Tracheobronchial angles in children: Three‐dimensional computed tomography‐based measurements

Pediatric Anesthesia, EarlyView.


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Reanalyzing language expectations: Native language knowledge modulates the sensitivity to intervening cues during anticipatory processing

Psychophysiology, EarlyView.


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The Denominator in Value-Based Health Care: Porter’s Hidden Costs

No abstract available

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In Response

No abstract available

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Brown’s Atlas of Regional Anesthesia, 5th ed

No abstract available

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Incidence and Risk Factors for Perioperative Cardiovascular and Respiratory Adverse Events in Pediatric Patients With Congenital Heart Disease Undergoing Noncardiac Procedures

BACKGROUND: While mortality and adverse perioperative events after noncardiac surgery in children with a broad range of congenital cardiac lesions have been investigated using large multiinstitutional databases, to date single-center studies addressing adverse outcomes in children with congenital heart disease (CHD) undergoing noncardiac surgery have only included small numbers of patients with significant heart disease. The primary objective of this study was to determine the incidences of perioperative cardiovascular and respiratory events in a large cohort of patients from a single institution with a broad range of congenital cardiac lesions undergoing noncardiac procedures and to determine risk factors for these events. METHODS: We identified 3010 CHD patients presenting for noncardiac procedures in our institution over a 5-year period. We collected demographic information, including procedure performed, cardiac diagnosis, ventricular function as assessed by echocardiogram within 6 months of the procedure, and classification of CHD into 3 groups (minor, major, or severe CHD) based on residual lesion burden and cardiovascular functional status. Characteristics related to conduct of anesthesia care were also collected. The primary outcome variables for our analysis were the incidences of intraoperative cardiovascular and respiratory events. Univariable and multivariable logistic regressions were used to determine risk factors for these 2 outcomes. RESULTS: The incidence of cardiovascular events was 11.5% and of respiratory events was 4.7%. Univariate analysis and multivariable analysis demonstrated that American Society of Anesthesiologists (≥3), emergency cases, major and severe CHD, single-ventricle physiology, ventricular dysfunction, orthopedic surgery, general surgery, neurosurgery, and pulmonary procedures were associated with perioperative cardiovascular events. Respiratory events were associated with American Society of Anesthesiologists (≥4) and otolaryngology, gastrointestinal, general surgery, and maxillofacial procedures. CONCLUSIONS: Intraoperative cardiovascular events and respiratory events in patients with CHD were relatively common. While cardiovascular events were highly associated with cardiovascular status, respiratory events were not associated with cardiovascular status. Accepted for publication March 5, 2018. Funding: None. J. A. DiNardo and K. Yuki contributed equally and share senior authorship. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Koichi Yuki, MD, Department of Anesthesiology, Perioperative and Pain Medicine, Cardiac Anesthesia Division, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115. Address e-mail to koichi.yuki@childrens.harvard.edu. © 2018 International Anesthesia Research Society

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Pediatrics and Beyond

No abstract available

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In Response

No abstract available

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World Health Organization-World Federation of Societies of Anaesthesiologists (WHO-WFSA) International Standards for a Safe Practice of Anesthesia

The International Standards for a Safe Practice of Anesthesia were developed on behalf of the World Federation of Societies of Anaesthesiologists (WFSA), a nonprofit organization representing anesthesiologists in 150 countries, and the World Health Organization (WHO). The recommendations have been approved by WHO and the membership of WFSA. These Standards are applicable to all anesthesia providers throughout the world. They are intended to provide guidance and assistance to anesthesia providers, their professional organizations, hospital and facility administrators, and governments for maintaining and improving the quality and safety of anesthesia care. The Standards cover professional aspects; facilities and equipment; medications and intravenous fluids; monitoring; and the conduct of anesthesia. HIGHLY RECOMMENDED standards, the functional equivalent of mandatory standards, include (amongst other things): the continuous presence of a trained and vigilant anesthesia provider; continuous monitoring of tissue oxygenation and perfusion by clinical observation and a pulse oximeter; intermittent monitoring of blood pressure; confirmation of correct placement of an endotracheal tube (if used) by auscultation and carbon dioxide detection; the use of the WHO Safe Surgery Checklist; and a system for transfer of care at the end of an anesthetic. The International Standards represent minimum standards and the goal should always be to practice to the highest possible standards, preferably exceeding the standards outlined in this document. Accepted for publication March 22, 2018. WHO ePub clearance: WHO ePub-IP-00090890-EC. This article is jointly published in the Canadian Journal of Anesthesia and Anesthesia & Analgesia. Address correspondence to Adrian W. Gelb, Department of Anesthesia & Perioperative Care, University of California San Francisco, 500 Parnassus Ave, MUE 404, San Francisco, CA 94143. Address e-mail to adrian.gelb@ucsf.edu. © 2018 International Anesthesia Research Society

