Copyright

Publication date: May 2018
Source:Radiologic Clinics of North America, Volume 56, Issue 3





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Contributors

Publication date: May 2018
Source:Radiologic Clinics of North America, Volume 56, Issue 3





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Contents

Publication date: May 2018
Source:Radiologic Clinics of North America, Volume 56, Issue 3





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CME Accreditation Page

Publication date: May 2018
Source:Radiologic Clinics of North America, Volume 56, Issue 3





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Forthcoming Issues

Publication date: May 2018
Source:Radiologic Clinics of North America, Volume 56, Issue 3





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Imaging of Lung Cancer: Update on Staging and Therapy

Publication date: May 2018
Source:Radiologic Clinics of North America, Volume 56, Issue 3
Author(s): Jeremy J. Erasmus, Mylene T. Truong




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Imaging of Lung Cancer: Update on Screening, Staging, and Therapy

Publication date: May 2018
Source:Radiologic Clinics of North America, Volume 56, Issue 3
Author(s): Jeremy J. Erasmus, Mylene T. Truong




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Pulmonary Nodule Management in Lung Cancer Screening

Publication date: May 2018
Source:Radiologic Clinics of North America, Volume 56, Issue 3
Author(s): Myrna C.B. Godoy, Erika G.L.C. Odisio, Mylene T. Truong, Patricia M. de Groot, Girish S. Shroff, Jeremy J. Erasmus

Teaser

The number of screening-detected lung nodules is expected to increase as low-dose computed tomography screening is implemented nationally. Standardized guidelines for image acquisition, interpretation, and screen-detected nodule workup are essential to ensure a high standard of medical care and that lung cancer screening is implemented safely and cost effectively. In this article, we review the current guidelines for pulmonary nodule management in the lung cancer screening setting.


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Tumor Staging of Lung Cancer

Publication date: May 2018
Source:Radiologic Clinics of North America, Volume 56, Issue 3
Author(s): Constantine A. Raptis, Caroline L. Robb, Sanjeev Bhalla

Teaser

Several important modifications have been proposed for the tumor (T) descriptor for lung cancers. New size cutoffs have been determined and there are new T descriptors for adenocarcinoma in situ, minimally invasive adenocarcinoma, and part-solid adenocarcinomas with a solid component > 0.5 cm to 3 cm (T1a, T1b, T1c). There are also recommendations for multifocal adenocarcinoma, which are classified by the lesion with the highest level T descriptor, and the number of lesions is indicated. Knowledge of these changes is important in the appropriate clinical staging of patients with lung cancer.


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Staging Lung Cancer

Publication date: May 2018
Source:Radiologic Clinics of North America, Volume 56, Issue 3
Author(s): Ahmed H. El-Sherief, Charles T. Lau, Brett W. Carter, Carol C. Wu

Teaser

This article reviews regional lymph node assessment in lung cancer. In the absence of a distant metastasis, the absence or location of lung cancer spread to a regional mediastinal lymph node affects treatment options and prognosis. Regional lymph node maps have been created to standardize assessment of the N descriptor. The International Association for the Study of Lung Cancer lymph node map is used for the standardization of N descriptor assessment. CT, PET/CT with fluorodeoxyglucose, endobronchial ultrasound–guided and/or esophageal ultrasound–guided biopsy, and mediastinoscopy are common modalities used to determine the N descriptor.


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Dilemmas in Lung Cancer Staging

Publication date: May 2018
Source:Radiologic Clinics of North America, Volume 56, Issue 3
Author(s): Ioannis Vlahos

Teaser

The advent of the 8th edition of the lung cancer staging system reflects a further meticulous evidence-based advance in the stratification of the survival of patients with lung cancer. Although addressing many limitations of earlier staging systems, several limitations in staging remain. This article reviews from a radiological perspective the limitations of the current staging system, highlighting the process of TNM restructuring, the residual issues with regards to the assignment of T, N, M descriptors, and their associated stage groupings and how these dilemmas impact guidance of multidisciplinary teams taking care of patients with lung cancer.


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Update of MR Imaging for Evaluation of Lung Cancer

Publication date: May 2018
Source:Radiologic Clinics of North America, Volume 56, Issue 3
Author(s): Mario Ciliberto, Yuji Kishida, Shinichiro Seki, Takeshi Yoshikawa, Yoshiharu Ohno

Teaser

Since MR imaging was introduced for the assessment of thoracic and lung diseases, various limitations have hindered its widespread adoption in clinical practice. Since 2000, various techniques have been developed that have demonstrated the usefulness of MR imaging for lung cancer evaluation, and it is now reimbursed by health insurance companies in many countries. This article reviews recent advances in lung MR imaging, focusing on its use for lung cancer evaluation, especially with regard to pulmonary nodule detection, pulmonary nodule and mass assessment, lung cancer staging and detection of recurrence, postoperative lung function prediction, and therapeutic response evaluation and prediction.


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Lung Cancer

Publication date: May 2018
Source:Radiologic Clinics of North America, Volume 56, Issue 3
Author(s): Marcelo F. Benveniste, James Welsh, Chitra Viswanathan, Girish S. Shroff, Sonia L. Betancourt Cuellar, Brett W. Carter, Edith M. Marom

Teaser

In this review, we discuss the different radiation delivery techniques available to treat non–small cell lung cancer, typical radiologic manifestations of conventional radiotherapy, and different patterns of lung injury and temporal evolution of the newer radiotherapy techniques. More sophisticated techniques include intensity-modulated radiotherapy, stereotactic body radiotherapy, proton therapy, and respiration-correlated computed tomography or 4-dimensional computed tomography for radiotherapy planning. Knowledge of the radiation treatment plan and technique, the completion date of radiotherapy, and the temporal evolution of radiation-induced lung injury is important to identify expected manifestations of radiation-induced lung injury and differentiate them from tumor recurrence or infection.


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Targeted Therapy and Immunotherapy in the Treatment of Non–Small Cell Lung Cancer

Publication date: May 2018
Source:Radiologic Clinics of North America, Volume 56, Issue 3
Author(s): Girish S. Shroff, Patricia M. de Groot, Vassiliki A. Papadimitrakopoulou, Mylene T. Truong, Brett W. Carter

Teaser

The treatment strategy in advanced non–small cell lung cancer (NSCLC) has evolved from empirical chemotherapy to a personalized approach based on histology and molecular markers of primary tumors. Targeted therapies are directed at the products of oncogenic driver mutations. Immunotherapy facilitates the recognition of cancer as foreign by the host immune system, stimulates the immune system, and alleviates the inhibition that allows the growth and spread of cancer cells. The authors describes the role of targeted therapy and immunotherapy in the treatment of NSCLC, patterns of disease present on imaging studies, and immune-related adverse events encountered with immunotherapy.


