Τετάρτη, 2 Μαΐου 2018

Estimating pediatric general anesthesia exposure: Quantifying duration and risk

Pediatric Anesthesia, EarlyView.


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Table of Contents



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Editorial Board w/barcode



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Pulsus alternans induced by spinal anesthesia

Pulsus alternans is attributed to an alteration of the stroke volume with every other cardiac cycle, and reduced venous return is considered an important causative factor. Tachycardia can exacerbate this process as diastolic filling becomes further impaired. During pulsus alternans, increased end-diastolic volume can increase wall stress, which further reduces systolic performance [1], making appropriate treatment essential, even if the patient shows no signs or symptoms of heart failure.

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Whether time of operation does not increase the mortality rate in emergency surgery?

In a retrospective analysis, Rodney AG and colleagues [1] claim that time of operation (after-hours versus day-time hours) was not associated with death in emergency surgery, and those patients who undergoing intrathoracic or intraabdominal surgery, older patients and patients with a higher ASA PS may be at a higher risk of intraoperative mortality. However, we think it is inappropriate to reach the conclusion that no association of perioperative mortality with time of day in emergency surgery.

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Airtraq® reduces the hemodynamic response to tracheal intubation using single-lumen tubes in adults compared with the Macintosh laryngoscope: A systematic review and meta-analysis of randomized control trials

To investigate whether Airtraq® attenuate the hemodynamic responses to tracheal intubation using single-lumen tubes in adults as compared with the Macintosh laryngoscope.

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Ultrasound-guided erector spinae plane block elicits sensory loss around the lateral, but not the parasternal, portion of the thorax

Ultrasound-guided erector spinae plane block (US-ESPB) has been recently reported to be an effective technique for thoracic surgery [1,2]. US-ESPB is a type of fascial block requiring a sufficient dose of drug to adequately cover the interfascial plane [3]. We performed US-ESPB for 12 patients in cases of thoracoscopic lobectomy and assessed the anesthetized area from anterior to lateral thorax, as well as postoperative pain scores, to verify the analgesic features for thoracic surgery. After obtaining written informed consent from all patients and approval from the Institutional Review Board of Ehime Prefectural Central Hospital, patients with American Society of Anesthesiologists physical status 1–3, who were scheduled to undergo complete video-assisted lobectomy without rib spreading, underwent US-ESPB followed by the induction of general anesthesia.

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Bilateral continuous erector spinae plane blocks for sternotomy in a pediatric cardiac patient

Effectiveness of continuous erector spinae plane (ESP) block as an alternative to thoracic epidural anesthesia have been reported for pain management in pulmonary malignancy [1]. In fact, there are multiple reports [2–5] can provide good analgesia for selective major thoracic procedures when epidural anesthesia is contraindicated, or if there are other concerns about administering an epidural.

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Transnasal sphenopalatine nerve block for patients with headaches

Letter to the editor

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Relationship between arthroscopic findings of synovitis and levels of tumour necrosis factor‐alpha and matrix metalloproteinases in synovial lavage fluid from patients with unilateral high mandibular condyle fractures

Journal of Oral Rehabilitation, EarlyView.


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Tissue-Specific Transcriptome for Poeciliopsis prolifica Reveals Evidence for Genetic Adaptation Related to the Evolution of a Placental Fish

The evolution of the placenta is an excellent model to examine the evolutionary processes underlying adaptive complexity due to the recent, independent derivation of placentation in divergent animal lineages. In fishes, the family Poeciliidae offers the opportunity to study placental evolution with respect to variation in degree of post-fertilization maternal provisioning among closely related sister species. In this study, we present a detailed examination of a new reference transcriptome sequence for the live-bearing, matrotrophic fish, Poeciliopsis prolifica, from multiple-tissue RNA-seq data. We describe the genetic components active in liver, brain, late-stage embryo, and the maternal placental/ovarian complex, as well as associated patterns of positive selection in a suite of orthologous genes found in fishes. Results indicate the expression of many signaling transcripts, "non-coding" sequences and repetitive elements in the maternal placental/ovarian complex. Moreover, patterns of positive selection in protein sequence evolution were found associated with live-bearing fishes, generally, and the placental P. prolifica, specifically, that appear independent of the general live-bearer lifestyle. Much of the observed patterns of gene expression and positive selection are congruent with the evolution of placentation in fish functionally converging with mammalian placental evolution and with the patterns of rapid evolution facilitated by the teleost-specific whole genome duplication event.



