Determination of cesium transfer factors by instrumental neutron activation analysis

Publication date: July 2018
Source:Journal of Environmental Radioactivity, Volume 187
Author(s): G. Bátor, A. Bednár, T.J. Glover, T. Kovács, S. Landsberger
Food-chain models are used to predict radionuclide ingestion after fallout deposition. These models include those transfer processes (soil-to-plant transfer factor(s) [TF], plant-to-animal transfer coefficient(s) [TC] and concentration ratio [CR]) that are likely to be important for radiological assessment. The range of variability for transfer factors for the same plant groups is great, about 4–5 orders of magnitude, which limits their applicability. A better way to determine the best estimate the factors for radiocaesium and other important radionuclides is if the site-specific data are available. Soil, plant and animal samples were collected from a pasture area in Hungary during the vegetation period in 2016. Stable ¹³³Cs concentration was analysed by comparative method with neutron activation analysis (NAA). The comparator and the samples were irradiated in thermal neutron flux 2.55 × 10¹² ncm⁻²s⁻¹ for 2 h (soil) and 6 h (vegetation, animal samples) in the TRIGA Mark II research reactor at the Nuclear Engineering Teaching Laboratory. After an appropriate decay time (12 days) the samples were measured by gamma-spectrometry and analysed. The observed stable caesium TCpm (0.48–0.53) and CRpm (0.41–0.45) were very close to ¹³⁷Cs factors in the IAEA 2009 Report of 0.49 and 0.54, respectively. This methodology is particularly suitable for the simultaneous study of natural caesium in ecosystem compartments. Consequently, the transfer of stable caesium in a pasture field may be regarded as a useful analogy in predicting the long-term changes of ¹³⁷Cs affected by site-specific environmental factors.



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Molecular characterization, tissue distribution, localization and mRNA expression of the bucky ball gene in the Dabry's sturgeon (Acipenser dabryanus) during oogenesis

Publication date: Available online 23 February 2018
Source:Gene Expression Patterns
Author(s): Huan Ye, Huamei Yue, Xiaoge Yang, Chuangju Li, Qiwei Wei
In many organisms, germ cells are specified during embryogenesis by the inheritance of maternally deposited RNAs and proteins termed germ plasm. In vertebrates, the bucky ball (buc) gene plays an essential role in the germ plasm aggregation. In this study, the full-length cDNA of buc homologue in Dabry's sturgeon, Adbuc, was isolated and characterized. Multiple sequence alignments showed that the BUVE domain of Buc was highly conserved in vertebrates, despite exhibiting low identities with each other across the whole protein. By quantitative real-time PCR analysis, we found that Adbuc RNAs were only detected in the gonad with a high level in the ovary and a very low level in the testis. During embryogenesis, these RNAs were highly expressed from the unfertilized eggs to blastula, declined dramatically from the gastrula stage, and hardly found after the neurula stage. Moreover, with the development of ovary, the expression level of Adbuc was increasing. By in situ hybridization, the signal of Adbuc was not found in the oogonia, increased slightly in the stage I oocytes, and extremely strong in the stage II oocytes, suggesting that the signal became much stronger with increasing size of oocytes. Additionally, Adbuc co-localized with the mitochondrial cloud. Thus, we conclude that Dabry's sturgeon buc gene might also function in germplasm formation.



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Redesigning the Maternal, Infant and Early Childhood Home Visiting Program Performance Measurement System

Abstract

Objectives Statute for the Maternal, Infant and Early Childhood Home Visiting (MIECHV) Program requires that states and territories receiving Program funding assess improvements for participating families across six areas that address maternal and child well-being. In 2015, the MIECHV Program performance measurement system was redesigned to allow for national-level analyses and cross-grantee comparisons. The new measures were aligned with other federal performance measures to help ensure context for program analyses. The number of measures was also reduced to lessen reporting burden. This paper describes the redesign process and resulting national performance measures. Methods The redesign process included holding listening sessions with stakeholders and experts; reviewing the findings from other home visiting performance initiatives; consulting with experts; soliciting and responding to public comment on draft measures; seeking clearance from the Office of Management and Budget; and specifying each measure with detailed eligibility criteria, the timing and frequency of assessments, and the window for data collection. Results The redesign resulted in a set of 19 measures that all MIECHV-funded home visiting programs began collecting in 2016. This is nearly half the number of measures that MIECHV awardees had been reporting prior to the redesign. The measures are aligned with other federal measures, including those used in Healthy People 2020 and those used for other maternal and child health programs. Conclusions for Practice Data reported by MIECHV Program awardees will be used to assess their performance, identify areas for targeted technical assistance to support continuous improvement, and ensure meaningful impacts for at-risk families.

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Genomic-Enabled Prediction Kernel Models with Random Intercepts for Multi-environment Trials

In this study, we compared the prediction accuracy of the main genotypic effect model (MM) without GxE interactions, the multi-environment single variance GxE deviation model (MDs), and the multi-environment environment-specific variance GxE deviation model (MDe) where the random genetic effects of the lines are modeled with the markers (or pedigree). With the objective of further modeling the genetic residual of the lines, we incorporated the random intercepts of the lines (l) and generated another three models. Each of these 6 models were fitted with a linear kernel method (Genomic Best unbiased predictor, GB) and a Gaussian Kernel (GK) method. We compared these 12 model-method combinations with another two multi-environment GxE interactions models with unstructured variance-covariances (MUC) using GB and GK kernels (4 model-method). Thus, we compared the genomic-enabled prediction accuracy of a total of 16 model-method combinations on two maize data sets with positive phenotypic correlations among environments, and on two wheat data sets with complex GxE that includes some negative and close to zero phenotypic correlations among environments. The two models (MDs and MDE with the random intercept of the lines and the GK method) were computationally efficient and gave high prediction accuracy in the two maize data sets. Regarding the more complex GxE wheat data sets, the prediction accuracy of the model-method combination with GxE, MDs and MDe, including the random intercepts of the lines with GK method had important savings in computing time as compared with the GxE interaction multi-environment models with unstructured variance-covariances but with lower genomic prediction accuracy.

