Analysis of the impact of race on blood transfusion in pediatric scoliosis surgery

Summary

Introduction

Surgical correction of pediatric scoliosis is associated with significant blood loss. Minimizing estimated blood loss and blood transfusion is beneficial as transfusions have been associated with increased morbidity, including risk of surgical site infections, longer hospitalizations, and increased cost. Although there is evidence that African-American or Black adults are more likely to require intraoperative blood transfusion compared with Caucasian or White adults, the reasons for this difference are unclear.

Methods

The electronic records for all patients <18 y/o undergoing primary corrective scoliosis surgery by a single pediatric orthopedic surgeon at a single academic medical center between 2013 and 2015 were collected and reviewed. Multivariate models were performed to assess the association between Black race and blood loss/transfusion in primary pediatric scoliosis surgery.

Results

In a multivariate model, Black race was independently associated with 1.61 times higher estimated blood loss than White race (P < .01; 95% CI = 1.16-2.23). Additionally, compared to a White patient, the odds a Black patient received blood transfusion was 6.25 times higher (P = .03; 95% CI = 1.56-25.06) and among the patients who received blood transfusion, Black race was independently associated with 2.61 times greater volume of blood transfusion than White race (P < .01; 95% CI = 1.54-4.41).

Conclusion

Black race was independently associated with increased estimated blood loss, increased rate of blood transfusion, and increased amount of blood transfused during surgical correction of pediatric scoliosis. Further investigation is needed to better understand the etiology of the disparity and assess opportunities for improving outcomes.

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Development of Foundational Movement Skills: A Conceptual Model for Physical Activity Across the Lifespan

Abstract

Evidence supports a positive association between competence in fundamental movement skills (e.g., kicking, jumping) and physical activity in young people. Whilst important, fundamental movement skills do not reflect the broad diversity of skills utilized in physical activity pursuits across the lifespan. Debate surrounds the question of what are the most salient skills to be learned which facilitate physical activity participation across the lifespan. In this paper, it is proposed that the term 'fundamental movement skills' be replaced with 'foundational movement skills'. The term 'foundational movement skills' better reflects the broad range of movement forms that increase in complexity and specificity and can be applied in a variety of settings. Thus, 'foundational movement skills' includes both traditionally conceptualized 'fundamental' movement skills and other skills (e.g., bodyweight squat, cycling, swimming strokes) that support physical activity engagement across the lifespan. A proposed conceptual model outlines how foundational movement skill competency can provide a direct or indirect pathway, via specialized movement skills, to a lifetime of physical activity. Foundational movement skill development is hypothesized to vary according to culture and/or geographical location. Further, skill development may be hindered or enhanced by physical (i.e., fitness, weight status) and psychological (i.e., perceived competence, self-efficacy) attributes. This conceptual model may advance the application of motor development principles within the public health domain. Additionally, it promotes the continued development of human movement in the context of how it leads to skillful performance and how movement skill development supports and maintains a lifetime of physical activity engagement.

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Exercise Professionals with Advanced Clinical Training Should be Afforded Greater Responsibility in Pre-Participation Exercise Screening: A New Collaborative Model between Exercise Professionals and Physicians

Abstract

Regular exercise improves health but can also induce adverse responses. Although such episodes are rare, many guidelines for pre-participation exercise screening have historically had a low threshold for recommending medical clearance prior to the commencement of exercise, placing the responsibility for decision making about exercise participation on physicians. The 'clearance to exercise' model still occurs widely in practice, but creates cost burdens and barriers to the uptake of exercise. Moreover, many physicians are not provided the training, nor time in a standard consultation, to be able to effectively perform this role. We present a model for pre-participation exercise screening and the initial assessment of clients wishing to commence an exercise programme. It is designed to guide professional practice for the referral, assessment and prescription of exercise for people across the health spectrum, from individuals who are apparently healthy, through to clients with pre-existing or occult chronic conditions. The model removes the request that physicians provide a 'clearance' for patients to engage in exercise programmes. Instead the role of physicians is identified as providing relevant clinical guidance to suitably qualified exercise professionals to allow them to use their knowledge, skills and expertise in exercise prescription to assess and manage any risks related to the prescription and delivery of appropriate exercise programmes. It is anticipated that removing unjustified barriers to exercise participation, such as mandated medical review, will improve the uptake of exercise by the unacceptably high proportion of the population who do not undertake sufficient physical activity for health benefit.

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Kidney enlargement and multiple liver cyst formation implicate mutations in PKD1/2 in adult sporadic polycystic kidney disease

Distinguishing autosomal dominant polycystic kidney disease (ADPKD) from other inherited renal cystic diseases in patients with adult polycystic kidney disease and no family history is critical for correct treatment and appropriate genetic counseling. However, for patients with no family history, there are no definitive imaging findings that provide an unequivocal ADPKD diagnosis. We analyzed 53 adult polycystic kidney disease patients with no family history. Comprehensive genetic testing was performed using capture-based next-generation sequencing for 69 genes currently known to cause hereditary renal cystic diseases including ADPKD. Through our analysis, 32 patients had PKD1 or PKD2 mutations. Additionally, three patients with disease-causing mutations in NPHP4, PKHD1, and OFD1 were diagnosed with an inherited renal cystic disease other than ADPKD. In patients with PKD1 or PKD2 mutations, the prevalence of polycystic liver disease, defined as more than 20 liver cysts, was significantly higher (71.9% versus 33.3%, p = 0.006), total kidney volume was significantly increased (median, 1580.7 ml versus 791.0 ml, p = 0.027) and mean arterial pressure was significantly higher (median, 98 mmHg versus 91 mmHg, p = 0.012). The genetic screening approach and clinical features described here are potentially beneficial for optimal management of adult sporadic polycystic kidney disease patients.

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Correction to: Strategies to Support the Education Goals of Youth and Young Adults with Serious Mental Health Conditions: A Case Study

Abstract

The original version of this article unfortunately contained a mistake. The spelling of the fifth author's name was incorrectly published as Masha Ellison.

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Updated database on natural radioactivity in building materials in Europe

Publication date: July 2018
Source:Journal of Environmental Radioactivity, Volume 187
Author(s): R. Trevisi, F. Leonardi, S. Risica, C. Nuccetelli
The paper presents the latest collection of activity concentration data of natural radionuclides (²²⁶Ra, ²³²Th and ⁴ K) in building materials. This database contains about 24200 samples of both bulk materials and their constituents (bricks, concrete, cement, aggregates) and superficial materials used in most European Union Member States and some European countries. This collection also includes radiological information about some NORM residues and by-products (by-product gypsum, metallurgical slags, fly and bottom ashes and red mud) which can be of radiological concern if recycled in building materials as secondary raw materials. Moreover, radon emanation and radon exhalation rate data are reported for bricks and concrete.



