Πέμπτη 10 Μαΐου 2018
EMT - Wilson County ESD #3
Paramedics and Basics FT/PRN - Wilson County ESD #3 is a growing EMS agency that provides 911 response for 349 square miles of Wilson County. We are seeking Paramedics and EMT basics for 12 and 24 hour shifts. We are an aggressive agency that operates Frazer Units using modern advanced technology to include Life Pak 15, Lucas 2, and EPCR's. We offer Holiday Pay, Health Benefits and competitive pay ...
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EMT - Wilson County ESD #3
Paramedics and Basics FT/PRN - Wilson County ESD #3 is a growing EMS agency that provides 911 response for 349 square miles of Wilson County. We are seeking Paramedics and EMT basics for 12 and 24 hour shifts. We are an aggressive agency that operates Frazer Units using modern advanced technology to include Life Pak 15, Lucas 2, and EPCR's. We offer Holiday Pay, Health Benefits and competitive pay ...
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GWAS by GBLUP: Single and Multimarker EMMAX and Bayes Factors, with an Example in Detection of a Major Gene for Horse Gait
Bayesian models for genomic prediction and association mapping are being increasingly used in genetics analysis of quantitative traits. Given a point estimate of variance components, the popular methods SNP-BLUP and GBLUP result in joint estimates of the effect of all markers on the analyzed trait; single and multiple marker frequentist tests (EMMAX) can be constructed from these estimates. Indeed, BLUP methods can be seen simultaneously as Bayesian or frequentist methods. So far there is no formal method to produce Bayesian statistics from GBLUP. Here we show that the Bayes Factor, a commonly admitted statistical procedure, can be computed as the ratio of two normal densities: the first, of the estimate of the marker effect over its posterior standard deviation; the second of the null hypothesis (a value of 0 over the prior standard deviation). We extend the BF to pool evidence from several markers and of several traits. A real data set that we analyze, with ours and existing methods, analyzes 630 horses genotyped for 41711 polymorphic SNPs for the trait "outcome of the qualification test" (which addresses gait, or ambling, of horses) for which a known major gene exists. In the horse data, single marker EMMAX shows a significant effect at the right place at Bonferroni level. The BF points to the same location although with low numerical values. The strength of evidence combining information from several consecutive markers increases using the BF and decreases using EMMAX, which comes from a fundamental difference in the Bayesian and frequentist schools of hypothesis testing. We conclude that our BF method complements frequentist EMMAX analyses because it provides a better pooling of evidence across markers, although its use for primary detection is unclear due to the lack of defined rejection thresholds.
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Dynamic Changes in Yeast Phosphatase Families Allow for Specialization in Phosphate and Thiamine Starvation
Convergent evolution is often due to selective pressures generating a similar phenotype. We observe relatively recent duplications in a spectrum of Saccharomycetaceae yeast species resulting in multiple phosphatases that are regulated by different nutrient conditions - thiamine and phosphate starvation. This specialization is both transcriptional and at the level of phosphatase substrate specificity. In Candida glabrata, loss of the ancestral phosphatase family was compensated by the co-option of a different histidine phosphatase family with three paralogs. Using RNA-seq and functional assays, we identify one of these paralogs, CgPMU3, as a thiamine phosphatase. We further determine that the 81% identical paralog CgPMU2 does not encode thiamine phosphatase activity; however, both are capable of cleaving the phosphatase substrate, 1-napthyl-phosphate. We functionally demonstrate that members of this family evolved novel enzymatic functions for phosphate and thiamine starvation, and are regulated transcriptionally by either nutrient condition, and observe similar trends in other yeast species. This independent, parallel evolution involving two different families of histidine phosphatases suggests that there were likely similar selective pressures on multiple yeast species to recycle thiamine and phosphate. In this work, we focused on duplication and specialization, but there is also repeated loss of phosphatases, indicating that the expansion and contraction of the phosphatase family is dynamic in many Ascomycetes. The dynamic evolution of the phosphatase gene families is perhaps just one example of how gene duplication, co-option, and transcriptional and functional specialization together allow species to adapt to their environment with existing genetic resources.
