damage signaling cascade through the effector kinases, Rad53 and Chk1, to regulate a variety of cellular processes including cell cycle progression, DNA damage repair, chromatin remodeling, and transcription. The DDR also regulates other cellular pathways, but direct substrates and mechanisms are still lacking. Using a mass spectrometry-based phosphoproteomic screen in Saccharomyces cerevisiae, we identified novel targets of Rad53, many of which are proteins that are involved in RNA metabolism. Of the 33 novel substrates identified, we verified that 12 are directly phosphorylated by Rad53 in vitro: Xrn1, Gcd11, Rps7b, Ded1, Cho2, Pus1, Hst1, Srv2, Set3, Snu23, Alb1, and Scp160. We further characterized Xrn1, a highly conserved 5' exoribonuclease that functions in RNA degradation and the most enriched in our phosphoproteomics screen. Phosphorylation of Xrn1 by Rad53 does not appear to affect Xrn1's intrinsic nuclease activity in vitro, but may affect its activity or specificity in vivo.

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Resting frontal EEG asymmetry in adolescents with major depression: impact of disease state and comorbid anxiety disorder

Major Depression (MD) is a severe mental disorder with lifetime prevalence rates of 17% (Kessler et al., 2005), mostly beginning between the ages of 12-18 years (Zisook et al., 2007). Up to 75% of children and adolescents with MD are affected by a depressive disorder as adults (Fombonne et al., 2001). Apart from the well-known diagnostic symptoms such as depressive mood (American Psychiatric Association, 2013), MD is also associated with abnormal approach and withdrawal tendencies (Derntl et al., 2011; Radke et al., 2014), which are reflected in aberrant cognition and behavior, such as e.g.

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Fibromyalgia: increased reactivity of the muscle membrane and a role of central regulation

Fibromyalgia (FM) is a chronic pain condition of unknown etiology and unclear pathophysiology. FM is characterized by widespread, especially tendomuscular, pain and generalized hypersensitivity to pain (Mease, 2005; Wolfe and Rasker, 2013; Yunus, 2008). There is evidence of hyperactivation/deregulation at various levels of the central nervous system (Banic et al., 2004; Burgmer et al., 2012; Choi et al., 2016; Desmeules et al., 2003; Gracely et al., 2002; Truini et al., 2015; Yunus, 2008). In addition, there is growing evidence of muscular function disturbance (Ge et al., 2009; Hubbard and Berkoff, 1993; Klaver-Krol, 2017; Vitali et al., 1989).

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Electrophysiological evidence for changes in attentional orienting and selection in functional somatic symptoms

Medically unexplained symptoms (MUS) or functional somatic symptoms are characterised by unpleasant physical sensations with medical characteristics that do not correspond adequately to any acknowledged medical impairment. The nature of symptoms greatly varies, ranging from headaches, joint weaknesses, back pains, and heart palpitation, to severe cases of temporal blindness, motor paralysis, and even epileptic seizure. However, the underlying cause of MUS remains largely unknown (APA, 2013; Hatcher and Arrol, 2008).

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Predictive Value of Intraoperative Bulbocavernosus Reflex during Untethering Surgery for Post-operative Voiding Function

Tethered cord syndrome (TCS) occurs as a result of inelastic structures anchoring the cord. Clinical presentation varies by age, but loss of bladder or bowel control, motor weakness, sensory loss, scoliosis, spasticity, and pain can develop (Frainey et al. 2014). Particularly, sacral function, including bladder and bowel control, as well as sexual function, is one of the major considerations because of its close relationship with quality of life. For treatment, surgical release of the tethered cord is recommended in early diagnosis to prevent functional deterioration (Solmaz et al.

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PREDICTORS OF HEPATOCELLULAR CARCINOMA IN HCV CIRRHOTIC PATIENTS TREATED WITH DIRECT ACTING ANTIVIRALS

Despite the dramatic improvement in viral eradication rates that has been reached with direct antiviral agents (DAAs), the real benefit of viral eradication after DAAs on hepatocellular carcinoma (HCC) development is still controversial.

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PREDICTORS OF HEPATOCELLULAR CARCINOMA IN HCV CIRRHOTIC PATIENTS TREATED WITH DIRECT ACTING ANTIVIRALS

Despite the dramatic improvement in viral eradication rates that has been reached with direct antiviral agents (DAAs), the real benefit of viral eradication after DAAs on hepatocellular carcinoma (HCC) development is still controversial.

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Chief John M. Buckman III joins IamResponding as Director of Government and Regional Outreach

Dewitt, New York - IamResponding.com is pleased to announce that Chief John M. Buckman III has joined the IamResponding team as its new Director of Government and Regional Outreach. IamResponding is excited to have Chief Buckman join its team of emergency services professionals and looks forward to working with Chief Buckman to enhance its current product offerings, and to expand its current...

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Molecular profiling of nonalcoholic fatty liver disease-associated hepatocellular carcinoma using SB transposon mutagenesis [Genetics]

Nonalcoholic fatty liver disease (NAFLD) is the fastest rising cause of hepatocellular carcinoma (HCC) in Western countries; however, the molecular mechanisms that cause NAFLD-HCC remain elusive. To identify molecular drivers of NAFLD-HCC, we performed Sleeping Beauty (SB) transposon mutagenesis screens in liver-specific Pten knockout and in high-fat diet-fed mice, which...

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Single-molecule DNA-mapping and whole-genome sequencing of individual cells [Genetics]

To elucidate cellular diversity and clonal evolution in tissues and tumors, one must resolve genomic heterogeneity in single cells. To this end, we have developed low-cost, mass-producible micro-/nanofluidic chips for DNA extraction from individual cells. These chips have modules that collect genomic DNA for sequencing or map genomic structure directly,...

