From Foundation to Demolition: The Influence of Perioperative Tranexamic Acid

No abstract available

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The Impact of Prehospital Tranexamic Acid on Blood Coagulation in Trauma Patients

BACKGROUND: There is limited data on prehospital administration of tranexamic acid (TXA) in civilian trauma. The aim of this study was to evaluate changes in coagulation after severe trauma from on-scene to the hospital after TXA application in comparison to a previous study without TXA. METHODS: The study protocol was registered at ClinicalTrials.gov (NCT02354885). A prospective, multicenter, observational study investigating coagulation status in 70 trauma patients receiving TXA (1 g intravenously) on-scene versus a control group of 38 patients previously published without TXA. To account for potential differences in patient and trauma epidemiology, crystalloid and colloidal resuscitation fluid, 2 propensity score matched groups (n = 24 per group) were created. Measurements included ROTEM, standard coagulation tests and blood gas analyses on-scene and emergency department admission. Presented values are mean and [standard deviation], and difference in means and 95% confidence intervals. RESULTS: Patient epidemiology was not different between groups. Coagulation assays on-scene were comparable between the TXA and C. Prehospital hyperfibrinolysis was blunted in all 4 patients in the TXA group. Viscoelastic FIBTEM maximum clot firmness (MCF), representing functional fibrinogen levels, did not change from on-scene to the emergency department in the TXA group, whereas MCF decreased −3.7 [1.8] mm in the control group. Decrease of MCF was significantly reduced in the TXA group in EXTEM by 9.2 (7.2–11.2) mm (P

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A Tale of Two Solutions: High vs Low-Chloride Intravenous Fluids

No abstract available

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

BACKGROUND: To assess whether use of low-chloride solutions in unselected critically ill or perioperative adult patients for maintenance or resuscitation reduces mortality and renal replacement therapy (RRT) use when compared to high-chloride fluids. METHODS: Systematic review and meta-analysis with random-effects inverse variance model. PubMed, Cochrane library, EMBASE, LILACS, and Web of Science were searched from inception to October 2016. Published and unpublished randomized controlled trials in any language that enrolled critically ill and/or perioperative adult patients and compared a low- to a highchloride solution for volume maintenance or resuscitation. The primary outcomes were mortality and RRT use. We conducted trial sequential analyses and assessed risk of bias of individual trials and the overall quality of evidence. Fifteen trials with 4067 patients, most at low risk of bias, were identified. Of those, only 11 and 10 trials had data on mortality and RRT use, respectively. A total of 3710 patients were included in the mortality analysis and 3724 in the RRT analysis. RESULTS: No statistically significant impact on mortality (odds ratio, 0.90; 95% confidence interval, 0.69–1.17; P = .44; I2 = 0%) or RRT use (odds ratio, 1.12; 95% confidence interval, 0.80–1.58; P = .52; I2 = 0%) was found. Overall quality of evidence was low for both primary outcomes. Trial sequential analyses highlighted that the sample size needed was much larger than that available for properly powered outcome assessment. CONCLUSIONS: The current evidence on low- versus high-chloride solutions for unselected critically ill or perioperative adult patients demonstrates no benefit, but suffers from considerable imprecision. We noted a limited exposure volume for study fluids and a relatively low risk of the populations in each study. Together with the relatively small pooled sample size, these data leave us underpowered to detect potentially important differences. Results from well-conducted, adequately powered randomized controlled trials examining sufficiently large fluid exposure are necessary.

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Brain Monitoring and the Depth of Anesthesia: Another Goldilocks Dilemma

No abstract available

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Sleep Interventions Designed to Improve Athletic Performance and Recovery: A Systematic Review of Current Approaches

Abstract

Background

Athletes experience various situations and conditions that can interfere with their sleep, which is crucial for optimal psychological and physiological recovery as well as subsequent performance. Conventional sleep screening and intervention approaches may not be efficacious for athletes given their lifestyle, the demands of training and travel associated with interstate/international competition.

Objectives

The present systematic review aimed to summarize and evaluate sleep intervention studies targeting subsequent performance and recovery in competitive athletes. Based on the findings, a secondary aim was to outline a possible sleep intervention for athletes, including recommendations for content, mode of delivery and evaluation.

Methods

A systematic review was conducted based on the PRISMA guidelines in May 2016 with an update completed in September 2017. Ten studies met our inclusion criteria comprising a total of 218 participants in the age range of 18–24 years with athletes from various sports (e.g., swimming, soccer, basketball, tennis). A modified version of the quality assessment scale developed by Abernethy and Bleakley was used to evaluate the quality of the studies.

Results

The included studies implemented several sleep interventions, including sleep extension and napping, sleep hygiene, and post-exercise recovery strategies. Evidence suggests that sleep extension had the most beneficial effects on subsequent performance. Consistent with previous research, these results suggest that sleep plays an important role in some, but not all, aspects of athletes' performance and recovery.

Conclusion

Future researchers should aim to conduct sleep interventions among different athlete populations, compare results, and further establish guidelines and intervention tools for athletes to address their specific sleep demands and disturbances.

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Refractory Heartburn: A Challenging Problem in Clinical Practice

Abstract

Gastroesophageal reflux disease (GERD) is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Heartburn and regurgitation are the typical symptoms of GERD. The treatment of GERD encompasses lifestyle modifications, pharmacological, endoscopic, and surgical therapy. The majority of the patients respond to 4–8 weeks of proton-pump inhibitors therapy, but 20–42% will demonstrate partial or complete lack of response to treatment. While these patients have been considered as having refractory heartburn, a subset of them does not have GERD or have not been adequately treated. The main causes of refractory heartburn include: poor compliance; inadequate proton-pump inhibitors dosage; incorrect diagnosis; comorbidities; genotypic differences; residual gastroesophageal reflux; eosinophilic esophagitis and others. Treatment is commonly directed toward the underlying cause of patients' refractory heartburn.

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Traumatic ulcerative granuloma with stromal eosinophilia: Review of the literature and case report

Olujide Soyele, Olufunlola Adesina, Adeola Ladeji, Kanmi Kuye, Foluso Owotade

African Journal of Medical and Health Sciences 2017 16(2):115-119

Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is an ulcerative condition of the oral mucosa with a chronic course and delayed healing. It is a reactive lesion that commonly affects the tongue. TUGSE is a relatively uncommon mucosal lesion that presents as an ulcer or an indurated submucosal mass and may cause diagnostic dilemma for the dental surgeon as it mimics a traumatic or neoplastic ulcer the pathogenesis of this lesion is obscure; however, chronic irritation from traumatic agents is considered to be a major initiating factor. The lesion is also known to undergo resolution following incisional biopsy. Histopathologically, it is characterized by eosinophilic inflammatory infiltrate penetrating into the underlying muscle. It is important to recognize this mucosal lesion as it mimics malignant ulcers and other ulcerative conditions of the oral cavity; however, the condition tends to resolve on its own. The lesion is also known to undergo resolution following incisional biopsy. Immunohistochemical positivity to CD30 found in nonneoplastic cutaneous conditions rich in neutrophils and eosinophils suggest CD30 cells as components of a reactive process. This is a review and report of a 37-year-old Nigerian woman who with an ulceroproliferative growth in the left side of the mouth. The aim of this article is to describe the presentation of TUGSE so as to enhance prompt diagnosis and rule lesions such as traumatic ulcer or squamous cell carcinoma of the tongue that may present in a similar way.

