Κυριακή, 11 Φεβρουαρίου 2018

Patient, Surgeon, and Anesthesiologist Satisfaction: Who has the Priority?

No abstract available

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Acquired Central Hypoventilation Syndrome Unmasked by Propofol Sedation

No abstract available

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Neurogenic Pulmonary Edema and Stunned Myocardium in a Patient With Meningioma: A Heart-Brain Cross Talk

No abstract available

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Prescribing 6-weeks of running training using parameters from a self-paced maximal oxygen uptake protocol

Abstract

Purpose

The self-paced maximal oxygen uptake test (SPV) may offer effective training prescription metrics for athletes. This study aimed to examine whether SPV-derived data could be used for training prescription.

Methods

Twenty-four recreationally active male and female runners were randomly assigned between two training groups: (1) Standardised (STND) and (2) Self-Paced (S-P). Participants completed 4 running sessions a week using a global positioning system-enabled (GPS) watch: 2 × interval sessions; 1 × recovery run; and 1 × tempo run. STND had training prescribed via graded exercise test (GXT) data, whereas S-P had training prescribed via SPV data. In STND, intervals were prescribed as 6 × 60% of the time that velocity at \(\dot {V}_}}\) ( \(_}\dot {V}_}}\) ) could be maintained (Tmax). In S-P, intervals were prescribed as 7 × 120 s at the mean velocity of rating of perceived exertion 20 (vRPE20). Both groups used 1:2 work:recovery ratio. Maximal oxygen uptake ( \(\dot {V}_}}\) ), \(_}\dot {V}_}}\) , Tmax, vRPE20, critical speed (CS), and lactate threshold (LT) were determined before and after the 6-week training.

Results

STND and S-P training significantly improved \(\dot {V}_}}\) by 4 ± 8 and 6 ± 6%, CS by 7 ± 7 and 3 ± 3%; LT by 5 ± 4% and 7 ± 8%, respectively (all P < .05), with no differences observed between groups.

Conclusions

Novel metrics obtained from the SPV can offer similar training prescription and improvement in \(\dot {V}_}}\) , CS and LT compared to training derived from a traditional GXT.



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Ethnic Variations in Adiponectin Levels and Its Association with Age, Gender, Body Composition and Diet: Differences Between Iranians, Indians and Europeans Living in Australia

Abstract

Adiponectin is an adipocyte-derived protein with anti-diabetic, anti-atherogenic and anti-inflammatory action, but there are few studies on its association with cardiovascular and metabolic risk factors in different ethnic groups in Australia. This cross-sectional study evaluated ethnic differences in adiponectin levels and its association with age, gender, body composition and diet in 89 adult Australians of European (n = 28), Indian (n = 28) and Iranian (n = 33) ancestries. Different measures of adiposity were assessed using the method of whole body dual energy X-ray absorptiometry (DEXA). Total adiponectin levels determined in Indians and Iranians were significantly lower than those in Europeans (p values < 0.001). There was no significant difference between the adiponectin levels in Indians and Iranians (p value > 0.05). There was no substantial change in the results after adjustment for potential confounders. Circulating levels of adiponectin was associated with age, truncal fat percentage, dietary glycemic index, glycemic load and carbohydrate intake, by correlation analysis (p values < 0.05). Using multiple linear regression analysis, a model including truncal fat percentage (p < 0.001), ethnicity (p = 0.001), age (p = 0.001) and dietary glycemic index (p = 0.04) could predict 50% of the variance in adiponectin levels (R2 = 0.504). Among different variables assessed, truncal fat percentage (in Indian and Iranian groups) and glycemic index (in European group) were the strongest predictors of serum adiponectin when data were analysed for three ethnic groups, separately. In conclusion, individuals with Iranian or Indian ancestries may have lower adiponectin levels compared to Europeans. Ethnicity was found as an independent factor affecting adiponectin levels. Our results also highlighted age, truncal adiposity and dietary glycemic index as other determinants of serum adiponectin, however the extent to which these factors influence adiponectin concentrations may vary across ethnicities.