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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.

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Free pre-operative clear fluids before day-surgery?: Challenging the dogma

No abstract available

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Reply to: what is more important, cost or effectiveness?

No abstract available

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Postoperative nausea and vomiting after unrestricted clear fluids before day surgery: A retrospective analysis

BACKGROUND Guidance on pre-operative fluids fasting policy continues to evolve. Current European guidelines encourage the intake of oral fluids up to 2 h before the induction of general anaesthesia. From October 2014, Torbay Hospital Day Surgery Unit commenced an unrestricted fluid policy, encouraging patients to drink clear fluids up until the time of transfer to theatre. OBJECTIVE The aim of this study was to assess the incidence of postoperative nausea and vomiting before and after the change to the unrestricted pre-operative clear oral fluids. DESIGN Retrospective, before and after study. SETTING Single district general hospital between November 2013 and February 2016. PATIENTS A total of 11 500 patients on the day case pathway who were receiving either sedation, general anaesthesia, regional anaesthesia or their combination. The data from these patients were collected routinely. This number of patients represents approximately 78% of all patients before the change in fluids policy and 74% after the change. Exclusions were patients undergoing a termination of pregnancy, or patients undergoing community dental procedures, from whom patient experience data are not collected. INTERVENTION Introduction of a change to the day surgery pathway policy permitting unrestricted clear oral fluids preoperatively until transfer to theatre (from October 2014). MAIN OUTCOME MEASURES Incidence of postoperative nausea and vomiting. RESULTS The rates of nausea within 24 h postoperatively were 270/5192 (5.2%) when patients could not drink within 2 h of surgery, and 179/4724 (3.8%) when patients could drink up until surgery, a relative rate (95% confidence interval) of 0.73 (0.61 to 0.88), P = 0.00074. The corresponding rates of vomiting were 146/5186 (2.8%) and 104/4716 (2.2%), a relative rate (95% confidence interval) of 0.78 (0.61 to 1.00), P = 0.053. CONCLUSION Our data suggest that the liberal consumption of clear fluids before the induction of scheduled day case anaesthesia reduced the rates of postoperative nausea and vomiting.

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Comparison of double intravenous vasopressor automated system using nexfin versus manual vasopressor bolus administration for maintenance of haemodynamic stability during spinal anaesthesia for caesarean delivery: A randomised double-blind controlled trial

BACKGROUND Hypotension is a common side effect of spinal anaesthesia during caesarean delivery and is associated with maternal and foetal adverse effects. We developed an updated double intravenous vasopressor automated (DIVA) system that administers phenylephrine or ephedrine based on continuous noninvasive haemodynamic monitoring using the Nexfin device. OBJECTIVE The aim of our present study is to compare the performance and reliability of the DIVA system against Manual Vasopressor Bolus administration. DESIGN A randomised, double-blind controlled trial. SETTING Single-centre, KK Women's and Children's Hospital, Singapore. PATIENTS Two hundred and thirty-six healthy women undergoing elective caesarean delivery under spinal anaesthesia. MAIN OUTCOME MEASURES The primary outcome was the incidence of maternal hypotension. The secondary outcome measures were reactive hypertension, total vasopressor requirement and maternal and neonatal outcomes. RESULTS The DIVA group had a significantly lower incidence of maternal hypotension, with 39.3% (46 of 117) patients having any SBP reading less than 80% of baseline compared with 57.5% (65 of 113) in the manual vasopressor bolus group (P = 0.008). The DIVA group also had fewer hypotensive episodes than the manual vasopressor bolus group (4.67 versus 7.77%; P 

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Intra-operative lidocaine in the prevention of vomiting after elective tonsillectomy in children: A randomised controlled trial

BACKGROUND Postoperative vomiting (POV) is a frequent complication of tonsillectomy in children. In adult patients undergoing abdominal surgeries, the use of intravenous lidocaine infusion can prevent POV. OBJECTIVE To evaluate the anti-emetic effect of an intravenous lidocaine infusion used as an adjuvant to general anaesthesia, in children undergoing elective ear, nose and throat surgery. DESIGN Double-blind, randomised, controlled study. SETTING Hospital-based, single-centre study in Chile. PATIENTS ASA I-II children, aged 2 to 12 years, scheduled for elective tonsillectomy. INTERVENTION We standardised the induction and maintenance of anaesthesia. Patients were randomly allocated to lidocaine (1.5 mg kg−1 intravenous lidocaine over 5 min followed by 2 mg kg−1 h−1) or 0.9% saline (at the same rate and volume). Infusions were continued until the end of the surgery. MAIN OUTCOME MEASURES Presence of at least one episode of vomiting, retching or both in the first 24 h postoperatively (POV). SECONDARY OUTCOMES Plasma concentrations of lidocaine and postoperative pain. RESULTS Ninety-two children were enrolled. Primary outcome data were available for 91. In the Lidocaine group, 28 of 46 patients (60.8%) experienced POV, compared with 37 of 45 patients (82.2%) in the Saline group [difference in proportions 21.3% (95% confidence interval (CI) 2.8 to 38.8), P = 0.024]. The intention-to-treat analysis showed that when we assumed that the patient in the Saline group lost to follow-up did not have POV, the difference in proportions decreased to 19.6% (95% CI, 0.9 to 37.2), with an unadjusted odds ratio of 0.38 (95% CI, 0.15 to 0.97, P = 0.044). The odds of having POV were 62% less likely in those patients receiving lidocaine compared with patients in the Saline group. The mean lidocaine plasma concentration was 3.91 μg ml−1 (range: 0.87 to 4.88). CONCLUSION Using an intravenous lidocaine infusion as an adjuvant to general anaesthesia decreased POV in children undergoing elective tonsillectomy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01986309.