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Editorial Board

Publication date: July 2018
Source:Journal of Environmental Radioactivity, Volume 187





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Deposition of artificial radionuclides in sediments of Loch Etive, Scotland

Publication date: July 2018
Source:Journal of Environmental Radioactivity, Volume 187
Author(s): Hamza Al-Qasmi, Gareth T.W. Law, L. Keith Fifield, John A. Howe, Tim Brand, Gregory L. Cowie, Kathleen A. Law, Francis R. Livens
The nuclear fuel reprocessing plants on the Sellafield site (UK) have released low-level effluents into the Irish Sea under authorisation since 1952. This has led to the labelling of nearby offshore sediments with a range of artificial radionuclides. In turn, these sediments act as a long-term secondary source of both soluble and particle-associated radionuclides to coastal areas. These radionuclides are of interest both in assessing possible environmental impacts and as tracers for marine processes. Here we present results from a study of the geochemistry of natural (^{234, 238}U) and artificial (¹³⁷Cs, ²⁴¹Am, ²³⁸Pu, ^239+240Pu, and ²³⁶U) radionuclides and their accumulation in sediments from Loch Etive, Scotland. The data are interpreted in the context of the historical radioactive discharges to the Irish Sea and biogeochemical processes in marine sediments. Loch Etive is divided into two basins; a lower, seaward basin where the sedimentation rate (∼0.6 cm/yr) is about twice that of the more isolated upper basin (∼0.3 cm/yr). These accumulation rates are consistent with the broad distribution of ¹³⁷Cs in the sediment profiles which can be related to the maximum Sellafield discharges of ¹³⁷Cs in the mid-1970s and suggest that ¹³⁷Cs was mainly transported in solution to Loch Etive during that period. Enrichments of Mn, Fe, and Mo in sediment and porewater from both Loch Etive basins result from contemporary biogeochemical redox processes. Enrichments of ²³⁸U and ²³⁴U in the lower basin may be a result of the cycling of natural U. By contrast, the Sellafield-derived artificial isotope ²³⁶U does not seem to be affected by the redox-driven reactions in the lower basin. The ²³⁸Pu/^239,240Pu ratios suggest contributions from both historical Sellafield discharges and global fallout Pu. The uniform sediment distributions of Pu and Am, which do not reflect Sellafield historical discharges, suggest the existence of a homogenous secondary source. This could be the offshore 'mud patch' in the vicinity of Sellafield from which the supply of radionuclides reflects time-integrated Sellafield discharges. This source could also account for the continuing supply of Cs to Loch Etive, even after substantial reductions in discharge from the Sellafield site.



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Radiocesium migration in the litter layer of different forest types in Fukushima, Japan

Publication date: July 2018
Source:Journal of Environmental Radioactivity, Volume 187
Author(s): Momo Kurihara, Yuichi Onda, Hiroaki Kato, Nicolas Loffredo, Tetsuo Yasutaka, Frederic Coppin
Cesium-137 (¹³⁷Cs) migration in the litter layer consists of various processes, such as input via throughfall, output via litter decomposition, and input from deeper layers via soil organism activity. We conducted litter bag experiments over 2 years (December 2014–November 2016) to quantify the inputs and outputs of ¹³⁷Cs in the litter layer in a Japanese cedar plantation (Cryptomeria japonica) and a mixed broadleaf forest dominated by Quercus serrata located 40 km northwest of the Fukushima Dai-ichi Nuclear Power Plant. The experiments included four conditions, combining contaminated and non-contaminated litter and deeper layer material, and the inputs and outputs were estimated from the combination of ¹³⁷Cs increases and decreases in the litter layer under each condition. The ¹³⁷Cs dynamics differed between the two forests. In the C. japonica forest, some ¹³⁷Cs input via throughfall remained in the litter layer, and downward ¹³⁷Cs flux passed through the litter layer was 0.42 (/year).Upward flux of ¹³⁷Cs from the deeper layer was very restricted, < 0.017 (/year). In the broadleaf forest, migration of ¹³⁷Cs in throughfall into deeper layers was restricted, downward ¹³⁷Cs flux was less than 0.003 (/year).Upward input of ¹³⁷Cs from the deeper layer was prominent, 0.037 (/year). ¹³⁷Cs output via litter decomposition was observed in both forests. The flux in the C. japonica forest was slower than that in the broadleaf forest, 0.12 and 0.15 (/year), respectively.



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AMS assessment of U-contamination of structural materials of the Garigliano NPP under decommissioning

Publication date: July 2018
Source:Journal of Environmental Radioactivity, Volume 187
Author(s): F. Terrasi, R. Buompane, A. D'Onofrio, A. Esposito, L. Gialanella, F. Marzaioli, A. Petraglia, G. Porzio, C. Sabbarese, F. Scolamacchia, C. Sirignano
The assessment of the radiological impact of decommissioning activities at a Nuclear Power Plant requires a detailed mapping of the distribution of radionuclides both in the environment surrounding the NPP and in its structural material. The detection of long-lived actinide isotopes and possibly the identification of their origin is particularly interesting and valuable if ultrasensitive measurement of the relative abundance of U isotopes is performed via Accelerator Mass Spectrometry (AMS). In this paper we present an investigation carried out on the structural materials of the Garigliano NPP aiming to determine the abundance of ^235,236,238U in the various compartments of the plant buildings under decommissioning. Since the expected values both for isotopic ratios and total U concentrations range over different orders of magnitude, we have developed a novel methodology for the measurement of ^234,235U/²³⁸U isotopic ratios in low U concentration samples. This allowed a systematic investigation of the distribution of all U isotopes in concrete and metal matrices of the NPP. The behavior of ^235,236U/²³⁸U isotopic ratios in the different compartments of the NPP is discussed. The correlation of these ratios with ⁶⁰Co and ¹³⁷Cs specific activities is also studied to show a different behavior for concrete and metal samples. These data represent a very valuable information to direct the decommissioning procedures under course.



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Mixtures of tritiated water, zinc and dissolved organic carbon: Assessing interactive bioaccumulation and genotoxic effects in marine mussels, Mytilus galloprovincialis

Publication date: July 2018
Source:Journal of Environmental Radioactivity, Volume 187
Author(s): Holly B.C. Pearson, Lorna J. Dallas, Sean D.W. Comber, Charlotte B. Braungardt, Paul J. Worsfold, Awadhesh N. Jha
Release of tritium (³H) in the marine environment is of concern with respect to its potential bioaccumulation and detrimental impact on the biota. Previous studies have investigated the uptake and toxicity of this radionuclide in marine mussels, and the interaction of ³H with dissolved organic ligands and elevated temperature. However, despite the well-established view that toxicity is partly governed by chemical speciation, and that toxic effects of mixture of contaminants are not always additive, there have been no studies linking the prevailing chemistry of exposure waters with observed biological effects and tissue specific accumulation of ³H in combination with other constituents commonly found in natural waters. This study exposed the marine mussel Mytilus galloprovincialis for 14 days to mixtures of ³H (as tritiated water, HTO) and zinc (Zn) at 5 Mbq L⁻¹, and 383, 1913 and 3825 nM Zn, respectively, to investigate (a) ³H and Zn partitioning in soft tissues of mussels, and (b) DNA damage in haemocytes, determined using the single cell gel electrophoresis or the comet assay. Additionally, the extent of association of ³H with dissolved organic carbon (DOC, added as humic acid) over the exposure period was investigated in order to aid the interpretation of biological uptake and effects. Results concluded a clear antagonistic effect of Zn on ³H-induced DNA damage at all Zn concentrations used, likely explained by the importance of Zn in DNA repair enzymes. The interaction of DOC with ³H was variable, with strong ³H-DOC associations observed in the first 3 d of the experiment. The secretion of ³H-binding ligands by the mussels is suggested as a possible mechanism for early biological control of ³H toxicity. The results suggest risk assessments for radionuclides in the environment require consideration of potential mixture effects.