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The cells and conductance mediating cholinergic neurotransmission in the murine proximal stomach

Abstract

Enteric motor neurotransmission is essential for normal gastrointestinal (GI) motility. Controversy exists regarding the cells and ionic conductance(s) that mediate post-junctional neuroeffector responses to motor neurotransmitters. Isolated intramuscular ICC (ICC-IM) and smooth muscle cells (SMCs) from murine fundus muscles were used to determine the conductances activated by carbachol (CCh) in each cell-type. The calcium-activated chloride conductance (CaCC), Ano1 is expressed by ICC-IM but not resolved in SMCs, and CCh activated a Cl conductance in ICC-IM and a non-selective cation conductance (NSCC) in SMCs. We also studied responses to nerve stimulation using electrical-field stimulation (EFS) of intact fundus muscles from wildtype and Anoctamin-1 (Ano1) knockout mice. EFS activated excitatory junction potentials (EJPs) in wildtype mice, but EJPs were absent in mice with congenital deactivation of Ano1 and greatly reduced in animals in which the CaCC-Ano1 was knocked down using the Cre/loxP technology. Contractions to cholinergic nerve stimulation were also greatly reduced in Ano1 knockouts. SMCs cells also have receptors and ion channels activated by muscarinic agonists. Blocking acetylcholine esterase with neostigmine revealed a slow depolarization that developed after EJPs in wildtype mice. This depolarization was still apparent in mice with genetic deactivation of Ano1. Pharmacological blockers of Ano1 also inhibited EJPs and contractile responses to muscarinic stimulation in fundus muscles Our data are consistent with the hypothesis that ACh released from motor nerves binds muscarinic receptors on ICC-IM with preference and activates Ano1. If metabolism of is inhibited, ACh overflows and binds to extrajunctional receptors on SMCs, eliciting a slower depolarization response.

This article is protected by copyright. All rights reserved



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Cloud computing for genomic data analysis and collaboration



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An initial experience with an Extraluminal EZ-Blocker®: A new alternative for 1-lung ventilation in pediatric patients

Summary

Background

The need for 1-lung ventilation in school age, pediatric patients is uncommon and as a result there are relatively few devices available to facilitate lung isolation in this population. Furthermore, little is known about the efficacy and techniques of placement of the currently available devices. One of the newest devices available that may be appropriate in this age group is the EZ-Blocker.

Aims

We aimed to examine our initial experience with the EZ-Blocker to evaluate the performance of this device with respect to potential improvements in technique and patient selection going forward.

Methods

We performed a retrospective chart review of all pediatric patients who underwent 1-lung ventilation with an EZ-Blocker since the blocker became available at our institution. We recorded demographics, details of placement, intraoperative course, number of repositions, and any postoperative morbidity related to blocker placement or 1-lung ventilation.

Results

We were able to correctly place the EZ-Blocker and achieve lung isolation in 8 of 11 patients. There was a single episode of repositioning required during 1-lung ventilation with an EZ-Blocker.

Conclusion

The EZ-Blocker was successful in providing lung isolation for a majority of our school age patients. Size constraints in children <6 years of age, excessive secretions, and distortions of tracheal anatomy seemed to be the greatest hindrances to successful placement and positioning of the device. Once correctly positioned, however, the EZ-Blocker may be more stable than the Arndt endobronchial blocker.



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Cancer gene-panel testing identifies two loss-of-function alleles in PALB2 and PTEN

Thumbnail image of graphical abstract

Synchronous loss-of-function mutations in the cancer predisposing genes, PTEN and PALB2 identified by multigene panel.