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Targeted Long-Read Sequencing of a Locus Under Long-Term Balancing Selection in Capsella

Rapid advances in short-read DNA sequencing technologies have revolutionized population genomic studies, but there are genomic regions where this technology reaches its limits. Limitations mostly arise due to the difficulties in assembly or alignment to genomic regions of high sequence divergence and high repeat content, which are typical characteristics for loci under strong long-term balancing selection. Studying genetic diversity at such loci therefore remains challenging. Here, we investigate the feasibility and error rates associated with targeted long-read sequencing of a locus under balancing selection. For this purpose, we generated bacterial artificial chromosomes (BACs) containing the Brassicaceae S-locus, a region under strong negative frequency-dependent selection which has previously proven difficult to assemble in its entirety using short reads. We sequence S-locus BACs with single-molecule long-read sequencing technology and conduct de novo assembly of these S-locus haplotypes. By comparing repeated assemblies resulting from independent long-read sequencing runs on the same BAC clone we do not detect any structural errors, suggesting that reliable assemblies are generated, but we estimate an indel error rate of 5.7' 10^-5. A similar error rate was estimated based on comparison of Illumina short-read sequences and BAC assemblies. Our results show that, until de novo assembly of multiple individuals using long-read sequencing becomes feasible, targeted long-read sequencing of loci under balancing selection is a viable option with low error rates for single nucleotide polymorphisms or structural variation. We further find that short-read sequencing is valuable complement, allowing correction of the relatively high rate of indel errors that result from this approach.

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Role of CTCF in DNA Damage Response

Publication date: Available online 23 February 2018
Source:Mutation Research/Reviews in Mutation Research
Author(s): Vinay Singh Tanwar, Cynthia C. Jose, Suresh Cuddapah
CCCTC-binding factor (CTCF) is a highly conserved, ubiquitously expressed zinc finger protein. CTCF is a multifunctional protein, associated with a number of vital cellular processes such as transcriptional activation, repression, insulation, imprinting and genome organization. Emerging evidence indicates that CTCF is also involved in DNA damage response. In this review, we focus on this newly identified role of CTCF in facilitating DNA double-strand break repair. Due to the large number of cellular processes in which CTCF is involved, factors that functionally affect CTCF could have serious implications on genomic stability. It is becoming increasingly clear that exposure to environmental toxicants could have adverse effects on CTCF functions. Here we discuss the various ways that the environmental toxicants could impact CTCF functions and the potential consequences on DNA damage response.



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DNA AND CHROMOSOME DAMAGE INDUCED BY BLEOMYCIN IN MAMMALIAN CELLS: AN UPDATE

Publication date: Available online 23 February 2018
Source:Mutation Research/Reviews in Mutation Research
Author(s): Alejandro D. Bolzán, Martha S. Bianchi
Bleomycin (BLM) is an antibiotic isolated from Streptomyces verticillus. It has radiomimetic actions on DNA thus it has been widely used in clinical chemotherapy for the treatment of different types of cancer, including head and neck tumors, lymphomas, squamous-cell carcinomas and germ-cell tumors. Because of this, the study of BLM genotoxicity is of practical interest. This antibiotic is an S-independent clastogen and an agent that generates free radicals and induces single- and double-strand breaks in DNA. In the present review, we will summarize our current knowledge concerning the DNA and chromosome damage induced by BLM in mammalian cells, with emphasis on new developments published since 1991.



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Laser evoked potential amplitude and laser-pain rating reduction during high-frequency non-noxious somatosensory stimulation

The inhibition of pain by non-nociceptive cutaneous stimulation represents a well known phenomenon. Daily experience teaches us that rubbing a painful area can reduce pain. The underlying mechanism of the analgesia induced by non-painful somatosensory stimuli has been hypothesized by Melzack and Wall in 1965 (Melzack and Wall, 1965). According to the "gate control theory of pain", it is the balance between the small diameter (C and Aδ) and large diameter (Aβ) fibres at their entrance to the spinal cord to control pain.

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Pain-motor Integration and Chronic Pain: One Step Ahead

Pain-motor integration refers to physiological processes responsible for mutual interaction between nociceptive and motor information in the central nervous system. Two separate lines of evidence support the hypothesis that pain-motor integration mechanisms operate in the human cerebral cortex. First, epidural motor cortex stimulation (MCS), as well as non-invasive brain stimulation (NIBS) protocols delivered over the primary motor cortex (M1), can both improve pain in patients with drug-resistant chronic pain.