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Salt abrasion: Is it possible?

Treville Pereira

African Journal of Medical and Health Sciences 2017 16(2):129-130

Abrasion is the physical wearing of a tooth surface which can involve the presence of a foreign object repeatedly being in contact with the tooth. A 58-year-old male patient patient visited the dental clinic with discolored teeth. A detailed history revealed that the patient used mishiri mixed with powdered rock salt to brush his teeth daily which had severely abraded his teeth. Conditions such as abrasion may need active restorations. A general dental practitioner should be able to accurately identify the cause and treat the aesthetic and functional impairment as required.

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Framingham risk assessment of metabolic syndrome patients at a tertiary hospital in Nigeria

Ifeyinwa Dorothy Osegbe, Adeyemi Dada, Oyetunji Soriyan

African Journal of Medical and Health Sciences 2017 16(2):89-93

Background: Cardiovascular disease (CVD) is an increasingly important cause of morbidity and mortality worldwide. Combination of risk factors for CVD can be seen in the metabolic syndrome (MS), which can be computed to get an assessment of an individual's risk for future cardiovascular events. Aims: We aimed to determine the Framingham risk assessment of MS patients at the Lagos University Teaching Hospital, Nigeria. Materials and Methods: This was a cross-sectional study of newly diagnosed patients with MS using the International Diabetes Federation criteria. Anthropometry and clinical data were obtained, and fasting blood glucose and lipid concentrations were also determined. Framingham risk assessment was calculated and categorized as <10%: low risk, 10–20%: intermediate risk, and >20%: high risk for future CVD. Results: There were 120 patients (females 82, males 38) with mean ages of 52 ± 13.5 years and 54 ± 14.2 years, respectively (P = 0.46). Framingham risk assessment showed 56 (47%) patients comprising of 42 females and 14 males had low risk; 31 (26%) patients comprising of 24 females and 7 males had intermediate risk while 32 (27%) patients comprising of 16 females and 16 males had high risk for CVD. The risk assessment significantly correlated with age, systolic blood pressure, and total and high-density lipoprotein-cholesterol (P < 0.05). Conclusion: Majority of the males had high 10-year risk for CVD while most of the females had low risk. Men may need to intensify strategies to reduce modifiable risk factors for CVD.

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A case report of significant congenital depressed skull fracture after cesarean section delivery

Alemayehu Mekonnen Gezmu, Loeto Mazhani

African Journal of Medical and Health Sciences 2017 16(2):123-125

We report a case of depressed skull fracture in an hour old newborn delivered by cesarean section for breech presentation. The depression was surgically corrected as a spontaneous resolution did not occur after some interval. Surgical correction of depressed skull fracture may be indicated depending on the depth of depression and thickness of the bone at involved part of the skull.

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Predictive significance of low maternal serum cholesterol concentrations in early pregnancy on low birth weight in term neonates

Kehinde Sharafadeen Okunade, Ayodeji Ayotunde Oluwole

African Journal of Medical and Health Sciences 2017 16(2):94-98

Background: Low- birthweight (LBW) is the single most powerful predictor of mortality in the first few months of life, especially in most developing countries. The physiologic hypercholesterolemia of later pregnancy suggests an adaptive function for pregnancy maintenance or fetal growth. Decreased levels of maternal total cholesterol have been reported in association with intrauterine growth restriction. Aim: The aim of this study is to assess the association between low maternal serum cholesterol during early pregnancy and LBW in term neonates. Patients and Methods: This was a prospective cohort study in which eligible participants were enrolled at the gestational age of 14–20 weeks over a period of 12 months. Blood samples were taken to measure the total serum cholesterol concentrations, and the sera were then analyzed enzymatically by the cholesterol oxidase: p-aminophenazone method. Association between low maternal serum cholesterol and LBW was tested by using Chi-square. All significances are reported at P < 0.05. Results: The present study showed an incidence of 13.4% for delivery of LBW babies in the low-risk study patients. LBW was 2.05 times more common with low total maternal cholesterol than with normal midrange maternal cholesterol levels (21.1% vs. 10.3%, P = 0.039). Conclusion: We can infer from the study that the low maternal serum cholesterol is associated with LBW in term neonates. We can, therefore, recommend that the concept of an optimal range for maternal serum cholesterol during pregnancy may have merit and pregnant women should be encouraged to follow a healthy, balanced diet, and ensure regular antenatal visit to their health-care provider.

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Clinical evaluation of acellular dermal matrix allograft (Alloderm®) with coronally advanced flap in the treatment of multiple gingival recessions: A clinical study

Gayathri Somasheker, Alampalli Viswanathamurthy Ramesh, K Roopa, Chinni Doraiswamy Dwarakanath

African Journal of Medical and Health Sciences 2017 16(2):81-88

Aims: The purpose of this study was to clinically evaluate the efficacy of Alloderm® with the coronally positioned flap in the treatment of multiple gingival recessions and to assess the esthetic and hypersensitivity evaluation from patient's perspective using visual analog scale (VAS). Subjects and Methods: A total of 10 systemically healthy male and female patients aged 18–50 years with Miller's class I and class II gingival recessions, who had dentin hypersensitivity and esthetic concern were selected for the study. Root coverage (RC) was done using coronally advanced flap with Alloderm®. Statistical Analysis: Descriptive statistical analysis was performed in the present study. Significance was assessed at 5% level of significance. Student's t-test was conducted to find the pairwise significance of the study parameters. Wilcoxon signed-rank test was used to find the significance of percentage of linear RC and percentage of volumetric RC (% of VRC) between 3 and 6 months. Results: A total 31 defects were treated with mean volumetric percentage RC (%RC) at 3 months of 35.21%. This remained the same at 6 months (P = 1.000). There was no statistically significant difference in the volumetric and Linear percentage of root coverage. Dentine hypersensitivity and esthetics were evaluated from patient's perspective using VAS ranging from a score of 0–10. Where 0 indicates very low and score of 10 indicates very high score. VAS indicated a decrease in the sensitivity after treatment. VAS mean score before treatment was 6.22 ± 0.83 with a mean score of 3.90, standard deviation (SD) of ± 1.37 after treatment and mean score of 5.10, SD of ± 0.57 for esthetic evaluation. Conclusions: The use of Alloderm® with coronally positioned flap provided a significant improvement in all the clinical parameters, but did not result in favorable outcome in terms of root coverage of facial gingival recessions of multiple adjacent teeth.