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Acute pain management in children: challenges and recent improvements

Purpose of review The evidence regarding the efficacy of analgesics available to guide postoperative pain treatment in pediatric patients is limited. Opioid medications are very often an important component of pediatric postoperative pain treatment but have been associated with perioperative complications. We will focus on initiatives aiming to provide effective treatment minimizing the use of opioids and preventing the long-term consequences of pain. Recent findings Interpatient variability in postoperative pain is currently managed by applying protocols or by trial and error, thus often leading to patients being either undertreated or overtreated. Few evidence-based reports are available to guide the use of opioid medications in children, including the prescription of opioids after hospital discharge. Using combinations of nonopioid analgesics in a multimodal approach may limit the need for opioids, thus decreasing the risk of toxicity and dose-related side effects. There is a lack of adequate research in this field, and more specifically on identifying which patient is at higher risk of poor postoperative pain management. Summary Treatment options have evolved in recent years, including the combinations of multimodal regimens and regional anesthetic techniques. Using combinations of nonopioid analgesics in a multimodal approach may limit the need for opioids. Correspondence to Pablo M. Ingelmo, MD, Department of Anesthesia, Montreal Children's Hospital, B.04.2427, 1001 Boulevard Decarie, Montreal, QC, Canada H4A3J1. Tel: +1 514 412 4448; e-mail: pablo.ingelmo@mcgill.ca Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Is spinal anaesthesia in young infants really safer and better than general anaesthesia?

Purpose of review Concerns regarding the potential neurotoxic effects of general anaesthesia have seen resurgence in awake spinal anaesthesia in neonates and infants. This review includes recently published data from a large prospective randomized controlled trial with view to determining if spinal anaesthesia is safer and better than general anaesthesia in this population. Recent findings Compared with general anaesthesia, spinal anaesthesia results in less haemodynamic instability and fewer early (

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Intensive care practitioner: I forgot half the things I learned and the other half seems to be all wrong!

No abstract available

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Long-term neurocognitive outcomes following surgery and anaesthesia in early life

Purpose of review Repeated controversial and alarming statements of the potential dangers of anaesthetic agents on neurological outcomes in children continue to be issued based primarily on preclinical studies. This review assesses the current evidence of laboratory and clinical data and identifies areas of concerns. Recent findings Published animal and laboratory data consistently indicate that prolonged and excessive use of anaesthetic agents can lead to morphological changes and neurocognitive impairment in animals without a clear cut-off age or a superiority of one technique over another. Retrospective human studies and prospective clinical trials indicate that short exposures to anaesthesia and surgery are safe and have no effect on long-term neurological outcomes. Small and consistent continuing improvements in the perioperative period (aggregation of marginal gains) will impact on long-term neurological morbidity in humans. Summary It is biologically plausible that anaesthetic agents may induce structural changes during mammalian brain development and beyond. However, in the absence of alternatives the impact of the choice of anaesthetic drugs on long-term neurocognitive outcomes is almost certainly to be of limited relevance in humans. The underlying disease processes, surgical intervention, and trauma as well as other known perioperative factors more significantly affect these outcomes. Correspondence to Tom G. Hansen, MD, PhD, Department of Anaesthesia & Intensive Care – Paediatric Section, Odense University Hospital, 5000 Odense C, Denmark. Tel: +45 6541 3812; fax: +45 6611 3415; e-mail: tomghansen@dadlnet.dk Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Classification of Intensity in Team-Sport Activity

AbstractPurposeTo assess the efficacy of critical metabolic power derived from variable-speed movement for classifying intensity in team sport activity.MethodsElite male hockey players (n = 12) completed a series of time trials (100 yd, 400 yd, 1500 yd) and a 3-min all-out test to derive both critical speed (CS) and critical power (CP). Heart rate (HR), blood lactate (BLa) and rating of perceived exertion (RPE) were measured during each protocol. Participants (n = 10) then played 2 competitive hockey matches. Time spent >85% of HRmax was compared to time spent above CS (from the time trials) and CP (from the 3-min test).ResultsBetween protocols, there was a moderate and non-significant association for CS (r = 0.359, P = 0.252), and a very large association for CP (r = 0.754, P = 0.005); the association was very large for peak HR (r = 0.866, P 85% HRmax and time spent above both CS (r = 0.719, P 85% of HRmax was compared to time spent above CS (from the time trials) and CP (from the 3-min test). Results Between protocols, there was a moderate and non-significant association for CS (r = 0.359, P = 0.252), and a very large association for CP (r = 0.754, P = 0.005); the association was very large for peak HR (r = 0.866, P 85% HRmax and time spent above both CS (r = 0.719, P

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Let the Pleasure Guide Your Resistance Training Intensity

