Παρασκευή, 18 Μαΐου 2018

Diagnostic criteria for temporomandibular disorders: Diagnostic accuracy for general dentistry procedure without mandatory commands regarding myalgia, arthralgia and headache attributed to temporomandibular disorder

Journal of Oral Rehabilitation, EarlyView.


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Generation of rat-mouse chimeras by introducing single cells of rat inner cell masses into mouse blastocysts

Publication date: Available online 18 May 2018
Source:Journal of Genetics and Genomics
Author(s): Tianda Li, Leyun Wang, Xinxin Zhang, Liyuan Jiang, Yufei Li, Junjie Mao, Tongtong Cui, Wei Li, Liu Wang, Qi Zhou




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Percent Differences: Another Look

This article discusses 3 common measures of comparison (absolute difference, ratio, and percent difference [PD]), explores the advantages and disadvantages of each, introduces a less-common measure called symmetrized percent change, and explains how it overcomes some of the disadvantages of the other measures.

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The E3 Ubiquitin Ligase MIB-1 Is Necessary To Form the Nuclear Halo in Caenorhabditis elegans Sperm

Unlike the classical nuclear envelope with two membranes found in other eukaryotic cells, most nematode sperm nuclei are not encapsulated by membranes. Instead, they are surrounded by a nuclear halo of unknown composition. How the halo is formed and regulated is unknown. We used forward genetics to identify molecular lesions behind three classical fer (fertilization defective) mutations that disrupt the ultrastructure of the Caenorhabditis elegans sperm nuclear halo. We found fer-2 and fer-4 alleles to be nonsense mutations in mib-1. fer-3 was caused by a nonsense mutation in eri-3. GFP::MIB-1 was expressed in the germline during early spermatogenesis, but not in mature sperm. mib-1 encodes a conserved E3 ubiquitin ligase homologous to vertebrate Mib1 and Mib2, which function in Notch signaling. Here, we show that mib-1 is important for male sterility and is involved in the regulation or formation of the nuclear halo during nematode spermatogenesis.



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Identifying Genetic Players in Cell Sheet Morphogenesis Using a Drosophila Deficiency Screen for Genes on Chromosome 2R Involved in Dorsal Closure

Cell sheet morphogenesis characterizes key developmental transitions and homeostasis, in vertebrates and throughout phylogeny, including gastrulation, neural tube formation and wound healing. Dorsal closure, a process during Drosophila embryogenesis, has emerged as a model for cell sheet morphogenesis. ~140 genes are currently known to affect dorsal closure and new genes are identified each year. Many of these genes were identified in screens that resulted in arrested development. Dorsal closure is remarkably robust and many questions regarding the molecular mechanisms involved in this complex biological process remain. Thus, it is important to identify all genes that contribute to the kinematics and dynamics of closure. Here, we used a set of large deletions (deficiencies), which collectively remove 98.5% of the genes on the right arm of Drosophila melanogaster's 2nd chromosome to identify "dorsal closure deficiencies". Through two crosses, we unambiguously identified embryos homozygous for each deficiency and time-lapse imaged them for the duration of closure. Images were analyzed for defects in cell shapes and tissue movements. Embryos homozygous for 47 deficiencies have notable, diverse defects in closure, demonstrating that a number of discrete processes comprise closure and are susceptible to mutational disruption. Further analysis of these deficiencies will lead to the identification of at least 30 novel "dorsal closure genes". We expect that many of these novel genes will identify links to pathways and structures already known to coordinate various aspects of closure. We also expect to identify new processes and pathways that contribute to closure.



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NAT2 ultra-slow acetylator and risk of anti-tuberculosis drug-induced liver injury: a genotype-based meta-analysis