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Adverse drug event following self-medication among ambulatory care patients in a tertiary Hospital in Ebonyi State

Chihurumnanya Alo, Nneamaka Chikerenma Alo, Nnaemeka C Oguejiofor, Ifeyinwa Chizoba Akamike

African Journal of Medical and Health Sciences 2017 16(2):99-103

Background: An adverse drug event (ADE) is defined as any injury, including physical harm, mental harm, or loss of function due to medication. Little is known about ADEs in ambulatory care settings. Self-medication by definition is the practice of taking medicines by individuals to treat self-recognized symptoms or illness. Aim: The objective of this study was to find out the prevalence of ADEs that occurred as a result of self-medication among ambulatory care patients in our center. Methodology: A cross-sectional study where a paper-based, pretested, semi-structured interviewer administered questionnaire was used to gather information from 398 adult patients attending the general outpatient clinic of a tertiary hospital. Data analysis was performed using Epi Info 7 and all statistical significance was set at P < 0.05. Results: The study had 398 respondents of which 161 (40.45%) and 237 (59.55%) were males and females, respectively. Mean age and the standard deviation was 37.17 ± 14.91. The frequency of self-medication was 375 (89.7%) and the frequency of those who have had at least one episode of ADE following self-medication was 88 (22.11%). Females, (207) significantly practiced self-medication than males (150), Z = 4.19, confidence interval (8.45, 23.49), P = 0.00002. ADE following self-medication occurred more in females (50) than in males, (38) and was not associated with self-medication. The majority of the symptoms reported were itching (47.73%), blurring of vision (14.77%), and abdominal pain. Conclusion: ADEs happen following self-medication among ambulatory patients, especially in women and among the married.

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A rare case of thymic hyperplasia in a 6-month-old HIV-exposed infant with signs of airway compression

Alemayehu Gezmu

African Journal of Medical and Health Sciences 2017 16(2):120-122

This is report of a rare case of thymic hyperplasia in a 6-month-old female child with significant compression effect on the airways and shift of the mediastinum. Timely imaging study and tissue biopsy play an important role in identifying cause of anterior mediastinal mass in this age group.

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Microbial isolates from endoscopic middle meatal swab in patients with chronic rhinosinusitis in Kaduna, Nigeria

Emmanuel Musa, Aliyu Mohammed Kodiya, Abdullahi Musa Kirfi, Onyekwere George B. Nwaorgu

African Journal of Medical and Health Sciences 2017 16(2):104-108

Background: Chronic rhinosinusitis (CRS) is a common disease in otorhinolaryngologic practice. Traditionally, the standard criterion for isolation of pathogens in CRS is the nonendoscopic maxillary sinus puncture through invasive procedures with well-documented hazards. Objectives: To evaluate the pathogens associated with CRS in patients with CRS from endoscopically guided middle meatal swab. Methodology: A prospective cross-sectional study in which endoscopically guided middle meatal swab was aseptically taken from patients with diagnostic criteria of CRS and healthy volunteers. The samples were sent to the laboratory for qualitative and semi-quantitative analysis. Data collected were analyzed using the Statistical Package for the Social Sciences version 16 (SPSS Inc., 233 South Wacker Drive, Chicago, Illinois, USA). Results: A total of 110 microbial isolates were recovered from 82 (63.08%) of the 130 patients with CRS while 46 recorded among 54 (51.92%) of the 104 healthy volunteers. There were 74 (56.92%) bacterial growth out of which 55 (74.32%) were aerobic and 19 (25.68%) anaerobic isolates among the test participants with fungal growth seen in 36 (27.7%) of them while about 18% yielded a mixed growth of aerobic, anaerobic, and/or fungal isolates. Among the control group, however, the 54 people with positive isolates had 21 fungal and 25 aerobic bacteria. Conclusion: Mixed growth of aerobes, anaerobes, and fungal isolates was observed in patients with CRS. Endoscopically guided middle meatal swab is a safe and practical means for collecting samples for microbial culture.

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Impalement abdominal injury in a 6-year-old child

Chigbundu Collins Nwokoro, EA Emmanuel, OM Fatungase, BA Salami, IO Ogundele, LO Amosu

African Journal of Medical and Health Sciences 2017 16(2):126-128

Penetrating abdominal injuries in children usually result from accident or nonintentional means. They are not as common as in adults. Impalement abdominal injuries in children are very rare and have been scarcely reported in the literature. An impalement abdominal injury with a pencil in a child is an unusual event which requires reporting. This case report is on a 6-year-old boy who sustained an impalement abdominal injury with a pencil, he was rushed to the Olabisi Onabanjo University Teaching Hospital, Sagamu with the impaled object (pencil) in situ. He was admitted to the children emergency room of the hospital, stabilized and had exploratory laparotomy and removal of the impaled object under direct vision.

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Oral hygiene status of elderly population in Port Harcourt, Rivers State, Nigeria

Omoigberai Bashiru Braimoh, Modupe Omotunde Soroye

African Journal of Medical and Health Sciences 2017 16(2):109-114

Background: The value of good oral hygiene practices has increased over the years, and the removal of bacteria plaque and other deposits from the teeth is essential for the prevention of dental caries and periodontal disease. Aims: The objectives of this study were to assess the oral hygiene status of the elderly population in Port Harcourt, Rivers State and investigate the influence of sociodemographic variables on oral hygiene. Subjects and Methods: The research was cross-sectional study. A total of 543 old people were selected by systematic random sampling. Data were collected with a self-developed oral health assessment questionnaire designed in two sections (A and B) and analyzed using SPSS version 20 (IBM SPSS Armonk, New York, USA). The relationship between variables was established using independent t-test and analysis of variance, and significance determined at 0.05 alpha level. Results: The overall mean oral hygiene score for the sample was 2.55 (standard deviation = 0.85). Most of the respondents had poor 245 (45.1%) and fair 254 (46.8%) oral hygiene. Females had significant better oral hygiene than males, while there was a significant increase in the oral hygiene score with increasing age. Educational status and retirement grade level were inversely and significantly associated with the oral hygiene score of the pensioners. Conclusion: The oral hygiene score recorded among the pensioners in this study was inadequate; therefore, the study participants need to be educated on the role of plaque in the development of dental caries and periodontal diseases, and the need to keep good oral hygiene.