ABSTRACTPurposeThe purpose of this study was to evaluate the feasibility and reliability of the Feeling Scale (FS) to self-regulate resistance training (RT) intensity.MethodsSixteen sedentary men (39.7±7.5 years) performed 3 familiarization sessions, 2 one repetition maximum testing (1RM), and 16 RT sessions (4 sessions for each FS descriptor; randomized). The FS descriptors were "very good" (FS+5), "good" (FS+3), "fairly good" (FS+1), and "fairly bad" (FS-1). Resistance exercises were leg press, chest press, knee extension, and seated biceps curl. Participants were instructed to select a load associated with the verbal/numerical descriptor of the FS to perform 3 sets of 10 repetitions.ResultsParticipants lifted a significantly greater %1RM as the FS level decreased from FS+5 to FS-1 (P

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Exercise Improves Physical Activity and Comorbidities in Obese Adults with Asthma

ABSTRACTIntroductionObese adults with asthma have an increased number of comorbidities and reduced daily life physical activity (DLPA), which may worsen asthma symptoms. Exercise is recommended to improve asthma outcomes; however, the benefits of exercise for psychosocial comorbidities and physical activity levels in obese adults with asthma have been poorly investigated.ObjectiveTo assess the effects of exercise on DLPA, asthma symptoms and psychosocial comorbidities in obese adults with asthma.MethodsFifty-five grade II obese adults with asthma were randomly assigned to either a weight-loss program+exercise program (WL+E group, n=28) or a weight-loss program+sham (WL+S group, n=27). The WL+E group incorporated aerobic and resistance muscle training into the weight-loss program (nutrition and psychological therapies), while the WL+S group performed breathing and stretching exercises. DLPA, asthma symptoms, sleep quality and anxiety and depression symptoms were quantified before and after treatment.ResultsAfter 3 months, the WL+E group presented a significant increase in daily step counts (3,068 ± 2,325 vs. 729 ± 1,118 steps/day) and the number of asthma-symptom-free days (14.5 ± 9.6 vs. 8.6 ± 11.4 d/mo) compared with the WL+S group. The proportion of participants with improvements in depression symptoms (76.4 vs. 16.6 %) and a lower risk of developing obstructive sleep apnea (56.5 vs. 16.3%) was greater in the WL+E group than in the WL+S group (P

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Changes in Motor Coordination Induced by Local Fatigue during a Sprint Cycling Task