Background NAT2 slow acetylator is a confirmed risk of anti-tuberculosis drug-induced liver injury (ATDILI). However, NAT2 ultra-slow acetylators, a new refinement among NAT2 slow acetylators, have been recently proposed. The patients with NAT2 genotypes of *6A/*6A, *6A/*7B and *7B/*7B are referred to in this group. Objective We aim to prove an association of the NAT2 ultra-slow acetylators with the risk of ATDILI. Materials and methods Systematic review and meta-analysis were performed based on each NAT2 genotype and risk of ATDILI cases and also new classification of the ultra-slow acetylators up to 31 October 2016. Meta-analysis of 18 studies with 822 ATDILI cases and 4630 controls was carried out in the RevMan software, version 5.3 with fixed-effect (low heterogeneity) and random effect (moderate to high heterogeneity) methods. Results The strong associations between each NAT2 slow acetylator genotypes and ATDILI were confirmed in meta-analysis except for NAT2*5B/*5B [odds ratio (OR): 1.69; 95% confidence interval (CI): 0.96–2.95; P=0.0679]. The NAT2 ultra-slow acetylators contribute to higher risk of ATDILI (OR: 3.60; 95% CI: 2.30–5.63; P=1.76E−08) than all NAT2 slow acetylators (OR: 2.80; 95% CI: 2.20–3.57; P=5.73E−18) as well as fast acetylators. Additional in-vitro study using isoniazid as a substrate supports the existence of ultra-slow acetylator alleles (NAT2*6A and NAT2*7B). Conclusion This is the first meta-analysis of NAT2 and the risk of ATDILI at the genotypic level. The result demonstrated that NAT2 ultra-slow acetylator genotypes will have the most effect on the increased risk of ATDILI. *Supharat Suvichapanich, Koya Fukunaga and Hilyatuz Zahroh contributed equally to the writing of this article. Correspondence to Surakameth Mahasirimongkol, Department of Medical Sciences, Medical Genetics Center, Medical Life Sciences Institute, Ministry of Public Health, Nonthaburi 11000, Thailand Tel: +66 295 10000 x98096; fax: +66 296 59757; e-mail: surakameth.m@dmsc.mail.go.th Received October 30, 2017 Accepted April 27, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Biomechanical comparison of cemented vs. non-cemented anterior screw fixation in type II odontoid fractures in the elderly: A cadaveric study

Background ContextOdontoid process fractures are the most common injuries of the cervical spine in the elderly. Anterior screw stabilisation of type 2 odontoid process fractures improves survival and function in these patients but may be complicated by failure of fixation.PurposeTo determine whether cement augmentation of a standard anterior screw provides biomechanically superior fixation of type II odontoid fractures in comparison to a non-cemented standard screw.Study designTwenty human cadaveric C2 vertebrae from elderly donors (mean age 83 years) were obtained.

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Reliability of the Star Excursion Balance Test and two new similar protocols to measure trunk postural control

Although the Star Excursion Balance test (SEBT) has shown a good intra-session reliability the inter-session reliability of this test has not been deeply studied. Furthermore, there is an evident high influence of the lower-limbs in the performance of the SEBT so even if it has been used to measure core stability it is possibly not the most suitable measurement.

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Motor Retraining (MoRe) for Functional Movement Disorders: Outcomes from a one-week multidisciplinary Rehabilitation Program

Functional Movement Disorders (FMD) are conditions of abnormal motor control thought to be caused by psychological factors. These disorders are commonly seen in neurological practice and prognosis is often poor. No consensus treatment guidelines have been established, however the role of physical therapy in addition to psychotherapy has increasingly been recognized. This study reports patient outcomes from a multidisciplinary FMD treatment program using motor retraining (MoRe) strategies.

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Participation in Daily Life: Influence on Quality of Life in Ambulatory Children with Cerebral Palsy

Cerebral palsy is a chronic condition which affects children and has an impact on social and physical activity, as well as participation in daily life. Participation and quality of life are two important measures of successful rehabilitation that have not been well studied in children with cerebral palsy.

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Safe Needle Approach for Examination of the Rhomboid Major

Safe and accurate needle access to the rhomboid major (RM) during electromyography is challenging due to the overlying trapezius muscle and the risk of pneumothorax.

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Finding the Whey to Improve Surgical Outcomes: Perioperative Nutrition Screening and Intervention

imageNo abstract available

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American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway

imagePerioperative malnutrition has proven to be challenging to define, diagnose, and treat. Despite these challenges, it is well known that suboptimal nutritional status is a strong independent predictor of poor postoperative outcomes. Although perioperative caregivers consistently express recognition of the importance of nutrition screening and optimization in the perioperative period, implementation of evidence-based perioperative nutrition guidelines and pathways in the United States has been quite limited and needs to be addressed in surgery-focused recommendations. The second Perioperative Quality Initiative brought together a group of international experts with the objective of providing consensus recommendations on this important topic with the goal of (1) developing guidelines for screening of nutritional status to identify patients at risk for adverse outcomes due to malnutrition; (2) address optimal methods of providing nutritional support and optimizing nutrition status preoperatively; and (3) identifying when and how to optimize nutrition delivery in the postoperative period. Discussion led to strong recommendations for implementation of routine preoperative nutrition screening to identify patients in need of preoperative nutrition optimization. Postoperatively, nutrition delivery should be restarted immediately after surgery. The key role of oral nutrition supplements, enteral nutrition, and parenteral nutrition (implemented in that order) in most perioperative patients was advocated for with protein delivery being more important than total calorie delivery. Finally, the role of often-inadequate nutrition intake in the posthospital setting was discussed, and the role of postdischarge oral nutrition supplements was emphasized.