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The trapezius plane block: a technique for regional anaesthesia of the superficial posterior thorax

No abstract available

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Oesophageal or transgastric views for estimating mean pulmonary artery pressure with transoesophageal echocardiography: A prospective observational study

BACKGROUND Recent data suggest that in cardiac surgical patients, the pulmonary artery acceleration time (PAT) is useful for estimating mean pulmonary artery pressure (MPAP) noninvasively with transoesophageal echocardiography (TOE). The pulmonary valve can be visualised from multiple echocardiographic windows, but it is unclear which, if any, view correlates best with MPAP. OBJECTIVE(S) To compare the PAT measured with TOE from oesophageal and transgastric views with MPAP obtained invasively with a pulmonary artery catheter. DESIGN A prospective observational study. SETTING St. Vincent's Hospital, Melbourne, a university tertiary referral centre in Australia. PATIENTS Sixty-three patients having cardiac surgery were included in our study. All patients had insertion of both a TOE probe and pulmonary artery catheter; this is the routine standard of care in our centre. INTERVENTION(S) Nil. MAIN OUTCOME MEASURES During a period of haemodynamic stability, the PAT was measured first from an oesophageal view and then immediately after from a transgastric view. The results were then compared with the invasively measured MPAP. RESULTS Simultaneous measurements of MPAP and PAT were taken in 63 patients. In two patients, these measurements were not possible in the transgastric position due to an inability to visualise the right ventricular outflow tract and pulmonary valve. A Bland–Altman analysis of the PAT measured from the upper oesophageal and transgastric views showed a mean difference of 1 ms and limits of agreement of −18 to 16 ms. The area under the receiver operating curves for predicting pulmonary hypertension with PAT were upper oesophageal view 0.99 [95% confidence interval (CI), 0.98 to 1.00] and transgastric view 0.99 (95% CI, 0.97 to 1.00). The agreement between the results from these two views in the diagnosis of pulmonary hypertension (defined as PAT  25 mmHg) with a sensitivity of 94.7% and specificity of 97.6%. The transgastric view predicted pulmonary hypertension with a sensitivity of 89.4% and specificity of 95.2%. CONCLUSION Oesophageal and transgastric measurements of PAT have close agreement and a similar high ability to discriminate between people with and without pulmonary hypertension. The transgastric measurement was unobtainable in a small percentage of patients and required more probe manipulation. We would recommend PAT measurement in the upper oesophageal view.

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Ultrasound examination of the antrum to predict gastric content volume in the third trimester of pregnancy as assessed by MRI: A prospective cohort study

BACKGROUND Ultrasound examination of the gastric antrum allows reliable pre-operative assessment of gastric contents and volume in adult patients. However, during pregnancy, the change in the anatomical position of the stomach due to the gravid uterus leads to a change in the measured value of the antral area. Therefore, current mathematical models predicting gastric content volume (GCV) in the adult may not apply in term pregnant women. OBJECTIVE To propose a mathematical model which is predictive of GCV in pregnant women and to assess the performance of an ultrasound qualitative grading scale (0 to 2) for the diagnosis of clear fluid volumes more than 0.8 and 1.5 ml kg−1. DESIGN Prospective cohort study. SETTING Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Lyon and Assistance Publique – Hôpitaux de Marseille, Hôpital Nord, Marseille, France. PATIENTS Pregnant women in the third trimester of pregnancy. MAIN OUTCOME MEASURES Comparison of the GCV as measured by MRI and the ultrasound measured antral cross-sectional area, and an assessment of gastric contents according to a 0 to 2 qualitative grading scale. RESULTS Data from 34 women were analysed. A linear model predictive of GCV was constructed with a 95% agreement band of ±95 ml, with a mean polar angle of −8.7°. Performance of the qualitative grading scale to detect fluid volumes >0.8 and >1.5 ml kg−1 was improved when used in a composite scale including a 505 mm2 antral area cut-off value in the semirecumbent supine position. CONCLUSION We report a new mathematical model predictive of GCV in women in the third trimester of pregnancy. Furthermore, the combination of the qualitative and the quantitative ultrasound examination of the gastric antrum might be useful to assess gastric fluid volume in pregnant women. TRIAL REGISTRATION ANSM Register N°2015-A00800-49

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Microvascular reactivity, assessed by near-infrared spectroscopy and a vascular occlusion test, is associated with patient outcomes following cardiac surgery: A prospective observational study

BACKGROUND Microvascular dysfunction in patients admitted to the ICU following cardiac surgery may be related to perioperative complications and increased resource utilisation even in the presence of acceptable systemic haemodynamic variables. OBJECTIVES To assess the relationship between microvascular impairment using peripheral near-infrared spectroscopy at ICU admission and 6 h postadmission and the duration of mechanical ventilatory support, length of stay in ICU and in hospital. DESIGN Prospective, observational cohort study. SETTING Single-centre, tertiary-level cardiac ICU. PATIENTS Sixty-nine adult patients following elective cardiac surgery excluding patients with on-going extracorporeal support or in whom tissue haemoglobin oxygen saturation (StO2) measurements were not feasible. MAIN OUTCOME MEASURES Thenar and forearm StO2 in response to a vascular occlusion test to calculate desaturation and reperfusion slopes. A logistic regression model was used to ascertain the associations between StO2, desaturation and reperfusion slopes as well as cardiac index, mean arterial pressure, arterial lactate concentrations and prolonged (≥75th percentile) duration of mechanical ventilation, ICU length of stay and hospital length of stay. RESULTS A reduced reperfusion slope at ICU admission was associated independently with prolonged mechanical ventilation at thenar (OR 0.08; 95% CI [0.02 to 0.47], P = 0.003) and forearm [OR 0.2 (0.04 to 0.59), P = 0.006] sites. Similarly, a reduced Rres was associated with prolonged ICU LOS at both thenar [OR 0.3 (0.13 to 0.77), P = 0.007] and forearm [OR 0.2 (0.05 to 0.62), P = 0.007] sites at ICU0 h, as well as ICU6 h [OR 0.2 (0.05 to 0.66), P = 0.004 and OR 0.05 (0.008 to 0.34), P = 0.002]. An increased Rdes was associated with prolonged hospital LOS at the thenar eminence at ICU0 h [OR 1.9 (1.4 to 2.3), P = 0.004] and ICU6 h [OR 6.7 (2.0 to 23), P = 0.002] as well as the forearm at ICU0 h [OR 1.5 (1.3 to 1.9), P = 0.004] and ICU6 h [OR 1.6 (1.3 to 2.1), P = 0.004]. CONCLUSION In the early postoperative period following cardiac surgery, changes in thenar and forearm tissue oxygenation variables are associated with patient resource utilisation outcomes.

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What is more important, cost or effectiveness?