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Sepsis Alliance & NAEMT team-up to combat sepsis

Sepsis Alliance, the nation's leading sepsis organization, and the National Association of Emergency Medical Technicians (NAEMT) are proud to announce their new partnership to combat sepsis and help save lives. Sepsis is the body's life-threatening reaction to an infection. In the United States, sepsis affects 1.7 million people and takes 270,000 lives. As many as 87% of sepsis cases...

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Association between intraoperative phenylephrine administration and umbilical artery pH in women with hypertensive disorders of pregnancy: a retrospective cohort study

Abstract

Purpose

In healthy pregnant women undergoing Cesarean section, treatment of post-spinal hypotension (PSH) with phenylephrine is reportedly more efficacious than ephedrine in preventing a decline in umbilical artery pH (UApH), which is an indicator of fetal acidosis. However, phenylephrine has the potential to reduce placental blood flow and consequently decrease UApH in women who develop hypertensive disorders of pregnancy (HDP), due to decreased cardiac function and placental vascular abnormalities. We aimed to verify the association between decreased UApH and phenylephrine administered before delivery to treat PSH in women with HDP.

Methods

This single-center retrospective cohort study was conducted between April 2008 and October 2016 by assessing the records of pregnant women with confirmed or suspected HDP who underwent Cesarean section under spinal anesthesia. The association between phenylephrine and the primary endpoint of decreased UApH was investigated using logistic regression analysis and propensity score matching.

Results

In the original cohort of 107 pregnant women with HDP, neither univariate nor multivariate analysis indicated a significant association between phenylephrine treatment and decreased UApH [crude odds ratio (OR) = 2.26; 95% confidence interval (CI) 0.75–6.77; P = 0.14], (adjusted OR = 1.80; 95% CI 0.55–5.93; P = 0.33). Thirty patients each who were not treated with phenylephrine (control group) and were treated with phenylephrine (phenylephrine group) were matched by propensity score analysis. UApH [median (interquartile range)] was not significantly different between control and phenylephrine groups [7.30 (7.25–7.35) vs. 7.27 (7.25–7.30); P = 0.14].

Conclusion

Intraoperative phenylephrine administration to treat PSH in women with HDP was not associated with decreased UApH.

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Pulsara unveiling major new features of its platform at EMS World 2018 in Nashville

BOZEMAN, Mont. — Pulsara will be unveiling critical new elements of its technology during the EMS World Expo conference this week in Nashville. Pulsara provides a real-time communication network in hospitals and across entities and regions—driving quality improvement and better patient coordination. The technology solution is being used by regional healthcare systems across the U.S....

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Theoretical Analysis of the Peculiarities of Motor Control at Generation of Two-joint Isometric Efforts by the Human Upper Limb

The biomechanical analysis of the functioning of a two-articular manipulator as a model of the human upper limb at generation of two-joint muscle efforts by the hand within a horizontal plane has been performed; the shoulder and elbow joints and the hand were also situated within this plane. Possible patterns of the motor commands at changes of the direction and magnitude of the produced effort in the case where the torque with respect to one of the joints remains constant have been analyzed. The possibility of using of a superposition principle for motor commands at different time courses of the generated efforts is also considered. Certain assumptions with respect to production of maximum efforts of different directions are put forward; these assumptions are based on the results of biomechanical analysis of the two-articular manipulator. Ideas of some experiments supposedly allowing researchers to better understand the principles of motor control are proposed. The mathematical apparatus for analysis and practical calculations of the parameters of the analyzed isometric motor task is described.

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Estimating radiological exposure of wildlife in the field

Publication date: Available online 29 October 2018

Source: Journal of Environmental Radioactivity

Author(s): Karine Beaugelin-Seiller, Jacqueline Garnier-Laplace, Nicholas A. Beresford

Abstract

The assessment of the ecological impact due to radionuclides at contaminated sites requires estimation of the exposure of wildlife, in order to correlate radiation dose with known radiological effects. The robust interpretation of field data requires consideration of possible confounding effects (e.g., from the tsunami at Fukushima) and an accurate and relevant quantification of radiation doses to biota. Generally, in field studies the exposure of fauna and flora has often been characterised as measurements of the ambient dose rate or activity concentrations in some components of the environment. The use of such data does not allow the establishment of a robust dose-effect relationship for wildlife exposed to ionising radiation in the field. Effects of exposure to radioactivity depend on the total amount of energy deposited into exposed organisms, which is estimated by adding doses (or dose rates) for all radionuclides and exposure pathways.

Realistic dose estimation needs to reflect the entire story of the organisms of interest during their whole exposure period. The process of identifying and collecting all the related information should allow the "W" questions (Which organisms are exposed, Where, When and hoW) to be answered. Some parameters are well known to influence dose (rate): the organism life stage, its ecological characteristics (e.g. habitat, behaviour), the source term properties (e.g. discharging facility, nature of radiation), etc. The closer the collated data are to the ideal data set, the more accurate and realistic the dose (rate) assessment will be. This means characterising each exposure pathway (internal and external), the activity concentration in each exposure source, the time each organism spends in a given place, as well as the associated dose. In this paper the process of data collation in view of dose reconstruction is illustrated for Japanese birds exposed to radioactive deposition following the Fukushima accident. With respect to the Chernobyl Exclusion Zone we will also consider variability under field conditions, availability of relevant datasets and options for better estimating internal and external doses received by wildlife.