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Gastric cancer: French Intergroup clinical practice guidelines for diagnosis, treatments and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO)
This document is a summary of the French Intergroup guidelines regarding the management of gastric cancer published in October 2016, available on the website of the French Society of Gastroenterology (SNFGE) (www.tncd.org), updated in October 2017.
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The Role of Pelvic Floor Muscle Training in the Conservative and Surgical Management of Female Stress Urinary Incontinence: Does the Strength of the Pelvic Floor Muscles Matter?
The purpose of this review is to provide an in-depth overview of the role of pelvic floor muscle training (PFMT) in the management of stress urinary incontinence (SUI). The definition, epidemiology, and pathogenesis of SUI are described. We review the anatomy of the pelvic floor muscles (PFM) and the importance of pelvic floor muscle strength in maintaining urinary continence and establishing normal voiding function. A brief description of the surgical options currently available for SUI and the existing data regarding the role of perioperative PFMT for SUI are included.
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Gastric cancer: French Intergroup clinical practice guidelines for diagnosis, treatments and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO)
This document is a summary of the French Intergroup guidelines regarding the management of gastric cancer published in October 2016, available on the website of the French Society of Gastroenterology (SNFGE) (www.tncd.org), updated in October 2017.
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Motor unit number estimation (MUNE): where are we now?
Counting the number of motor units (MUs) in a muscle appears a deceptively simple task. Count the number of muscle fibers and count the number of motor axons supplying the muscle, then divide the former by the latter. But there's a problem. This erroneously assumes that each MU is approximately the same size. However, the innervation ratio varies between muscles (Feinstein et al., 1955). Also, type II MUs are larger than type I MUs and the proportions of these two basic MU types varies between muscles (Brooke and Engel, 1969; McComas et al., 1971).
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Two ways to improve myoelectric control for a transhumeral amputee after targeted muscle reinnervation: a case study
Myoelectric control of multifunctional prostheses is challenging for individuals with high-level amputations due to insufficient surface electromyography (sEMG) signals. A surgical technique called targeted mu...
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Inside EMS Podcast: What it takes to work in the EMS field
Co-hosts Chris Cebollero and Kelly Grayson discuss Chris' latest project — writing a book
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Incidence of akathisia after postoperative nausea and vomiting prophylaxis with droperidol and ondansetron in outpatient surgery: A multicentre controlled randomised trial
BACKGROUND Akathisia, a distressing movement disorder induced by butyrophenones, has been described with low doses of droperidol used for postoperative nausea and vomiting (PONV) prophylaxis, but the incidence remains unclear. OBJECTIVES To determine the incidence of akathisia after PONV prophylaxis with two doses of droperidol in comparison with ondansetron, in patients undergoing ambulatory surgery. We hypothesised that the incidence of akathisia is higher with droperidol than that with ondansetron. DESIGN Randomised controlled double blind trial. SETTING Two University Hospital Centres and two private Clinics from January to September 2014. PATIENTS Patients (n=297) undergoing general anaesthesia for ambulatory surgery were randomly allocated to receive PONV prophylaxis with droperidol (0.625 or 1.25 mg) or ondansetron 4 mg; patients of the three groups also received 4 mg of dexamethasone. Exclusion criteria were contraindication to droperidol and ondansetron, use of psychotropic medications or benzodiazepines or history of psychotic illness. INTERVENTIONS Participants received droperidol (0.625 or 1.25 mg) or ondansetron 4 mg during general anaesthesia. After discharge from the postanaesthesia care unit presence and severity of akathisia were assessed using the Barnes Akathisia Rating Scale at 4 h postoperatively. MAIN OUTCOME MEASURES Score of the Global Clinical Assessment of Akathisia of Barnes Akathisia Rating Scale. RESULTS The number of akathisia observed was 1/118 (0.8%) in the ondansetron group, 1/84 (1.2%) in