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Corticosteroid Injections into Lumbar Facet Joints: A Prospective, Randomized, Double-Blind Placebo-Controlled Trial

Background Corticosteroid injections into the intra-articular (IA) zygapophysial (z-joints) are frequently utilized to treat this cause of low back pain. No studies have been done on the efficacy of IA corticosteroids in those with z-joint pain confirmed by dual comparative medial branch blocks (MBB). Objective To determine if an injection of a corticosteroid into lumbar z-joints is effective in reducing pain and the need for radiofrequency neurotomy (RFN). Design Double-Blind, prospective, randomized, placebo controlled trial Setting Academic Medical Center Patients 28 subjects with z-joint pain confirmed by MBBs. Methods Subjects with confirmed z-joint pain via dual comparative MBB were randomized to receive either intra-articular corticosteroid (triamcinolone 20 mg) or saline via fluoroscopic guided injection. Outcomes Need for RFN Results No statistically significant difference in the need for radiofrequency neurotomy (RFN) between the groups, with 75% [95% CI (50.5-99.5%)] of the saline group vs 91% [95% CI (62.3-100%)] of the corticosteroid group receiving RFN. No difference in mean time to RFN between saline (6.1 weeks) and corticosteroid (6.5 weeks) groups. Conclusions Corticosteroid injections into the lumbar z-joints were not effective in reducing the need for RFN of the medial branches in those with z-joint pain confirmed by dual comparative MBBs. Corresponding Author: Byron J Schneider MD, 2201 Children's Way, Suite 1318, Nashville, TN 37212, CA 94063, Email: Byron.j.schneider@vanderbilt.edu No relevant disclosures for any authors Funding from the Spine Intervention Society Findings previously presented in abstract form at AAPM&R and SIS annual meetings. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Association of Academic Physiatrists Women’s Task Force Report

The Association of Academic Physiatrists (AAP) convened a women's task force in 2016, and the members agreed on a list of metrics that would permit retrospective data review pertaining to the representation and inclusion of women physicians in the society. Examples of categories examined included leadership positions (i.e., board membership, board presidents, committee membership, committee chairs, and resident fellow physician chairs), conference presentations (i.e., annual meeting session proposals, annual meeting faculty, annual meeting plenary speakers) and recognition awards (i.e., recognition award nominations and recipients). The findings highlight areas in which the AAP has been successful in supporting gender equity and other areas in which women physiatrists have been underrepresented. The task force worked with the Board of Trustees to construct an action plan; asking the respective committees to address areas of underrepresentation. A volunteer from each committee was deemed a "diversity steward" and going forward will work directly with the task force as a liaison to document an action plan and collect data. The board plans to transparently report progress to members and other stakeholders, and the task force aims to publish a follow-up report within the next five years. Corresponding Author Julie K. Silver, MD, Address: 300 1st Avenue, Charlestown, MA 02025. Email: Julie_silver@hms.harvard.edu Disclosures Julie K. Silver, MD - none Sara Cuccurullo, MD - none Anne Felicia Ambrose, MD – none Saurabha Bhatnagar, MD - none Glendaliz Bosques, MD – none Talya K. Fleming, MD - none Walter R. Frontera, MD, PhD - none Danielle Perret Karimi, MD - none Mooyeon Oh-Park, MD - none Gwendolyn Sowa, MD, PhD - none Christopher Visco, MD - none Lyn Weiss, MD - none Tiffany Knowlton, JD, MBA - none Funding Information – No funding was received for this work. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Two-Year Longitudinal changes in lower limb strength and its relation to loss in function in a large cohort of patients with Duchenne Muscular Dystrophy

Objective The main objective of this study were to examine the effect of disease on strength in two functionally important lower limb muscles over a period of two-years in children with Duchene Muscular Dystrophy (DMD). Design Seventy-Seven DMD children participated in this study. Plantar flexors (PF), knee extensors (KE) strength and performance on timed tests (Six-min walk, 4-stairs, 10m-walk, supine-up) was assessed yearly over two-years. Multivariate normal regression was used to assess changes in strength over time in the DMD group. Spearman correlations were computed to examine relationship between strength and function. Results Normalized PF and KE strength, showed a significant decrease (p

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Effects of repetitive transcranial magnetic stimulation on walking and balance function after stroke: A systematic review and meta-analysis