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Aflatoxin B1 metabolism: regulation by phase I and II metabolizing enzymes and chemoprotective agents

Publication date: Available online 29 October 2018

Source: Mutation Research/Reviews in Mutation Research

Author(s): Jiang Deng, Zhao Ling, Zhang Ni-Ya, Niel Alexander Karrow, Steven Krumm Christopher, Qi De-Sheng, Sun Lv-Hui

Abstract

Aflatoxin B₁ (AFB₁) widely contaminates staple food and feed crops and is well-known as the most potent natural hepatocarcinogen in humans and domesticated animals. This review highlights significant advances in our understanding of the pivotal role of phase I and II metabolizing enzymes in the bioactivation and detoxification of AFB₁ and its metabolites across species. In humans, cytochrome P450 (CYP) 1A2, CYP3 A4, CYP3 A5, and CYP3 A7 in liver and CYP2A13 in lung are essential for the bioactivation of AFB₁ to the extremely toxic exo-AFB₁-8,9-epoxide (AFBO), whereas CYP1A1, CYP1A2, CYP2A6, and CYP3 A4 are important in the turkey and duck, CYP1A1 and CYP2A6 are important in the chicken and quail, CYP3 A11 and CYP3 A13 are important in mice, and CYP2A5 are important in the hamster. In contrast, glutathione-S-transferase (GST) M1 and GSTT1 are primary responsible for detoxification of the AFB₁ by catalyzing the conjugation of GSH to AFBO in humans, whereas GSTM2 in a nonhuman primate, GSTA3 in mice, GSTA5 in rats, and GSTA1, GSTA2, GSTA3 and GSTA4 in the turkey are important. Additionally, microsomal epoxide hydrolase (mEH) and aflatoxin-aldehyde reductase (AFAR) have also been shown to play key roles in AFB₁ detoxification in the human, rat, and pig. Moreover, an overview of the chemoprotective agents, including synthetic compounds and naturally occurring plant compounds, which can be used to reduce aflatoxicosis is provided based on their ability to regulate these key enzymes. Collectively, this review summarizes the pivotal enzymes in the metabolism of AFB₁ among humans, experimental and farm animals, as well as the chemoprotective agents that can be used to minimize risk of aflatoxicosis.

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The somatosensory mismatch negativity as a window into body representations in infancy

Publication date: Available online 30 October 2018

Source: International Journal of Psychophysiology

Author(s): Guannan Shen, Staci M. Weiss, Andrew N. Meltzoff, Peter J. Marshall

Abstract

How the body is represented in the developing brain is a topic of growing interest. The current study takes a novel approach to investigating neural body representations in infants by recording somatosensory mismatch negativity (sMMN) responses elicited by tactile stimulation of different body locations. Recent research in adults has suggested that sMMN amplitude may be influenced by the relative distance between representations of the stimulated body parts in somatosensory cortex. The current study uses a similar paradigm to explore whether the sMMN can be elicited in infants, and to test whether the infant sMMN response is sensitive to the somatotopic organization of somatosensory cortex. Participants were healthy infants (n = 31) aged 6 and 7 months. The protocol leveraged a discontinuity in cortical somatotopic organization, whereby the representations of the neck and the face are separated by representations of the arms, the hands and the shoulder. In a double-deviant oddball protocol, stimulation of the hand (100 trials, 10% probability) and neck (100 trials, 10% probability) was interspersed among repeated stimulation of the face (800 trials, 80% probability). Waveforms showed evidence of an infant sMMN response that was significantly larger for the face/neck contrast than for the face/hand contrast. These results suggest that, for certain combinations of body parts, early pre-attentive tactile discrimination in infants may be influenced by distance between the corresponding cortical representations. The results provide the first evidence that the sMMN can be elicited in infants, and pave the way for further applications of the sMMN in studying body representations in preverbal infants.

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Longitudinal trends in renal function in chronic hepatitis B patients receiving oral antiviral treatment

Alimentary Pharmacology and Therapeutics

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Diabetes, plasma glucose, and incidence of fatty liver, cirrhosis, and liver cancer: A prospective study of 0.5 million people

Hepatology

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A study of the circulating fibroblast growth factor 21 as a novel noninvasive biomarker of hepatic injury in genotype-4 chronic hepatitis C: Egyptian patients and their response to direct-acting antiviral agents

Clinical and Experimental Gastroenterology

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Risk factors of bloodstream infections in recipients after liver transplantation: A meta-analysis

Infection

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Determinants and Outcomes of Late Presentation of HIV Infection in Migrants in Catalonia, Spain: PISCIS Cohort 2004–2016

Abstract

This study using the Catalan PISCIS cohort explores risk factors of migrants' late presentation and the impact of late presentation on their health outcomes. We analyse 9590 new HIV diagnoses enrolled in the cohort between 2004 and 2016. Univariate and multivariate logistic regression models are used to identify risk factors associated with late presentation among migrants, giving crude and adjusted odds ratios and their 95% confidence intervals. Cox regression models are estimated to identify risk factors associated with AIDS/death, and crude and adjusted hazard ratios and 95% confidence intervals are reported. Late presentation is higher in migrants than non-migrants. Among migrants, region of origin is associated with late presentation and AIDS/death during follow-up. The results highlight persisting inequalities in HIV diagnosis and care among migrants in Catalonia. Targeted interventions addressed to specific subgroups in the migrant population are needed.