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Sensory gating in the ipsilateral somatosensory cortex during voluntary activity: what might this mean for chronic limb pain?

Abstract

It is well established that motor tasks are associated with gating of irrelevant sensory input from the contralateral side of the body. In a recent issue of the Journal of Physiology, Lei and Perez (2017) present novel findings that suggest the ipsilateral somatosensory cortex (iS1) is also likely to contribute to sensorimotor integration.

This article is protected by copyright. All rights reserved

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Improved Genome Assembly and Annotation for the Rock Pigeon (Columba livia)

The domestic rock pigeon (Columba livia) is among the most widely distributed and phenotypically diverse avian species. C. livia is broadly studied in ecology, genetics, physiology, behavior, and evolutionary biology, and has recently emerged as a model for understanding the molecular basis of anatomical diversity, the magnetic sense, and other key aspects of avian biology. Here we report an update to the C. livia genome reference assembly and gene annotation dataset. Greatly increased scaffold lengths in the updated reference assembly, along with an updated annotation set, provide improved tools for evolutionary and functional genetic studies of the pigeon, and for comparative avian genomics in general.

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Inducible Genome Editing with Conditional CRISPR/Cas9 Mice

Genetically engineered mouse models (GEMMs) are powerful tools by which to probe gene function in vivo, obtain insight into disease etiology, and identify modifiers of drug response. Increased sophistication of GEMMs has led to the design of tissue-specific and inducible models in which genes of interest are expressed or ablated in defined tissues or cellular subtypes. Here we describe the generation of a transgenic mouse harboring a doxycycline-regulated Cas9 allele for inducible genome engineering. This model provides a flexible platform for genome engineering since editing is achieved by exogenous delivery of sgRNAs and should allow for the modelling of a range of biological and pathological processes.

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Functional Validation of Candidate Genes Detected by Genomic Feature Models

Understanding the genetic underpinnings of complex traits requires knowledge of the genetic variants that contribute to phenotypic variability. Reliable statistical approaches are needed to obtain such knowledge. In genome-wide association studies, variants are tested for association with trait variability to pinpoint loci that contribute to the quantitative trait. Because stringent genome-wide significance thresholds are applied to control the false positive rate, many true causal variants can remain undetected. To ameliorate this problem, many alternative approaches have been developed, such as genomic feature models (GFM). The GFM approach tests for association of set of genomic markers, and predicts genomic values from genomic data utilizing prior biological knowledge. We investigated to what degree the findings from GFM have biological relevance. We used the Drosophila Genetic Reference Panel to investigate locomotor activity, and applied genomic feature prediction models to identify gene ontology (GO) categories predictive of this phenotype. Next, we applied the covariance association test to partition the genomic variance of the predictive GO terms to the genes within these terms. We then functionally assessed whether the identified candidate genes affected locomotor activity by reducing gene expression using RNA interference. In five of the seven candidate genes tested, reduced gene expression altered the phenotype. The ranking of genes within the predictive GO term was highly correlated with the magnitude of the phenotypic consequence of gene knockdown. This study provides evidence for five new candidate genes for locomotor activity, and provides support for the reliability of the GFM approach.

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Rapid Nuclear Exclusion of Hcm1 in Aging Saccharomyces cerevisiae Leads to Vacuolar Alkalization and Replicative Senescence

The yeast, Saccharomyces cerevisiae, like other higher eukaryotes, undergo a finite number of cell divisions before exiting the cell cycle due to the effects of aging. Here, we show that yeast aging begins with the nuclear exclusion of Hcm1 in young cells, resulting in loss of acidic vacuoles. Autophagy is required for healthy aging in yeast, with proteins targeted for turnover by autophagy directed to the vacuole. Consistent with this, vacuolar acidity is necessary for vacuolar function and yeast longevity. Using yeast genetics and immunofluorescence microscopy, we confirm that vacuolar acidity plays a critical role in cell health and lifespan, and is potentially maintained by a series of Forkhead Box (Fox) transcription factors. An interconnected transcriptional network involving the Fox proteins (Fkh1, Fkh2 and Hcm1) are required for transcription of v-ATPase subunits and vacuolar acidity. As cells age, Hcm1 is rapidly excluded from the nucleus in young cells, blocking the expression of Hcm1 targets (Fkh1 and Fkh2), leading to loss of v-ATPase gene expression, reduced vacuolar acidification, increased α-syn-GFP vacuolar accumulation, and finally, diminished replicative lifespan (RLS). Loss of vacuolar acidity occurs about the same time as Hcm1 nuclear exclusion and is conserved; we have recently demonstrated that lysosomal alkalization similarly contributes to aging in C. elegans following a transition from progeny producing to post-reproductive life. Our data points to a molecular mechanism regulating vacuolar acidity that signals the end of RLS when acidification is lost.

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Caring for patients with epilepsy: The many ways EEG is useful

Epileptic activity presents with prominent electroencephalography (EEG) features. It comes as no surprise that EEG is useful to identify, categorize, diagnose, and monitor patients with epilepsy (PWE).

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An evaluation of kurtosis beamforming in magnetoencephalography to localize the epileptogenic zone in drug resistant epilepsy patients

The aim of epilepsy surgery is to remove the epileptogenic zone (EZ), i.e. the region whose removal ensures postoperative seizure freedom (Engel, 1996; Lüders et al., 2006). Hypotheses about the location of the EZ are typically generated on the basis of the patient's clinical history, as well as electroencephalography (EEG), neuropsychological and neuroimaging assessments (Engel, 1996; Lüders et al., 2006; Dorfer et al., 2015). Approximately 15-25% of patients yield inconclusive or non-localizing results (Zumsteg et al., 2000; Carrette et al., 2010) often meaning that additional invasive testing is required (Blount et al., 2008).

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A reappraisal of the mechanisms of action of ketamine to treat complex regional pain syndrome in the light of cortical excitability changes

Complex regional pain syndrome (CRPS) is a multi-symptom, multi-system painful syndrome whose pathophysiological mechanisms remain partly unknown. The acronym CRPS refers to a disorder characterized by spontaneous or stimulus-induced pain that is disproportionate to the inciting event and is accompanied by a combination of various autonomic and motor disturbances. The activation of the sympathetic nervous system is likely involved. A neurological injury, when identified, is generally peripheral, leading to the distinction between CRPS type I (without nerve injury) and type II (with nerve injury).