AbstractPurposeThis study investigated how muscle coordination is adjusted in response to a decrease in the force-generating capacity of one muscle group during a sprint cycling task.MethodsFifteen participants were tested during a sprint before and after a fatigue electromyostimulation protocol was conducted on the quadriceps of one leg. Motor coordination was assessed by measuring myoelectrical activity, pedal force and joint power.ResultsThe decrease in force-generating capacity of the quadriceps (-28.0±6.8%) resulted in a decrease in positive knee extension power during the pedaling task (-34.4±30.6 W; P=0.001). The activity of the main non-fatigued synergist and antagonist muscles (triceps surae, gluteus maximus and hamstrings) of the ipsilateral leg decreased, leading to a decrease in joint power at the hip (-30.1±37.8 W; P=0.008) and ankle (-20.8±18.7 W; P=0.001). However, both the net power around the knee and the ability to effectively orientate the pedal force were maintained during the extension by reducing the co-activation and the associated negative power produced by the hamstrings. Adaptations also occurred in flexion phases in both legs, exhibiting an increased power (+17.9±28.3 [P=0.004] and +19.5 ± 21.9 W [P=0.026]), associated with an improvement in mechanical effectiveness.ConclusionThese results demonstrate that the nervous system readily adapts coordination in response to peripheral fatigue by i) decreasing the activation of adjacent non-fatigued muscles to maintain an effective pedal force orientation (despite reducing pedal power) and ii) increasing the neural drive to muscles involved in the flexion phases such that the decrease in total pedal power is limited. Purpose This study investigated how muscle coordination is adjusted in response to a decrease in the force-generating capacity of one muscle group during a sprint cycling task. Methods Fifteen participants were tested during a sprint before and after a fatigue electromyostimulation protocol was conducted on the quadriceps of one leg. Motor coordination was assessed by measuring myoelectrical activity, pedal force and joint power. Results The decrease in force-generating capacity of the quadriceps (-28.0±6.8%) resulted in a decrease in positive knee extension power during the pedaling task (-34.4±30.6 W; P=0.001). The activity of the main non-fatigued synergist and antagonist muscles (triceps surae, gluteus maximus and hamstrings) of the ipsilateral leg decreased, leading to a decrease in joint power at the hip (-30.1±37.8 W; P=0.008) and ankle (-20.8±18.7 W; P=0.001). However, both the net power around the knee and the ability to effectively orientate the pedal force were maintained during the extension by reducing the co-activation and the associated negative power produced by the hamstrings. Adaptations also occurred in flexion phases in both legs, exhibiting an increased power (+17.9±28.3 [P=0.004] and +19.5 ± 21.9 W [P=0.026]), associated with an improvement in mechanical effectiveness. Conclusion These results demonstrate that the nervous system readily adapts coordination in response to peripheral fatigue by i) decreasing the activation of adjacent non-fatigued muscles to maintain an effective pedal force orientation (despite reducing pedal power) and ii) increasing the neural drive to muscles involved in the flexion phases such that the decrease in total pedal power is limited. Correspondence and reprints: Sylvain DOREL, PhD, University of Nantes, Laboratory "Motricité, Interactions, Performance" (EA4334), 25 bis boulevard Guy Mollet, BP 72206, 44322 Nantes cedex 3, France. Email: sylvain.dorel@univ-nantes.fr Project support was provided by the Region Pays de la Loire (ANOPACy project) and the French Ministry of Sport (14-R-23). Francois Hug was supported by a fellowship from the Institut Universiatire de France (IUF). The authors report 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: 6 February 2018 © 2018 American College of Sports Medicine

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Dexmedetomidine as a part of general anaesthesia for caesarean delivery in patients with pre-eclampsia: Efficacy and foetal outcome a randomised double-blinded trial

BACKGROUND During general anaesthesia, endotracheal intubation of patients with pre-eclampsia causes stimulation of the sympathetic nervous system and catecholamine release, which may lead to maternal and neonatal complications. OBJECTIVE To attenuate both the stress response and the haemodynamic response to tracheal intubation in patients with pre-eclampsia. DESIGN A randomised, double-blind, controlled study. SETTING Single University Hospital. PATIENTS Sixty patients aged 18 to 45 years with pre-eclampsia receiving general anaesthesia for caesarean section. INTERVENTIONS The patients were randomly allocated to three groups. Groups D1and D2 received an infusion of dexmedetomidine 1 μg kg−1 over the 10 min before induction of general anaesthesia, then 0.4 and 0.6 μg kg−1 h−1 dexmedetomidine, respectively. Group C received equivalent volumes of 0.9% saline. MAIN OUTCOME MEASURES The primary outcome was the effect of dexmedetomidine on mean arterial blood pressure measured before induction of general anaesthesia at 1 and 5 min after intubation, and then every 5 min until 10 min after extubation. The secondary outcomes were blood glucose and serum cortisol (measured before induction of general anaesthesia, and at 1 and 5 min after intubation), postoperative visual analogue pain scores, time to first request for analgesia, the total consumption of analgesia, Ramsay sedation score, maternal and placental vein blood serum levels of dexmedetomidine and neonatal Apgar score at 1 and 5 min. RESULTS At all assessment times, the mean arterial pressures were significantly lower in the dexmedetomidine groups than in the control group. Compared with group C, the heart rate was significantly lower in both groups D1 and D2. In group D2, the heart rate was lower than in group D1. Serum glucose and cortisol were significantly higher in the controls than in either group D1 or D2. Group D2 patients were significantly more sedated on arrival in the recovery room followed by D1. Time to first analgesia was significantly longer in groups D2 and D1 than in group C, and the visual analogue pain scores were significantly lower in groups D1 and D2 than in group C at 1, 2, 3 and 5 h. Total morphine consumption was significantly lower in groups D1 and D2 than in the control group. There was no difference in Apgar scores across the three groups despite significantly higher dexmedetomidine concentrations in group D2 (both maternal and placental vein) than in group D1. CONCLUSION Administration of dexmedetomidine in doses 0.4 and 0.6 μg kg−1 h−1 was associated with haemodynamic and hormonal stability, without causing significant adverse neonatal outcome. TRIAL REGISTRATION Pan African Clinical Trial Registry (PACTR201706002303170), (www.pactr.org). Correspondence to Ashraf M. Eskandr, MD, Department of Anesthesia, ICU and Pain Therapy, Faculty of Medicine, Menoufiya University, 3 Yassin Abd-Elghafar Street, Shibin El-koom, Egypt E-mail: ameskandr@yahoo.com © 2018 European Society of Anaesthesiology