droperidol 0.625 mg group (DRO 0.625), and 3/87 (3.4%) in droperidol 1.25 mg group (DRO 1.25). The akathisia rate difference among the three groups was not significant (P = 0.52). We could not demonstrate significant differences in the incidence of akathisia between the two doses of droperidol. The only case of marked akathisia treated with benzodiazepines was observed after droperidol 1.25 mg. CONCLUSION The use of droperidol or ondansetron for PONV prophylaxis is associated to a low incidence of akathisia (0.8 to 3.4%) after general anaesthesia for ambulatory surgery. TRIAL REGISTRATION Clinicaltrials.gov: NCT01942343. Correspondence to Antoine Charton, Service d'Anesthésie-Réanimation, Hôpital de Hautepierre, 1 Avenue Molière, CP 67000 Strasbourg, France Tel: +33 388127076; fax: +33 388127074; e-mail: Antoine.charton@chru-strasbourg.fr © 2018 European Society of Anaesthesiology
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Screening Endoscopy Contributes to Relevant Modifications of Therapeutic Regimen in Children with Intestinal Failure
Objective: The role of endoscopy in the diagnostic work-up of children with intestinal failure (IF) is not well defined. It is unclear whether endoscopies should be performed as a screening procedure or only upon manifestation of symptoms. The aim of this study is to evaluate, whether performing screening endoscopy contributes to clinical management in children with IF. Methods: Comparative retrospective case-series study in children with IF (mean age 70,4 months ± 58,4 months) presenting for diagnostic work-up in a single intestinal rehabilitation center. Endoscopies were performed either as a screening procedure (Group 1, n = 45) or as indicated by symptoms of gastrointestinal dysfunction (Group 2, n = 11). Results: A total of 92 endoscopies (56 esophagogastroduodenoscopies; 12 enteroscopies; 24 colonoscopies) were performed in 56 children. IF etiology included short bowel syndrome (n = 37), motility disorder (n = 16) and mucosal enteropathy (n = 3). Comparing Group 1 with Group 2 abnormal endoscopic findings were detected in 66,7 % vs. 81,8 %. Findings led to adaptation of therapeutic regimes in 64,7 % vs. 85,7 %. We detected a higher rate of erosive and ulcerative gastritis and duodenitis, enteritis and colitis in Group 1 compared to Group 2. Conclusion: Endoscopy in children with IF frequently reveals abnormal findings, leading to recommendations for treatment adaptation in the majority of cases, irrespective of whether endoscopy has been performed as a screening procedure or as indicated by symptoms. Using endoscopy as a screening tool may improve both, the detection of gastrointestinal pathology and the clinical management of children with IF. Address correspondence and reprint requests to Andreas Busch, MD, University Children's Hospital Tübingen, Pediatric Gastroenterology and Hepatology, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany (e-mail: andreas.busch@med.uni-tuebingen.de). Received 22 November, 2017 Accepted 26 April, 2018 Disclosure: The authors have no conflicts of interest to disclose Funding support: None © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,
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Recommendations for Diagnosis and Management of Autoimmune Pancreatitis in Childhood: Consensus from INSPPIRE
Objectives: Autoimmune pancreatitis (AIP) represents a complex immune-mediated pancreas disorder. Pediatric AIP (P-AIP) is rare. We have recently summarized the characteristic features of P-AIP. We now aim to develop recommendation statements to standardize the diagnostic and therapeutic approach to P-AIP and facilitate future research in the field. Methods: A panel of pediatric gastroenterologists participating in the International Study Group of Pediatric Pancreatitis: In search for a cuRE (INSPPIRE) was formed to discuss and then vote on 15 recommendation statements. A consensus of at least 80% was obtained following 3 voting rounds and revision of the statements. Results: We have now generated 15 statements to help standardize the approach to diagnosis and management of P-AIP. Conclusions: The first P-AIP recommendation statements developed by the INSPPIRE group are intended to bring standardization to the diagnosis and treatment of this rare childhood disorder. These statements may help guide a uniform approach to patient care and facilitate future research studies. Address correspondence and reprint requests to Tanja Gonska, MD, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1H4 (e-mail: tanja.gonska@sickkids.ca). Received 14 August, 2017 Accepted 18 March, 2018 Aliye Uc and Tanja Gonska are Equal senior authors. Grant support: This work was supported by NIH DK096327 (AU), DK108334 (AU); by National Pancreas Foundation (AU); INSPPIRE registry was developed by CTSA (2UL1 TR000442) and REDCap. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Disclosures: ML is consultant for AbbVie, Inc.; Nordmark Arzneimittel GmbH & Co. KG; is in the Board of Directors of the National Pancreas Association; receives royalties from Millipore Inc. IS is supported by a Restracomp Grant and a Fondation St Luc Grant. TG received a research grant from Vertex Pharmaceuticals. AU is a member of the American Board of Pediatrics, Subboard of Pediatric Gastroenterology. Author contributions: IS: study design, acquisition of data, analysis and interpretation of data, voting panel, statistical analysis, drafting of the manuscript. JJP, SF, MW, US: member of the AIP working group within INSPPIRE, acquisition of data, voting panel, critical revision of the manuscript for important intellectual content. AM, BB, DF, CG, MG, MH, RH, SH, TL, QL, ML, MM, VM, CO, EP, DP, JFP, SS, DT, SW: voting panel, critical revision of the manuscript. AU: member of the AIP working group within INSPPIRE, voting panel, acquisition of data, critical revision of the manuscript for important intellectual content, obtained funding, study supervision. TG: member of the AIP working group within INSPPIRE, study concept and design, acquisition of data, voting panel, drafting and critical revision of the manuscript for important intellectual content, study supervision. The other authors have no disclosure or conflict of interest. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,
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Esophageal Intramural Pseudodiverticulosis with Tracking in a Child with Autosomal Dominant Hyper-IgE Syndrome
No abstract available
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Authors’ Response
No abstract available
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Nutritional Considerations in Pediatric Pancreatitis: A Position Paper from the NASPGHAN Pancreas Committee, ESPGHAN Pancreas Working Group
Objectives: Wide variations exist in how physicians manage the nutritional aspects of children affected by acute pancreatitis (AP), acute recurrent pancreatitis (ARP) and chronic (CP) pancreatitis. Better consensus for optimal management is needed. Methods: This consensus statement on nutrition in pediatric pancreatic diseases was developed through a joint ESPGHAN-NASPGHAN working group that performed an evidence-based search of the literature on nutrition in AP, ARP, and CP with a focus on pediatrics. The literature was summarized, quality of evidence reviewed, and expert recommendations developed. The authorship met to discuss the evidence and statements. Voting on recommendations occurred over two rounds based on feedback. A consensus of at least 75% was required to approve a recommendation. Areas requiring further research were identified. Results and Discussion: The literature on nutrition in pediatric pancreatitis is limited. Children with mild AP benefit from starting an early nutritional regimen in the course of the attack. Early nutrition should be attempted in severe AP when possible; enteral nutrition is preferred over parenteral nutrition. Children with ARP are likely to tolerate and benefit from a regular diet. Children with CP need ongoing assessment for growth and nutritional deficiencies, exocrine and endocrine insufficiencies. Conclusion: This document presents the first authoritative recommendations on nutritional considerations in pediatric pancreatitis. Future research should address the gaps in knowledge particularly relating to optimal nutrition for AP in children, role of diet or dietary supplements on recurrent attacks of pancreatitis and pain episodes, monitoring practices to detect early growth and nutritional deficiencies in CP and identifying risk factors that predispose children to these deficiencies. Address correspondence and reprint requests to Veronique D. Morinville, MDCM, FRCPC, Division of Pediatric Gastroenterology and Nutrition, Montreal Children's Hospital, McGill University Health Centre; B04.2443, 1001 Blvd Decarie, Montreal, QC, Canada, H4A 3J1 (E-mail: Veronique.morinville@mcgill.ca). Received 10 July, 2017 Accepted 2 April, 2018 Funding Sources: This publication was supported by the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN); European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN); MAEH by the National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK) under award Number R43 DK105640-01; AU: U01 DK108334, DK097820, DK096327 Conflicts of interest: nil reported by all authors. NASPGHAN Pancreas Committee Member: Maisam Abu-El-Haija, Aliye Uc, Steven L. Werlin, A. Jay Freeman and Veronique D. Morinville ESPGHAN Cystic Fibrosis/ Pancreas Working Group Member: Miglena Georgieva, Danijela Jojkić-Pavkov, Brigitte Kochavi, Bart G. P. Koot, Stephanie Van Biervliet, Jaroslaw Walkowiak, and Michael Wilschanski. DISCLAIMER: ESPGHAN/ NASPGHAN are not responsible for the practices of physicians and provide guidelines and position papers as indicators of best practice only. Diagnosis and treatment are at the discretion of physicians. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,