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Live birth following abdominal cervical cerclage in a woman with recurrent pregnancy losses

Samuel Obozegie Egbaname Aigere, Ovoke Egagifo, Gabriel Oseremen Igberase

African Journal of Medical and Health Sciences 2017 16(2):131-132

We present a case of abdominal cervical cerclage with live birth. She was a 40-year-old woman with a history of recurrent second-trimester pregnancy losses and preterm deliveries. A cervicoisthmic cerclage was applied through the abdominal route at 16 weeks of gestation and the pregnancy progressed to 35 weeks and 4 days when she developed preterm contractions necessitating an emergency cesarean delivery of a set of healthy twins. Only few centers in Nigeria offer abdominal cerclage because of paucity in skills. This case is presented as a reminder that such cases still exist, and the skill must be maintained and taught resident doctors as it may become useful when such cases present.

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The Highly Divergent Mitochondrial Genomes Indicate That the Booklouse, Liposcelis bostrychophila (Psocoptera: Liposcelididae) Is a Cryptic Species

The booklouse, Liposcelis bostrychophila is an important storage pest worldwide. The mt genome of an asexual strain (Beibei, China) of the booklouse, L. bostrychophila, comprises two chromosomes; each chromosome contains approximate half of the 37 genes typically found in animals. The mt genomes of two sexual strains of L. bostrychophila, however, comprise five and seven chromosomes respectively; each chromosome contains one to six genes. To understand mt genome evolution in L. bostrychophila and whether L. bostrychophila is a cryptic species, we sequenced the mt genomes of six strains of asexual L. bostrychophila collected from different locations in China, Croatia and USA. The mt genomes of all of the six asexual strains of L. bostrychophila collected in China, Croatia and USA have two chromosomes. Phylogenetic analysis of mt genome sequences divided nine strains of L. bostrychophila into four groups. Each group has a distinct mt genome organization and substantial sequence divergence (48.7-87.4%) from other groups. Furthermore, the seven asexual strains of L. bostrychophila including the published Beibei strain are more closely related to two other species of booklice, L. paeta and L. sculptilis, than to the sexual strains of L. bostrychophila. Our results revealed highly divergent mt genomes in the booklouse, L. bostrychophila, and indicated that L. bostrychophila is a cryptic species.

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Functional Analysis of Cancer-Associated DNA Polymerase {varepsilon} Variants in Saccharomyces cerevisiae

DNA replication fidelity relies on base selectivity of the replicative DNA polymerases, exonucleolytic proofreading, and post-replicative DNA mismatch repair (MMR). Ultramutated human cancers without MMR defects carry alterations in the exonuclease domain of DNA polymerase (Pol). They have been hypothesized to result from defective proofreading. However, modeling in yeast of the most common variant, Pol-P286R, produced an unexpectedly strong mutator effect that exceeded the effect of proofreading deficiency by two orders of magnitude and indicated the involvement of other infidelity factors. The in vivo consequences of many additional Pol mutations reported in cancers remain poorly understood. Here we genetically characterized 13 cancer-associated Pol variants in the yeast system. Only variants directly altering the DNA binding cleft in the exonuclease domain elevated mutation rate. Among these, frequently recurring variants were stronger mutators than rare variants, in agreement with the idea that mutator phenotype plays a causative role in tumorigenesis. In nearly all cases, the mutator effects exceeded those of an exonuclease-null allele, suggesting that mechanisms distinct from loss of proofreading may drive the genome instability in most ultramutated tumors. All mutator alleles were semidominant, supporting the view that heterozygosity for the polymerase mutations is sufficient for tumor development. In contrast to the DNA binding cleft alterations, peripherally located variants, including a highly recurrent V411L, did not significantly elevate mutagenesis. Finally, the analysis of Pol variants found in MMR-deficient tumors suggested that the majority cause no mutator phenotype alone but some can synergize with MMR deficiency to increase mutation rate.

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Identification and Validation of a New Source of Low Grain Cadmium Accumulation in Durum Wheat

Cadmium (Cd) is a heavy metal that has no known biological function and is toxic for many living organisms. The maximum level of Cd concentration allowed in the international market for wheat grain is 0.2 mg kg-1. Because phenotyping for Cd uptake is expensive and time consuming, molecular markers associated with genes conferring low Cd uptake would expedite selection and lead to the development of durum cultivars with reduced Cd concentrations. Here, we identified single nucleotide polymorphisms (SNPs) associated with a novel low Cd uptake locus in the durum experimental line D041735, which has hexaploid common wheat in its pedigree. Genetic analysis revealed a single major QTL for Cd uptake on chromosome arm 5BL within a 0.3 cM interval flanked by SNP markers. Analysis of the intervening sequence revealed a gene with homology to an aluminum-induced protein as a candidate gene. Validation and allelism tests revealed that the low Cd uptake gene identified in this study is different from the closely linked Cdu1-B gene, which also resides on 5BL. This study therefore confirmed that the durum experimental line D041735 contains a novel low Cd uptake gene that was likely acquired from hexaploid wheat.

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Whole-Genome Sequencing of Suppressor DNA Mixtures Identifies Pathways That Compensate for Chromosome Segregation Defects in Schizosaccharomyces pombe

Suppressor screening is a powerful method to identify genes that when mutated, rescue the temperature sensitivity of the original mutation. Previously, however, identification of suppressor mutations has been technically difficult. Due to the small genome size of Schizosaccharomyces pombe, we developed a spontaneous suppressor screening technique, followed by a cost-effective sequencing method. Genomic DNAs of 10 revertants which survived at the restrictive temperature of the original temperature sensitive (ts) mutant were mixed together as one sample before constructing a library for sequencing. Responsible suppressor mutations were identified bioinformatically based on allele frequency. Then we isolated a large number of spontaneous extragenic suppressors for 3 ts mutants that exhibited defects in chromosome segregation at their restrictive temperature. Screening provided new insight into mechanisms of chromosome segregation: Loss of Ufd2 E4 multi-ubiquitination activity suppresses defects of an AAA ATPase, Cdc48. Loss of Wpl1, a releaser of cohesin, compensates for the Eso1 mutation, which may destabilize sister chromatid cohesion. The segregation defect of a ts histone H2B mutant is rescued if it fails to be de-ubiquitinated by the SAGA complex, because H2B is stabilized by monoubiquitination.

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Natural orifice endoscopic biopsy access − a tunnel of opportunity to gastrointestinal stromal tumors

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LOW CHILDHOOD HIGH DENSITY LIPOPROTEIN CHOLESTEROL LEVELS AND SUBSEQUENT RISK FOR CHRONIC INFLAMMATORY BOWEL DISEASE

and aims. Several genetic and environmental risk factors have been linked to chronic inflammatory bowel disease (IBD). The incidence of IBD has significantly increased in developed countries during last decades. The aim of the present study was to examine childhood risk factors for subsequent IBD diagnosis in a longitudinal cohort study of children and adolescents.