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Sex Determination in Ceratopteris richardii Is Accompanied by Transcriptome Changes That Drive Epigenetic Reprogramming of the Young Gametophyte

The fern Ceratopteris richardii is an important model for studies of sex determination and gamete differentiation in homosporous plants. Here we use RNA-seq to de novo assemble a transcriptome and identify genes differentially expressed in young gametophytes as their sex is determined by the presence or absence of the male-inducing pheromone called antheridiogen. Of the 1,163 consensus differentially expressed genes identified, the vast majority (1,030) are up-regulated in gametophytes treated with antheridiogen. GO term enrichment analyses of these DEGs reveals that a large number of genes involved in epigenetic reprogramming of the gametophyte genome are up-regulated by the pheromone. Additional hormone response and development genes are also up-regulated by the pheromone. This C. richardii gametophyte transcriptome and gene expression dataset will prove useful for studies focusing on sex determination and differentiation in plants.



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Activation of Self-Incompatibility Signaling in Transgenic Arabidopsis thaliana Is Independent of AP2-Based Clathrin-Mediated Endocytosis

Internalization of plasma membrane (PM)-localized ligand-activated receptor kinases and their trafficking to sorting endosomes have traditionally been viewed as functioning primarily in the down-regulation of receptor signaling, but are now considered to be also essential for signaling by some receptors. A major mechanism for internalization of PM proteins is clathrin-mediated endocytosis (CME). CME is mediated by the Adaptor Protein Complex 2 (AP2), which is involved in interaction of the AP2 μ-adaptin subunit with a tyrosine-based Yxx motif located in the cytoplasmic domain of the cargo protein. In this study, we investigated the role of AP2-mediated CME for signaling by the S-locus receptor kinase (SRK), a protein localized in the PM of stigma epidermal cells, which, together with its pollen coat-localized S-locus cysteine-rich (SCR) ligand, functions in the self-incompatibility (SI) response of the Brassicaceae. Using Arabidopsis thaliana plants that were made self-incompatible by transformation with an A. lyrata-derived SRK/SCR gene pair, we tested the effect on SI of site-directed mutations in each of the two Yxx motifs in SRK and of a CRISPR/Cas9-induced null mutation in the AP2 μ-adaptin gene AP2M. Both in vitro SRK kinase activity and the in planta SI response were abolished by substitution of tyrosine in one of the two Yxx motifs, but were unaffected by elimination of either the second Yxx motif or AP2M function. Thus, AP2-mediated CME is considered to be unnecessary for SRK signaling in the SI response.



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Tissue-Specific Functions of fem-2/PP2c Phosphatase and fhod-1/formin During Caenorhabditis elegans Embryonic Morphogenesis

The cytoskeleton is the basic machinery that drives many morphogenetic events. Elongation of the C. elegans embryo from a spheroid into a long, thin larva initially results from actomyosin contractility, mainly in the lateral epidermal seam cells, while the corresponding dorsal and ventral epidermal cells play a more passive role. This is followed by a later elongation phase involving muscle contraction. Early elongation is mediated by parallel genetic pathways involving LET-502/Rho kinase and MEL-11/MYPT myosin phosphatase in one pathway and FEM-2/PP2c phosphatase and PAK-1/p21 activated kinase in another. While the LET-502/MEL-11 pathway appears to act primarily in the lateral epidermis, here we show that FEM-2 can mediate early elongation when expressed in the dorsal and ventral epidermis. We also investigated the early elongation function of FHOD-1, a member of the formin family of actin nucleators and bundlers. Previous work showed that FHOD-1, a member of the formin family of actin nucleators and bundlers, acts in the LET-502/MEL-11 branch of the early elongation pathway and as well as in muscle for sarcomere organization. Consistent with this, we found that lateral epidermal cell-specific expression of FHOD-1 is sufficient for elongation, and FHOD-1 effects on elongation appear to be independent of its role in muscle. Also, we found that fhod-1 encodes long and short isoforms that differ in the presence of a predicted coiled-coil domain. Based on tissue-specific expression constructions and an isoform-specific CRISPR allele, the two FHOD-1 isoforms show partially specialized epidermal or muscle function. Although fhod-1 shows only impenetrant elongation phenotypes, we were unable to detect redundancy with other C. elegans formin genes.



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Probing under pressure: a look inside the compartmental haemodynamics of skeletal muscle during rest and contraction

The Journal of Physiology, EarlyView.


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A scoping review of assessment tools for laparoscopic suturing

Abstract

Background

A needs assessment identified a gap in teaching and assessment of laparoscopic suturing (LS) skills. The purpose of this review is to identify assessment tools that were used to assess LS skills, to evaluate validity evidence available, and to provide guidance for selecting the right assessment tool for specific assessment conditions.

Methods

Bibliographic databases were searched till April 2017. Full-text articles were included if they reported on assessment tools used in the operating room/simulation to (1) assess procedures that require LS or (2) specifically assess LS skills.

Results

Forty-two tools were identified, of which 26 were used for assessing LS skills specifically and 26 for procedures that require LS. Tools had the most evidence in internal structure and relationship to other variables, and least in consequences.