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Prediction of secondary generalization from a focal onset seizure in intracerebral EEG

Approximately 30% of patients with focal epilepsy are unresponsive to antiepileptic medications and many are considered surgical candidates (Johnson and Krauss, 2016). These patients continue to experience several physical and physiological complications and the conditions become worse when their uncontrolled seizures evolve from focal to bilateral tonic-clonic seizure (van Mierlo et al., 2014). Such seizures severely affect the patient's safety and quality of life (Yang et al., 2017; Yoo et al., 2014).

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Event-related brain potentials elicited by high-speed cooling of the skin: a robust and non-painful method to assess the spinothalamic system in humans

Neuropathic pain is defined by the International Association for the Study of Pain as "pain arising as a direct consequence of a lesion or disease of the somatosensory system" (Loeser and Treede, 2008). This implies that the diagnostic work-up of neuropathic pain requires clinical tools to assess the function of the somatosensory system, including the function of the spinothalamic system. The most recent guidelines on neuropathic pain assessment state that the recording of laser-evoked brain potentials (LEPs) – i.e.

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Effect of posterior instrumented fusion on three-dimensional volumetric growth of cervical ossification of the posterior longitudinal ligament: a multiple regression analysis

Background Context: Despite the fact that ossification of posterior longitudinal ligament (OPLL) is a three-dimensional disease, conventional studies have mainly focused on a two-dimensional measurement, and it is difficult to accurately determine the volume of OPLL growth and analyze the factors affecting OPLL growth after posterior decompression (laminoplasty or laminectomy and fusion).Purpose: This study aimed to investigate the factors affecting OPLL volume growth using a three-dimensional measurement.

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Relative pelvic version (RPV): an individualized pelvic incidence-based proportional parameter that quantifies pelvic version more precisely than pelvic tilt

Pelvic Tilt (PT) is used as an indicator of pelvic version with increased values indicating retroversion and disability. The concept of using PT solely as an absolute numerical value can be misleading, especially for the patients with Pelvic Incidence (PI) values near the upper and lower normal limits. Relative Pelvic Version (RPV) is a PI-based individualized measure of the pelvic version. RPV indicates the individualized spatial orientation of the pelvis relative to the ideal sacral slope as defined by the magnitude of PI.

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The effect of inter-body fusion cage design on the stability of the instrumented spine in response to cyclic loading: an experimental study.

In the lumbar spine, end plate preparation for the interbody fusion cages may critically affect the cage's long term performance. This study investigated the effect of the interbody cage design on the compliance and cage subsidence of instrumented spines under cyclic compression.

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Transcriptional regulation mediated by H2A.Z via ANP32e-dependent inhibition of protein phosphatase 2A

Publication date: Available online 8 March 2018
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms
Author(s): Hyewon Shin, Minzhen He, Zhi Yang, Yong Heui Jeon, Jessica Pfleger, Danish Sayed, Maha Abdellatif
The mechanisms that regulate H2A.Z and its requirement for transcription in differentiated mammalian cells remains ambiguous. In this study, we identified the interaction between the C-terminus of ANP32e and N-terminus of H2A.Z in a yeast two-hybrid screen. Knockdown of ANP32e resulted in proteasomal degradation and nuclear depletion of H2A.Z or of a chimeric green florescence protein fused to its N-terminus. This effect was reversed by inhibition of protein phosphatase 2A (PP2A) and, conversely, reproduced by overexpression of its catalytic subunit. Accordingly, knockdown of ANP32e inhibited phosphorylation of H2A.Z, whereas a mutation of serine-9 proved its requirement for both the protein's stability and nuclear localization, as did knockdown of the nuclear mitogen and stress-induced kinase 1. Moreover, ANP32e's knockdown also revealed its differential requirement for cell signaling and gene expression, whereas, genome-wide binding analysis confirmed its co-localization with H2A.Z at transcription start sites, as well as, gene bodies of inducible and tissue-specific genes. The data also suggest that H2A.Z restricts transcription, which is moderated by ANP32e at the promoter and gene bodies of expressed genes. Thus, ANP32e, through inhibition of PP2A, is required for nucleosomal inclusion of H2A.Z and the regulation of gene expression.



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Association study between copy number variation and beef fatty acid profile of Nellore cattle

Abstract

The aim of this study was to analyze the association between the copy number variation regions (CNVRs) and fatty acid profile phenotypes for saturated (SFA), monosaturated (MUFA), polyunsaturated (PUFA), ω6 and ω3 fatty acids, PUFA/SFA and ω6/ω3 ratios, as well as for their sums, in Nellore cattle (Bos primigenius indicus). A total of 963 males were finished in feedlot and slaughtered with approximately 2 years of age. Animals were genotyped with the BovineHD BeadChip (Illumina Inc., San Diego, CA, USA). The copy number variation (CNV) detection was performed using the PennCNV algorithm. Log R ratio (LRR) and allele B frequency (BAF) were used to estimate the CNVs. The association analyses were done using the CNVRuler software and applying a logistic regression model. The phenotype was adjusted using a linear model considering the fixed effects of contemporary group and the animal age at slaughter. The fatty acid profile was analyzed on samples of longissimus thoracis muscle using gas chromatography with a 100-m capillary column. For the association analysis, the adjusted phenotypic values were considered for the traits, while the data was adjusted for the effects of the farm and year of birth, management groups at birth, weaning, and superannuation. A total of 186 CNVRs were significant for SFA (43), MUFA (42), PUFA (66), and omega fatty acid (35) groups, totaling 278 known genes. On the basis of the results, several genes were associated with several fatty acids of different saturations. Olfactory receptor genes were associated with C12:0, C14:0, and C18:0 fatty acids. The SAMD8 and BSCL2 genes, both related to lipid metabolic process, were associated with C12:0. The RAPGEF6 gene was found to be associated with C18:2 cis-9 cis-12 n-6, and its function is related to regulation of GTPase activity. Among the results, we highlighted the olfactory receptor activity (GO:0004984), G-protein-coupled receptor activity (GO:0004930), potassium:proton antiporter activity (GO:0015386), sodium:proton antiporter activity (GO:0015385), and odorant-binding (GO:0005549) molecular functions. A large number of genes associated with fatty acid profile within the CNVRs were identified in this study. These findings must contribute to better elucidate the genetic mechanism underlying the fatty acid profile of intramuscular fat in Nellore cattle.

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Procalcitonin and C-reactive protein as early markers of anastomotic leak after laparoscopic colorectal surgery within an enhanced recovery after surgery (ERAS) program

Abstract

Background

C-reactive protein (CRP) and procalcitonin (PCT) have been described as good predictors of anastomotic leak after colorectal surgery, obtaining the highest diagnostic accuracy on the 5th postoperative day. However, if an enhanced recovery after surgery (ERAS) program is performed, early predictors are needed in order to ensure a safe and early discharge. The aim of this study was to investigate the efficacy of CRP, PCT, and white blood cell (WBC) count determined on first postoperative days, in predicting septic complications, especially anastomotic leak, after laparoscopic colorectal surgery performed within an ERAS program.