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Interaction of interaural cues and their contribution to the lateralisation of Mongolian gerbils ( Meriones unguiculatus )

Abstract

The main sound localisation cues in the horizontal plane are interaural time and level differences (ITDs and ILDs, respectively). ITDs are thought to be the dominant cue in the low-frequency range, ILDs the dominant cue in the high-frequency range. ITDs and ILDs co-occur. Their interaction and contribution to the lateralisation of pure tones by Mongolian gerbils was investigated behaviourally using cross-talk cancellation techniques for presenting ITDs and ILDs independently. First, ITDs were applied to pure tones with frequencies ≤ 2 kHz to the ongoing waveform, at the onsets and offsets, or in both the ongoing waveform and at the onsets and offsets. Gerbils could lateralise tones only if ongoing ITDs were present indicating that ongoing ITDs are decisive for the lateralisation of low-frequency tones. Second, an ITD was added to 2-to-6-kHz tones with varying ILD. Gerbils' lateralisation was unaffected by the ITD indicating that a large ILD provides a strong lateralisation cue at those frequencies. Finally, small ILDs were applied to 2-kHz tones with an ongoing ITD, pointing either to the same or opposing sides as the ITD. Gerbils' lateralisation was driven by the ITD but strongly affected by the ILD indicating that both interaural cues contribute to the lateralisation.

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Biomechanical evaluation of sacroiliac joint fixation with decortication

Fusion typically consists of joint preparation, grafting and rigid fixation. Fusion has been successfully used to treat symptomatic disruptions of the SIJ and degenerative sacroiliitis using purpose-specific, threaded implants. The biomechanical performance of these systems is important but has not been studied.

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Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial

The optimal number of visits for the care of cervicogenic headache (CGH) with spinal manipulative therapy (SMT) is unknown.

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Utilization of Mental Health Services by Preschool-Aged Children with Private Insurance Coverage

Abstract

There is increasing recognition that some preschool-aged children suffer from mental health conditions, but little is known about the treatment they receive. Using the 2014 MarketScan Commercial Claims and Encounters database (N = 1,987,759) the study finds that only a small proportion of preschool-aged children receive any behavioral interventions, including psychotherapy, in conjunction with having a filled psychiatric prescription. Nearly all of the preschool-aged children who had psychotropic prescriptions filled had no other claims for treatment, and among those children who had prescriptions for psychotropic medication filled, the vast majority did not have a mental health diagnosis on a claim.

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Genome-wide identification and characterization of the RIO atypical kinase family in plants

Abstract

Members of the right open reading frame (RIO) atypical kinase family are present in all three domains of life. In eukaryotes, three subfamilies have been identified: RIO1, RIO2, and RIO3. Studies have shown that the yeast and human RIO1 and RIO2 kinases are essential for the biogenesis of small ribosomal subunits. Thus far, RIO3 has been found only in multicellular eukaryotes. In this study, we systematically identified members of the RIO gene family in 37 species representing the major evolutionary lineages in Viridiplantae. A total of 84 RIO genes were identified; among them, 41 were classified as RIO1 and 43 as RIO2. However, no RIO3 gene was found in any of the species examined. Phylogenetic trees constructed for plant RIO1 and RIO2 proteins were generally congruent with the species phylogeny. Subcellular localization analyses showed that the plant RIO proteins were localized mainly in the nucleus and/or cytoplasm. Expression profile analysis of rice, maize, and Arabidopsis RIO genes in different tissues revealed similar expression patterns between RIO1 and RIO2 genes, and their expression levels were high in certain tissues. In addition, the expressions of plant RIO genes were regulated by two drugs: mycophenolic acid and actinomycin D. Function prediction using genome-wide coexpression analysis revealed that most plant RIO genes may be involved in ribosome biogenesis. Our results will be useful for the evolutionary analysis of the ancient RIO kinase family and provide a basis for further functional characterization of RIO genes in plants.

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Longitudinal Impact of a Randomized Clinical Trial to Improve Family Function, Reduce Maternal Stress and Improve Child Outcomes in Families of Children with ADHD

Abstract

Objective Evaluate the efficacy of a 12 month nursing case-management intervention over a period of 18 months, 6 months after the end of intervention, for families of children attention deficit hyperactivity disorder (ADHD). Methods Mother and child dyads were enrolled to participate in a randomized controlled clinical trial. Children were 4–18 years old. Data were collected at baseline, 6, 12, and 18 months or 6 months after the termination of direct intervention. Longitudinal analyses, using generalized estimating equations, were conducted to assess change in study outcomes relating to family function, maternal stress, and child behavior over the 18 month period. Results Compared to control families, some family function outcomes were moderately improved in the intervention group. In particular, intervention families demonstrated substantial improvement in implementing family behavior controls (p value = 0.038) and improvement in family satisfaction (not statistically significant p = 0.062). Although there was improvement in the overall family function measure there was not a statistically significant difference between groups. Maternal stress and child behavior outcomes were not significantly different between control and intervention groups by the end of the intervention. Conclusions for Practice Addressing ADHD is complex and requires the assessment of comorbidities that might exacerbate negative behavior. Our findings support the latest American Academy of Pediatrics guidelines to use behavioral therapy as the first line of treatment in young children. Nursing case-management interventions that provide direct family education and improve family function, especially with respect to providing structure and behavior control, may complement and facilitate behavioral therapy for treatment of ADHD and improving child behavior.

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Lessons from the sky: an aviation-based framework for maximizing the delivery of quality anesthetic care

Abstract

Though aviation is practiced in airplanes and anesthesiology in operating rooms, the two professions have substantial parallels. Both require readiness to manage a crisis situation, where lives are at stake, at a moment's notice and with incomplete information. The determinants of quality performance in both professions extend far beyond knowledge base and formal training. The science of human factors, a prominent cornerstone of the aviation industry, has not yet found the same place in medicine, but it could change the understanding and execution of medical decision-making in profound ways. This article reviews specific components of crisis management and root cause analysis in aviation that can serve as models for improving those same aspects within anesthesiology.