Conclusion

Through identification and evaluation of assessment tools, the results of this review could be used as a guideline when implementing assessment tools into training programs.



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Oncological outcomes of robotic-assisted laparoscopic versus open lateral lymph node dissection for locally advanced low rectal cancer

Abstract

Background

The long-term outcomes of robotic-assisted laparoscopic lateral lymph node dissection (RALLD) have not been fully investigated. This study aimed to assess the oncological and long-term outcomes of RALLD for rectal cancer through comparison with those of open lateral lymph node dissection (OLLD) in a retrospective study.

Methods

Between September 2002 and October 2014, the medical data of 426 patients who underwent total mesorectal excision with lateral lymph node dissection for primary rectal cancer were collected. Of these, 115 patients were excluded after data collection (stage IV, n = 61; total pelvic exenteration, n = 31; multiple cancer, n = 20; conventional laparoscopic surgery, n = 3). Before matching, 311 patients with clinical stage II/III were analyzed. Using exact matching, patients were stratified into RALLD (n = 78) and OLLD (n = 78) groups. Pathological findings and long-term outcomes were compared between the groups.

Results

The pathological stage and number of harvested lymph nodes showed no significant differences between the groups. The rate of positive resection margin in the RALLD group tended to be lower compared with that of the OLLD group (p = 0.059). The median follow-up duration was 54.0 months in 156 patients. The 5-year overall survival rate was 95.4 and 87.8% in the RALLD and OLLD groups, respectively (p = 0.106). The 5-year relapse-free survival rate was 79.1 and 69.9% in the RALLD and OLLD groups, respectively (p = 0.157). The 5-year local relapse-free survival rate was 98.6 and 90.9% in the RALLD and OLLD groups, respectively (p = 0.029).

Conclusions

The short- and long-term outcomes indicated that RALLD may be a useful modality for locally advanced low rectal cancer.



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Implementing Motor Unit Number Index (MUNIX) in a large clinical trial: real world experience from 27 centres

abductor digiti minimi muscle

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Visit Telrepco at booth #9 at the 2018 Zoll Summit

Telrepco will be at the booth #9 at the 2018 Zoll Summit at the Sheraton Denver, Downtown Hotel in Denver, CO from May 8-May10. We will be displaying new and refurbished Panasonic Toughbooks and related accessories including vehicle mounting solutions, ruggedized mobile broadband routers and gateways, ruggedized printing solutions, and more. We will also be raffling off a $100 American Express Gift ...

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Editorial Board

Experimental Physiology, Volume 103, Issue 5, Page 777-779, 1 May 2018.


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Feedback requested for EMS Agenda 2050

The first draft of the EMS Agenda 2050 was released for public comment after a technical expert panel spent over a year soliciting input to create it

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Atypical presentations associated with non‐polyalanine repeat PHOX2B mutations

American Journal of Medical Genetics Part A, EarlyView.


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A missense mutation in EBF2 was segregated with imperforate anus in a family across three generations

American Journal of Medical Genetics Part A, EarlyView.


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A sibling pair with cardiofaciocutaneous syndrome (CFC) secondary to BRAF mutation with unaffected parents—the first cases of gonadal mosaicism in CFC?

American Journal of Medical Genetics Part A, EarlyView.


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Familial autosomal dominant severe ankyloglossia with tooth abnormalities

American Journal of Medical Genetics Part A, EarlyView.


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Recessive variants of MuSK are associated with late onset CMS and predominant limb girdle weakness

American Journal of Medical Genetics Part A, EarlyView.


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Sleep disturbances in Rett syndrome: Impact and management including use of sleep hygiene practices

American Journal of Medical Genetics Part A, EarlyView.


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Loss of function IFT27 variants associated with an unclassified lethal fetal ciliopathy with renal agenesis

American Journal of Medical Genetics Part A, EarlyView.


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Retraction Note to: Cadmium permeates through calcium channels and activates transcriptomic complexity in wheat roots in response to cadmium stress

The authors are retracting this article [1] because Figs. 1A, 1E and 1F have been taken without permission from the Master's thesis of Qiaoling Wang.



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The anti-axiom axiom

While EMS education and protocols are important, experience proves that every situation is different and nuanced

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Role of inter-trial phase coherence in atypical auditory evoked potentials to speech and nonspeech stimuli in children with autism