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Electronic Medical Records Enable Precision Medicine Approaches for Celiac Disease
No abstract available
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Serine Protease Inhibitor Kazal Type I (SPINK1) Mutation: A Risk Factor for Early Onset Chronic Pancreatitis?
No abstract available
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Comorbidities in Childhood Celiac Disease: A Phenome Wide Association Study using the Electronic Health Record
Objectives: Celiac disease (CD) is associated with a variety of extraintestinal autoimmune and inflammatory findings that manifest clinically as symptoms and comorbidities. Understanding these comorbidities may improve identification of the disease and prevent sequelae. In this study, we use an unbiased electronic health record (EHR)-based Phenome Wide Association Study (PheWAS) method to confirm known comorbidities, discover novel associations and enhance characterization of the clinical presentation of CD in children. Methods: Data were extracted from the Nationwide Children's Hospital EHR. Confirmed CD cases (n = 433) were matched with 4330 randomly selected controls. Utilizing an EHR-based PheWAS method to analyze associations of phenotypes with CD, we conducted an unbiased screening of all ICD-10 diagnostic codes and examined significance by performing Fisher's Exact tests. We further tested for the association between CD and 14 previously-identified comorbidities in an a priori fashion. Results: We found 45 ICD-10 codes significantly associated with CD. Thirteen are known comorbidities and nine are expected symptoms of CD, thus validating our study methods. Further investigation found symptoms that characterized CD clinically and discovered a significant association between eosinophilic disorders of the esophagus and CD. Of 14 previously-identified comorbidities, 8 were significantly associated with CD. Conclusions: An EHR-based PheWAS method is a powerful, efficient, and cost-effective method to screen for possible CD comorbidities and validate associations at the population level. Ours is the first PheWAS of CD to confirm a significant association of eosinophilic disorders of the esophagus with CD in a controlled study. Address correspondence and reprint requests to Ariana Prinzbach, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH (e-mail: ariana.prinzbach@osumc.edu); Simon Lin, MD, MBA, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH, Research Information Solutions and Innovation, The Research Institute at Nationwide Children's Hospital, Columbus, OH (e-mail: simon.lin@nationwidehildrens.org). Received 24 February, 2017 Accepted 1 April, 2018 Grant support: Grant UL1TR001070 from Center for Clinical and Translational Science at the Ohio State University. Author Contributions to Manuscript: Ariana Prinzbach: Analysis and interpretation of data; clinical analysis; drafting of the manuscript. Soheil Moosavinasab: Acquisition of data; analysis and interpretation of data; statistical analysis. Steve Rust, PhD: Analysis and interpretation of data; statistical analysis; study supervision. Brendan Boyle, MD, MPH: Acquisition of data; clinical analysis and support. John A. Barnard, MD: Critical revision of the manuscript for important intellectual content; clinical analysis. Yungui Huang, PhD, MBA: Study concept and design; analysis and interpretation of data; study supervision. Simon Lin, MD, MBA: Study concept and design; analysis and interpretation of data; study supervision; critical revision for intellectual content. Disclosures: No Conflict of Interest to Disclose. Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,
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Impact of acute dynamic exercise on radial artery low-flow mediated constriction in humans
Abstract
Purpose
A "low-flow mediated constriction" (L-FMC) is evoked in the radial artery by the inflation of an ipsilateral wrist cuff to a supra-systolic pressure. We sought to test the hypothesis that the radial artery L-FMC response is augmented immediately following acute dynamic leg exercise in young healthy individuals.