Objective To investigate the effects of repetitive transcranial magnetic stimulation (rTMS) on walking and balance function in patients with stroke. Design MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, CENTRAL, and the Physiotherapy Evidence Database were comprehensively searched for randomized controlled trials published through March 2017 that investigated the effects of rTMS on lower limb function. Main outcomes included walking speed, balance function, motor function, and cortical excitability. Results Nine studies were included. The meta-analysis revealed a significant effect of rTMS on walking speed (SMD 0.64, 95% CI: 0.32 to 0.95), particularly ipsilesional stimulation (SMD 0.80, 95% CI: 0.36 to 1.24). No significant effects were found for balance function (SMD 0.10, 95% CI: -0.26 to 0.45), motor function (MD 0.50, 95% CI: -0.68 to 1.68) or cortical excitability (motor-evoked potentials (MEPs) of the affected hemisphere: MD 0.21 mV, 95% CI: -0.11 to 0.54; MEPs of the unaffected hemisphere: MD 0.09 mV, 95% CI: -0.16 to -0.02). Conclusion These results suggest that rTMS, particularly ipsilesional stimulation, significantly improves walking speed. Future studies with larger sample sizes and an adequate follow-up period are required to further understand the effects of rTMS on lower limb function and its relationship with changes in cortical excitability with the help of functional neuroimaging techniques. Corresponding Author: Dr. Chengqi He, No 37 Guo-xue-xiang Street, Chengdu, E-mail: hxkfhcq2015@126.com, Pro. Shasha Li, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA 02129, Email: pmr.shashali@gmail.com Author Disclosures: This work was supported by the National Natural Science Foundation of China, No. 81000852 and 81301677; the American Heart Association Award, No. 17POST32530004; the Supporting Project of Science & Technology of Sichuan Province of China, No. 2012SZ0140. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Cost-Effectiveness Analysis of Routine Venous Doppler Ultrasound for Diagnosis of Deep Venous Thrombosis at Admission to Inpatient Rehabilitation

Objective 1. Identify whether timing of venous thromboembolism (VTE) diagnosis is associated with differences in patient outcomes. 2. Perform a cost-effectiveness analysis of routine venous Doppler ultrasound at admission to inpatient rehabilitation (IPR), taking into account costs associated with prolonged IPR length of stay (LOS) and development of pulmonary embolism (PE). Design This was a retrospective cohort study of 2312 consecutive patient discharges from a single IPR facility over an 18-month period. Cost-effectiveness model was built using TreeAge Healthcare Pro. The base case was constructed using probabilities and IPR LOS identified from retrospective analysis. Cost of Doppler ultrasound was obtained through the literature, and daily IPR cost was obtained from the study institution. Results VTE was diagnosed in 6.6% of patients. Asymptomatic patients diagnosed with VTE on screening Doppler ultrasound had shorter IPR LOS (p = 0.045) and lower rate of PE (p

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Ocean acidification modulates the incorporation of radio-labeled heavy metals in the larvae of the Mediterranean sea urchin Paracentrotus lividus

Publication date: October 2018
Source:Journal of Environmental Radioactivity, Volumes 190–191
Author(s): Narimane Dorey, Sophie Martin, François Oberhänsli, Jean-Louis Teyssié, Ross Jeffree, Thomas Lacoue-Labarthe
The marine organisms which inhabit the coastline are exposed to a number of anthropogenic pressures that may interact. For instance, the accumulation of toxic metals present in coastal waters is expected to be modified by ocean acidification through e.g. changes in physiological performance and/or elements availability. Changes in bioaccumulation due to lowering pH are likely to be differently affected depending on the nature (essential vs. non-essential) and speciation of each element. The Mediterranean is of high concern for possible cumulative effects due to strong human influences on the coastline.The aim of this study was to determine the effect of ocean acidification (from pH 8.1 down to −1.0 pH units) on the incorporation kinetics of six trace metals (Mn, Co, Zn, Se, Ag, Cd, Cs) and one radionuclide (²⁴¹Am) in the larvae of an economically- and ecologically-relevant sea urchin of the Mediterranean coastline: Paracentrotus lividus. The radiolabelled metals and radionuclides added in trace concentrations allowed precise tracing of their incorporation in larvae during the first 74 h of their development.Independently of the expected indirect effect of pH on larval size/developmental rates, Paracentrotus lividus larvae exposed to decreasing pHs incorporated significantly more Mn and Ag and slightly less Cd. The incorporation of Co, Cs and ²⁴¹Am was unchanged, and Zn and Se exhibited complex incorporation behaviors. Studies such as this are necessary prerequisites to the implementation of metal toxicity mitigation policies for the future ocean. We discuss possible reasons and mechanisms for the specific effect of pH on each metals.