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Publication date: July 2018
Source:Clinical Neurophysiology, Volume 129, Issue 7
Author(s): Luodi Yu, Suiping Wang, Dan Huang, Xueyuan Wu, Yang Zhang
ObjectiveThis autism study investigated how inter-trial phase coherence (ITPC) drives abnormalities in auditory evoked potential (AEP) responses for speech and nonspeech stimuli.MethodsAuditory P1-N2 responses and ITPCs in the theta band (4–7 Hz) for pure tones and words were assessed with EEG data from 15 school-age children with autism and 16 age-matched typically developing (TD) controls.ResultsThe autism group showed enhanced P1 and reduced N2 for both speech and nonspeech stimuli in comparison with the TD group. Group differences were also found with enhanced theta ITPC for P1 followed by ITPC reduction for N2 in the autism group. The ITPC values were significant predictors of P1 and N2 amplitudes in both groups.ConclusionsAbnormal trial-to-trial phase synchrony plays an important role in AEP atypicalities in children with autism. ITPC-driven enhancement as well as attenuation in different AEP components may coexist, depending on the stage of information processing.SignificanceIt is necessary to examine the time course of auditory evoked potentials and the corresponding inter-trial coherence of neural oscillatory activities to better understand hyper- and hypo- sensitive responses in autism, which has important implications for sensory based treatment.



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Incongruent visual feedback during a postural task enhances cortical alpha and beta modulation in patients with Parkinson’s disease

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Publication date: July 2018
Source:Clinical Neurophysiology, Volume 129, Issue 7
Author(s): Maarten R.C. van den Heuvel, Erwin E.H. van Wegen, Peter J. Beek, Gert Kwakkel, Andreas Daffertshofer
ObjectiveIn patients with Parkinson's disease (PD), augmented visual feedback (VF) can improve functional motor performance. Conversely, they appear to rely more on visual information than healthy subjects, which is unfavorable when this information is unreliable. Cortical beta activity is thought to be associated with the need for motor adaptation. We here compared event-related EEG parameters during a whole-body postural weight-shifting task between congruent and incongruent feedback conditions.MethodsTwenty-four patients with PD and fifteen healthy, age- and gender-matched controls performed rhythmic swaying movements. VF was presented in real-time (congruent), delayed (incongruent), or was entirely absent. We estimated source activity in four regions-of-interest and determined motor-related spectral power and power modulation in alpha and beta frequency bands.ResultsFor congruent VF no significant differences in cortical activity between the two groups were present. For incongruent VF, the PD group showed significantly higher beta modulation in primary motor cortex, and higher alpha modulation in primary visual cortex.ConclusionsEvent-related beta modulation in the motor network and alpha modulation in visual areas discriminated between groups, suggesting altered visuomotor processing in PD patients.SignificanceThis study finds evidence for increased modulation of alpha/beta activity during perceptual-motor tasks in PD, possibly indicating an unwarranted higher confidence in VF.



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The effects of a single dose of fluoxetine on practice-dependent plasticity

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Publication date: July 2018
Source:Clinical Neurophysiology, Volume 129, Issue 7
Author(s): Michelle N. McDonnell, Carl Zipser, Ghazaleh Darmani, Ulf Ziemann, Florian Müller-Dahlhaus
ObjectiveTo determine whether a single dose of fluoxetine increases corticomotoneuronal excitability, motor performance and practice-dependent plasticity.MethodsTwelve healthy adults completed this placebo-controlled, pseudo-randomized, double-blind crossover study. Transcranial magnetic stimulation (TMS) was used to assess corticomotoneuronal excitability, and two uni-axial accelerometers measured kinetics of fastest possible ballistic voluntary thumb movements and TMS-evoked thumb movements. Six hours after administration of either 20 mg of the serotonin reuptake inhibitor fluoxetine or placebo, participants practiced ballistic thumb movements in the direction opposite to the TMS-evoked thumb movements. The primary outcome of this study was the proportion of thumb movements that fell within the target-training zone (TTZ) during and for 30 min after the practice.ResultsAll participants demonstrated practice-dependent plasticity evidenced by an increase of TMS-evoked thumb movements falling into the TTZ (P = 0.045), with no difference between drugs. There was a significant increase in peak acceleration of the practiced voluntary thumb movements (P = 0.002), but no DRUG by TIME interaction. Motor-evoked potential amplitudes were not changed by drug intake or practice.ConclusionsA single dose of 20 mg of fluoxetine did not enhance corticomotoneuronal excitability, performance of a ballistic thumb movement task, or practice-dependent plasticity in healthy adults.SignificanceLonger administration fluoxetine may be necessary to enhance motor performance and plasticity.



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Exaggerated startle in post-infectious opsoclonus myoclonus syndrome

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Publication date: July 2018
Source:Clinical Neurophysiology, Volume 129, Issue 7
Author(s): Daniel J. Blackburn, Mhairi Forbes, Zoe Unwin, Nigel Hoggard, Marios Hadjivassiliou, Ptolemaios G. Sarrigiannis




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Assessing sudomotor impairment in patients with peripheral neuropathy: Comparison between electrochemical skin conductance and skin biopsy