Methods
Ten healthy and recreationally active men (23 ± 4 years) undertook a 30-min trial of incremental dynamic leg cycling exercise (10 min at 50, 100 and 150 W) and a 30-min time control trial (seated rest). Trials were randomly assigned and performed on separate days. Radial artery characteristics (diameter, blood flow and shear rate) were assessed throughout each trial, with L-FMC and flow-mediated vasodilatation (FMD) assessments conducted prior to and immediately following (10 min) trials.
Results
Dynamic leg cycling exercise increased radial artery blood flow, along with mean, retrograde and anterograde shear rate (P < 0.05). Blood flow profiles were unchanged during the time control trial (P > 0.05). Following exercise L-FMC was increased (mean [SD]; − 5.6 [3.3] vs. − 10.1 [3.8] %, P < 0.05), while it was not different in the time control condition (− 8.1 [3.2] vs. − 6.7 [3.4] %, P > 0.05). FMD was not different following either the exercise or time control trials (P > 0.05), but the composite end-point of L-FMC + FMD was enhanced post-exercise (P < 0.05).
Conclusions
Dynamic exercise with a large muscle mass acutely augments the vasoconstrictor response of the radial artery in response to a reduction in blood flow (L-FMC) in young healthy individuals. The time course of this post-exercise response and the underlying vasoregulatory mechanisms require elucidation.
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Controlling nuclear RNA levels
Controlling nuclear RNA levels
Controlling nuclear RNA levels, Published online: 10 May 2018; doi:10.1038/s41576-018-0013-2
RNA is controlled at various stages of transcription and processing to achieve appropriate gene regulation. Whereas much research has focused on the cytoplasmic control of RNA levels, this Review discusses our emerging appreciation of the importance of nuclear RNA regulation, including the molecular machinery involved in nuclear RNA decay, how functional RNAs bypass degradation and roles for nuclear RNA decay in physiology and disease.