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Restoration of somatosensory perception via electrical stimulation of peripheral nerves

Sensory impairment hinders a person's ability to interact with their environment, and thus reduces their quality of life. In the case of impaired somatosensory perception, visual input can only provide indirect information at non-negligible cognitive cost. Therefore, restoration of natural somatosensory perception via artificial means has led to the exploration of different biological targets (Weber et al., 2012). Stimulation of the somatosensory cortex (Bensmaia, 2015), dorsal root ganglia (Weber et al., 2011), and peripheral nerves (Pasluosta et al., 2018) can produce intuitive and near-natural tactile and proprioceptive sensations, although proprioception has been studied to a lesser extent than touch (Weber et al., 2012).

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Sensorimotor integration is problematic in amyotrophic lateral sclerosis

Pathophysiological descriptions of amyotrophic lateral sclerosis (ALS) have broadened in recent years to include recognition of widespread involvement of brain pathways in the 'connectome', including corpus callosum, with degenerative neuronal pathology in associated cortical areas, basal ganglia, brainstem, cerebellum and spinal cord. In general, these pathological changes are in the anterior brain and its connections, and thus in the classical motor and also in the emotionally expressive brain, including frontal lobes anterior to primary motor areas and temporal lobes.

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Constipation in Parkinson’s Disease: a Nuisance or Nuanced Answer to the Pathophysiological Puzzle?

Abstract

Purpose of Review

Chronic constipation is a common, nonmotor, and prodromal symptom in Parkinson's disease (PD). Its underlying neuropathology may provide pathophysiological insight into PD. Here, we critically review what is currently known about the neuroanatomical and brain-gut interactions, and the origin and progression of Lewy pathology (LP) at three levels—brain/brainstem, spinal cord, and enteric nervous system.

Recent Findings

Many recent studies have illustrated the challenges of examining LP in tissues obtained from colon biopsies of PD patients. Large-scale epidemiological studies have not confirmed the widely accepted Braakpostula.

Summary

In this review, we propose an alternative origin and route of spread of LP in PD. We describe novel, noninvasive neurophysiological testing that could advance the understanding of LP and complex bidirectional brain-pelvic floor neural pathways in PD—a true disease model of a neurogastrointestinal disorder. This review may provide the impetus for future studies investigating gut and brain interaction and constipation in PD.

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L5 incidence: an important parameter for spinopelvic balance evaluation in high grade spondylolisthesis

In high grade spondylolisthesis (HGSPL), the pelvic incidence (PI) is not a reliable measurement due to doming of the sacrum. Measurement of L5 incidence (L5I) was described as a tool to measure pelvic morphology in HGSPL and for surgical follow up.

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Motor impairment in patients with chronic neck pain: does the traumatic event play a significant role? – a case control study

Motor impairment is a key-sign in patients with traumatic (WAD) and non-traumatic (INP) neck pain.

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A Consensus Has Not Been Reached for Pathology Reporting of Tall-Cell Variant of Papillary Thyroid Carcinoma

Clinical Thyroidology Jan 2018, Vol. 30, No. 1: 25-29.


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Should a Young Patient in Whom a Multinodular Goiter Develops Be Assessed for DICER1 Mutations?

Clinical Thyroidology Jan 2018, Vol. 30, No. 1: 3-6.


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Levothyroxine Treatment Does Not Reduce Risk for Premature Delivery Among TPO-Negative Pregnant Women with a TSH of 2.5 to 10.0 mIU/L

Clinical Thyroidology Jan 2018, Vol. 30, No. 1: 7-9.


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Harmonized Guidelines Developed, but Lack of Evidence Illustrates the Need for Further Research to Determine the Best Method of Surveillance for Thyroid Cancer in Survivors of Childhood Cancer

Clinical Thyroidology Jan 2018, Vol. 30, No. 1: 33-35.


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Adding the Immunosuppressant Mycophenolate Mofetil to Medium-Dose Infusions of Methylprednisolone Improves the Treatment of Graves’ Orbitopathy

Clinical Thyroidology Jan 2018, Vol. 30, No. 1: 10-14.


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Selenium Supplementation May Help Protect Salivary Glands After Iodine-131 Therapy for Differentiated Thyroid Cancer

Clinical Thyroidology Jan 2018, Vol. 30, No. 1: 21-24.


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Surgery for Hyperthyroidism Lowers Cardiovascular Mortality Compared with Radioactive Iodine

Clinical Thyroidology Jan 2018, Vol. 30, No. 1: 15-17.


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Probiotic Substances Do Not Impair Oral Levothyroxine Intestinal Absorption

Clinical Thyroidology Jan 2018, Vol. 30, No. 1: 30-32.


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Primary Thyroid MALT Lymphoma is Cured by Either Radiation Therapy or Chemotherapy

Clinical Thyroidology Jan 2018, Vol. 30, No. 1: 18-20.


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Thyroid Sarcoidosis Presenting as Hürthle-Cell Neoplasm: Case Report and Literature Review

Clinical Thyroidology Jan 2018, Vol. 30, No. 1: 36-41.


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Crestline’s 2018 ambulance product showcase

SASKATOON, Canada — Crestline Coach, a global leader in ambulance and specialty vehicle manufacturing, released its annual product showcase ebook. The downloadable ebook provides an inside look into how Crestline product is manufactured to be the safest and most durable product in the marketplace. Readers will also learn how Crestline is continuing advances in ambulance safety and patient care ...

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Web-Based Training Methods for Behavioral Health Providers: A Systematic Review

Abstract

There has been an increase in the use of web-based training methods to train behavioral health providers in evidence-based practices. This systematic review focuses solely on the efficacy of web-based training methods for training behavioral health providers. A literature search yielded 45 articles meeting inclusion criteria. Results indicated that the serial instruction training method was the most commonly studied web-based training method. While the current review has several notable limitations, findings indicate that participating in a web-based training may result in greater post-training knowledge and skill, in comparison to baseline scores. Implications and recommendations for future research on web-based training methods are discussed.

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Video: Drone rescues 2 swimmers in Australia during training session

Lifeguards were practicing with the new drone when they were alerted that two men were caught in 10-foot swells

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Sleep patterns open the window into disorders of consciousness

The presence of sleep-wakefulness cycles is one of the main clinical symptoms marking the transition from coma to chronic disorders of consciousness (DoC). That is, eyes of coma patients are regularly closed while eyes of DoC patients are sometimes closed, sometimes opened. But does it mean that they really sleep? Landsness et al. (2011) published a broadly cited study in which they reported that only one group of DoC patients (those with the diagnosis of Minimally Conscious State, or MCS: Giacino et al., 2002) slept in the exact physiological sense of this term, i.e., they had regular circadian changes of EEG, electrooculogram (EOG), and muscle tone similar (though not identical) to those of healthy humans.