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Publication date: July 2018
Source:Clinical Neurophysiology, Volume 129, Issue 7
Author(s): Mathilde Duchesne, Laurence Richard, Jean-Michel Vallat, Laurent Magy
ObjectiveSudoscan provides a rapid assessment of sudomotor function based on the measurement of electrochemical skin conductance (ESC), which is thought to be proportional to small nerve fibres innervating the sweat glands. However, the relationship between ESC and small nerve fibre density on skin biopsy remains unclear.MethodsIn a retrospective single-centre study, we compared ESC measurements with autonomic sweat gland nerve fibre density (SGNFD) and somatic intraepidermal nerve fibre density (IENFD) in patients with polyneuropathy.Results63 patients were included (mean age: 60.6 ± 13.3 years). ESC was more strongly correlated with SGNFD (r = 0.49; p = 0.0005) than with IENFD (r = 0.42; p = 0.0005). Foot ESC was lower in patients with abnormal SGNFD (1.0 ± 0.3 µS/kg versus 0.7 ± 0.4 µS/kg; p = 0.0419) or abnormal IENFD (1.1 ± 0.3 µS/kg versus 0.8 ± 0.3 µS/kg; p = 0.0425).ConclusionESC measurement is a novel method of potential value for assessing sudomotor function. More studies are required to define its place beside ancient well-established techniques.SignificanceThe weak correlation of ESC with skin biopsy results suggests that mechanisms other than the loss of innervating fibres may be responsible for sweat gland dysfunction in polyneuropathies.



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Emergency Medical Products unveils new branding

DUBLIN, Ohio — Emergency Medical Products Inc. (EMP), part of the fast-growing Sarnova family of companies, today announced the business has just completed an extensive rebranding effort, including development of a new logo and visual style. The new EMP brand brings a more modern and bold visual identity to the company, which has served first responders for over 45 years. Providing quick and easy ...

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Fla. county waives ambulance fees for residents

A new policy went into effect May 1 in which Bay County will only collect the amount insurance pays, and nothing out of pocket

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The effects of different durations of static stretching within a comprehensive warm-up on voluntary and evoked contractile properties

Abstract

Evidence for performance decrements following prolonged static stretching (SS) has led to a paradigm shift in stretching routines within a warm-up. Rather than SS, dynamic stretching (DS) and dynamic activity (DA) have replaced SS within warm-up routines. The objective of the present study was to compare the effect of differing lower limb SS durations (30 [SS30s], 60 [SS60s] or 120 s [SS120s] of SS per muscle group or no-stretch control) within a comprehensive warm-up protocol consisting of aerobic activity, DS and DA. Sixteen male participants completed the four stretching conditions in a randomized order, after a 5-min low-intensity (cycle) warm-up and before a DS/DA component on separate days. Tests included passive hip and knee ranges of motion (ROM), maximum voluntary knee extensor/flexor force, force produced at 100 ms (F100), vertical jump height and evoked knee extensor contractile properties. For hip flexion (hamstrings) ROM, SS120s provided the largest increase (5.6–11.7%) followed by SS60s (4.3–11.4%), control (4.4–10.6%) and SS30s (3.6–11.1%). For knee flexion (quadriceps) ROM, SS30s provided the largest increase (9.3–18.2%) followed by SS120s (6.5–16.3%), SS60s (7.2–15.2%) and control (6.3–15.2%). There were decreases in quadriceps F100 following SS in SS120s (29.6%) only. There were increases in vertical jump performance in the control (6.2%), SS60s (4.6%) and SS30s (3.3%). While 120 s SS per muscle increased ROM, even within a comprehensive warm-up routine, it also elicited notable performance decrements. However, moderate durations of SS were observed to improve ROM whilst either having negligible or beneficial (but not detrimental) effects on specific aspects of athletic performance.



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When is a proxy not a proxy? The foibles of studying non‐image forming light

The Journal of Physiology, EarlyView.


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Functional decoupling of melatonin suppression and circadian phase resetting in humans

The Journal of Physiology, EarlyView.


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Issue Information

The Journal of Physiology, Volume 596, Issue 9, Page 1529-1530, 1 May 2018.


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Altered autonomic control of heart rate variability in the chronically hypoxic fetus

The Journal of Physiology, EarlyView.


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Electromagnetic field exposure (50 Hz) impairs response to noxious heat in American cockroach

Abstract

Exposure to electromagnetic field (EMF) induces physiological changes in organism that are observed at different levels—from biochemical processes to behavior. In this study, we evaluated the effect of EMF exposure (50 Hz, 7 mT) on cockroach's response to noxious heat, measured as the latency to escape from high ambient temperature. We also measured the levels of lipid peroxidation and glutathione content as markers of oxidative balance in cockroaches exposed to EMF. Our results showed that exposure to EMF for 24, 72 h and 7 days significantly increases the latency to escape from noxious heat. Malondialdehyde (MDA) levels increased significantly after 24-h EMF exposure and remained elevated up to 7 days of exposure. Glutathione levels significantly declined in cockroaches exposed to EMF for 7 days. These results demonstrate that EMF exposure is a considerable stress factor that affects oxidative state and heat perception in American cockroach.