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A case of anosmia and hypogeusia as a complication of propofol

Abstract

Anesthetics represent an uncommon cause of taste and smell disorders. We describe a case of anosmia and hypogeusia for 6 weeks after recovery from a uterine curettage operation in a 32-year-old woman. The case is unusual because propofol was the only anesthetic used during surgery and anesthesia. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed no abnormality. This case may highly suggest that propofol could induce smell and taste disorders.

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Analysis of gene expression in red maple ( Acer rubrum ) and trembling aspen ( Populus tremuloides ) populations from a mining region

Abstract

The Greater Sudbury Region has been known as one of the most ecologically disturbed areas in Canada for the past century. Plant adaptation to environmental stressors often results in modifications in gene expression at the transcriptional level. The main objective of the present study was to compare the expression of genes associated with nickel resistance in Acer rubrum and Populus tremuloides growing in areas contaminated and uncontaminated with metals. Primers targeting Nramps4, Nas 3, At2G, MRP4 and alpha-tubulin genes were used to amplify cDNA of both species. The expression of the At2G gene, was 2× and 9× higher in P. tremuloides than in A. rubrum for St. Charles (uncontaminated site) and Kelly Lake (metal contaminated site), respectively. There was a much smaller difference between the two species for the Nramps 4 gene as its expression was 2.5× and 3× higher in P. tremuloides compared to A. rubrum from St. Charles and Kelly Lake, respectively. The same trend was observed for the MRP4 gene whose expression was 2× and 14× higher in P. tremuloides than in A. rubrum from St. Charles and Kelly Lake, respectively. For the Nas 3 gene, the expression was similar in both sites. This gene was upregulated 11× and 10× in P. tremuloides compared to A. rubrum in samples from St. Charles and Kelly Lake, respectively. In general, no significant difference was observed between the metal contaminated and uncontaminated sites for gene expression. In depth analysis revealed that AT2G and MRP4 genes were significantly down regulated in A. rubrum from the metal contaminated sites compared to those from uncontaminated areas, but environmental factors driving this differential gene expression couldn't be established.

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Profiling and identification of pregnancy-associated circulating microRNAs in dairy cattle

Abstract

Holstein is one among the dairy cattle which provide higher milk yields than most other cattle breeds. Lack of high-accuracy, reliable methods for early detection of cattle pregnancy reduces overall productivity and constitutes a high economic burden to the dairy industry. The circulating microRNAs (miRNAs) in exosomes could provide information and serve as potential biomarkers for livestock health and disease. However, the complexity of miRNA in response to cattle early pregnancy remains unknown. Hence, we collected blood samples of three healthy dairy cows of normal and 30 days of pregnancy, in order to further characterize the miRNA transcriptome profile. A high-throughput RNA-Seq approach detected 794 known and 2154 novel circulating miRNAs in six libraries. A total of 29 miRNAs in the 30 days of pregnancy group showed significant differences compared to the normal group. Further, bta-miR-450b, bta-miR-146b, bta-miR-26b and bta-miR-27b were up-regulated which shown to be involved in preeclampsia, immune response and mammary gland development. GO enrichment analysis showed these target genes were involved in the metabolic process, signal transducer activity, and membrane etc., while KEGG analysis showed that these genes were enriched in membrane trafficking, chromosome and associated proteins, exosome and G protein-coupled receptors pathways. These results provide an experimental basis to reveal the potential role of miRNAs as biomarkers in early diagnosis of pregnancy and other molecular functions.

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CKAP2L mutation confirms the diagnosis of Filippi syndrome

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The Relationship Between Perceived Unmet Mental Health Care Needs and Suicidal Ideation and Attempt

Abstract

This study utilizes data from the National Survey of Drug Use and Health (NSDUH) to analyze the relationship between perceived unmet mental health care needs and suicidal ideation and attempt. Estimates from multivariable logistic regression models suggest that individuals who report perceived unmet mental health care needs have higher probability of experiencing suicidal ideation and attempt. Perceived unmet mental health care need has an important association with suicidal ideation and attempt, and efforts aimed at improving access to care are needed to address this issue.

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Value of ictal and interictal epileptiform discharges and high frequency oscillations for delineating the epileptogenic zone in patients with focal cortical dysplasia

Publication date: Available online 22 February 2018
Source:Clinical Neurophysiology
Author(s): C. Cuello-Oderiz, N. von Ellenrieder, R. Sankhe, A. Olivier, J. Hall, F. Dubeau, J. Gotman
ObjectivesThere are different neurophysiological markers of the Epileptogenic Zone (EZ), but their sensitivity and specificity for the EZ is not known in Focal Cortical Dysplasia (FCD) patients.MethodsWe studied patients with FCD who underwent stereoelectroencephalography (SEEG) and surgery. We marked in the SEEG: a) typical and atypical interictal epileptiform patterns, b) ictal onset patterns, and c) rates of ripples (80-250 Hz) and fast ripples (FRs) (>250 Hz). High frequency oscillations were marked automatically during one hour of deep sleep. Surgical outcome was defined as good (Engel I) or poor (Engel II-IV). We computed the sensitivity and, as a measure of specificity, the false positive rate to identify the EZ, and compared them across the different neurophysiological markers.ResultsWe studied 21 patients, 19 with FCD II. Ictal and typical interictal pattern were the markers with highest sensitivity, while the atypical interictal pattern had the lowest. We found no significant difference in specificity among markers. However, there is a tendency that FRs had the lowest false positive rate.ConclusionThe typical interictal pattern has the highest sensitivity. The clinical use of FRs is limited by their low sensitivity.SignificanceWe suggest to analyze the typical interictal pattern first. FRs should be analyzed in a second step. If, for instance, a focus with FRs and no typical interictal pattern is found, this area could be considered for resection.