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Author’s Reply to Nunes et al.: Comment on: “Comparison of Periodized and Non-Periodized Resistance Training on Maximal Strength: A Meta-Analysis”

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Lower Serum Zinc Concentration Despite Higher Dietary Zinc Intake in Athletes: A Systematic Review and Meta-analysis

Abstract

Background

Zinc is an essential trace element that has been implicated in numerous biological functions, including immunity, energy metabolism and antioxidative processes. Recent evaluations of the literature have provided evidence of significant acute changes in zinc metabolism following a bout of aerobic exercise.

Objective

The aim of this study was to determine the zinc status of trained athletes compared with control populations, as described in cross-sectional studies.

Design

We conducted a systematic literature search of the PubMed, Scopus, SPORTDiscus and Cochrane Library electronic databases from inception to 28 January 2016 to identify cross-sectional studies that determined the zinc status of athletes compared with a control population. Meta-analysis of the differences in serum zinc concentration and dietary zinc intake between groups were conducted.

Results

Twelve studies were included in the systematic review. Of the included studies, nine and eight studies provided sufficient data for the meta-analysis of serum zinc concentration and dietary zinc intake, respectively. Serum zinc concentration was significantly lower in athletes [− 0.93 μmol/L, 95% confidence interval (CI) − 1.62 to − 0.23] despite significantly higher dietary zinc intake compared with the control population (2.57 mg/day, 95% CI 0.97–4.16). Data on erythrocyte and urinary zinc from the included studies were insufficient for meta-analysis.

Conclusions

Despite higher total dietary zinc intake, athletes generally have lower serum zinc concentration, which suggests that athletes have higher requirement of zinc than those who are physically inactive. Further investigations of zinc metabolism during exercise and dietary zinc requirement in active populations are needed to establish evidence-based recommendations.

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Correction to: Current Methodologies and Implications of Phase Identification of the Vertical Jump: A Systematic Review and Meta-analysis

Abstract

Pages 1313-5, table 1, column 1: The cell entries in the 'Reference' column, which previously read:

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Comment on: “Comparison of Periodized and Non-Periodized Resistance Training on Maximal Strength: A Meta-Analysis”

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Sport-Related Concussion and Mental Health Outcomes in Elite Athletes: A Systematic Review

Abstract

Background

Elite athletes can experience a diverse range of symptoms following post-concussive injury. The impact of sport-related concussion on specific mental health outcomes is unclear in this population.

Objective

The aim was to appraise the evidence base regarding the association between sport-related concussion and mental health outcomes in athletes competing at elite and professional levels.

Methods

A systematic search of PubMed, EMBASE, SPORTDiscus, PsycINFO, Cochrane, and Cinahl databases was conducted.

Results

A total of 27 studies met inclusion criteria for review. Most of the included studies (67%, n = 18) were published in 2014 or later. Study methodology and reporting varied markedly. The extant research has been conducted predominantly in North America (USA, n = 23 studies; Canada, n = 3), often in male only (44.4%, n = 12) and college (70.4%, n = 19) samples. Depression is the most commonly studied mental health outcome (70.4%, n = 19 studies). Cross-sectional retrospective studies and studies including a control comparison tend to support an association between concussion exposure and depression symptoms, although several studies report that these symptoms resolved in the medium term (i.e. 1 month) post-concussion. Evidence for anxiety is mixed. There are insufficient studies to draw conclusions for other mental health domains.

Conclusion

Consistent with current recommendations to assess mood disturbance in post-concussive examinations, current evidence suggests a link between sports-related concussion and depression symptoms in elite athletes. Causation cannot be determined at this stage of enquiry because of the lack of well-designed, prospective studies. More research is required that considers a range of mental health outcomes in diverse samples of elite athletes/sports.

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Correction to: Attenuation of cortical activity triggering descending pain inhibition in chronic low back pain patients: a functional magnetic resonance imaging study

Abstract

Inadvertently, the Fig. 7 was published incorrectly in the original publication of the article. The correct figure should be as below:

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In reply: Is sugammadex alone enough to cause anaphylaxis?

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Retraction

No abstract available

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In Response

No abstract available

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In Response

No abstract available

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The Unknown Mechanism of Exogenous Tetrahydrobiopterin in the Renal Protection of Sheep Ischemia and Reperfusion

No abstract available

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Surveying the Literature: Synopsis of Recent Key Publications

No abstract available

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New Modalities for the Administration of Inhaled Nitric Oxide in Intensive Care Units After Cardiac Surgery or for Neonatal Indications: A Prospective Observational Study

BACKGROUND: Nitric oxide (NO) has a well-known efficacy in pulmonary hypertension (PH), with wide use for 20 years in many countries. The objective of this study was to describe the current use of NO in real life and the gap with the guidelines. METHODS: This is a multicenter, prospective, observational study on inhaled NO administered through an integrated delivery and monitoring device and indicated for PH according to the market authorizations. The characteristics of NO therapy and ventilation modes were observed. Concomitant pulmonary vasodilator treatments, safety data, and outcome were also collected. Quantitative data are expressed as median (25th, 75th percentile). RESULTS: Over 1 year, 236 patients were included from 14 equipped and trained centers: 117 adults and 81 children with PH associated with cardiac surgery and 38 neonates with persistent PH of the newborn. Inhaled NO was initiated before intensive care unit (ICU) admission in 57%, 12.7%, and 38.9% with an initial dose of 10 (10, 15) ppm, 20 (18, 20) ppm, and 17 (11, 20) ppm, and a median duration of administration of 3.9 (1.9, 6.1) days, 3.8 (1.8, 6.8) days, and 3.1 (1.0, 5.7) days, respectively, for the adult population, pediatric cardiac group, and newborns. The treatment was performed using administration synchronized to the mechanical ventilation. The dose was gradually decreased before withdrawal in 86% of the cases according to the usual procedure of each center. Adverse events included rebound effect for 3.4% (95% confidence interval [CI], 0.9%–8.5%) of adults, 1.2% (95% CI, 0.0%–6.7%) of children, and 2.6% (95% CI, 0.1%–13.8%) of neonates and methemoglobinemia exceeded 2.5% for 5 of 62 monitored patients. Other pulmonary vasodilators were associated with NO in 23% of adults, 95% of children, and 23.7% of neonates. ICU stay was respectively 10 (6, 22) days, 7.5 (5.5, 15) days, and 9 (8, 15) days and ICU mortality was 22.2%, 6.2%, and 7.9% for adults, children, and neonates, respectively. CONCLUSIONS: This study confirms the safety of NO therapy in the 3 populations with a low rate of rebound effect. Gradual withdrawal of NO combined with pulmonary vasodilators are current practices in this population. The use of last-generation NO devices allowed good compliance with recommendations. Accepted for publication November 29, 2017. Funding: This study was funded by Air Liquide Healthcare. Conflicts of Interest: See Disclosures at the end of the article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). Trial registration: NCT02821156; Clinicaltrials.gov; retrospectively registered May 20, 2016. Reprints will not be available from the authors. Address correspondence to Philippe Pouard, MD, Service Réanimation Chirurgie Pédiatrique, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75015 Paris, France. Address e-mail to pp@invivo.edu. © 2018 International Anesthesia Research Society

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Statistical Significance Versus Clinical Importance of Observed Effect Sizes: What Do P Values and Confidence Intervals Really Represent?