No abstract available

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Prediction of bilateral cerebral oxygen desaturations from a single sensor in adult cardiac surgery: A prospective observational study

BACKGROUND Monitoring regional cerebral oxygen saturation (rcSO2) with near-infrared spectroscopy is increasingly being performed in patients scheduled for cardiac surgery. It is sometimes difficult to monitor both frontal lobes due to anatomical or space compromises. However, it remains unclear whether the use of only one lateral or medial probe can provide adequate bilateral monitoring. OBJECTIVE To evaluate the efficacy of using a single lateral or medial probe to detect substantial desaturations on both sides. DESIGN A prospective observational study. SETTING Tertiary university teaching hospital. PATIENTS Seventeen adult patients undergoing elective cardiac surgery monitored with three near-infrared spectroscopy probes (two lateral and one medial) using an INVOS 5100C monitor. INTERVENTIONS The value of rcSO2 was recorded up to 19 times during each procedure. Substantial desaturation was defined as an absolute rcSO2 value of 50% or less or a decrease of more than 20% compared with baseline values on spontaneous ventilation with 21% oxygen. MAIN OUTCOME MEASURES The level of agreement between the three pairs of probes using the Bland–Altman method for repeated measures, and the grade of concordant and discordant results between the three pairs of probes by means of contingency tables and the κ coefficient. RESULTS We obtained 244 records per probe. Greater agreement was observed between the two lateral probes (mean ± SD of the differences between recordings was -0.9 ± 5.5); mean difference between left and medial, and right and medial probes was 2.4 ± 7.3 and 3.3 ± 6.7, respectively. The rate of discordant results between the two lateral probes was 5.7%, κ coefficient of 0.6 with 95% confidence interval (95% CI 0.4 to 0.8), and between the left and medial, and right and medial of 8.2 and 7.4%, with κ coefficients of 0.57 (95% CI 0.38 to 0.76) and 0.5 (95% CI 0.29 to 0.71), respectively. CONCLUSION In cardiac surgery patients in whom there is difficulty in accommodating two rcSO2 probes, a single lateral probe can effectively measure bilateral rcSO2 in specific scenarios.

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Intubation with cervical spine immobilisation: a comparison between the KingVision videolaryngoscope and the Macintosh laryngoscopeA randomised controlled trial

No abstract available

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

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

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Economic evaluation of bilateral sternal local anaesthetic infusions via multi-hole catheters after cardiac surgery

No abstract available

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Sacroiliac joint dysfunction patients exhibit altered movement strategies when performing a sit-to-stand task

The ability to rise from a chair is a basic functional task that is frequently compromised in individuals diagnosed with orthopedic disorders in the low back and hip. There is no published literature that describes how this task is altered by sacroiliac joint dysfunction (SIJD).

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Xio is a component of the Drosophila sex determination pathway and RNA N6-methyladenosine methyltransferase complex [Genetics]

N6-methyladenosine (m6A), the most abundant chemical modification in eukaryotic mRNA, has been implicated in Drosophila sex determination by modifying Sex-lethal (Sxl) pre-mRNA and facilitating its alternative splicing. Here, we identify a sex determination gene, CG7358, and rename it xio according to its loss-of-function female-to-male transformation phenotype. xio encodes a conserved...

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Genetic mapping of species differences via in vitro crosses in mouse embryonic stem cells [Genetics]

Discovering the genetic changes underlying species differences is a central goal in evolutionary genetics. However, hybrid crosses between species in mammals often suffer from hybrid sterility, greatly complicating genetic mapping of trait variation across species. Here, we describe a simple, robust, and transgene-free technique to generate "in vitro crosses" in...

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Precise Cas9 targeting enables genomic mutation prevention [Genetics]

Here, we present a generalized method of guide RNA "tuning" that enables Cas9 to discriminate between two target sites that differ by a single-nucleotide polymorphism. We employ our methodology to generate an in vivo mutation prevention system in which Cas9 actively restricts the occurrence of undesired gain-of-function mutations within a...

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Predictive Validity of the STarT Back Tool for Risk of Persistent Disabling Back Pain in a United States Primary Care Setting

Publication date: Available online 3 April 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Pradeep Suri, Kristin Delaney, Sean D. Rundell, Daniel C. Cherkin
ObjectiveTo examine the predictive validity of the STarT Back tool for classifying people with back pain into categories of low, medium, and high risk of persistent disabling back pain, in US primary care.DesignSecondary analysis of data from participants receiving usual care in a randomized clinical trial.SettingPrimary care clinics.Participants1109 adults with back pain ≥18 years of age. Those with specific causes of back pain (pregnancy, disc herniation, vertebral fracture, spinal stenosis) and work-related injuries were not included.InterventionsN/AMain Outcome MeasuresThe original 9-item version of the STarT Back tool, administered at baseline, stratified patients by their risk (low, medium, high) of persistent disabling back pain ('STarT Back risk group'). Persistent disabling back pain was defined as Roland-Morris Disability Questionnaire scores of ≥7 at 6-month follow-up.ResultsSTarT Back risk group was a significant predictor of persistent disabling back pain (p<0.0001) at 6-month follow-up. The proportion of individuals with persistent disabling back pain at follow-up was 22% (95% confidence interval [CI] 18-25%) in the low risk group, 62% (95% CI 57-67%) in the medium-risk group, and 80% (95% CI 75-85%) in the high-risk group. The relative risk of persistent disabling back pain was 2.9 (95% CI 2.4-3.5) in the medium-risk group as compared to the low-risk group, and 3.7 (95% CI 3.1-4.4) in the high-risk group.ConclusionsWe found that the STarT Back risk groups successfully separated people with back pain into distinct categories of risk for persistent disabling back pain at 6-month follow-up in US primary care. These results were very similar to those seen in the original STarT Back validation study. This validation study is a necessary first step towards identifying whether the entire STarT Back approach, including matched/targeted treatment, can be effectively used for primary care in the US.