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Auditory sensitivity exhibits sexual dimorphism and seasonal plasticity in music frogs

Abstract

Seasonal changes in the structure and function of the vertebrate brain have been described in many species, particularly in seasonal breeders. However, it remains unclear whether sexual dimorphism varies between breeding seasons for specific brain regions. Auditory event-related potential (ERP) changes were evaluated in the Emei music frog (Babina daunchina) to assess sexual dimorphism and seasonal variations in auditory sensitivity. An acoustic playback experiment using an oddball paradigm design was conducted, in which two conspecific call types were used as deviant stimuli with synthesized white noise as standard stimulus. ERP components were analyzed for the telencephalon and mesencephalon of both sexes in the non-reproductive and reproductive states. Results show that auditory sensitivity is modulated by reproductive status, implying that seasonal plasticity is involved in auditory perception. Moreover, the amplitude of the N1 ERP component (mean amplitudes during the interval occurring 30–130 ms after stimulus onset) is higher in females for the telencephalon and higher in males for the mesencephalon, regardless of reproductive status and acoustic stimulus type. These results show that auditory ERP responses for specific brain regions exhibit sexual dimorphism in the absence of exogenous sexual stimulation during both the two reproductive states in the music frog.

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Frequency of medication error in pediatric anesthesia: A systematic review and meta‐analytic estimate

Pediatric Anesthesia, EarlyView.


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Enrollment challenges in multicenter, international studies: The example of the GAS trial

Pediatric Anesthesia, EarlyView.


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The power of N‐PASS, aEEG, and BIS in detecting different levels of sedation in neonates: A preliminary study

Pediatric Anesthesia, EarlyView.


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Performance of blow‐by methods in delivering oxygen to pediatric patients during transport: A laboratory study

Pediatric Anesthesia, EarlyView.


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A retrospective comparison of propofol to dexmedetomidine for pediatric magnetic resonance imaging sedation in patients with mucopolysaccharidosis type II

Pediatric Anesthesia, EarlyView.


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Anesthetic considerations for magnetic resonance imaging‐guided right‐heart catheterization in pediatric patients: A single institution experience

Pediatric Anesthesia, EarlyView.


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Analgesic effectiveness, pharmacokinetics, and safety of a paracetamol/ibuprofen fixed‐dose combination in children undergoing adenotonsillectomy: A randomized, single‐blind, parallel group trial

Pediatric Anesthesia, EarlyView.


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Challenges and hurdles for patient safety in obstetric anesthesia in Japan

Abstract

The use of pain relief for labor has gained popularity in Japan. However, its acceptance is still low among laboring women: only 6.1% of Japanese parturients receive labor analgesia, in contrast with the United States, where approximately 70% receive labor analgesia. Unfortunately, several maternal deaths associated with labor analgesia have been reported in recent years in Japan and how to achieve safer obstetric care is a pressing concern. In this review, we focus on current approaches to labor analgesia in the United States as they compare to existing practices in Japan. We discuss challenges for the introduction and implementation of standard anesthesia practice into the Labor and Delivery Room (LDR; i.e., labor and delivery ward), aiming to secure safety for both mothers and fetus in every part of Japan in the near future.

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A retrospective observational study of acquired subglottic stenosis using low‐pressure, high‐volume cuffed endotracheal tubes

Pediatric Anesthesia, EarlyView.


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Study of QTLs linked to awn length and their relationships with chloroplasts under control and saline environments in bread wheat

Abstract

Introduction

Some studies in wheat showed that awns may have a useful effect on yield, especially under drought stress. Up to this time few researches has identified the awn length QTLs with different effect in salinity stress.

Objective

The primary objective of this study was to examine the additive (a) and the epistatic (aa) QTLs involve in wheat awns length in control and saline environments.

Methods

A F7 RIL population consisting of 319 sister lines, derived from a cross between wheat cultivars Roshan and Falat (seri82), and the two parents were grown in two environments (control and Saline) based on an alpha lattice design with two replications in each environment. At flowering, awn length was measured for each line. For QTL analysis, the linkage map of the ''Roshan × Falat'' population was used, which included 748 markers including 719 DArT, 29 simple sequenced repeats (SSRs). Additive and pleiotropic QTLs were identified. In order to reveal the relationship between the identified QTL for awns length and the role of the gene or genes that it expresses, the awns length locus location and characteristics of its related CDS, gene, UTRs, ORF, exons and Introns were studied using ensemble plant (http://plants.ensembl.org/Triticum_aestivum). Furthermore, the promoter analysis has been done using NSITE-PL.

Results

We identified 6 additive QTLs for awn length by QTL Cartographer program using single-environment phenotypical values. Also, we detected three additive and two epistatic QTLs for awn length by the QTLNetwork program using multi-environment phenotypical values. Our results showed that none of the additive and epistatic QTLs had interactions with environment. One of the additive QTLs located on chromosome 4A was co-located with QTLs for number of sterile spikelet per spike in both environment and number of seed per spike in control environment.

Coclusion

Studies of the locus linked to the awns length QTL revealed the role of awn and its chloroplasts in grain filing during abiotic stress could be enhanced by over expression of some genes like GTP-Binding proteins which are enriched in chloroplasts encoded by genes included wPt-5730 locus.

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Effect of partial head extension swallowing exercise on the strength of the suprahyoid and tongue muscles in healthy subjects: A feasibility study

Journal of Oral Rehabilitation, Volume 0, Issue ja, -Not available-.


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Issue Information

Journal of Oral Rehabilitation, Volume 45, Issue 12, Page ii-iv, December 2018.


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Cover Image

Journal of Oral Rehabilitation, Volume 45, Issue 12, Page i-i, December 2018.


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Bruxism—What is missing in the new consensus definition?

Journal of Oral Rehabilitation, Volume 45, Issue 12, Page 921-921, December 2018.