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Low anaesthetic waste gas concentrations in postanaesthesia care unit: A prospective observational study

BACKGROUND Volatile anaesthetics are a potential hazard during occupational exposure, pregnancy or in individuals with existing disposition to malignant hyperthermia. Anaesthetic waste gas concentration in postanaesthesia care units (PACU) has rarely been investigated. OBJECTIVE(S) The current study aims to assess concentrations of volatile anaesthetics in relation to room size, number of patients and ventilator settings in different PACUs. DESIGN A prospective observational study. SETTING Two different PACUs of the Hannover Medical School (Hannover, Germany) were evaluated in this study. The rooms differed in dimensions, patient numbers and room ventilation settings. PATIENTS During the observation period, sevoflurane anaesthesia was performed in 65 of 140 patients monitored in postanaesthesia unit one and in 42 of 70 patients monitored in postanaesthesia unit two. MAIN OUTCOME MEASURES Absolute trace gas room concentrations of sevoflurane measured with a compact, closed gas loop high-resolution ion mobility spectrometer. RESULTS Traces of sevoflurane could be detected in 805 out of 970 samples. Maximum concentrations were 0.96 ± 0.20 ppm in postanaesthesia unit one, 0.82 ± 0.07 ppm in postanaesthesia unit two. Median concentration was 0.12 (0.34) ppm in postanaesthesia unit one and 0.11 (0.28) ppm in postanaesthesia unit two. CONCLUSION Low trace amounts of sevoflurane were detected in both PACUs equipped with controlled air exchange systems. Occupational exposure limits were not exceeded. Correspondence to Dr. Sebastian Heiderich, MD, Clinic of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany E-mail: heiderich.sebastian@mh-hannover.de © 2018 European Society of Anaesthesiology

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Low perfusion pressure is associated with renal tubular injury in infants undergoing cardiac surgery with cardiopulmonary bypass: A secondary analysis of an observational study

BACKGROUND Earlier work on adults undergoing surgery with cardiopulmonary bypass suggests that there is a close relationship between the lower limit of the cerebral and renal autoregulation pressures. Although cerebral autoregulation during bypass in infants has been extensively investigated, the impact of bypass on kidney function is not well known. It is, nevertheless, acknowledged that the main pathophysiological process involved in cardiac surgery-related kidney damage is tubular injury, and that urine neutrophil gelatinase-associated lipocaline (uNGAL) is a reliable biomarker of injury. OBJECTIVE To identify the most predictive bypass variable for the measurement of renal injury, its threshold value and the most predictive time below that threshold. DESIGN Observational study linking electronically recorded bypass perfusion pressure and oxygen delivery rate with intra-operative uNGAL excretion. Variations in bypass variables were accounted for by their excursions below several thresholds. SETTING French tertiary referral paediatric cardiac centre. PATIENTS A total of 72 infants in whom uNGAL was measured within 1 h of bypass. INTERVENTIONS None. MAIN OUTCOME MEASURE Renal injury, identified by a high creatinine normalised uNGAL concentration (>21.2 μg mmol−1). RESULTS At the end of bypass, 43.75% of infants had high uNGAL. A more than 40% pressure drop below the normal age-standardised mean arterial pressure was associated with high uNGAL. Receiver operating curve [interquartile range] areas were 0.626 [0.501 to 0.752] for a more than 40% drop, and 0.679 [0.555 to 0.804] for a more than 50% drop. A more than 40% pressure drop for 19.5 min provided a 0.65 negative predictive value for high uNGAL, and a more than 50% pressure drop for 5.4 min provided a 0.67 negative predictive value. The link between uNGAL and oxygen delivery rate was negligible. CONCLUSION Maintaining the perfusion pressure above 60% of the normal age-standardised mean arterial pressure may provide an effective renal protective strategy. TRIAL REGISTRATION Registered on October 11, 2010, ClinicalTrials.gov Identifier: NCT01219998. Correspondence to Mirela Bojan, MD, PhD, Department of Anaesthesiology and Critical Care, Necker-Enfants Malades University Hospital, Assistance Publique – Hôpitaux de Paris, 149, rue de Sèvres, 75743 Paris, France Tel: +33 171396663; e-mail: mirela.bojan@nck.aphp.fr © 2018 European Society of Anaesthesiology