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Association of Lower Limb Compression Garments During High-Intensity Exercise with Performance and Physiological Responses: A Systematic Review and Meta-analysis

Abstract

Background

Although compression garments are used to improve sports performance, methodological approaches and the direction of evidence regarding garments for use in high-intensity exercise settings are diverse.

Objectives

Our primary aim was to summarize the association between lower-limb compression garments (LLCGs) and changes in sports performance during high-intensity exercise. We also aimed to summarize evidence about the following physiological parameters related to sports performance: vertical jump height (VJ), maximal oxygen uptake (VO2max), submaximal oxygen uptake (VO2submax), blood lactate concentrations ([La]), and ratings of perceived exertion (RPE, 6–20 Borg scale).

Methods

We searched electronic databases (PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov) and reference lists for previous reviews. Eligible studies included randomized controlled trials with athletes or physically active subjects (≥ 18 years) using any type of LLCG during high-intensity exercise. The results were described as weighted mean difference (WMD) with a 95% confidence interval (95% CI).

Results

The 23 included studies showed low statistical heterogeneity for the pooled outcomes. We found that LLCGs yielded similar running performance to controls (50–400 m: WMD 0.06 s [95% CI − 1.99 to 2.11]; 800–3000 m: WMD 6.10 s [95% CI − 7.23 to 19.43]; > 5000 m: WMD 1.01 s [95% CI − 84.80 to 86.82]). Likewise, we found no evidence that LLCGs were superior in secondary outcomes (VJ: WMD 2.25 cm [95% CI − 2.51 to 7.02]; VO2max: WMD 0.24 mL.kg−1.min−1 [95% CI − 1.48 to 1.95]; VO2submax: WMD − 0.26 mL.kg−1.min−1 [95% CI − 2.66 to 2.14]; [La]: WMD 0.19 mmol/L [95% CI − 0.22 to 0.60]; RPE: WMD − 0.20 points [95% CI − 0.48 to 0.08]).

Conclusions

LLCGs were not associated with improved performance in VJ, VO2max, VO2submax, [La], or RPE during high-intensity exercise. Such evidence should be taken into account when considering using LLCGs to enhance running performance.



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Relationships Between Neighbourhood Physical Environmental Attributes and Older Adults’ Leisure-Time Physical Activity: A Systematic Review and Meta-Analysis

Abstract

Background

Activity-friendly neighbourhood physical environments with access to recreational facilities are hypothesised to facilitate leisure-time physical activity (LTPA) among older adults (≥ 65 years old). The aim of the current study was to systematically review and quantitatively summarise study findings on the relationships between physical environmental attributes and LTPA among older adults.

Methods

An extensive search of literature, including grey literature, yielded 72 articles eligible for inclusion. The reported associations between seven categories of environmental attributes and six LTPA outcomes were extracted, weighted by sample size and study quality, and quantitatively summarised. Reported moderating effects of individual and environmental characteristics and neighbourhood definition were also examined.

Results

We observed positive associations for walkability (p = 0.01), land-use mix—access (p = 0.02) and aesthetically pleasing scenery (p < 0.001) with leisure-time walking. For leisure-time walking within the neighbourhood, evidence was found for positive associations with land-use mix—access (p = 0.03) and access to public transit (p = 0.05), and a negative association with barriers to walking/cycling (p = 0.03). Evidence for positive relationships between overall LTPA and access to recreational facilities (p = 0.01) and parks/open space (p = 0.04) was found. Several environmental attribute–LTPA outcome combinations were insufficiently studied to draw conclusions. No consistent moderating effects were observed for individual and environmental characteristics and neighbourhood definition.

Conclusions

The observed significant relationships can be used to inform policy makers and planners on how to (re-)design neighbourhoods that promote LTPA among older adults. Many environmental attribute–LTPA outcome relationships have been studied insufficiently and several methodological issues remain to be addressed.

Systematic Review Registration Number

PROSPERO 2016:CRD42016051180.



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Whole-exome sequencing analysis reveals co-segregation of a COL20A1 missense mutation in a Pakistani family with striate palmoplantar keratoderma