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Conceptual Underpinnings of the Quality of Life in Neurological Disorders (Neuro-QoL): Comparisons of Core Sets for Stroke, Multiple Sclerosis, Spinal Cord Injury, and Traumatic Brain Injury

Publication date: Available online 3 April 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Alex W.K. Wong, Stephen C.L. Lau, Mandy W.M. Fong, David Cella, Jin-Shei Lai, Allen W. Heinemann
ObjectiveTo determine the extent to which the content of the Quality of Life in Neurological Disorders (Neuro-QoL) covers the ICF core sets for multiple sclerosis (MS), stroke, spinal cord injury (SCI), and traumatic brain injury (TBI) using summary linkage indicators.DesignContent analysis by linking content of the Neuro-QoL to corresponding ICF codes of each core set for MS, stroke, SCI, and TBI.SettingThree academic centersParticipantsNoneInterventionsNoneMain Outcome MeasureFour summary linkage indicators proposed by MacDermid and colleagues were estimated to compare the content coverage between Neuro-QoL and the ICF codes of core sets for MS, stroke, MS, and TBI.ResultsNeuro-QoL represented 20%-30% core set codes for different conditions in which more codes in core sets for MS (29%), stroke (28%), and TBI (28%) were covered than those for SCI in the LT (20%) and EPA (19%) contexts. Neuro-QoL represented nearly half of the unique Activity and Participation codes (43%–49%) and less than one-third of the unique Body Function codes (12%−32%). It represented fewer environmental codes (2%−6%) and no Body Structures codes. Absolute linkage indicators found that at least 60% of Neuro-QoL items were linked to core set codes (63%-95%) but many items covered same codes as revealed by unique linkage indicators (7%-13%), suggesting high concept redundancy among items.ConclusionThe Neuro-QoL links more closely to ICF core sets for stroke, MS, and TBI than to those for SCI, and primarily covers Activity and Participation ICF domains. Other instruments are needed to address concepts not measured by the Neuro-QoL when a comprehensive health assessment is needed.



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Measurement Characteristics and Clinical Utility of the Pediatric Evaluation of Disability Inventory in Children With Cerebral Palsy

Publication date: Available online 3 April 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Sarah Brew, Erin Langan, Amanda Link-Dudek, Ryan Walsh, Linda Ehrlich-Jones




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Effectiveness of Client-Centered “Tune-Ups” on Community Reintegration, Mobility, and Quality of Life After Stroke: A Randomized Controlled Trial

Publication date: Available online 3 April 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Brenda Brouwer, Dianne Bryant, S. Jayne Garland
ObjectiveTo explore the effectiveness of a 2-week client-centered rehabilitation intervention (tune-up) delivered 6 months after inpatient discharge on community reintegration at 1 year in people with stroke.DesignA multicenter randomized controlled trial with 2 groups: an intervention ("tune-up") group and a control group having the same exposure to assessment.SettingThree research laboratories.ParticipantsParticipants (N=103) with hemiparetic stroke recruited from inpatient rehabilitation units at the time of discharge.InterventionsParticipants randomized to the tune-up group received 1-hour therapy sessions in their home 3times/wk for 2 weeks at 6 months postdischarge focusing on identified mobility-related goals. A second tune-up was provided at 12 months.Main Outcome MeasuresCommunity reintegration measured by the Subjective Index of Physical and Social Outcome at 12 months and secondary outcomes included the Berg Balance Scale and measures of mobility and health-related quality of life up to 15 months.ResultsAt 12 months, both groups showed significant improvement in community reintegration (P<.05), a trend evident at all time points, with no difference between groups (mean difference, −0.5; 95% confidence interval, −1.8 to 2.7; P=.68). Similarly, a main effect of time reflected improvement in mobility-related and quality of life outcomes for both groups (P≤.0.5), but no group differences (P≥.30).ConclusionsAll participants in the tune-up group met or exceeded at least 1 mobility-related goal; however, the intervention did not differentially improve community reintegration. The improvements in mobility and quality of life over the 15-month postdischarge period may be secondary to high activity levels in both study groups and exposure to regular assessment.



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Is going beyond Rasch analysis necessary to assess the construct validity of a motor function scale?

Publication date: Available online 3 April 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Tiffanie Guillot, Sylvain Roche, Pascal Rippert, Dalil Hamroun, Jean Iwaz, René Ecochard, Carole Vuillerot
ObjectiveExamine whether a Rasch analysis is sufficient to establish the construct validity of the Motor Function Measure (MFM) and discuss whether weighting the MFM item scores would improve the MFM construct validity.DesignObservational cross-sectional multicenter study.Setting23 physical medicine departments, neurology departments, or reference centers for neuromuscular diseasesParticipants911 patients (aged 6 to 60 years) with Charcot-Marie-Tooth disease (CMT), facio-scapulo-humeral dystrophy (FSHD), or myotonic dystrophy type 1 (DM1)InterventionsNone.Main Outcome Measure(s)Comparison of the goodness-of-fit of the Confirmatory Factor Analysis (CFA) model vs. that of a modified multidimensional Rasch model on MFM item scores in each considered disease.ResultsCFA model showed good fit to the data and significantly better goodness-of-fit than the modified multidimensional Rasch model whatever the disease (P<0.001). Statistically significant differences in item standardized factor loadings were found between DM1, CMT, and FSHD in only 6 out of 32 items (Items 6, 27, 2, 7, 9 and 17).ConclusionIn the case of multidimensional scales designed to measure patient abilities in various diseases, a Rasch analysis might not be the most convenient whereas a CFA is able to establish the scale construct validity and provide weights to adapt the item scores to a specific disease.



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Variability in circulating gas emboli after a same scuba diving exposure

Abstract

Purpose

A reduction in ambient pressure or decompression from scuba diving can result in ultrasound-detectable venous gas emboli (VGE). These environmental exposures carry a risk of decompression sickness (DCS) which is mitigated by adherence to decompression schedules; however, bubbles are routinely observed for dives well within these limits and significant inter-personal variability in DCS risk exists. Here, we assess the variability and evolution of VGE for 2 h post-dive using echocardiography, following a standardized pool dive in calm warm conditions.

Methods

14 divers performed either one or two (with a 24 h interval) standardized scuba dives to 33 mfw (400 kPa) for 20 min of immersion time at NEMO 33 in Brussels, Belgium. Measurements were performed at 21, 56, 91 and 126 min post-dive: bubbles were counted for all 68 echocardiography recordings and the average over ten consecutive cardiac cycles taken as the bubble score.

Results

Significant inter-personal variability was demonstrated despite all divers following the same protocol in controlled pool conditions: in the detection or not of VGE, in the peak VGE score, as well as time to VGE peak. In addition, intra-personal differences in 2/3 of the consecutive day dives were seen (lower VGE counts or faster clearance).