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How to label bruxism that is a sign of a disorder? That's the question! Response to letter by Meira e Cruz & Ettlin (2018)

Journal of Oral Rehabilitation, Volume 45, Issue 12, Page 922-923, December 2018.


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Tongue pressure distribution of individual normal occlusions and exploration of related factors

Journal of Oral Rehabilitation, Volume 0, Issue ja, -Not available-.


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Organ blood flow and O2 transport during hypothermia (27°C) and rewarming in a pig model

Experimental Physiology, Volume 0, Issue ja, -Not available-.


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Carotid bodies contribute to sympathoexcitation induced by acute salt overload

Experimental Physiology, Volume 0, Issue ja, -Not available-.


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Acknowledgement to Referees

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Genetics of anophthalmia and microphthalmia. Part 2: Syndromes associated with anophthalmia–microphthalmia

Abstract

As new genes for A/M are identified in the genomic era, the number of syndromes associated with A/M has greatly expanded. In this review, we provide a brief synopsis of the clinical presentation and molecular genetic etiology of previously characterized pathways involved in A/M, including the Sex-determining region Y-box 2 (SOX2), Orthodenticle Homeobox 2 (OTX2) and Paired box protein-6 (PAX6) genes, and the Stimulated by retinoic acid gene 6 homolog (STRA6), Aldehyde Dehydrogenase 1 Family Member A3 (ALDH1A3), and RA Receptor Beta (RARβ) genes that are involved in retinoic acid synthesis. Less common genetic causes of A/M, including genes involved in BMP signaling [Bone Morphogenetic Protein 4 (BMP4), Bone Morphogenetic Protein 7 (BMP7) and SPARC-related modular calcium-binding protein 1 (SMOC1)], genes involved in the mitochondrial respiratory chain complex [Holocytochrome c-type synthase (HCCS), Cytochrome C Oxidase Subunit 7B (COX7B), and NADH:Ubiquinone Oxidoreductase subunit B11 (NDUFB11)], the BCL-6 corepressor gene (BCOR), Yes-Associated Protein 1 (YAP1) and Transcription Factor AP-2 Alpha (TFAP2α), are more briefly discussed. We also review several recently described genes and pathways associated with A/M, including Smoothened (SMO) that is involved in Sonic hedgehog (SHH) signaling, Structural maintenance of chromosomes flexible hinge domain containing 1 (SMCHD1) and Solute carrier family 25 member 24 (SLC25A24), emphasizing phenotype–genotype correlations and shared pathways where relevant.

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Complex Neurobehavioral Testing of a Rat Model of the Irritable Bowel Syndrome

In albino Wistar rats, the irritable bowel syndrome (IBS) was induced by chronic restraint stress (restriction of the animals in plastic containers, 6 h per day during 7 days). In the Y-like maze, IBS rats demonstrated smaller numbers of spontaneous alternations (indices of immediate spatial memory; P < 0.05) than control animals. In the elevated plus maze, IBS rats showed a significantly reduced time spent in the open arms (P < 0.03) compared to the controls, suggesting anxiety-like effects. Moreover, episodes of stretching in this maze were more numerous in the IBS group (P < 0.05), also suggesting anxiogenic effects. Some depression-like behavior of IBS rats was observed in the forced swimming test, as was demonstrated by a significantly shorter mobility time, as compared to the control group (P < 0.05). In the radial 8-arm maze, however, chronic stress-induced IBS did not significantly affect the number of reference memory errors and time necessary for completing the task. Still, some working memory deficit was observed in the IBS group in this test, as the number of the respective errors was significantly greater (P < 0.05) in such rats vs. controls within some time intervals. In the open field test, suppression of locomotor activity (reduced number of square crossings), significantly increased number of rearings (suggesting higher anxiety), and altered fecal elimination in the IBS group were obvious (P < 0.05). Also, an increased time of grooming was observed in IBS rats in the above test (characterizing a higher anxiety level in the stress-exposed IBS group). When zoosocial behavior was tested in a three-chambered apparatus (10-min-long period of testing), rats of the IBS group spent significantly more time in the empty compartment (without a stranger rat) and less time in the compartment with a conspecific of the same age and weight (P < 0.01), which indicates decreased social motivation in the IBS group. Our results suggest that the aforementioned chronic stress-induced IBS model results in increased anxiety, depression, and suppressed social behavior. The IBS affects immediate and working memory (with nearly no effect, however, on reference memory).

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Correction to: Event-Related EEG Synchronization/Desynchronization under Conditions of Cessation and Switching over of the Programs of Manual Movements in Men

There was an error in transliteration of the name of one of the co-authors; the correct name is O. V. Korzhyk.

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Correction to: Parameters of Components N2 and P3 of the Auditory Cognitive Evoked Potentials in Musicians and Non-musicians

There was an error in the initials of one of the co-authors; the correct version is T. V. Kutsenko.

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Effects of Crocins in the Management of Neurodegenerative Pathologies: A Review

Flavonoids, in particular crocins (active compounds of Crocus and Gardenia), have been extensively used in traditional medicine and been proposed to be effective in the management of various diseases, including neurodegenerative problems. Antiepileptic and anti-Alzheimer effects of crocins have been demonstrated. The efficacy of crocins in the treatment of cerebral ischemia and traumatic brain injury was also confirmed in experimental animal studies. Treatment with crocins increased dopamine levels in the brain of an experimental model of Parkinson's disease. In addition, crocins modulate the opioid system and decrease the withdrawal syndrome. The review of the respective publications indicates that crocins can be considered effective auxiliary agents in the management of neurobiological diseases, mostly due to their antioxidant and anti-inflammatory effects.