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Reduced Hemidiaphragmatic Paresis With a “Corner Pocket” Technique for Supraclavicular Brachial Plexus Block: Single-Center, Observer-Blinded, Randomized Controlled Trial
Background and Objective Hemidiaphragmatic paresis is common after supraclavicular brachial plexus block (SCBPB). In this randomized trial, we compared the incidence of hemidiaphragmatic paresis in patients who had local anesthetic injected primarily in the corner pocket (defined as the intersection of the first rib and subclavian artery) during SCBPB with that of patients who underwent injection primarily inside the neural cluster. Methods Thirty-six patients scheduled for right elbow, forearm, wrist, or hand surgery under SCBPB (using 12.5 mL of 0.75% ropivacaine and 12.5 mL of 2% lidocaine with 1:200,000 epinephrine) were randomly assigned to 1 of 2 groups. In group CP, local anesthetic was injected primarily in the corner pocket (20 mL) and secondarily inside the neural cluster (5 mL). In group NC, local anesthetic was deposited primarily inside the neural cluster (20 mL) and secondarily in the corner pocket (5 mL). The primary outcome was the incidence of hemidiaphragmatic paresis, as measured by M-mode ultrasonography 30 minutes after SCBPB. Results The incidence of hemidiaphragmatic paresis was significantly lower in group CP than in group NC (27.8% vs 66.7%, P = 0.019). The median decreases in forced expiratory volume at 1 second (7.5% [interquartile range, 3.3%–17.1%] vs 24.4% [interquartile range, 10.2%–31.2%]; P = 0.010) and forced vital capacity (6.4% [interquartile range, 3.3%–11.1%] vs 19.3% [interquartile range, 13.7%–33.2%]; P = 0.001) were also lower in group CP than in group NC. Conclusions The incidence of hemidiaphragmatic paresis was effectively reduced when local anesthetic was injected primarily in the corner pocket during right-sided SCBPB. However, the 28% incidence of hemidiaphragmatic paresis associated with the corner pocket technique may still represent a prohibitive risk for patients with preexisting pulmonary compromise. Clinical Trial Registration This study was registered at Clinical Trial Registry of Korea, identifier KCT0001769. Accepted for publication January 15, 2018. Address correspondence to: Duck Hwan Choi, MD, PhD, Department of Anesthesiology and Pain Medicine, Samsung Medical Center, 81 Irwon ro, Gangnam gu, Seoul 06351, Korea (e-mail: duckhwanc@gmail.com). R.A.K. and Y.H.C. contributed equally as first authors. The authors have no sources of funding to declare for this article. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.
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A Cadaveric Study Investigating the Mechanism of Action of Erector Spinae Blockade
Background and Objectives Erector spinae block is an ultrasound-guided interfascial plane block first described in 2016. The objectives of this cadaveric dye injection and dissection study were to simulate an erector spinae block to determine if dye would spread anteriorly to the involve origins of the ventral and dorsal branches of the spinal nerves. Methods In 10 unembalmed human cadavers, 20 mL of 0.25% methylene blue dye was injected bilaterally into the plane between the fifth thoracic transverse process and erector spinae muscle. An in-plane ultrasound-guided technique with the transducer orientated longitudinally was used. During dissection, superficial and deep muscles were identified, and extent of dye spread was documented in cephalocaudal and lateral directions. The ventral and dorsal rami of spinal nerves and dorsal root ganglion at each level were examined to determine if they were stained by dye. Results There was extensive cephalocaudad and lateral spread of dye deep and superficial to the erector spinae muscles. Except for 1 injection (from 20), the ventral rami were not stained by the dye. In only 2 injections did the dye track posteriorly through the costotransverse foramen to the dorsal root ganglion. In all other cases, the dorsal root ganglia were not involved in the dye injection. The dye stained the dorsal rami posterior to the costotransverse foramen. Conclusions There was no spread of dye anteriorly to the paravertebral space to involve origins of the ventral and dorsal branches of the thoracic spinal nerves. Dorsal ramus involvement was posterior to the costotransverse foramen. Accepted for publication January 15, 2018. Address correspondence to: Michael J. Barrington, PhD, MBBS, FANZCA, Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Victoria Parade, PO Box 2900 Fitzroy, Victoria 3065, Australia (e-mail: Michael.Barrington@svha.org.au). Funding was from departmental resources only. Support was provided by the Imaging and Posters Unit at the Department of Anatomy and Neuroscience, University of Melbourne, and Anastasia Arsenoulis from FUJIFILM SonoSite, Inc, which provided an ultrasound machine. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.