Conclusions

Since VGE evolution post-dive varies between people, more work is clearly needed to isolate contributing factors. In this respect, going toward a more continuous evaluation, or developing new means to detect decompression stress markers, may offer the ability to better assess dynamic correlations to other physiological parameters.

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In reply: Why remifentanil?

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Major hepatectomy for primary hepatolithiasis: a comparative study of laparoscopic versus open treatment

Abstract

Background

Due to higher technical requirements, laparoscopic major hepatectomy (LMH) for primary hepatolithiasis have been limited to a few institutions. This retrospective study was performed to evaluate the therapeutic safety, and perioperative and long-term outcomes of LMH versus open major hepatectomy (OMH) for hepatolithiasis.

Methods

From January 2012 to December 2016, 61 patients with hepatolithiasis who underwent major hepatectomy were enrolled, including 29 LMH and 32 OMH. The perioperative outcomes and postoperative complications, as well as long-term outcomes, including the stone clearance and recurrence rate, were evaluated.

Results

There was no difference of surgical procedures between the two groups. The mean operation time was (262 ± 83) min in the LMH group and (214 ± 66) min in the OMH group (p = 0.05). There is no difference of intra-operative bleeding (310 ± 233) ml versus (421 ± 359) ml (p = 0.05). In the LMH group, there were shorter time to postoperative oral intake ((1.1 ± 0.6) days versus (3.1 ± 1.8) days, p = 0.01) and shorter hospital stay [(7.2 ± 2.3) days versus (11.8 ± 5.5) days, p = 0.03] than the open group. The LMH group had comparable stone clearance rate with the OMH group during the initial surgery (82.8% vs. 84.4%, p = 0.86).

Conclusions

LMH could be an effective and safe treatment for selected patients with hepatolithiasis, with an advantage over OMH in the field of less intra-operative blood loss, less intra-operative transfusion, less overall complications, and faster postoperative recovery.

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Principles behind variance misallocation in temporal exploratory factor analysis for ERP data: Insights from an inter-factor covariance decomposition

Publication date: Available online 3 April 2018
Source:International Journal of Psychophysiology
Author(s): Florian Scharf, Steffen Nestler
Temporal exploratory factor analysis (EFA) is commonly applied to ERP data sets to reduce their dimensionality and the ambiguity with respect to the underlying components. However, the risk of variance misallocation (i.e., the incorrect allocation of condition effects) has raised concerns with regard to EFA usage. Here, we show that variance misallocation occurs because of biased factor covariance estimates and the temporal overlap between the underlying components. We also highlight the consequences of our findings for the analysis of ERP data with EFA. For example, a direct consequence of our expositions is that researchers should use oblique rather than orthogonal rotations, especially when the factors have a substantial topographic overlap. A Monte Carlo simulation confirms our results by showing, for instance, that characteristic biases occur only for orthogonal Varimax rotation but not for oblique rotation methods such as Geomin or Promax. We discuss the practical implications of our results and outline some questions for future research.



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Long-term course of shoulders after ultrasound therapy for calcific tendinitis: results of the ten years’ follow-up of an RCT

Objective To follow both the structure and function related long-term course of shoulders that had been treated with therapeutic ultrasound (US) for symptomatic calcific tendinitis. Design Long-term follow-up of 45 shoulders (37 patients) that had been treated for symptomatic calcific tendinitis with either a series of US or sham US ten years ago. The main outcome variables were presence of calcium deposits and subacromial impingement on standardized X-ray imaging, shoulder symptoms (Binder score) and function (Constant score). Results At ten years, a similar proportion of calcium deposits had resolved in 78% of the originally US treated compared with 83% of sham treated shoulders, whereas at nine months significantly more calcium deposits had been resolved in the US group (p=0.045). Relative to baseline, shoulder symptoms and function had significantly improved at both the ten-years´ and nine-months´ follow-up examinations with no significant differences between groups. Regular sports performance at baseline predicted a favorable long-term outcome. Conclusions Symptomatic calcific tendinitis of the shoulder has a good likelihood to completely resolve in the long-term. Treating the calcium deposit effectively, however, may not be causal to the recovery from symptoms and function in calcific tendinitis. Acknowledgments: None. Conflict of interest: None. Funding or grants: None. Financial benefits: None. Previous presentation: The research was presented at the 2016 Annual Assembly of the American Academy of Physical Medicine & Rehabilitation and awarded with the AAPM&R President's Citation Award 2016. Corresponding author: Gerold Ebenbichler MD, Department of Physical Medicine, Rehabilitation and Occupational Medicine, Waehringer Guertel 18-20, A-1090 Vienna, Austria, Email: gerold.ebenbichler@meduniwien.ac.at Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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In Vivo Evaluation of Subacromial and Internal Impingement Risk in Asymptomatic Individuals

Objective The study aim was to evaluate subacromial and internal impingement risk between shoulders (dominant/non-dominant) during dynamic motion using subject-specific anatomy and precise in vivo kinematics. Design In a prospective cross-sectional study, 9 subjects underwent bilateral MR (N=18 shoulders) and fluoroscopic imaging during external rotation at 90° abduction (ER) and elevation. Subject-specific bone models were created and distances from footprint to (a) acromion and (b) glenoid were measured to evaluate risk. Results Throughout elevation, subacromial impingement risk was greater in the dominant shoulder (P=0.0178). Regardless of side, high subacromial impingement risk occurred at 30% (78°), 50% (101°), and 70% (57°) of the elevation cycle (P

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Response to the letter to the editor on the article “Evaluation of Posterosuperior Labral Tear with Shoulder Sonography after Intra-articular Injection”

No abstract available

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Hamstring co-contraction in the early stage of rehabilitation following anterior cruciate ligament reconstruction: A longitudinal study

Objective Hamstring co-contraction may affect recovery from anterior cruciate ligament reconstruction (ACLR). We aimed to evaluate the changes in hamstring co-contraction during the early postoperative stages. Design Twenty-five patients with ACLR were followed up for 1-3 months postoperatively, during which the Lysholm and International Knee Documentation Committee (IKDC) questionnaires were completed and surface electromyograms (sEMG) were assessed during terminal knee extension maximum voluntary contraction (TKE-MVC) and step-up tests. The integrated electromyogram of the tested muscles and co-contraction ratio (CR) were analyzed. Results CR during TKE-MVC at 3 months postoperatively was significantly less than that at 1 month postoperatively (p

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Evaluation of Posterosuperior Labral Tear with Shoulder Sonography After Intra-articular Injection