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Identification of forearm skin zones with similar muscle activation patterns during activities of daily living

A deeper knowledge of the activity of the forearm muscles during activities of daily living (ADL) could help to better understand the role of those muscles and allow clinicians to treat motor dysfunctions more...

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Exploiting the heightened phase synchrony in patients with neuromuscular disease for the establishment of efficient motor imagery BCIs

Phase synchrony has extensively been studied for understanding neural coordination in health and disease. There are a few studies concerning the implications in the context of BCIs, but its potential for estab...

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Phenomic Selection Is a Low-Cost and High-Throughput Method Based on Indirect Predictions: Proof of Concept on Wheat and Poplar

Genomic selection - the prediction of breeding values using DNA polymorphisms - is a disruptive method that has widely been adopted by animal and plant breeders to increase productivity. It was recently shown that other sources of molecular variations such as those resulting from transcripts or metabolites could be used to accurately predict complex traits. These endophenotypes have the advantage of capturing the expressed genotypes and consequently the complex regulatory networks that occur in the different layers between the genome and the phenotype. However, obtaining such omics data at very large scales, such as those typically experienced in breeding, remains challenging. As an alternative, we proposed using near-infrared spectroscopy (NIRS) as a high-throughput, low cost and non-destructive tool to indirectly capture endophenotypic variants and compute relationship matrices for predicting complex traits, and coined this new approach "phenomic selection" (PS). We tested PS on two species of economic interest (Triticum aestivum L. and Populus nigra L.) using NIRS on various tissues (grains, leaves, wood). We showed that one could reach predictions as accurate as with molecular markers, for developmental, tolerance and productivity traits, even in environments radically different from the one in which NIRS were collected. Our work constitutes a proof of concept and provides new perspectives for the breeding community, as PS is theoretically applicable to any organism at low cost and does not require any molecular information.

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Training Population Optimization for Prediction of Cassava Brown Streak Disease Resistance in West African Clones

Cassava production in the central, southern and eastern parts of Africa is under threat by cassava brown streak virus (CBSV). Yield losses of up to 100% occur in cases of severe infections of edible roots. Easy illegal movement of planting materials across African countries, and long-range movement of the virus vector (Bemisia tabaci) may facilitate spread of CBSV to West Africa. Thus, effort to pre-emptively breed for CBSD resistance in W. Africa is critical. Genomic selection (GS) has become the main approach for cassava breeding, as costs of genotyping per sample have declined. Using phenotypic and genotypic data (genotyping-by-sequencing), followed by imputation to whole genome sequence (WGS) for 922 clones from National Crops Resources Research Institute, Namulonge, Uganda as a training population (TP), we predicted CBSD symptoms for 35 genotyped W. African clones, evaluated in Uganda. The highest prediction accuracy (r = 0.44) was observed for cassava brown streak disease severity scored at three months (CBSD3s) in the W. African clones using WGS-imputed markers. Optimized TPs gave higher prediction accuracies for CBSD3s and CBSD6s than random TPs of the same size. Inclusion of CBSD QTL chromosome markers as kernels, increased prediction accuracies for CBSD3s and CBSD6s. Similarly, WGS imputation of markers increased prediction accuracies for CBSD3s and for cassava brown streak disease root severity (CBSDRs), but not for CBSD6s. Based on these results we recommend TP optimization, inclusion of CBSD QTL markers in genomic prediction models, and the use of high-density (WGS-imputed) markers for CBSD predictions across population.

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Coronary flow reserve in patients with Primary Biliary Cholangitis

It is still not clear whether primary biliary cholangitis (PBC) is associated with abnormalities of the cardiovascular system. We aimed to assess the relationship between PBC and coronary flow reserve (CFR).

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ERECTILE DYSFUNCTION IN COMPENSATED LIVER CIRRHOSIS

Data on erectile dysfunction (ED) in cirrhotic patients are limited as yet. Aim of this study was to investigate the prevalence of ED and the factors potentially involved in its development in compensated cirrhosis.

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Simulation-based mastery learning significantly reduces gender differences on the Fundamentals of Endoscopic Surgery performance exam

Abstract

Background

Analysis of the Fundamentals of Endoscopic Surgery (FES) performance exam showed higher scores for men than women. Gender differences have been reduced with task-specific practice. We assessed the effect of simulation-based mastery learning (SBML) on FES performance exam differences by gender.

Methods

Forty-seven surgical trainees [29 men (m), 18 women (w)] completed a SBML curriculum and were assessed by FES. Fourteen trained on the GI Mentor 2, 18 on the Endoscopy Training System, and 15 using the Surgical Training for Endoscopic Proficiency curriculum. Performance of male and female trainees was compared.

Results

On the pre-training assessment, there were large differences between genders in FES pass rates (m 77%, w 15%, p < 0.001), total scores (m 69 ± 11, w 50 ± 12; p < 0.001), and in four of five FES sub-task scores (Navigation, m 73 ± 19, w 55 ± 22, p = 0.02; Loop reduction, m 34 ± 29, w 14 ± 22, p = 0.02; Retroflexion, m 81 ± 17, w 47 ± 27, p < 0.001; Targeting, m 89 ± 10, w 66 ± 23, p = 0.002). No differences were discernible post training (Pass rate, m 100%, w 94%, p = 0.4; Total score, m 77 ± 8, w 72 ± 12, p = 0.2; Navigation, m 91 ± 13, w 80 ± 13, p = 0.009; Loop reduction, m 49 ± 26, w 46 ± 36, p = 0.7; Retroflexion, m 82 ± 18, w 81 ± 15, p = 0.9; Targeting, m 92 ± 15, w 86 ± 12, p = 0.12). Time needed to complete curricula was not discernably different by gender (m 3.8 ± 1.7 h, w 5.0 ± 2.6 h, p = 0.17).