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A novel, fast and efficient single-sensor automatic sleep-stage classification based on complementary cross-frequency coupling estimates

Publication date: April 2018
Source:Clinical Neurophysiology, Volume 129, Issue 4
Author(s): Stavros I. Dimitriadis, Christos Salis, David Linden
ObjectiveLimitations of the manual scoring of polysomnograms, which include data from electroencephalogram (EEG), electro-oculogram (EOG), electrocardiogram (ECG) and electromyogram (EMG) channels have long been recognized. Manual staging is resource intensive and time consuming, and thus considerable effort must be spent to ensure inter-rater reliability. As a result, there is a great interest in techniques based on signal processing and machine learning for a completely Automatic Sleep Stage Classification (ASSC).MethodsIn this paper, we present a single-EEG-sensor ASSC technique based on the dynamic reconfiguration of different aspects of cross-frequency coupling (CFC) estimated between predefined frequency pairs over 5 s epoch lengths. The proposed analytic scheme is demonstrated using the PhysioNet Sleep European Data Format (EDF) Database with repeat recordings from 20 healthy young adults. We validate our methodology in a second sleep dataset.ResultsWe achieved very high classification sensitivity, specificity and accuracy of 96.2 ± 2.2%, 94.2 ± 2.3%, and 94.4 ± 2.2% across 20 folds, respectively, and also a high mean F1 score (92%, range 90–94%) when a multi-class Naive Bayes classifier was applied. High classification performance has been achieved also in the second sleep dataset.ConclusionsOur method outperformed the accuracy of previous studies not only on different datasets but also on the same database.SignificanceSingle-sensor ASSC makes the entire methodology appropriate for longitudinal monitoring using wearable EEG in real-world and laboratory-oriented environments.



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Sodium-potassium pump assessment by submaximal electrical nerve stimulation

Publication date: April 2018
Source:Clinical Neurophysiology, Volume 129, Issue 4
Author(s): Steven Hageman, Maria O. Kovalchuk, Boudewijn T.H.M. Sleutjes, Leonard J. van Schelven, Leonard H. van den Berg, Hessel Franssen
ObjectiveSodium-potassium pump dysfunction in peripheral nerve is usually assessed by determining axonal hyperpolarization following maximal voluntary contraction (MVC) or maximal electrical nerve stimulation. As MVC may be unreliable and maximal electrical stimulation too painful, we assessed if hyperpolarization can also be induced by submaximal electrical nerve stimulation.MethodsIn 8 healthy volunteers different submaximal electrical stimulus trains were given to the median nerve at the wrist, followed by 5 min assessment of thresholds for compound muscle action potentials of 20%, 40% or 60% of maximal.ResultsThreshold increase after submaximal electrical nerve stimulation was most prominent after an 8 Hz train of at least 5 min duration evoking submaximal CMAPs of 60%. It induced minimal discomfort and was not painful. Threshold increase after MVC was not significantly higher than this stimulus train.ConclusionsSubmaximal electrical stimulation evokes activity dependent hyperpolarization in healthy test subjects without causing significant discomfort.SignificanceSodium-potassium pump function may be assessed using submaximal electrical stimulation.



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Caveolin-3 dependent loss of t-tubular ICa during hypertrophy and heart failure in mice

Abstract

Background

Previous work has shown redistribution of L-type Ca current (I_Ca) from the t-tubules to the surface membrane of rat ventricular myocytes following myocardial infarction. However, whether this occurs in all species and in response to other insults, the relationship of this redistribution to the severity of the pathology, and the underlying mechanism, are unknown. We have therefore investigated the response of mouse hearts and myocytes to pressure overload induced by transverse aortic constriction (TAC).

Methods

Male C57BL/6 mice underwent TAC or equivalent Sham operation 8 weeks before use. I_Ca and calcium transients were measured in isolated myocytes, and Caveolin-3 (Cav-3) Junctophillin-2 (JPH-2) and Bridging Integrator-1 (BIN-1) expression determined. C3SD peptide was used to disrupt Cav-3 binding to its protein partners.

Results

Some animals showed cardiac hypertrophy in response to TAC with little evidence of heart failure, whereas others showed greater hypertrophy and pulmonary congestion. These graded changes were accompanied by graded cellular hypertrophy, t-tubule disruption, decreased expression of JPH-2 and Cav-3, and decreased t-tubular I_Ca density, with no change at the cell surface, and graded impairment of Ca release at t-tubules. C3SD decreased I_Ca density in control, but not in TAC myocytes.

Conclusions

These data suggest that the graded changes in cardiac function and size that occur in response to TAC are paralleled by graded changes in cell structure and function, which will contribute to the impaired function observed in vivo. They also suggest that loss of t-tubular I_Ca is due to loss of Cav-3 dependent stimulation of I_Ca.

This article is protected by copyright. All rights reserved

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A different perspective: anesthesia for extreme premature infants is there an age limitation or how low should we go?