Effect size measures are used to quantify treatment effects or associations between variables. Such measures, of which >70 have been described in the literature, include unstandardized and standardized differences in means, risk differences, risk ratios, odds ratios, or correlations. While null hypothesis significance testing is the predominant approach to statistical inference on effect sizes, results of such tests are often misinterpreted, provide no information on the magnitude of the estimate, and tell us nothing about the clinically importance of an effect. Hence, researchers should not merely focus on statistical significance but should also report the observed effect size. However, all samples are to some degree affected by randomness, such that there is a certain uncertainty on how well the observed effect size represents the actual magnitude and direction of the effect in the population. Therefore, point estimates of effect sizes should be accompanied by the entire range of plausible values to quantify this uncertainty. This facilitates assessment of how large or small the observed effect could actually be in the population of interest, and hence how clinically important it could be. This tutorial reviews different effect size measures and describes how confidence intervals can be used to address not only the statistical significance but also the clinical significance of the observed effect or association. Moreover, we discuss what P values actually represent, and how they provide supplemental information about the significant versus nonsignificant dichotomy. This tutorial intentionally focuses on an intuitive explanation of concepts and interpretation of results, rather than on the underlying mathematical theory or concepts. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Accepted for publication November 29, 2017. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Patrick Schober, MD, PhD, MMedStat, Department of Anesthesiology, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, the Netherlands. Address e-mail to p.schober@vumc.nl. © 2018 International Anesthesia Research Society

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Bolus Norepinephrine Administration and Fetal Acidosis at Cesarean Delivery Under Spinal Anesthesia

No abstract available

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Nutrition in the ICU: new trends versus old-fashioned standard enteral feeding?

Purpose of review The narrative review aims to summarize the relevant studies from the last 2 years and provide contextual information to understand findings. Recent findings Recent ICU studies have provided insight in the pathophysiology and time course of catabolism, anabolic resistance, and metabolic and endocrine derangements interacting with the provision of calories and proteins. Early provision of high protein intake and caloric overfeeding may confer harm. Refeeding syndrome warrants caloric restriction and to identify patients at risk phosphate monitoring is mandatory. Infectious complications of parenteral nutrition are associated with overfeeding. In recent studies enteral nutrition is no longer superior over parenteral nutrition. Previously reported benefits of glutamine, selenium, and fish oil seem to have vanished in recent studies; however, studies on vitamin C, thiamine, and corticosteroid combinations show promising results. Summary Studies from the last 2 years will have marked impact on future nutritional support strategies and practice guidelines for critical care nutrition as they challenge several old-fashioned concepts. Correspondence to Arthur R.H. van Zanten, M.D., PhD, Department of Intensive Care, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands. Tel: +31 318 43 41 15; e-mail: zantena@zgv.nl Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Cardiac dysfunction in critical illness

Purpose of review Sepsis and septic shock are prevalent conditions that are likely to increase in prevalence in the future. Given the high mortality and morbidity associated with sepsis and sepsis-induced cardiac dysfunction, we must continue to make advances in knowledge of the complex physiologic interactions and how we may target specific mediators for potential therapeutic options in the future. Recent findings Multiple biomarkers have been discovered, which when assayed in sepsis-induced cardiomyopathy predict morbidity and mortality. With increased sensitivity of echocardiography, we can diagnose subclinical cardiac dysfunction, which may have future implications for slowing or preventing progressive dysfunction. Summary Sepsis-induced cardiomyopathy is the result of complicated interactions between the pathogen, the body's response to infection, and iatrogenic injury. Interplay between inflammatory, metabolic, and adrenergic systems results in direct and indirect myocardial injury leading to decreases in both systolic and diastolic cardiac function. As the interactions are further elucidated with additional research into other proteins and mediators, new treatment options can be researched. Video Abstract http://ift.tt/2mYIq1V Correspondence to Allison Dalton, MD, University of Chicago, 5841 S. Maryland Ave, MC 4028, Chicago, IL 60637, USA. E-mail: adalton@dacc.uchicago.edu Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://ift.tt/1qR4umk). Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Worldwide end-of-life practice for patients in ICUs

Purpose of review Published data and practice recommendations on end-of-life (EOL) generally reflect Western practice frameworks. Understanding worldwide practices is important because improving economic conditions are promoting rapid expansion of intensive care services in many previously disadvantaged regions, and increasing migration has promoted a new cultural diversity previously predominantly unicultural societies. This review explores current knowledge of similarities and differences in EOL practice between regions and possible causes and implications of these differences. Recent findings Recent observational and survey data shows a marked variability in the practice of withholding and withdrawing life sustaining therapy worldwide. Some evidence supports the view that culture, religion, and socioeconomic factors influence EOL practice, and individually or together account for differences observed. There are also likely to be commonly desired values and expectations for EOL practice, and recent attempts at establishing where worldwide consensus may lie have improved our understanding of shared values and practices. Summary Awareness of differences, understanding their likely complex causes, and using this knowledge to inform individualized care at EOL is likely to improve the quality of care for patients. Further research should clarify the causes of EOL practice variability, monitor trends, and objectively evaluate the quality of EOL practice worldwide. Correspondence to Professor Gavin M. Joynt, MBBCh, FFA (SA), FRCP, Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Room 04D24, 4/F, Shatin, Hong Kong. Tel: +852 35051313; e-mail: gavinmjoynt@cuhk.edu.hk Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Recent evidence on early mobilization in critical-Ill patients

Purpose of review To examine the benefits of early mobilization and summarize the results of most recent clinical studies examining early mobilization in critically ill patients followed by a presentation of recent developments in the field. Recent findings Early mobilization of ICU patients, defined as mobilization within 72 h of ICU admission, is still uncommon. In medical and surgical critically ill patients, mobilization is well tolerated even in intubated patients. In neurocritical care, evidence to support early mobilization is either lacking (aneurysmal subarachnoid hemorrhage), or the results are inconsistent (e.g. stroke). Successful implementation of early mobilization requires a cultural change; preferably based on an interprofessional approach with clearly defined responsibilities and including a mobilization scoring system. Although the evidence for the majority of the technical tools is still limited, the use of a bed cycle ergometer and a treadmill with strap system has been promising in smaller trials. Summary Early mobilization is well tolerated and feasible, resulting in improved outcomes in surgical and medical ICU patients. Implementation of early mobilization can be challenging and may need a cultural change anchored in an interprofessional approach and integrated in a patient-centered bundle. Scoring systems should be integrated to define daily goals and used to verify patients' achievements or identify barriers immediately. Correspondence to Dr Stefan J. Schaller, MD, MHBA, Klinik für Anaesthesiologie, Klinikum rechts der Isar der TUM, Ismaningerstr, 22, 81675 Munich, Germany. Tel: +49 89 4140 9635; e-mail: s.schaller@tum.de Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Three-generation family with novel contiguous gene deletion on chromosome 2p22 associated with thoracic aortic aneurysm syndrome