Graphical abstract

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Improved lung recruitment and oxygenation during mandatory ventilation with a new expiratory ventilation assistance device: A controlled interventional trial in healthy pigs

BACKGROUND In contrast to conventional mandatory ventilation, a new ventilation mode, expiratory ventilation assistance (EVA), linearises the expiratory tracheal pressure decline. OBJECTIVE We hypothesised that due to a recruiting effect, linearised expiration oxygenates better than volume controlled ventilation (VCV). We compared the EVA with VCV mode with regard to gas exchange, ventilation volumes and pressures and lung aeration in a model of peri-operative mandatory ventilation in healthy pigs. DESIGN Controlled interventional trial. SETTING Animal operating facility at a university medical centre. ANIMALS A total of 16 German Landrace hybrid pigs. INTERVENTION The lungs of anaesthetised pigs were ventilated with the EVA mode (n=9) or VCV (control, n=7) for 5 h with positive end-expiratory pressure of 5 cmH2O and tidal volume of 8 ml kg−1. The respiratory rate was adjusted for a target end-tidal CO2 of 4.7 to 6 kPa. MAIN OUTCOME MEASURES Tracheal pressure, minute volume and arterial blood gases were recorded repeatedly. Computed thoracic tomography was performed to quantify the percentages of normally and poorly aerated lung tissue. RESULTS Two animals in the EVA group were excluded due to unstable ventilation (n=1) or unstable FiO2 delivery (n=1). Mean tracheal pressure and PaO2 were higher in the EVA group compared with control (mean tracheal pressure: 11.6 ± 0.4 versus 9.0 ± 0.3 cmH2O, P  0.99). Minute volume was lower in the EVA group compared with control (5.5 ± 0.2 versus 7.0 ± 1.0 l min−1, P = 0.02) with normoventilation in both groups (PaCO2 5.4 ± 0.3 versus 5.5 ± 0.3 kPa, P > 0.99). In the EVA group, the percentage of normally aerated lung tissue was higher (81.0 ± 3.6 versus 75.8 ± 3.0%, P = 0.017) and of poorly aerated lung tissue lower (9.5 ± 3.3 versus 15.7 ± 3.5%, P = 0.002) compared with control. CONCLUSION EVA ventilation improves lung aeration via elevated mean tracheal pressure and consequently improves arterial oxygenation at unaltered positive end-expiratory pressure (PEEP) and peak inspiratory pressure (PIP). These findings suggest the EVA mode is a new approach for protective lung ventilation. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. https://ift.tt/OBJ4xP Correspondence to Johannes Schmidt, MD, Department of Anesthesiology and Critical Care, Medical Centre – University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany Tel: +49 761 270 26390; fax: +49 761 270 23280; e-mail: johannes.schmidt@uniklinik-freiburg.de Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (https://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

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General Anesthetic Use in Fragile X Spectrum Disorders

The fragile X premutation is characterized by a repeat expansion mutation (between 55 to 200 CGG repeats) in the fragile X mental retardation 1 (FMR1) gene, which leads to RNA toxicity at the cellular level. This may cause patients with the premutation to be particularly susceptible to environmental toxins, which could manifest clinically as new or worsening ataxia and memory loss. Multiple published case reports have also suggested general anesthetics as a potential toxin leading to negative side effects when used in patients with fragile X- associated disorders. However, at this time, there have been no formal research studies regarding cellular changes or long-term clinical manifestations after general anesthetic use in this population. This review aims to highlight previous case reports regarding sequelae related to general anesthetic use in fragile X-associated disorders. New case reports related to this phenomenon are also included. Supported through NICHD grant HD036071, the MIND Institute Intellectual and Developmental Disabilities Research Center (grant U54 HD079125) and the National Center for Advancing Translational Sciences and National Institutes of Health (grant UL1 TR001860). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. R.H. has received support from Novartis, Alcobra, Neuren, and Marinus for studies in fragile X syndrome. She has also consulted with Zynerba, Fulcrum, and Ovid regarding studies in fragile X syndrome. The remaining authors have no conflicts of interest to disclose. Address correspondence to: Randi Hagerman, MD, MIND Institute, UCDMC, 2825 50th Street, Sacramento, CA 95817 (e-mail: rjhagerman@ucdavis.edu). Received August 23, 2017 Accepted April 10, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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Safety of Sodium Bicarbonate for Control of ICP (Letter)

No abstract available

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Discontinued stimulation of cardiomyocytes provides protection against hypothermia–rewarming‐induced disruption of excitation–contraction coupling

Experimental Physiology, EarlyView.


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Regulation of muscle protein synthesis in an in vitro cell model using ex vivo human serum

Experimental Physiology, EarlyView.


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Femoral vascular conductance and peroneal muscle sympathetic nerve activity responses to acute epidural spinal cord stimulation in humans

Experimental Physiology, EarlyView.


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Calcium‐dependent potassium channels control proliferation of cardiac progenitor cells and bone marrow‐derived mesenchymal stem cells

The Journal of Physiology, EarlyView.


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Expanding the clinical spectrum of biallelic ZNF335 variants

Clinical Genetics, EarlyView.


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