No abstract available

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Neuromuscular Dysfunction and Cortical Impairment in Sleep Apnea Syndrome

Purpose Lower muscle strength and endurance have been reported in severe obstructive sleep apnea (OSA). Increased intracortical inhibition previously reported at rest in OSA suggests central neuromuscular impairments in these patients. We hypothesized that (i) OSA patients demonstrate reduced knee extensor strength and endurance due to central impairments and (ii) continuous positive airway pressure (CPAP) treatment improves neuromuscular function in these patients. Methods Twelve OSA patients and 11 healthy controls performed intermittent knee extensions until task failure before and after 8 weeks of CPAP treatment or control period. Maximal voluntary contraction (MVC), voluntary activation (VA) and corticospinal excitability and inhibition assessed by single- and paired-pulse transcranial magnetic stimulation (TMS) were measured before and during the fatiguing task. Results Time to exhaustion was lower in OSA (before CPAP treatment: 1008 ± 549 s; after CPAP treatment: 975 ± 378 s) compared to controls (before control period: 1476 ± 633 s; after control period: 1274 ± 506 s; p = 0.017). OSA patients had reduced MVC and VATMS compared to controls throughout the fatiguing task as well as increased intracortical inhibition (all p 0.05 for all parameters). Conclusion This study demonstrates that severe OSA patients have cortical impairments which are likely contributing to their reduced knee extensors strength and endurance. Both cortical impairments and neuromuscular function are not improved following 8 weeks of CPAP treatment. Corresponding author: Dr. Samuel Verges, Laboratoire HP2 (U1042 INSERM), Univ. Grenoble Alpes, UM Sports Pathologies, Hôpital Sud, Avenue Kimberley, 38 434 Echirolles - France. E-mail: sverges@chu-grenoble.fr This work has been funded by the Fond de dotation AGIR pour les maladies chroniques and by the Fonds de dotation Recherche en Santé Respiratoire. MM, MG, SB, TLRM, BW, RT, PL and SV have nothing to disclose. JLP reports grants and personal fees from Philips, RESMED, Fisher & Paykel, grants from Fondation de la Recherche Médicale, Direction de la Recherche Clinique du CHU de Grenoble, Fonds de dotation "Agir pour les Maladies Chroniques", personal fees from Astra Zeneka, SEFAM, Agiradom, outside the submitted work. The results of the present study do not constitute endorsement by the American College of Sports Medicine. The authors declare that the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 6 March 2018 © 2018 American College of Sports Medicine

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Continuous Glucose Monitoring at High Altitude—Effects on Glucose Homeostasis

Purpose Exposure to high altitude has been shown to enhance both glucose and lipid utilization depending on experimental protocol. In addition, high and low blood glucose levels have been reported at high altitude. We hypothesized that gradual ascent to high altitude results in changes in glucose levels in healthy young adults. Methods 25 adult volunteers, split into two teams, took part in the British Services Dhaulagiri Medical Research Expedition completing 14 days of trekking around the Dhaulagiri circuit in Nepal reaching a peak altitude of 5300m on Day 11 of the trek. Participants wore blinded continuous glucose monitors (CGM) throughout. Blood samples for c-peptide, pro-insulin and triacylglycerides were taken at sea level (UK) and in acclimatisation camps at 3600m, 4650m and 5120m. Energy intake was determined from food diaries. Results There was no difference in time spent in hypoglycemia stratified by altitude. Nocturnal CGM readings (22.00-06.00 hrs) were chosen to reduce the short-term impact of physical activity and food intake and showed a significant (p

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Exercise Reduces Dopamine D1R and Increases D2R in Rats: Implications for Addiction

Introduction Exercise has been shown to be effective for preventing and treating substance abuse in both clinical and preclinical studies. Less is known, however, regarding the underlying neurobiological mechanisms driving these changes in drug-seeking behavior. One possibility is that exercise may alter the mesolimbic dopamine pathway in such a way that makes drugs of abuse less salient and/or rewarding. Methods To examine possible exercise-induced changes in dopamine signaling, male and female Lewis rats were split into exercise and sedentary groups at 8 weeks of age. Exercise rats were run on a treadmill at 10m/min, five days per week, for six weeks, while sedentary rats remained in their home cage. Rats were euthanized following the 6 weeks of treatment, and their brains were used for in vitro autoradiography using [3H]SCH 23,390, [3H]Spiperone, and [3H]WIN55,428 ligands to quantify D1R-like, D2R-like, and dopamine transporter (DAT) binding, respectively. Results Exercised rats had 18% and 21% lower D1R-like binding levels compared to sedentary rats within the olfactory tubercle (OT) and nucleus accumbens shell (AcbS), respectively. In addition, male and female exercise rats showed greater D2R-like binding levels within the dorsomedial (DM CPu; 30%), ventrolateral (VL CPu; 24%), and ventromedial (VM CPu; 27%) caudate putamen, as well as the OT (19%). Greater D2R-like binding in the nucleus accumbens core (AcbC; 24%) and shell (AcbS; 25%) of exercised rats compared to sedentary rats approached significance. No effects were found for DAT binding. Conclusions These findings support the hypothesis that aerobic exercise results in changes in the mesolimbic pathway that could mediate exercise-induced attenuation of drug-seeking behavior. Correspondence should be addressed to: Panayotis K. Thanos, Address: 1021 Main Street, Buffalo, NY 14203-1016, Email: pthanos@ria.buffalo.edu This research was funded by the NY Research Foundation (RIAQ094O). The authors report no conflicts of interest. The results of the present study do not constitute endorsement by ACSM. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 23 May 2018 © 2018 American College of Sports Medicine

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Biomechanical Model for Stress Fracture–related Factors in Athletes and Soldiers