Methods

We conducted a prospective study including 134 patients who underwent laparoscopic colorectal surgery within an ERAS program between 2015 and 2017. The primary endpoint investigated was anastomotic leak. CRP, PCT, and WBC count were determined in the blood sample extracted on postoperative day 1 (POD 1), POD 2 and POD 3.

Results

Anastomotic leak (AL) was detected in 6 patients (4.5%). Serum levels of CRP and PCT, but not WBC, determined on POD 1, POD 2, and POD 3 were significantly higher in patients who had AL in the postoperative course. Using ROC analysis, the best AUC of the CRP and PCT levels was on POD 3 (0.837 and 0.947, respectively). A CRP cutoff level at 163 mg/l yielded 85% sensitivity, 80% specificity, and 99% negative predictive value (NPV). A PCT cutoff level at 2.5 ng/ml achieved 85% sensitivity, 95% specificity, 44% positive predictive value, and 99% NPV.

Conclusions

CRP and PCT are relevant markers for detecting postoperative AL after laparoscopic colorectal surgery. Furthermore, they can ensure an early discharge with a low probability of AL when an ERAS program is performed.

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Adjusted calculation model of heparin management during cardiopulmonary bypass in obese patients: A randomised controlled trial

BACKGROUND Anticoagulation during cardiopulmonary bypass (CPB) is usually adapted to total body weight (TBW). This may be inaccurate in obese patients and lead to heparin overdose with a risk of bleeding. OBJECTIVES To validate the efficacy and safety of an adjusted calculation model of heparin dosing based on ideal body weight (IBW) rather than TBW in obese CPB patients, with an expected target mean plasma heparin concentration of 4.5 IU ml−1 after onset of CPB in the experimental group. DESIGN Prospective, randomised controlled study. SETTING University hospital. PATIENTS Sixty obese patients (BMI ≥ 30 kg m−2) scheduled for CPB were included from January to June 2016. INTERVENTIONS Patients received a bolus dose of unfractionated heparin of either 300 IU kg−1 of TBW or 340 IU kg−1 of IBW before onset of CPB. Additional adjusted boluses were injected to maintain an activated clotting time (ACT) of at least 400 s. MAIN OUTCOME MEASURES Plasma heparin concentration and ACT were measured at different time points. Total heparin doses and transfusion requirements were recorded. RESULTS The target heparin concentration of 4.5 IU ml−1 was reached in the IBW group at the onset of CPB and maintained at all time points during CPB. Heparin concentrations were significantly higher in the TBW group after the bolus (6.52 ± 0.97 vs. 4.54 ± 1.13 IU ml−1, P 

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Spinal anaesthesia with chloroprocaine 1% versus total intravenous anaesthesia for outpatient knee arthroscopy: A randomised controlled trial

BACKGROUND Both general and spinal anaesthesia with short-acting local anaesthetics are suitable and reliable for knee arthroscopy as an ambulatory procedure. Chloroprocaine (CP) 1% seems to be the ideal spinal local anaesthetic for this indication. OBJECTIVE The aim of this study was to compare spinal anaesthesia using CP 1% with general for outpatient knee arthroscopy with regard to procedure times, occurrence of pain, patient satisfaction and recovery, and also costs. DESIGN A randomised controlled single-centre trial. SETTING University Medical Centre Mannheim, Department of Anaesthesiology and Surgical Intensive Care Medicine, Mannheim, Germany. April 2014 to August 2015. PATIENTS A total of 50 patients (women/men, 18 to 80 years old, ASA I to III) undergoing outpatient knee arthroscopy were included. A contra-indication to an allocated anaesthetic technique or an allergy to medication required in the protocol led to exclusion. INTERVENTIONS Either general anaesthesia with sufentanil, propofol and a laryngeal mask for airway-management or spinal with 40-mg CP 1% were used. We noted procedure times, patient satisfaction/recovery and conducted a 7-day follow-up. MAIN OUTOMES Primary outcome was duration of stay in the day-surgery centre. Secondary outcomes were first occurrence of pain, patient satisfaction, quality of recovery and adverse effects. In addition, we analysed treatment costs. RESULTS Spinal had faster recovery than general anaesthesia with patients reaching discharge criteria significantly earlier [117 min (66 to 167) versus 142 min (82 to 228), P = 0.0047]. Pain occurred significantly earlier in the general anaesthesia group (P = 0.0072). Costs were less with spinal anaesthesia (cost ratio spinal: general 0.57). Patients felt significantly more uncomfortable after general anaesthesia (P = 0.0096). CONCLUSION Spinal anaesthesia with 40-mg CP 1% leads to a significantly earlier discharge and is cheaper compared with general. TRIAL REGISTRATION German Clinical Trials Register, www.drks.de, identifier: DRKS00005989. Correspondence to Prof. Dr. med. Marc D. Schmittner, Head, Department of Anaesthesiology, Intensive Care and Pain Medicine, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Str. 7, 12683 Berlin, Germany Tel: +49 (0) 30 56 81 3100; fax: +49 (0) 30 56 81 3103; e-mail: marc.schmittner@ukb.de © 2018 European Society of Anaesthesiology

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Early and late selection processes have separable influences on the neural substrates of attention

Publication date: Available online 7 March 2018
Source:International Journal of Psychophysiology
Author(s): Brandi Lee Drisdelle, Pierre Jolicoeur
To improve our understanding of the mechanisms of target selection, we examined how the spatial separation of salient items and their similarity to a pre-defined target interact using lateralised electrophysiological correlates of visual spatial attention (N2pc component) and visual-short term memory (VSTM; SPCN component). Using these features of target selection, we sought to expand on previous work proposing a model of early and late selection, where the N2pc is suggested to reflect the selection probability of visual stimuli (Aubin and Jolicoeur, 2016). The authors suggested that early-selection processes could be enhanced when items are adjacent. In the present work, the stimuli were short oriented lines, all of which were grey except for two that were blue and hence salient. A decrease in N2pc amplitude with decreasing spatial separation between salient items was observed. The N2pc increased in amplitude with increasing similarity of salient distractors to the target template, but only in target-absent trials. There was no interaction between these two factors, suggesting that separable attentional mechanisms influenced the N2pc. The findings suggest that selection is initially based on easily-distinguished attributes (i.e., both blue items) followed by a later identification-based process (if necessary), which depends on feature similarity to a target template. For the SPCN component, the results were in line with previous work: for target-present trials, an increase in similarity of salient distractors was associated with an increase in SPCN amplitude, suggesting more information was maintained in VSTM. In sum, results suggest there is a need for further inspection of salient distractors when they are similar to the target, increasing the need for focal attention, demonstrated by an increase in N2pc amplitude, followed by a higher probability of transfer to VSTM, demonstrated by an increase in SPCN amplitude.