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Prediction of acute kidney injury in cirrhotic patients: A new score combining renal, liver and inflammatory markers
International Journal of Nephrology and Renovascular Disease
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Impact of the treatment of pancreatic exocrine insufficiency on survival of patients with unresectable pancreatic cancer: A retrospective analysis
BMC Cancer
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Low circulating total adiponectin, especially its non-high-molecular weight fraction, represents a promising risk factor for colorectal cancer: A meta-analysis
OncoTargets and Therapy
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Prognostic value of Chromogranin A in patients with GET/NEN in the pancreas and the small intestine
Endocrine Connections
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Laparoscopic abdominoperineal resection with lateral lymph node dissection for advanced rectal and prostate cancer with synchronous lateral lymph node metastases
Asian Journal of Endoscopic Surgery, EarlyView.
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Hepatic IRS1 and ß-catenin expression is associated with histological progression and overt diabetes emergence in NAFLD patients
Abstract
Background
Nonalcoholic fatty liver disease (NAFLD) is a risk factor for type 2 diabetes. Our aim was to investigate the relationship between NAFLD and impaired glucose metabolism in terms of insulin receptor substrate 1 and 2 (IRS1 and IRS2) expression in the liver.
Methods
Liver biopsy was performed at the University of Tokyo Hospital between November 2011 and March 2016 on 146 patients with NAFLD who were not being treated with any diabetes or dyslipidemia drugs. Among them, 63 underwent liver biopsy after an overnight fast, and 83 at 5 h after an oral glucose tolerance test (OGTT). Differences in messenger RNA (mRNA) levels of several glucose metabolism-related factors were determined and correlated with hepatic histological changes assessed by NAFLD activity score. We prospectively followed up with the patients until May 2017.
Results
Hepatic necroinflammation was significantly correlated with serum insulin levels and inversely correlated with IRS1 mRNA levels. In specimens obtained after an OGTT, hepatic necroinflammation and IRS1 expression correlated significantly with both peripheral and hepatic insulin resistance. We also found that hepatic β-catenin and glucokinase mRNA levels were elevated in patients undergoing liver biopsy after an OGTT, especially in those with less hepatic necroinflammation and a lower degree of fibrosis. A prospective cohort study showed that ballooning is the most significant risk factor for developing diabetes.
Conclusions
The decreased hepatic expression of IRS1 and β-catenin in NAFLD is linked to histological progression such as ballooning, and might lead to diabetes as a result of impaired glucose metabolism.
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Aerobic fitness alters the capacity of mononuclear cells to produce pentraxin 3 following maximal exercise
Abstract
Purpose
Pentraxin 3 (PTX3) is a vital regulator of innate immune function. Although plasma PTX3 concentrations are elevated with aerobic fitness, the cellular functions of PTX3 remain unknown in aerobically trained and untrained subjects.
Methods
Thirty individuals (aerobically trained = 15 and untrained = 15) participated in a maximal exercise protocol to examine ex vivo PTX3 production from isolated peripheral blood mononuclear cells (PBMCs) exposed to LPS or palmitate. The capacity of PTX3 to stimulate inflammatory cytokine production ex vivo was also examined.
Results
Elevated plasma PTX3 concentrations prior to exercise were positively associated with the percent change (pre to post exercise) in plasma PTX3 concentrations in all subjects, independent of cardiorespiratory fitness (VO2max). In addition, elevated plasma PTX3 concentrations in aerobically trained subjects at rest predicted changes in the LPS- and palmitate-stimulated PTX3 production from isolated PBMCs following acute exercise. In response to PTX3 simulation, the capacity of PBMCs to produce the anti-inflammatory cytokine IL-10 was decreased following acute exercise in all subject (no changes in IL-6, TGF-β1, and TNF-α observed). However, the percent change in IL-6 production was positively associated with VO2max in all subjects, and in aerobically trained subjects only, positively associated with elevated plasma PTX3 concentrations at rest and in response to acute exercise.
Conclusion
These results suggest that aerobic training enhances the utilization of plasma PTX3 concentrations to predict the capacity of mononuclear cells to produce PTX3, and potentially, its reciprocal role of PTX3 as an initiator of the innate immune response following maximal exercise.
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