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10-10 Electrode Placement System

In a good overview of electrode nomenclature, Seeck et al. (2017) describe the methods for naming recording regions between the major 10-20 electrode nomenclature locations. This excellent presentation describes and illustrates current ideas about high density sampling sites.

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To warn or not to warn: A reappraisal of brainstem auditory evoked potential warning criteria during surgery

Neurophysiologic intraoperative monitoring (NIOM) is widely used to reduce neurologic morbidity in many types of surgeries where nervous tissue is at risk. Somatosensory and motor evoked potentials (SEP, MEP) have been shown to reduce the risk of paraplegia in spinal surgeries (Nuwer et al., 2012). Brainstem auditory evoked potentials (BAEP), similarly, have been shown to reduce the risk of hearing loss in surgeries involving the manipulation of the vestibulocochlear nerve, brainstem or cerebellum (Radtke et al., 1989).

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On the origin of epileptic High Frequency Oscillations observed on clinical electrodes

In drug-resistant partial epilepsies, resective surgery is the treatment of choice to suppress seizures, provided that the epileptogenic zone (EZ) is clearly identified and that it can be safely removed. In this context, the capacity to rely on objective biomarkers of the EZ is fundamental to define the optimal surgical approach in the specific context of each patient. Prior to surgery, patients may benefit from pre-surgical investigations, among which depth-EEG recordings which play a key role as the use of intracranial electrodes offer the unique opportunity to directly and locally record field potentials from brain areas with an excellent temporal resolution (sub-millisecond).

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On the origin of epileptic High Frequency Oscillations observed on clinical electrodes

Publication date: Available online 11 February 2018
Source:Clinical Neurophysiology
Author(s): Mohamad Shamas, Pascal Benquet, Isabelle Merlet, Mohamad Khalil, Wassim El Falou, Anca NICA, Fabrice Wendling
ObjectiveIn this study we aim to identify the key (patho)physiological mechanisms and biophysical factors which impact the observability and spectral features of High Frequency Oscillations (HFOs).MethodsIn order to accurately replicate HFOs we developed virtual-brain / virtual-electrode simulation environment combining novel neurophysiological models of neuronal populations with biophysical models for the source/sensor relationship. Both (patho)physiological mechanisms (synaptic transmission, depolarizing GABAA effect, hyperexcitability) and physical factors (geometry of extended cortical sources, size and position of electrodes) were taken into account. Simulated HFOs were compared to real HFOs extracted from intracerebral recordings of 2 patients.ResultsOur results revealed that HFO pathological activity is being generated by feed-forward activation of cortical interneurons that produce fast depolarizing GABAergic post-synaptic potentials (PSPs) onto pyramidal cells. Out of phase patterns of depolarizing GABAergic PSPs explained the shape, entropy and spatiotemporal features of real human HFOs.ConclusionsThe terminology "high-frequency oscillation" (HFO) might be misleading as the fast ripple component (200-600Hz) is more likely a "high-frequency activity" (HFA), the origin of which is independent from any oscillatory process.SignificanceNew insights regarding the origins and observability of HFOs along depth-EEG electrodes were gained in terms of spatial extent and 3D geometry of neuronal sources.