Purpose of review To put in perspective, the various challenges that faces pediatric anesthesiologists because of the recently lowered limits with regards to the viability of a fetus. Both medical and ethical considerations will be highlighted. Recent findings Issues related to: who should anesthetize these tiny babies; can we provide adequate and legal monitoring during the anesthetic; does these immature babies need hypnosis and amnesia and the moral/ethical implications associated with being involved with care of doubtful long-term outcome are reviewed. Summary There does currently not exist sufficient research data to provide any evidence-based guidelines for the anesthetic handling of extreme premature infants. Current practice relies on extrapolations from other patient groups and from attempting to preserve normal physiology. Thus, focused research initiatives within this specific field of anesthesia should be a priority. Furthermore, in-depth multiprofessional ethical discussions regarding long-term outcome of aggressive care of extremely premature babies are urgently needed, including the new concepts of disability-free survival and number-need-to-suffer. Correspondence to Per-Arne Lönnqvist, MD, DEAA, FRCA, PhD, Paediatric Anaesthesia, PICU & ECMO Services, Karolinska University Hospital, Solna, SE 171 76 Stockholm, Sweden. Tel: +46 70 721 06 50; fax: +46 8 5177 7260; e-mail: per-arne.lonnqvist@ki.se Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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The opioid epidemic and the current prevalence of substance use disorder in anesthesiologists

Purpose of review There has been a substantial increase in prescription and illicit opioid abuse in the general population observed over the last two decades. Initially fueled by an influx of prescription opioid medications, the opioid epidemic now includes increasingly potent heroin and illicit fentanyl. Younger anesthesiologists, those currently in training or recent graduates, have come of age in a society where opioid abuse is much more prevalent. Recent findings The current prevalence of substance use disorder (SUD) in the physician population is slightly higher than in the general population and appears to be increasing. Although most anesthesiologists with SUD will abuse alcohol as their drug of choice, the incidence of opioid and nonopioid anesthetic agent abuse, especially propofol, is increasing. The incidence of SUD among the anesthesia resident population decreased somewhat during the 1990s but has been steadily increasing since the year 2000. Summary The increasing incidence of substance use disorder in anesthesia residents may reflect the significantly increased number of persons addicted to opioids and other drugs of abuse in the general population. Despite educational and surveillance programs put in place to prevent diversion, susceptible individuals with access are still abusing anesthetic agents. Correspondence to Ethan O. Bryson, MD, Department of Anesthesiology, Pain Management and Perioperative Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, Box 1010, One Gustave L Levy Place, New York, NY 10029, USA. Tel: +1 212 241 9240; fax: +1 212 876 3906; e-mail: ethan.bryson@mountsinai.org Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Chronic pain after hysterectomy

Purpose of review Hysterectomy is a common surgical procedure with a low risk of major complications. However, some women experience long-lasting complications, including chronic postsurgical pain, which can have a negative impact on their quality of life. This review aims to present the recent literature on chronic pain following hysterectomy for benign indications. Recent findings Chronic pain following hysterectomy is reported in 10–50% of women. Risk factors include preoperative pelvic pain, pain elsewhere, acute postoperative pain, surgical procedure, and psychological factors such as anxiety and depression. The pain may be neuropathic in 5–50% of cases. Summary Chronic pain may occur after hysterectomy. Preoperative screening tools, including psychological screening for depression and anxiety, may identify women at risk of developing chronic postsurgical pain, and future studies should examine perioperative interventions aimed at preventing the development of chronic pain after hysterectomy. Correspondence to Birgitte Brandsborg, Department of Anaesthesiology, Aarhus University Hospital, THG, Tage-Hansens Gade 2, bldg.2, 2., 8000 Aarhus C, Denmark. Tel: +45 26844438; e-mail: birbrand@rm.dk Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Occupational stress, burnout and personality in anesthesiologists

Purpose of review There is a growing awareness of the problem of occupational stress and burnout among anesthesiologists. Occupational stress was found to be related to burnout, a process that is supposed to be moderated by personality. This article will discuss the topic of stress and burnout in relationship to anesthesiologists' personality based on recent literature. Recent findings Studies among anesthesiologists are in concordance with the broader body of literature on this topic. Personality consistently influences stress appraisal and coping and consequently the development of burnout. Neuroticism, negative affectivity and cooperativeness all contribute to burnout. Summary Strategies to alleviate stress and hence the development of burnout should not only be directed at adapting occupational or organizational factors but also at equipping anesthesiologists with psychological tools to deal with occupational stress. Furthermore, personality traits that predispose for development of burnout could be taken into consideration in resident selection procedures. Correspondence to Raymond A.B. van der Wal, MD, Anesthesiologist, Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Center, Internal Postal Code 717, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands. Tel: +31 24 361 4406; fax: +31 24 354 0462; e-mail: Raymond.vanderwal@radboudumc.nl Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Anesthesia and analgesia for gynecological surgery

Purpose of review High-quality analgesia has been linked to improved patient satisfaction as well as improved short-term and long-term postoperative outcomes. Acute surgical pain is a modifiable risk factor for development of chronic postoperative pain, which is reported by up to 26% of gynecologic surgical patients. In other surgical populations, multimodal analgesia has shown improved pain control and decreased reliance on opioids. This review examines recent evidence for various analgesic modalities applied specifically to the gynecologic surgical population. Recent findings Nonopioid agents like acetaminophen, nonsteroidal anti-inflammatories, and gamma-aminobutyric acid analogs resulted in reduction in postoperative pain and opioid consumption. Application of regional anesthetic techniques had a favorable effect that persisted beyond the immediate recovery period. Preemptive analgesia remains unproven. The best evidence for effective combinations comes from ERAS studies that incorporated multimodal analgesia into a systemic approach geared towards early discharge. Summary Multimodal analgesia had demonstrated advantages for all types of gynecological surgeries in terms of improving postoperative pain control and minimizing opioid-related adverse effects. Multimodal analgesia includes acetaminophen, NSAIDS, and gamma-aminobutyric acid analogs combined with intraoperative nonopioid analgesics such as ketamine, regional anesthesia or intrathecal morphine. Further research should focus on determining most effective combinations and doses of multimodal analgesia. Correspondence to Dr Ronald B. George, MD, FRCPC, Department of Women's and Obstetric Anesthesia, IWK Health Centre, 5850/5980 University Avenue, P.O. Box 9700, Halifax, NS B3K 6R8, Canada. Tel: +1 902 470 6627; fax: +1 902 470 6626; e-mail: rbgeorge@dal.ca,@Ron_George Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Technology as friend or foe? Do electronic health records increase burnout?