Latent transforming growth factor binding proteins (LTBP) are a family of extracellular matrix glycoproteins that play an important role in the regulation of transforming growth factor beta (TGF-ß) activation. Dysregulation of the TGF-ß pathway has been implicated in the pathogenesis of inherited disorders predisposing to thoracic aortic aneurysms syndromes (TAAS) including Marfan syndrome (MFS; FBN1) and Loeys–Dietz syndrome (LDS; TGFBR1, TGFBR2, TGFB2, TGFB3, SMAD2, SMAD3). While these syndromes have distinct clinical criteria, they share clinical features including aortic root dilation and musculoskeletal findings. LTBP1 is a component of the TGF-ß pathway that binds to fibrillin-1 in the extracellular matrix rendering TGF-ß inactive. We describe a three-generation family case series with a heterozygous ∼5.1 Mb novel contiguous gene deletion of chromosome 2p22.3-p22.2 involving 11 genes, including LTBP1. The deletion has been identified in the proband, father and grandfather, who all have a phenotype consistent with a TAAS. Findings include thoracic aortic dilation, ptosis, malar hypoplasia, high arched palate, retrognathia, pes planus, hindfoot deformity, obstructive sleep apnea, and low truncal tone during childhood with joint laxity that progressed to reduced joint mobility over time. While the three affected individuals did not meet criteria for either MFS or LDS, they shared features of both. Although the deletion includes 11 genes, given the relationship between LTBP1, TGF-ß, and fibrillin-1, LTBP1 stands out as one of the possible candidate genes for the clinical syndrome observed in this family. More studies are necessary to evaluate the potential role of LTBP1 in the pathophysiology of TAAS.

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Modulation rate transfer functions from four species of stranded odontocete ( Stenella longirostris, Feresa attenuata, Globicephala melas, and Mesoplodon densirostris )

Abstract

Odontocete marine mammals explore the environment by rapidly producing echolocation signals and receiving the corresponding echoes, which likewise return at very rapid rates. Thus, it is important that the auditory system has a high temporal resolution to effectively process and extract relevant information from click echoes. This study used auditory evoked potential methods to investigate auditory temporal resolution of individuals from four different odontocete species, including a spinner dolphin (Stenella longirostris), pygmy killer whale (Feresa attenuata), long-finned pilot whale (Globicephala melas), and Blainville's beaked whale (Mesoplodon densirostris). Each individual had previously stranded and was undergoing rehabilitation. Auditory Brainstem Responses (ABRs) were elicited via acoustic stimuli consisting of a train of broadband tone pulses presented at rates between 300 and 2000 Hz. Similar to other studied species, modulation rate transfer functions (MRTFs) of the studied individuals followed the shape of a low-pass filter, with the ability to process acoustic stimuli at presentation rates up to and exceeding 1250 Hz. Auditory integration times estimated from the bandwidths of the MRTFs ranged between 250 and 333 µs. The results support the hypothesis that high temporal resolution is conserved throughout the diverse range of odontocete species.

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Father Absence, Social Networks, and Maternal Ratings of Child Health: Evidence from the 2013 Social Networks and Health Information Survey in Mexico

Abstract

Objectives To bridge the literature on the effect of father absence, international migration, and social networks on child health, we assess the association between father absence and maternal ratings of child poor health (MCPH). Next we test whether social networks of immediate and extended kin mediate the relationship between fathers' absence and MCPH. Methods Nested logistic regression models predicting MCPH are estimated using the 2013 Social Networks and Health Information Survey, collected in a migrant-sending community in Guanajuato, Mexico. These unique data distinguish among father absence due to migration versus other reasons and between immediate and extended kin ties. Results Descriptive results indicate that 25% of children with migrant fathers are assessed as having poor health, more often than children with present (15.5%) or otherwise absent fathers (17.5%). In the multivariate models, fathers' absence is not predictive of MCPH. However, the presence of extended kin ties for the mother was associated with approximately a 50% reduction in the odds of MCPH. Additionally, mother's poor self-assessed health was associated with increased odds of MCPH while the presence of a co-resident adult lowered the odds of MCPH. In sensitivity analysis among children with migrant fathers, the receipt of paternal remittances lowered the odds of MCPH. Conclusions for Practice Social networks have a direct and positive association with MCPH rather than mediating the father absence-MCPH relationship. The presence of extended kin ties in the local community is salient for more favorable child health and should be considered in public health interventions aimed at improving child health.

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Effects of long-term balance training with vibrotactile sensory augmentation among community-dwelling healthy older adults: a randomized preliminary study

Sensory augmentation has been shown to improve postural stability during real-time balance applications. Limited long-term controlled studies have examined retention of balance improvements in healthy older ad...

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Evaluation of the stability and stratification of propofol and ketamine mixtures for pediatric anesthesia

Summary

Background

The combination of propofol and ketamine is commonly used for total intravenous anesthesia. These drugs can be delivered in different syringes or in the same syringe. We hypothesized that the drugs might separate and different concentrations of each drug could be found in different parts of the syringe during the procedure period when they were mixed in 1 syringe.

Methods

Twelve 60-mL polypropylene syringes were prepared by mixing propofol and ketamine as 4 groups on the basis of propofol/ketamine mixture ratios (5:1 and 6.7:1) and propofol solution concentrations. Syringes were placed upright in the vertical position into a rack and kept at room temperature (21.5-22.5°C), in daylight conditions and were not moved for 360 minutes. Samples of the mixture were taken from both the top and the bottom of the syringe. The first 1 mL of the samples was discarded, the following second 1 mL of the samples was filtered using 0.2-μm polytetrafluoroethylene filters and measured twice (n = 6). Samples were taken at the following time intervals: T0, T10, T30, T60, T90, T120, T180, T240, T300, and T360 min. Syringes were checked visually for any color change and separation lines between the drugs.

Results

There were no significant differences between the propofol and ketamine concentrations of the top and bottom samples in all 4 groups. In addition, there were no statistically significant changes of propofol and ketamine concentrations of samples over 360 minutes in any of the 4 groups. No visual changes were observed during 6 hours' observation.

Conclusion

The results of our measurements demonstrated that mixtures of propofol (1% and 2%) and ketamine at 5:1 and 6.7:1 ratios could be used in terms of mixture homogeneity and stability in a polypropylene syringe during a 6-hour period at room temperature.

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