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10-10 Electrode Placement System

Publication date: Available online 11 February 2018
Source:Clinical Neurophysiology
Author(s): Marc R. Nuwer




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To warn or not to warn: A reappraisal of brainstem auditory evoked potential warning criteria during surgery

Publication date: Available online 11 February 2018
Source:Clinical Neurophysiology
Author(s): Aatif M. Husain




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Functional capacity in adults with cerebral palsy: Lower limb muscle strength matters.

Publication date: Available online 10 February 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Jarred G. Gillett, Glen A. Lichtwark, Roslyn N. Boyd, Lee A. Barber
ObjectiveTo investigate the relationship between lower limb muscle strength, passive muscle properties and functional capacity outcomes in adults with cerebral palsy (CP).DesignCross-sectional study.SettingTertiary institution biomechanics laboratory.ParticipantsSample of 33 adults with spastic-type CP with a mean age of 25 (range, 15-51) years; mean ± SD body mass 70.15 ± 21.35 kg; Gross Motor Function Classification System (GMFCS) level I n=20, level II n=13.InterventionsNot applicable.Main Outcome MeasuresSix-minute walk test (6MWT) distance (m); lateral step-up (LSU) test performance (total repetitions); timed up-stairs (TUS) performance (s); maximum voluntary isometric strength of plantar flexors (PF) and dorsiflexors (DF) (Nm.kg-1); and passive ankle joint and muscle stiffness.ResultsMaximum isometric PF strength independently explained 61% of variance in 6MWT performance; 57% of variance in LSU test performance; and 50% of variance in TUS test performance. GMFCS level was significantly and independently related to all three functional capacity outcomes, and age was retained as a significant independent predictor of LSU, and TUS test performance. Passive medial gastrocnemius muscle fascicle stiffness and ankle joint stiffness were not significantly related to functional capacity measures in any of the multiple regression models.ConclusionsLow isometric PF strength was the most important independent variable related to distance walked on the 6MWT, fewer repetitions on the LSU test, and slower TUS test performance. These findings suggest lower isometric muscle strength contributes to the decline in functional capacity in adults with CP.



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What factors are associated with the recovery of autonomy after a hip fracture? A prospective multicentric cohort study

Publication date: Available online 10 February 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Mattia Morri, Paolo Chiari, Cristiana Forni, Antonella Orlandi Magli, Domenica Gazineo, Natalia Franchini, Lorenzo Marconato, Tiziana Giamboi, Andrea Cotti
Objectiveto identify the factors associated with recovering autonomy in the activities of daily livingDesignA prospective cohort studySettingThe orthopedic and orthogeriatric departments of 2 regional hospitalsParticipantsPatients 65 years of age or older with a diagnosis of fragility hip fracture. There were 840 eligible patients. Forty-three patients were excluded and 55 were lost. Seven hundred and forty-two consecutive patients was enrolled at the time of hospitalization and 727 at follow-up.Main Outcome MeasuresThe level of autonomy at 4 months was assessed using the ADL scale.ResultsThe score of the ADL scale at 4 months had a median equal to 3 (IQR=5). Half of the population was unable to recover their prefracture autonomy levels. The following were found to be risk factors: increasing age (B= 0.02; p<0.001), an elevated number of comorbidities (B=0.044; p=0.005); a lower level of prefracture autonomy (B=0.087; p<0.001); more frequent use of an anti-decubitus mattress (B=0.211; p<0.001), an increased number of days with disorientation (B=0.002; p=0.012); failure to recover deambulation (B=0.199; p<0.001); an increased number of days with diapers (B=0.003; p<0.001), with a urinary catheter (B=0.03; p<0.001) and with bed rails (B=0.001; p=0.014), and a non-intensive care pathway (B=0,199; p=0,014).ConclusionIn the initial phase, treatment of patients with hip fractures is significantly associated with the functional recovery of autonomy and should be activated starting from those factors which have the possibility of being modified in clinical practice: recovery of deambulation, treatment for disorientation and management of incontinence.



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