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Postoperative cesarean pain: real but is it preventable?

Purpose of review Cesarean section is the most common surgical procedure performed in the world. Postoperative pain management remains a challenge, particularly in a context of enhanced recovery after surgery. Several barriers related to the specific condition of 'postpartum recovery' may prevent application of effective analgesia in this population. The present review focuses on novel approaches of cesarean section postoperative pain assessment, beyond pain-rating intensity, including objective patient-centered recovery parameters. Predictive tools currently available to target patients at high risk of acute and chronic pain are also examined. Recent findings Postoperative pain after cesarean section is more severe than reported in the majority of randomized control trials. Pain seriously interferes with early and also late functional recovery, although Enhanced Recovery after Surgery (ERAS) programmes are being promoted. Pain-rating scores can differ from scores of physical comfort and physical independence, which are priorities for postpartum patients. Further, the value of subjective pain intensity rating to adapt analgesic prescription is misleading and may promote opioid over-prescription. Available tools to predict at-risk patients for severe pain after cesarean section are not easy to use in daily clinical practice and have, at best, moderate predictive value. Summary Patient and healthcare provider education on reported pain and well tolerated analgesic use is the key to improve postpartum pain management after cesarean section. Correspondence to Patricia Lavand'homme, MD, PhD, Department of Anesthesiology, Cliniques Universitaires St Luc - University Catholic of Louvain, Av Hippocrate 10, B-1200 Brussels, Belgium. Tel: +32 2 764 18 21; fax: +32 2 764 36 99; e-mail: patricia.lavandhomme@uclouvain.be Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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The reliability of methods to estimate the number and size of human motor units and their use with large limb muscles

Abstract

Purpose

Current methods for estimating muscle motor unit (MU) number provide values which are remarkably similar for muscles of widely differing size, probably because surface electrodes sample from similar and relatively small volumes in each muscle. We have evaluated an alternative means of estimating MU number that takes into account differences in muscle size.

Methods

Intramuscular motor unit potentials (MUPs) were recorded and muscle cross-sectional area (CSA) was measured using MRI to provide a motor unit number estimate (iMUNE). This was compared to the traditional MUNE method, using compound muscle action potentials (CMAP) and surface motor unit potentials (sMUPs) recorded using surface electrodes. Data were collected from proximal and distal regions of the vastus lateralis (VL) in young and old men while test–retest reliability was evaluated with VL, tibialis anterior and biceps brachii.

Results

MUPs, sMUPs and CMAPs were highly reliable (r = 0.84–0.91). The traditional MUNE, based on surface recordings, did not differ between proximal and distal sites of the VL despite the proximal CSA being twice the distal CSA. iMUNE, however, gave values that differed between young and old and were proportional to the muscle size.

Conclusion

When evaluating the contribution that MU loss makes to muscle atrophy, such as in disease or ageing, it is important to have a method such as iMUNE, which takes into account any differences in total muscle size.

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Predicting the ergogenic response to methylphenidate

Abstract

Purpose

Methylphenidate (MPH) and other stimulants have been shown to enhance physical performance. However, stimulant research has almost exclusively been conducted in young, active persons with a normal BMI, and may not generalize to other groups. The purpose of this study was to determine whether the ergogenic response to MPH could be predicted by individual level characteristics.

Methods

We investigated whether weekly minutes of moderate-to-vigorous physical activity (MVPA), age, and BMI could predict the ergogenic response to MPH. In a double-blind, cross-over design 29 subjects (14M, 15F, 29.7 ± 9.68 years, BMI: 26.1 ± 6.82, MVPA: 568.8 ± 705.6 min) ingested MPH or placebo before performing a handgrip task. Percent change in mean force between placebo and MPH conditions was used to evaluate the extent of the ergogenic response.

Results

Mean force was significantly higher in MPH conditions [6.39% increase, T(25) = 3.09, p = 0.005 118.8 ± 37.96 (± SD) vs. 111.8 ± 34.99 Ns] but variable (coefficient of variation:163%). Using linear regression, we observed that min MVPA (T(25) = −2.15, β = −0.400, p = 0.044) and age [T(25) = −3.29, β = −0.598, p = 0.003] but not BMI [T(25) = 1.67, β = 0.320 p = 0.109] significantly predicted percent change in mean force in MPH conditions.

Conclusions

We report that lower levels of physical activity and younger age predict an improved ergogenic response to MPH and that this may be explained by differences in dopaminergic function. This study illustrates that the ergogenic response to MPH is partly dependent on individual differences such as habitual levels of physical activity and age.

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Episodic bouts of hyperaemia and shear stress improve arterial blood flow and endothelial function

Abstract

Introduction

Exercise and heat stress lead to systemic improvements in arterial endothelial function, vascular stiffness, and cardiopulmonary capacity. The improvements in endothelial function may be primarily mediated via increases in shear stress. This study examined whether improvements in arterial function may be achieved in the absence of systemic vascular adaptations. Specifically, we hypothesized that repeated bouts of brief occlusion would improve arterial endothelial function via shear stress-dependent mechanisms.

Methods

Eleven healthy males underwent a shear stress intervention (5 s brachial occlusion, 10 s rest) for 30 min, five times weekly for 6 weeks on one arm while the other acted as an untreated control. Ultrasound was used to assess brachial arterial forearm blood flow (FBF) and vascular conductance (FVC), diameter, and shear rate (SR), while endothelial function was assessed by flow-mediated dilatation (FMD). Post-occlusive reactive hyperaemia and pulse wave velocity (PWV) were also measured.

Results

There were no changes in any of the measures in the control arm (all d < 0.2, p > 0.05). After 3 weeks of the intervention, FMD was increased from baseline (7.6 ± 0.6 vs. 5.9 ± 0.9%; d = 1.3, p = 0.038) and further increased after 6 weeks to 9.5 ± 2.6% (d = 1.7, p < 0.001). SR was also increased following the 6-week intervention (all d ≥ 0.6, p < 0.001). Resting and peak FBF and FVC were also increased in response to the intervention (all d ≥ 0.6, p < 0.001) and PWV was reduced.

Conclusions

These data demonstrate that episodic increases in shear stress elicit marked increases in arterial endothelial function and vascular reactivity.

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Effects of daily walking on intermuscular adipose tissue accumulation with age: a 5-year follow-up of participants in a lifestyle-based daily walking program

Abstract

Purpose

Intermuscular adipose tissue (IMAT) accumulates with age. However, there has been no long-term intervention study examining whether daily walking prevents or decreases the age-related IMAT accumulation. The purpose of this study was to determine effects of a long-term lifestyle-based daily walking program on age-related IMAT accumulation after a 5-year follow-up.

Methods

Using a pedometer, daily step count was evaluated for 5 years in 24 middle-aged and elderly male and female participants. Using magnetic resonance imaging, thigh muscle, thigh subcutaneous adipose tissue, IMAT, abdominal subcutaneous adipose tissue, and visceral adipose tissue were examined at baseline and after 5 years.