Abstract

Palmoplantar keratoderma (PPK) is a rare group of excessive skin disorder characterized by thickness over the palms and soles. The striate palmoplantar keratoderma (PPKS) is a form in which hyperkeratotic lesions are restricted to the pressure regions extending longitudinally in the length of each finger to the palm. Dominantly inherited mutations in genes including desmoglein 1, desmoplakin and keratin 1 have been suggested as genetic causes of PPKS. In this study, we investigated a three-generation Pakistani family segregating PPKS phenotype in autosomal dominant fashion to identify genetic cause in this family. We have performed whole-exome and Sanger sequencing followed by in silico bioinformatics analysis to pinpoint candidate mutation associated with PPK. Revealed a novel heterozygous mutation (NM_020882.2, COL20A1 c. 392C > G; p.Ser131Cys) in the loop region close to fibronectin type III-1 domain of the c ollagen 20 α1. This variant was not found in our in-house 219 ethnically matched Pakistani unaffected controls and showed minor allele frequency of 3.4 × 10−5 in Exome Aggregation Consortium database containing exome data of 59,464 worldwide individuals. It was assigned as "pathogenic" by in silico prediction tools. Previously, association of mutation in the COL14A1, one of the paralogous gene of COL20A1, with PPK was reported in the study with a Chinese family. Our study proposes COL20A1 gene as another potential candidate gene for PPKS which expand the spectrum of collagen proteins in the pathogenicity of PPK.



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Change-of-Direction Biomechanics: Is What’s Best for Anterior Cruciate Ligament Injury Prevention Also Best for Performance?

Abstract

Change-of-direction maneuvers (e.g., side-step cutting) are an important aspect of performance in multi-directional sports, but these maneuvers are also associated with anterior cruciate ligament (ACL) injury. Despite this, the impact of biomechanics on ACL injury risk and performance is often examined in isolation. The purpose of this review was to examine the alignment between biomechanical recommendations for ACL injury prevention and performance with regard to change-of-direction maneuvers. Several studies linking change-of-direction biomechanics to both ACL injury risk and performance were examined. A degree of overlap was identified between biomechanical strategies that could both reduce ACL injury risk and enhance performance during change-of-direction maneuvers. A fore-foot footfall pattern along with trunk rotation and lateral flexion in the intended cutting direction were identified as biomechanical strategies that could both reduce potentially hazardous knee joint moments and enhance change-of-direction speed. Minimizing knee valgus during change-of-direction maneuvers may also reduce ACL injury risk, with this biomechanical strategy found to have no impact on performance. Certain biomechanical strategies proposed to reduce ACL injury risk were linked to reduced change-of-direction performance. A narrow foot placement and "soft" landings with greater knee flexion were identified as ACL injury prevention strategies that could have a negative impact on performance. The findings of this review emphasize the need to consider both ACL injury risk and performance when examining the biomechanics of change-of-direction maneuvers.



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Effect of Atropine With Propofol vs Atropine With Atracurium and Sufentanil on Oxygen Desaturation in Neonates Requiring Nonemergency Intubation: A Randomized Clinical Trial.

Related Articles

Effect of Atropine With Propofol vs Atropine With Atracurium and Sufentanil on Oxygen Desaturation in Neonates Requiring Nonemergency Intubation: A Randomized Clinical Trial.

JAMA. 2018 May 01;319(17):1790-1801

Authors: Durrmeyer X, Breinig S, Claris O, Tourneux P, Alexandre C, Saliba E, Beuchée A, Jung C, Levy C, Marchand-Martin L, Marcoux MO, Dechartres A, Danan C, PRETTINEO Research Group

Abstract
Importance: Propofol or a combination of a synthetic opioid and muscle relaxant are both recommended for premedication before neonatal intubation but have yet to be compared.
Objective: To compare prolonged desaturation during neonatal nasotracheal intubation after premedication with atropine-propofol vs atropine-atracurium-sufentanil treatment.
Design, Setting, and Participants: Multicenter, double-blind, randomized clinical trial (2012-2016) in 6 NICUs in France that included 173 neonates requiring nonemergency intubation. The study was interrupted due to expired study kits and lack of funding.
Interventions: Eighty-nine participants were randomly assigned to the atropine-propofol group and 82 to the atropine-atracurium-sufentanil group before nasotracheal intubation.
Main Outcomes and Measures: The primary outcome was prolonged desaturation (Spo2 <80% lasting > 60 seconds), using intention-to-treat analysis using mixed models. Secondary outcomes assessed the characteristics of the procedure and its tolerance.
Results: Of 173 neonates randomized (mean gestational age, 30.6 weeks; mean birth weight, 1502 g; 71 girls), 171 (99%) completed the trial. Of 89 infants, 53 (59.6%) in the atropine-propofol group vs 54 of 82 (65.9%) in the atropine-atracurium-sufentanil group achieved the primary outcome (adjusted RD, -6.4; 95% CI, -21.0 to 8.1; P = .38). The atropine-propofol group had a longer mean procedure duration than did the atropine-atracurium-sufentanil group (adjusted RD, 1.7 minutes; 95% CI, 0.1-3.3 minutes; P = .04); a less frequent excellent quality of sedation rate, 51.7% (45 of 87) vs 92.6% (75 of 81; P < .001); a shorter median time to respiratory recovery, 14 minutes (IQR, 8-34 minutes) vs 33 minutes (IQR, 15-56 minutes; P = .002), and shorter median time to limb movement recovery, 18 minutes (IQR, 10-43 minutes) vs 36 minutes (IQR, 19-65 minutes; P = .003). In the 60 minutes after inclusion, Spo2 was preserved significantly better in the atropine-propofol group (time × treatment interaction P  = .02). Of the atropine-propofol group 20.6% had head ultrasound scans that showed worsening intracranial hemorrhaging (any or increased intraventricular hemorrhage) in the 7 days after randomization vs 17.6% in the atropine-atracurium-sufentanil group (adjusted RD, 1.2; 95% CI, -13.1 to 15.5, P = .87). Severe adverse events occurred in 11% of the atropine-propofol group and in 20% of the atropine-atracurium-sufentanil group.
Conclusions and Relevance: Among neonates undergoing nonemergency nasotracheal intubation, the frequency of prolonged desaturation did not differ significantly between atropine used with propofol or atropine used with atracurium and sufentanil. However, the study may have been underpowered to detect a clinically important difference, and further research may be warranted.
Trial Registration: ClinicalTrials.gov Identifier: NCT01490580, EudraCT number: 2009-014885-25.