Conclusions

Gender-based differences are nearly eliminated through task-specific SBML training. This lends further evidence to the validity argument for the FES performance exam as a measure of basic endoscopic skills.

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The American Association for the Surgery of Trauma Emergency General Surgery Anatomic Severity Scoring System as a predictor of cost in appendicitis

Abstract

Background

The World Society for Emergency Surgery determined that for appendicitis managed with appendectomy, there is a paucity of evidence evaluating costs with respect to disease severity. The American Association for the Surgery of Trauma (AAST) disease severity grading system is valid and generalizable for appendicitis. We aimed to evaluate hospitalization costs incurred by patients with increasing disease severity as defined by the AAST. We hypothesized that increasing disease severity would be associated with greater cost.

Methods

Single-institution review of adults (≥ 18 years old) undergoing appendectomy for acute appendicitis during 2010–2016. Demographics, comorbidities, operative details, hospital stay, complications, and institutional cost data were collected. AAST grades were assigned by two independent reviewers based on operative findings. Total cost was ascertained from billing data and normalized to median grade I cost. Non-parametric linear regression was utilized to assess the association of several covariates and cost.

Results

Evaluated patients (n = 1187) had a median [interquartile range] age of 37 [26–55] and 45% (n = 542) were female. There were 747 (63%) patients with Grade I disease, 219 (19%) with Grade II, 126 (11%) with Grade III, 50 (4%) with Grade IV, and 45 (4%) with Grade V. The median normalized cost of hospitalization was 1 [0.9–1.2]. Increasing AAST grade was associated with increasing cost (ρ = 0.39; p < 0.0001). Length of stay exhibited the strongest association with cost (ρ = 0.5; p < 0.0001), followed by AAST grade (ρ = 0.39), Clavien–Dindo Index (ρ = 0.37; p < 0.0001), age-adjusted Charlson score (ρ = 0.31; p < 0.0001), and surgical wound classification (ρ = 0.3; p < 0.0001).

Conclusions

Increasing anatomic severity, as defined by AAST grade, is associated with increasing cost of hospitalization and clinical outcomes. The AAST grade compares favorably to other predictors of cost. Future analyses evaluating appendicitis reimbursement stand to benefit from utilization of the AAST grade.

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Laparoscopic versus open emergent ventral hernia repair: utilization and outcomes analysis using the ACSNSQIP database

Abstract

Introduction

Laparoscopic ventral hernia repair (VHR) is associated with decreased morbidity and shorter length of stay (LOS) when compared to open VHR. Despite evidence of the benefits of laparoscopy, its utilization in VHR has lagged behind that of other complex surgical procedures. We hypothesized that utilization is further reduced in emergency cases. The aim of this study was to evaluate the utilization of laparoscopy in emergent VHR and to assess 30-day outcomes for patients undergoing laparoscopic emergent ventral hernia repair (LEVHR) versus open emergent ventral hernia repair (OEVHR).

Methods

We used the ACS-NSQIP database for years 2006–2015 to compare LEVHR versus OEVHR. Inclusion required two factors: (1) classification as an emergency case and (2) primary procedure documented as laparoscopic or open repair of incarcerated umbilical, ventral, or incisional hernia. LOS and 30-day morbidity and mortality were assessed.

Results

A total of 13,126 patients underwent emergent repair of initial or recurrent umbilical, ventral, or incisional hernia. 1130 (8.6%) underwent LEVHR repair and 11,996 (91.4%) underwent OEVHR. Patient demographic data display a trend toward decreased utilization of laparoscopy in patients with more significant comorbidities. LEVHR was associated with decreased operative time and postoperative LOS. LEVHR was associated with decreased superficial surgical site infection (SSI), deep SSI, and 30-day mortality. Subgroup analysis displays decreased incidence of superficial SSI, deep SSI, wound disruption, pneumonia, and postoperative sepsis for patients ASA1-3 undergoing LEVHR versus OEVHR.

Conclusion

Utilization of laparoscopy in VHR is low in emergency cases. Patients who did undergo LEVHR had decreased postoperative LOS and decreased infectious and wound-related morbidity. Increased utilization in emergency VHR could significantly improve patient outcomes. Further study is warranted.

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Laparoscopic right hemicolectomy with CME: standardization using the “critical view” concept

Abstract

Background

Complete mesocolic excision is gradually becoming an established oncologic surgical principle for right hemicolectomy. However, the procedure is technically demanding and carries the risk of serious complications, especially when performed laparoscopically. A standardized procedure that minimizes technical hazards and facilitates teaching is, therefore, highly desirable.

Methods

An expert group of surgeons and one anatomist met three times. The initial aim was to achieve consensus about the surgical anatomy before agreeing on a sequence for dissection in laparoscopic CME. This proposal was evaluated and discussed in an anatomy workshop using post-mortem body donors along with videos of process-informed procedures, leading to a definite consensus.

Results

In order to provide a clear picture of the surgical anatomy, the "open book" model was developed, consisting of symbolic pages representing the corresponding dissection planes (retroperitoneal, ileocolic, transverse mesocolic, and mesogastric), vascular relations, and radicality criteria. The description of the procedure is based on eight preparative milestones, which all serve as critical views of safety. The chosen sequence of the milestones was designed to maximize control during central vascular dissection. Failure to reach any of the critical views should alert the surgeon to a possible incorrect dissection and to consider converting to an open procedure.