Purpose of review To summarize recent relevant studies regarding the use of electronic health records and physician burnout. Recent findings Recently acquired knowledge regarding the relationship between electronic health record use, professional satisfaction, burnout, and desire to leave clinical practice are discussed. Summary Adoption of electronic health records has increased across the United States and worldwide. Although electronic health records have many benefits, there is growing concern about the adverse consequences of their use on physician satisfaction and burnout. Poor usability, incongruent workflows, and the addition of clerical tasks to physician documentation requirements have been previously highlighted as ongoing concerns with electronic health record adoption. In multiple recent studies, electronic health records have been shown to decrease professional satisfaction, increase burnout, and the likelihood that a physician will reduce or leave clinical practice. One interventional study demonstrated a positive effect of a dedicated electronic health record entry clerk on physicians working in an outpatient practice. Correspondence to Jesse M. Ehrenfeld, MD, MPH, Professor of Anesthesiology, Surgery, Biomedical Informatics & Health Policy, Director, Education Research – Office of Health Sciences Education, Director, Program for LGBTI Health, Associate Director, Vanderbilt Anesthesiology & Perioperative Informatics Research Division, Vanderbilt University School of Medicine, 1301 Medical Center Drive, Suite TVC 4648, Nashville, TN 37232, USA. E-mail: jesse.ehrenfeld@vanderbilt.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Level of agreement between laboratory and point-of-care prothrombin time in patients after stopping or continuation of acenocoumarol anticoagulation: A comparison of diagnostic accuracy

BACKGROUND Procedures requiring optimisation of the coagulation status of patients using vitamin K antagonists are frequently postponed due to the late availability of laboratory international normalised ratio (INR) test results. A point-of-care (POC) alternative may facilitate early decision-making in peri-operative patients. OBJECTIVES To assess the level of agreement between the POC-INR and the laboratory INR in patients who continue or stop vitamin K antagonists to determine whether the POC test may be a good alternative to the laboratory INR. DESIGN Study of diagnostic accuracy. SETTING Single-centre study at Zaans Medical Centre, The Netherlands. PATIENTS Included patients were scheduled for cardioversion (these continued taking vitamin K antagonists), or a surgical procedure (these stopped taking vitamin K antagonists). MAIN OUTCOME MEASURES The level of agreement and clinical acceptability of the laboratory and POC-INR results, evaluated by Bland–Altman analysis and error grid analysis. RESULTS The surgical and cardioversion groups consisted of 47 and 46 patients, respectively. The bias in the INR in the surgical group was −0.12 ± 0.09 with limits of agreement of −0.29 to 0.05, whereas the cardioversion group showed a bias in the INR of −0.22 ± 0.36 with limits of agreement from −0.93 to 0.48. The percentage errors between methods in the surgical and cardioversion groups were 16 and 21%, respectively. Error grid analysis showed that the diagnostic accuracy of the POC prothrombin time is clinically acceptable as the difference did not lead to a different clinical decision in the surgical group with INR values less than 1.8. CONCLUSION The current study shows a good level of agreement and clinical accuracy between the laboratory and POC-INR in patients who stopped anticoagulation intake for surgery. However, in patients who continued their anticoagulation therapy, the agreement between the two methods was less accurate. Correspondence to Elisabeth A.J. de Vos, MD, Department of Anesthesiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands Tel: +31 20 4443830; e-mail: e.devos@vumc.nl © 2018 European Society of Anaesthesiology

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Improving detection of patient deterioration in the general hospital ward environment

Patient monitoring on low acuity general hospital wards is currently based largely on intermittent observations and measurements of simple variables, such as blood pressure and temperature, by nursing staff. Often several hours can pass between such measurements and patient deterioration can go unnoticed. Moreover, the integration and interpretation of the information gleaned through these measurements remains highly dependent on clinical judgement. More intensive monitoring, which is commonly used in peri-operative and intensive care settings, is more likely to lead to the early identification of patients who are developing complications than is intermittent monitoring. Early identification can trigger appropriate management, thereby reducing the need for higher acuity care, reducing hospital lengths of stay and admission costs and even, at times, improving survival. However, this degree of monitoring has thus far been considered largely inappropriate for general hospital ward settings due to device costs and the need for staff expertise in data interpretation. In this review, we discuss some developing options to improve patient monitoring and thus detection of deterioration in low acuity general hospital wards. 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. http://ift.tt/OBJ4xP Correspondence to Dr Jean-Louis Vincent, Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium E-mail: jlvincent@intensive.org © 2018 European Society of Anaesthesiology

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Opioid-related genetic polymorphisms do not influence postoperative opioid requirement: A prospective observational study