Stress fractures (SFs) are one of the most common and potentially serious overuse injuries. Purpose to develop a computational biomechanical model of strain in human tibial bone that will facilitate better understanding of the pathophysiology of SFs. Methods MRI of a healthy, young male, was used for full anatomical segmentation of the calf tissues, which considered hard-soft tissues biomechanical interactions. From the undeformed coronal MR images, the geometry of bones, muscles, connecting ligaments, and fat were reconstructed in three-dimensions, and meshed to a finite element model. A force that simulated walking was applied on the tibial plateaus. The model was then analyzed for strains in the tibia under various conditions: unloaded walking, walking with a load equivalent to 30% of bodyweight, and walking under conditions of muscular fatigue. In addition, the effect of tibia robustness on strain was analyzed. Results the model showed that the tibia is mostly loaded by compression, with maximal strains detected in the distal anterior surface; 1241 and 384 microstrain, compressive and tensile, respectively. Load carriage resulted in ~30% increase in maximal effective strains. Muscle fatigue has a complex effect; fatigued calf muscles (soleus) reduced the maximal effective strains up to 9%, but fatigued thigh muscles increased those strains by up to 3%. It had also been shown that a slender tibia is substantially prone to higher maximal effective strains compared to an average (22% higher) or robust tibia (39% higher). Conclusions thigh muscle fatigue, load carriage, and a slender tibia were detected as factors that may contribute to the development of SFs. The methodology presented here is a novel tool for investigating the pathophysiology of SFs. Corresponding author: Prof. Yoram Epstein, FACSM, Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer, 52621, Yoram.epstein@sheba.health.gov.il The research was funded by a research grant from the Israeli Ministry of Defense. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute endorsement by ACSM. Conflict of interest: none Accepted for Publication: 9 March 2018 © 2018 American College of Sports Medicine

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Relationships between Habitual Cadence, Footstrike, and Vertical Loadrates in Runners

Excessive vertical ground reaction force (VGRF) loadrates have been linked with running injuries. Increasing cadence (CAD) has been shown to reduce loadrates; however relationships between habitual cadence and loadrates across a population of runners have not been examined. Purpose To examine the relationships between habitual running cadence and vertical loadrates in healthy and injured runners using habitual footstrike patterns. As CAD increased, we expected vertical loadrates would decrease. Methods Healthy runners (n=32, 25 male) and injured runners (n=93, 45 male) seeking treatment were analyzed. Footstrike classifications were heel at initial contact (RFS) or forefoot at initial contact (FFS). Runners were divided into 4 injury-status/footstrike pattern (FSP) subgroups: healthy-RFS (n=19), injured-RFS (n=70), healthy-FFS (n=13), and injured-FFS (n=23). VGRF and CAD were recorded as participants ran on an instrumented treadmill at self-selected speed (x =2.6m/s ±0.12). Healthy runners used lab footwear similar to their habitual footwear and injured runners used habitual footwear. The vertical average and instantaneous loadrates (VALR, VILR) of the VGRF of each runner's right leg were calculated and correlated with CAD for 4 injury status-FSP subgroups and for all runners combined. Results There were no differences in CAD between all runners or any subgroup (p>0.05). VALR and VILR were significantly higher (p

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Timing and Predictors of Mild and Severe Heat Illness among New Military Enlistees

Purpose Heat illnesses are important and potentially fatal conditions among physically active individuals. We determined predictors of heat illness among enlistees in a large military population experiencing common physical activity patterns. Methods We estimated the adjusted odds of mild and severe heat illness associated with demographic, health-related, and geographic factors among active-duty, United States Army soldiers enlisting between January 2011 – December 2014 (N=238,168) using discrete-time multivariable logistic regression analyses. Results We observed 2,612 incident cases of mild heat illness (MHI) and 732 incident cases of severe heat illness (SHI) during 427,922 person-years of follow-up, with a mean and median of 21.6 and 21 months per subject. During the first six duty months, 71.3% of the MHIs and 60.2% of the SHIs occurred, peaking at month two. The odds of MHI quadrupled among those with prior SHI (OR=4.02, 95% confidence interval [CI]: 2.67 – 6.03). Body mass index (BMI) extremes increased risk substantially (ORs at BMI ≥30: for MHI, 1.41, CI 1.19 – 1.67; for SHI, 1.94, CI 1.47 – 2.56; ORs at BMI

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Proving cortical death after vascular coma: Evoked potentials, EEG and neuroimaging

Publication date: June 2018
Source:Clinical Neurophysiology, Volume 129, Issue 6
Author(s): Florent Gobert, Frederic Dailler, Catherine Fischer, Nathalie André-Obadia, Jacques Luauté
ObjectivesSeveral studies have shown that bilateral abolition of somatosensory evoked potentials after a nontraumatic coma has 100% specificity for nonawakening with ethical consequences for active care withdrawal. We propose to evaluate the prognostic value of bilateral abolished cortical components of SEPs in severe vascular coma.MethodsA total of 144 comatose patients after subarachnoid haemorrhage were evaluated by multimodal evoked potentials (EPs); 7 patients presented a bilateral abolition of somatosensory and auditory EPs. Their prognosis value was interpreted with respect to brainstem auditory EPs, EEG, and structural imaging.ResultsOne patient emerged from vegetative state during follow-up; 6 patients did not return to consciousness. The main neurophysiological difference was a cortical reactivity to pain preserved in the patient who returned to consciousness. This patient had focal sub-cortical lesions, which could explain the abolition of primary cortical components by a bilateral deafferentation of somatosensory and auditory pathways.ConclusionsThis is the first report of a favourable outcome after a multimodal abolition of primary cortex EPs in vascular coma. For the 3 cases of vascular coma with preserved brainstem function, EEG reactivity and cortical EPs were abolished by a diffuse ischaemia close to cerebral anoxia.SignificanceThe complementarity of EPs, EEG, and imaging must be emphasised if therapeutic limitations are considered to avoid over-interpretation of the prognosis value of EPs.



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Newborn Screening Collection and Delivery Processes in Michigan Birthing Hospitals: Strategies to Improve Timeliness

Abstract

Objectives This study aimed to determine which steps in the newborn screening collection and delivery processes contribute to delays and identify strategies to improve timeliness. Methods Data was analyzed from infants (N = 94,770) who underwent newborn screening at 83 hospitals in Michigan between April 2014 and March 2015. Linear mixed effects models estimated effects of hospital and newborn characteristics on times between steps in the process, whereas simulation explored how to improve timeliness through adjustments to schedules for the state laboratory and for specimen pickup from hospitals. Results Time from collection to receipt of arrival to the state laboratory varied greatly with collection timing (P < 0.001), with specimens collected on Friday or Saturday delayed an average of 9–12 h compared to other specimens. Simulation estimates shifting specimen pickup from 6 p.m. Sunday–Friday to 9 p.m. Sunday–Friday could lead to an additional 12.6% of specimens received by the Michigan laboratory within 60 h of birth. Conclusions for Practice The time between when a specimen is collected and received by the laboratory can be a significant bottleneck in the newborn screening process. Modifying hospital pickup schedules appears to be a simple way to improve timeliness.

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