Results

After 5 years, there was no significant increase in IMAT in all participants. In addition, IMAT significantly decreased in participants with a daily step count of > 9000 (4.0 ± 2.1 vs. 3.1 ± 1.6 cm²; p < 0.05). Moreover, changes in IMAT within 5 years correlated with changes in daily step counts, even after adjusting for confounding factors (p < 0.05).

Conclusions

Long-term lifestyle-based daily walking program prevented the age-related IMAT accumulation in middle-aged and elderly adults. Furthermore, increased daily walking correlated with decreased IMAT over 5 years.

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Effects of combining ergonomic interventions and motor control exercises on muscle activity and kinematics in people with work-related neck–shoulder pain

Abstract

Purpose

This study compared the effects of "Ergomotor" intervention and conventional physiotherapy, on influencing the motor control in the neck–shoulder region in people with work-related neck–shoulder pain (WRNSP).

Methods

101 patients (age range 20–54 years) diagnosed with chronic WRNSP were randomized into control (CO) group (n = 50) and Ergomotor (EM) group (n = 51). Each group received a 12-week intervention. Participants in CO group received treatment for pain relief and general exercises. EM group received individualized motor control training and advice of ergonomic modifications at their workplaces.

Results

At post-intervention, EM group showed significant reduction of bilateral upper trapezius muscle activity during active neck movements (left: 40–35%, right: 35–27%) and functional tasks such as lifting a weight forward–backward (left: 31–21%, right: 22–14%) and upward–downward (left: 26–23%, right: 20–13%). Cervical erector spinae also showed significant decrease in muscle activity during some phases of the functional tasks (left: 13–6%, right: 10–2%). In contrast, CO group did not show such changes in muscle activity at post-intervention. EM group also showed significant increase in movement velocity and acceleration during active neck movements in all directions (from 18 to 31%), while CO group only showed significant increase in movement velocity in some directions. Both groups reported significant but similar reduction in pain scores, at post-intervention and 1-year follow-up.

Conclusions

The present results provided some evidence to support the positive and sustainable benefits of integrating motor control training into the workplace postures and motions.

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Fibre sub-type specific conduction reveals metabolic function in mouse sciatic nerve

Abstract

The stimulus evoked compound action potential (CAP), recorded using suction electrodes, provides an index of the relative number of conducting axons within a nerve trunk. As such the CAP has been used to elucidate the diverse mechanisms of injury resulting from a variety of metabolic insults to central nervous white matter, whilst also providing a model with which to assess the benefits of clinically relevant neuro-protective strategies. In addition the technique lends itself to the study of metabolic cell-to-cell signalling that occurs between glial cells and neurones, and to exploring the ability of non-glucose substrates to support axon conduction. Although peripheral nerves are sensitive to metabolic insult and are susceptible to diabetic neuropathy, there is a lack of fundamental information regarding peripheral nerve metabolism. A confounding factor in such studies is the extended duration demanded by the experimental protocol, requiring stable recording for periods of many hours. We describe a method that allows us to record simultaneously the stimulus evoked CAPs from A and C fibres from mouse sciatic nerve, and demonstrate its utility as applied to investigations into fibre sub-type substrate use. Our results suggest that C fibres directly take up and metabolise fructose, whereas A fibre conduction is supported by fructose-derived lactate, implying there exist unique metabolic profiles in neighbouring fibre sub-types present within the same nerve trunk.

This article is protected by copyright. All rights reserved

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The role of sciatic nerve block to complement femoral nerve block in total knee arthroplasty: a meta-analysis of randomized controlled trials

Abstract

Introduction

Femoral nerve block (FNB) appears to have higher postoperative analgesic benefits compared with the patient-controlled analgesia (PCA) in total knee arthroplasty (TKA). However, the role of sciatic nerve block (SNB) as a complement to FNB remains controversial. We performed a meta-analysis assessing the benefits of the SNB as a complement to FNB, as well as comparing the efficacy of single-injection versus continuous SNB in TKA.

Methods

Our group conducted a systematic literature search in PubMed, EMBASE and Google Scholar. We retrieved randomized trials comparing either SNB versus placebo or continuous versus single-injection SNB. The intervention group was the use of SNB as a complement to FNB, while the control group was FNB alone. Pain score at rest and movement (at 4, 12, 24, 48 and 72 h), patient-controlled intravenous opioid consumption, length of hospital stay, and incidence of nausea were extracted from each study. Random-effects model was used for meta-analysis and standardized mean difference (SMD) was used as the effect size.

Results

Ten articles comprising 514 patients were included to compare the effects of SNB combined with FNB versus FNB alone. Interventional group was found to significantly reduce pain score at for 4 h (SMD = − 0.94, 95% CI − 1.42 to − 0.47, P < 0.001, I² = 76.5%) compared with the control group. Pain score at rest was significantly reduced at movement for 12 h (SMD = − 0.29, 95% CI − 0.54 to − 0.04, P = 0.02, I² = 0%). Opioid consumption was significantly reduced at 24 (SMD = − 0.60, 95% CI − 1.01 to − 0.17, P = 0.01, I² = 69.1%) and 48 h (SMD = − 1.04, 95% CI − 1.46 to − 0.61, P < 0.001, I² = 43.4%) after TKA using SNB as a complement to FNB. Three articles were additionally meta-analyzed to compare the efficacy of single-injection (n = 79) versus continuous SNB (n = 79), being the latter one significantly associated with less pain score at 24 (SMD = -0.77, 95% CI − 1.10 to − 0.45, P < 0.001, I² = 0%) and 48 h (SMD = − 0.69, 95% CI − 1.01 to − 0.36, P < 0.001, I² = 0%), but not at 12 h (SMD = − 0.34, 95% CI − 0.73 to − 0.06, P = 0.10, I² = 0%).

Conclusions

This meta-analysis provides evidence-based supports to the benefits of SNB as a complement to FNB in TKA. The combination sciatic–femoral nerve block appears to be the optimal choice for patients in high risk of postoperative opioids consumption or acute pain after TKA.

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Correction to: skeletal muscle mechanics: questions, problems and possible solutions

In Fig. 3a of the original manuscript [1], the passive force at the beginning of the force-time history (approximately from 0 to 1 s) of each of the black and orange traces was interchanged in the coloring pro...

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Liquid biopsies: DNA methylation analyses in circulating cell-free DNA

Publication date: Available online 8 March 2018
Source:Journal of Genetics and Genomics
Author(s): Hu Zeng, Bo He, Chengqi Yi, Jinying Peng
Analysis of patient's materials like cells or nucleic acids obtained in a minimally invasive or noninvasive manner through the sampling of blood or other body fluids serves as liquid biopsies, which has huge potential for numerous diagnostic applications. Circulating cell-free DNA (cfDNA) is explored as a prognostic or predictive marker of liquid biopsies with the improvements in genomic and molecular methods. DNA methylation is an important epigenetic mark known to affect gene expression. cfDNA methylation detection is a very promising approach as abnormal distribution of DNA methylation is one of the hallmarks of many cancers and methylation changes occur early during carcinogenesis. This review summarizes the various investigational applications of cfDNA methylation and its oxidized derivatives as biomarkers for cancer diagnosis, prenatal diagnosis and organ transplantation monitoring. The review also provides a brief overview of the technologies for cfDNA methylation analysis based on next generation sequencing.