Conclusion

Combining the open-book anatomical model with a clearly structured dissection sequence, using critical views as safety checkpoints, may provide a safe and efficient platform for teaching laparoscopic right hemicolectomy with CME.

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Canadian general surgery residents’ need formal curricula and objective performance assessments in gastrointestinal endoscopy training: a program director census

Abstract

Introduction

Methods of developing and determining General Surgery (GS) residents' competency in gastrointestinal endoscopy in Canada are not currently standardized. This study aimed to assess the status of gastrointestinal endoscopy training in Royal College of Physicians and Surgeons of Canada (RCPSC) GS residency programs.

Methods

A 35-question survey was developed using GS gastrointestinal endoscopy curricula guidelines. All 17 RCPSC GS program directors were contacted to complete the questionnaire via the web-based SurveyMonkey.ca® platform.

Results

All 17 program directors completed the survey (100% response rate). Program demographics Sixteen programs reported having dedicated endoscopy rotations with a mean duration of 2.8 months (range 0–4, SD 1.1). Upon completion of dedicated endoscopy rotations, four programs (25%) reported having formal skills assessments and three (18.8%) reported formal knowledge examinations. All programs required endoscopy procedures be logged throughout residency, but only three (21.4%) included quality indicators. Only one program required residents to obtain Fundamentals of Endoscopic Surgery certification. Program outcomes The reported estimated mean number of procedures during residents' endoscopy rotations was 82 (range 10–150, standard deviation 33.6) gastroscopies and 156 (40–350, 76.3) colonoscopies. The mean number of procedures during residents' entire residencies was 150 (20–400, 98.6) gastroscopies and 241 (50–500, 76.3) colonoscopies. The number of months of dedicated endoscopy training significantly correlated with the total estimated number of endoscopic procedures performed (ρ = 0.67, p = 0.02). Eleven program directors (73.3%) believed residents were prepared for independent endoscopy practice, while four disagreed (26.7%). Program directors' perceptions of residents' preparedness were significantly correlated with the number of endoscopic procedures performed by residents (p < 0.01) but not the robustness of the endoscopy curriculum (p = 0.72).

Conclusion

Endoscopy training in RCPSC GS residency programs is highly variable. Program directors' perceptions of residents' competency appear to be significantly correlated with procedure numbers and few have adopted formal curricula and performance assessments.

Visual abstract

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Laparoscopic extended liver resection: are postoperative outcomes different?

Abstract

Background

Although laparoscopic major hepatectomy (LMH) is becoming increasingly common in specialized centers, data regarding laparoscopic extended major hepatectomies (LEMH) and their outcomes are limited. The aim of this study was to compare the perioperative characteristics and postoperative outcomes of LEMH to standard LMH.

Methods

All patients who underwent purely laparoscopic anatomical right or left hepatectomy and right or left trisectionectomy between February 1998 and January 2016 are enrolled. Demographic, clinicopathological, and perioperative factors were collected prospectively and analyzed retrospectively. Perioperative characteristics and postoperative outcomes in LEMH were compared to those of standard LMH.

Results

Among 195 patients with LMH, 47 (24.1%) underwent LEMH, colorectal liver metastases representing 66.7% of all indications. Preoperative portal vein embolization was undertaken in 31 (15.9%) patients. Despite more frequent vascular clamping, blood loss was higher in LEMH group (400 vs. 214 ml; p = 0.006). However, there was no difference in intraoperative transfusion requirements. Thirty-one patients experienced liver failure with no differences between LMH and LEMH groups. Postoperative mortality was comparable in the two groups [3 (2.5%) LMH patients vs. 2 (5%) LEMH patients (p = 0.388)]. Overall morbidity was higher in the LEMH group [49 LMH patients (41.5%) vs. 24 LEMH patients (60%) (p = 0.052)]. Patients treated with left LEMH experienced more biliary leakage (p = 0.011) and more major pulmonary complications (p = 0.015) than left LMH.

Conclusion

LEMH is feasible at the price of important morbidity, with manageable and acceptable outcomes. These exigent procedures require high-volume centers with experienced surgeons.

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Minimally invasive surgery techniques in pelvic exenteration: a systematic and meta-analysis review

Abstract

Background

Pelvic exenteration is potentially curative for locally advanced and recurrent pelvic cancers. Evolving technology has facilitated the use of minimally invasive surgical (MIS) techniques in selected cases. We aimed to compare outcomes between open and MIS pelvic exenteration.

Methods

A review of comparative studies was performed. Firstly, we evaluated the differences in surgical techniques with respect to operative time, blood loss, and margin status. Secondly, we assessed differences in 30-day morbidity and mortality rates, and length of hospital stay.

Results

Four studies that directly compared open and MIS exenteration were included. Analysis was performed on 170 patients; 78.1% (n = 133) had open pelvic exenteration, while 21.8% (n = 37) had a MIS exenteration. The median age for open exenteration was 57.7 years versus 63 years for MIS exenteration. Even though the operative time for MIS exenteration was 83 min longer (p < 0.001), it was associated with a median of 1,750mls less blood loss. The morbidity rate for MIS exenterative group was 56.7% (n = 21/37) versus 88.5% (n = 85/96) in the open exenteration group, with pooled analysis observing a 1.17 relative risk increase in 30-day morbidity (p = 0.172) in the open exenteration group. In addition, the MIS cohort had a 6-day shorter length of hospital stay (p = 0.04).

Conclusion

MIS exenteration can be performed in highly selective cases, where there is favourable patient anatomy and tumour characteristics. When feasible, it is associated with reduced intra-operative blood loss, shorter length of hospital stay, and reduced morbidity.

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