PMID: 29715354 [PubMed - in process]



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Estimation of critical end-test torque using neuromuscular electrical stimulation of the quadriceps in humans

Abstract

Characterization of critical power/torque (CP/CT) during voluntary exercise requires maximal effort, making difficult for those with neuromuscular impairments. To address this issue we sought to determine if electrically stimulated intermittent isometric exercise resulted in a critical end-test torque (ETT) that behaved similar to voluntary CT. In the first experiment participants (n = 9) completed four bouts of stimulated exercise at a 3:2 duty cycle, at frequencies of 100, 50, 25 Hz, and a low frequency below ETT (Sub-ETT; ≤ 15 Hz). The second experiment (n = 20) consisted of four bouts at a 2:2 duty cycle—two bouts at 100 Hz, one at an intermediate frequency (15–30 Hz), and one at Sub-ETT. The third experiment (n = 12) consisted of two bouts at 50 Hz at a 3:2 duty* cycle with proximal blood flow occlusion during one of the bouts. ETT torque was similar (p ≥ 0.43) within and among stimulation frequencies in experiment 1. No fatigue was observed during the Sub-ETT bouts (p > 0.05). For experiment 2, ETT was similar at 100 Hz and at the intermediate frequency (p ≥ 0.29). Again, Sub-ETT stimulation did not result in fatigue (p > 0.05). Altering oxygen delivery by altering the duty cycle (3:2 vs. 2:2; p = 0.02) and by occlusion (p < 0.001) resulted in lower ETT values. Stimulated exercise resulted in an ETT that was consistent from day-to-day and similar regardless of initial torque, as long as that torque exceeded ETT, and was sensitive to oxygen delivery. As such we propose it represents a parameter similar to voluntary CT.



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Impact of tumor localization on the outcomes of surgery for an intrahepatic cholangiocarcinoma

Abstract

Background

Intrahepatic cholangiocarcinoma (ICC) shows differing clinical outcomes depending on its localization.

Methods

We reviewed the surgical outcomes of 104 ICC patients who underwent liver resection at our institution. We divided ICC into hilar type (HICC) and peripheral type (PICC) depending on positive contact with the hepatic hilum on preoperative computed tomography (CT).

Results

The survival outcomes were significantly poorer in HICC patients. HICCs showed a larger tumor size and more frequent bile duct invasion, lymph node metastasis, and non-curative resection than PICC. Resections for HICC had greater blood loss and required a longer operation time, larger hepatectomy, and more frequent extrahepatic bile duct resection. HICCs, even if small in size, also showed a greater tendency to metastasize to the lymph nodes of the hepatoduodenal ligament. Univariate analysis of the ICCs in our current cohort revealed that tumor size, multiple tumors, bile duct invasion, lymph node metastasis, non-curative resection, and HICC are associated with a poorer overall survival outcome. Multivariate analysis indicated that multiple tumors and non-curative resection were independent prognostic factors for survival. Among the curative resection cases, however, survival did not differ significantly between HICC and PICC. The accuracy rate of our CT-based classification for the pathological classification was 81.7%.

Conclusions

HICC shows more frequent bile duct invasion and lymph node metastasis, requires more extensive surgery, and has a higher rate of non-curative resection than PICC. However, if curative resection is achieved, the survival outcomes are expected to be equivalent between HICC and PICC.



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Correction to: Identification of novel mutations in FFPE lung adenocarcinomas using DEPArray sorting technology and next-generation sequencing

In the original article, part of Table 1 headings and entries were missing. The correct Table is as shown below. The original article has been corrected.



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Differences in the oral health status and oral hygiene practices according to the extent of post‐stroke sequelae

Journal of Oral Rehabilitation, EarlyView.


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