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The sag response in human muscle contraction

Abstract

Purpose

We examined how muscle length and time between stimuli (inter-pulse interval, IPI) influence declines in force (sag) seen during unfused tetani in the human adductor pollicis muscle.

Methods

A series of 16-pulse contractions were evoked with IPIs between 1 × and 5 × the twitch time to peak tension (TPT) at large (long muscle length) and small (short muscle length) thumb adduction angles. Unfused tetani were mathematically deconstructed into a series of overlapping twitch contractions to examine why sag exhibits length- and IPI-dependencies.

Results

Across all IPIs tested, sag was 62% greater at short than long muscle length, and sag increased as IPI was increased at both muscle lengths. Force attributable to the second stimulus increased as IPI was decreased. Twitch force declined from maximal values across all IPI tested, with the greatest reductions seen at short muscle length and long IPI. At IPI below 2 × TPT, the twitch with highest force occurred earlier than the peak force of the corresponding unfused tetani. Contraction-induced declines in twitch duration (TPT + half relaxation time) were only observed at IPI longer than 1.75 × TPT, and were unaffected by muscle length.

Conclusions

Sag is an intrinsic feature of healthy human adductor pollicis muscle. The length-dependence of sag is related to greater diminution of twitch force at short relative to long muscle length. The dependence of sag on IPI is related to IPI-dependent changes in twitch duration and twitch force, and the timing of peak twitch force relative to the peak force of the associated unfused tetanus.

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Fluid intake restores retinal blood flow early after exhaustive exercise in healthy subjects

Abstract

Purpose

It remains unclear whether rehydration restores retinal blood flow reduced by exhaustive exercise. We investigated the effect of fluid intake on retinal blood flow after exhaustive exercise.

Methods

Blood flow in the inferior (ITRA) and superior temporal retinal arterioles (STRA) was measured before and after incremental cycling exercise until exhaustion in 13 healthy males. After the exercise, the subjects rested without drinking (control condition: CON) or with drinking an electrolyte containing water (rehydrate condition: REH) and were followed up for a period of 120 min. To assess the hydration state, the body mass was measured, and venous blood samples were collected and plasma volume (PV) was calculated.

Results

Body mass decreased in CON after the trial [− 1.1 ± 0.1% (mean ± SE), p < 0.05]. PV was lower in CON than in REH during recovery. The ITRA and STRA blood flows decreased immediately after exercise from the resting baseline (ITRA; − 23 ± 4% in REH and − 30 ± 4% in CON, p < 0.05). The ITRA blood flow recovered baseline level at 15 min of recovery in REH (− 9 ± 3%, p = 0.5), but it remained reduced in CON (-14 ± 3%, p < 0.05). The STRA blood flow was higher in REH than in CON at 15 min (2 ± 3 vs. − 5 ± 3%, p < 0.05).

Conclusions

The results of this study suggest that the reduction in retinal blood flow induced by exhaustive exercise can be recovered early by rehydration.

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Completing the Maternal Care Team: OB/GYN Expertise at Rural District Hospitals in Ghana, a Qualitative Study

Abstract

Introduction To provide a qualitative perspective on the changes that occurred after newly placed OB/GYNs began working at district hospitals in Ashanti, Ghana. Methods Structured interviews of healthcare professionals were conducted at eight district hospitals located throughout the Ashanti district of Ghana, four with and four without a full-time OB/GYN on staff. Individuals interviewed include: medical superintendents, medical officers, district hospital administrators, OB/GYNs (where applicable), and nurse-midwives. Interviews were transcribed verbatim and content analysis was performed to identify common themes. Characteristics quotes were identified to illustrate principal interview themes. Quotes were verified in context by researchers for accuracy. Results Interviews with providers revealed four areas most impacted by an OB/GYN's leadership and expertise at district hospitals: patient referral patterns, obstetric protocol and training, facility management and organization, and hospital reputation. Discussion OB/GYNs are uniquely positioned to add clinical capacity and care quality to established maternal care teams at district hospitals–empowering district hospitals as reliable care centers throughout rural Ghana for women's health. Coordinated efforts between government, donors and OBGYN training institutions to provide complete obstetric teams is the next step to achieve the global goal of eliminating preventable maternal mortality by 2030.

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Constructing a Culturally Informed Spanish Decision-Aid to Counsel Latino Parents Facing Imminent Extreme Premature Delivery

Abstract

Objective How Latino parents perceive and understand antenatal counseling for extreme prematurity, < 26 weeks of gestational age (GA), is not clear. We aim to characterize Latino parental perceptions of antenatal counseling in order to construct and validate a Spanish decision-aid (SDA) to improve parental knowledge of prematurity after antenatal consults. Methods This is a three-phased, prospective, multicenter study. First, interviews of 22 Latino parents with a history of birth < 26 weeks GA were conducted. Thematic analysis identified themes valued during antenatal counseling for decisions regarding neonatal resuscitation. Next, we incorporated these themes into the SDA. Finally, improvement in knowledge of prematurity in two Spanish-speaking groups, 'experienced' parents with a history of extremely premature birth and 'naïve' adult Latino volunteers, was measured using a multiple choice test before and after simulated counseling with the SDA. Result Twenty-two interviews generated seven unique themes. An SDA was constructed that preserved six themes paralleled by those found in a previously studied English population, and addressed a novel theme of "intercultural linguistic barriers" unique to our population. Knowledge scores rose in "naive" volunteers, 41 ± 12% to 71 ± 15% (P < 0.001), after simulated counseling with the SDA. 'Experienced' parents had a ceiling effect in knowledge scores, 62 ± 9% to 65 ± 11% (P = 0.22). The SDA was well received by participants. Conclusions for Practice Interviews of Latino parents with a history of premature birth generated similar themes to English-speaking parents, with intercultural linguistic barriers as a novel theme. An SDA for Latino parents facing extremely premature birth may improve comprehension of antenatal counseling.

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Attitudes of Austrian Psychotherapists Towards Process and Outcome Monitoring

Abstract

While monitoring systems in psychotherapy have become more common, little is known about the attitudes that mental health practitioners have towards these systems. In an online survey among 111 Austrian psychotherapists and trainees, attitudes towards therapy monitoring were measured. A well-validated questionnaire measuring attitudes towards outcome monitoring, the Outcome Measurement Questionnaire, was used. Clinicians' theoretical orientations as well as previous knowledge and experience with monitoring systems were associated with positive attitudes towards monitoring. Possible factors that may have led to these findings, like the views of different theoretical orientations or obstacles in Austrian public health care, are discussed.

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