BACKGROUND Among the various factors that may influence the pharmacological response to opioids, genetic polymorphisms [single nucleotide polymorphisms (SNP)] have generated some interest. OBJECTIVES To examine the influence on morphine dose requirements and adverse events in the postoperative period of four SNP [opioid receptor mu1 (OPRM1), ATP-binding cassette subfamily B, member 1 (ABCB1) ex-21 and ex-26, catechol-o-methyltransferase (COMT)] in candidate genes involved in morphine pharmacodynamics and pharmacokinetics. DESIGN A single centre prospective study. SETTING University Hospital, Paris, France, from 2 January 2007 to 15 November 2011. PATIENTS A total of 438 white adults scheduled for major orthopaedic surgery (spine, hip and knee) under general anaesthesia. The main exclusion criteria were receiving opioids for chronic pain, nonopioid drugs within 2 days prior to surgery, pregnancy, renal insufficiency, sleep apnoea obstruction syndrome, morbid obesity, severe hepatic impairment, cognitive dysfunction. INTERVENTIONS Assays of plasma concentrations of morphine and metabolites (morphine 3-glucuronide and morphine 6-glucuronide) were performed and common polymorphisms in four candidate genes [OPRM1 A118G rs1799971; P-glycoprotein (ABCB1) T3435C (rs1045642) and G2677T/A (rs2032582); COMT Val 158 Met (rs4680)] were analysed. Morphine was titrated by staff in the postanaesthesia care unit (PACU) and in the ward patient-controlled intravenous analgesia was used for 24 h. MAIN OUTCOME MEASURES The dose of morphine required to achieve pain relief and the influence of SNP in genes involved in morphine pharmacodynamics and kinetics on morphine dose requirements. Secondary endpoints were the concentrations of morphine, morphine 6-glucuronide and morphine 3-gluguronide, the proportion of patients requiring a rescue analgesic and the proportion of morphine-related adverse events. RESULTS A total of 404 patients completed the study to final analysis. The mean ± SD morphine dose to achieve pain relief was 15.8 ± 8.8 mg in the PACU and 22.7 ± 18.6 mg during patient-controlled intravenous administration. Morphine-related adverse events were observed in 37%. There was no relationship between any genetic polymorphisms and morphine dose, morphine 3-gluguronide and morphine 6-glucuronide concentration, morphine-related adverse events or pain level. In the PACU only, P-glycoprotein polymorphisms (ex-21; ex-26) were significantly associated with morphine concentration but the prediction of the model was poor (R2 = 0.04) CONCLUSION No major relationship has been demonstrated between SNP of OPRM1, ABCB1, COMT and morphine requirement, pain level or adverse effects in the postoperative period. TRIAL REGISTRATION NCT00822549 (www.clinicaltrials.gov). Correspondence to Frédéric Aubrun, Département d'Anesthésie-Réanimation, Hôpital de la Croix-Rousse, 103 Boulevard de La Croix Rousse, 69004 Lyon, France E-mail: frederic.aubrun@chu-lyon.fr 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/2ylyqmW). © 2018 European Society of Anaesthesiology

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Heritability of the airway structure and head posture using twin study

Abstract

Background

Inherited traits of obstructive sleep apnea (OSA) may have link to the heritability of the airway anatomy.

Objectives

The aim of present study was to investigate heritability of the airway anatomy by comparing skeletal and soft tissue features of Korean monozygotic (MZ) and dizygotic twins (DZ).

Methods

In total, 72 participants (mean age, 41.5 ± 5.9 years; 40 males, 32 females) including 48 MZ (24 pairs) and 24 DZ (12 pairs) with same sex were participated. The craniofacial, craniovertebral, hyoideal, and pharyngeal parameters were measured using lateral cephalograms. The genetic analysis was performed using Falconer's method.

Results

High heritability was detected in the hyoid position and inclination of the cervical column. The velopharyngeal and hypopharyngeal dimensions showed higher heritability compared to those of the nasopharynx and oropharynx. The body mass index (BMI) had interactions with the nasopharyngeal and hypopharyngeal dimensions and length of the tongue and soft palate. The mandibular growth had correlations with the nasopharyngeal and hypopharyngeal dimensions. The vertical skeletal relationships appeared to have interaction with the nasopharyngeal, velopharyngeal, and hypopharyngeal dimensions, as well as length of the tongue and soft palate. A forwarded inclination of the cervical columns was seen in connections with BMI and the nasopharyngeal and hypopharyngeal dimensions.

Conclusion

The airway structures and head postures seemed to be under strong genetic controls. The airway dimensions had associations with BMI, head postures and skeletal structures which showed high heritability. Forwarded head postures would be physiological adaptions of compromised airway adequacy by increased BMI and retrognathia.

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Influence of CAD/CAM fabrication on denture surface properties

Abstract

Background

Three main properties are responsible for the microbial attractiveness of denture surfaces: roughness, hydrophilicity and free surface energy.

Objective

This study investigated whether CAD/CAM-fabricated dentures are more favourable for these surface properties than conventionally fabricated dentures.

Methods

The mucosal surface roughness of 54 standardised study dentures was measured using contact profilometry. The surface hydrophilicity and free surface energy of 70 standardised denture-resin specimens were determined by contact angle measurements. Both experimental settings compared AvaDent (AD), Baltic Denture System (BDS), Vita VIONIC (VV), Whole You Nexteeth (WN) and Wieland Digital Dentures (WDD) surfaces with conventionally manufactured denture surfaces (control group). The data were analysed using ANOVA together with Tukey's test or the Games-Howell post hoc test.

Results

All CAD/CAM dentures had lower mean surface roughness values than conventional dentures. For AD, VV, WN and WDD, the differences were statistically significant. VV (p < .001), coated WN (p < .001), AD (p = .023) and BDS specimens (p = .027) were significantly more hydrophilic than the control group. All measured surface energies were of similar magnitude (mean values between 31.82 mJ/m² and 33.68 mJ/m²), and only coated WN specimens had a significantly increased mean value (66.62 mJ/m², p < .001).

Conclusion

Although most CAD/CAM dentures have smoother and more hydrophilic surfaces than conventional dentures, there is no difference in their free surface energy, except for coated dentures.

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