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No Guts, No Recovery: A Rational Approach to Postoperative Gastrointestinal Dysfunction

imageNo abstract available

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American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Gastrointestinal Dysfunction Within an Enhanced Recovery Pathway for Elective Colorectal Surgery

imageThe primary driver of length of stay after bowel surgery, particularly colorectal surgery, is the time to return of gastrointestinal (GI) function. Traditionally, delayed GI recovery was thought to be a routine and unavoidable consequence of surgery, but this has been shown to be false in the modern era owing to the proliferation of enhanced recovery protocols. However, impaired GI function is still common after colorectal surgery, and the current literature is ambiguous with regard to the definition of postoperative GI dysfunction (POGD), or what is typically referred to as ileus. This persistent ambiguity has impeded the ability to ascertain the true incidence of the condition and study it properly within a research setting. Furthermore, a rational and standardized approach to prevention and treatment of POGD is needed. The second Perioperative Quality Initiative brought together a group of international experts to review the published literature and provide consensus recommendations on this important topic with the goal to (1) develop a rational definition for POGD that can serve as a framework for clinical and research efforts; (2) critically review the evidence behind current prevention strategies and provide consensus recommendations; and (3) develop rational treatment strategies that take into account the wide spectrum of impaired GI function in the postoperative period.

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American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway

imagePatient-reported outcomes (PROs) are measures of health status that come directly from the patient. PROs are an underutilized tool in the perioperative setting. Enhanced recovery pathways (ERPs) have primarily focused on traditional measures of health care quality such as complications and hospital length of stay. These measures do not capture postdischarge outcomes that are meaningful to patients such as function or freedom from disability. PROs can be used to facilitate shared decisions between patients and providers before surgery and establish benchmark recovery goals after surgery. PROs can also be utilized in quality improvement initiatives and clinical research studies. An expert panel, the Perioperative Quality Initiative (POQI) workgroup, conducted an extensive literature review to determine best practices for the incorporation of PROs in an ERP. This international group of experienced clinicians from North America and Europe met at Stony Brook, NY, on December 2–3, 2016, to review the evidence supporting the use of PROs in the context of surgical recovery. A modified Delphi method was used to capture the collective expertise of a diverse group to answer clinical questions. During 3 plenary sessions, the POQI PRO subgroup presented clinical questions based on a literature review, presented evidenced-based answers to those questions, and developed recommendations which represented a consensus opinion regarding the use of PROs in the context of an ERP. The POQI workgroup identified key criteria to evaluate patient-reported outcome measures (PROMs) for their incorporation in an ERP. The POQI workgroup agreed on the following recommendations: (1) PROMs in the perioperative setting should be collected in the framework of physical, mental, and social domains. (2) These data should be collected preoperatively at baseline, during the immediate postoperative time period, and after hospital discharge. (3) In the immediate postoperative setting, we recommend using the Quality of Recovery-15 score. After discharge at 30 and 90 days, we recommend the use of the World Health Organization Disability Assessment Scale 2.0, or a tailored use of the Patient-Reported Outcomes Measurement Information System. (4) Future study that consistently applies PROMs in an ERP will define the role these measures will have evaluating quality and guiding clinical care. Consensus guidelines regarding the incorporation of PRO measures in an ERP were created by the POQI workgroup. The inclusion of PROMs with traditional measures of health care quality after surgery provides an opportunity to improve clinical care.

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EMS on the Hill: Supporting legislation to improve EMS

At NAEMT's advocacy event, EMS participants from 37 states spoke with members of congress about legislation that impacts the profession

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Rapid Response: Santa Fe shooting a reminder of additional threats on scene

What happened: Just prior to school opening for the day, Friday, May 18, 2018, a gunman opened fire at Santa Fe High School just outside of Houston, Texas. At the time of this writing, the number of fatalities has not been confirmed, but the Harris County Sheriff has reported 8 to 10 fatalities, with the majority being students. There are an as yet unknown number of additional wounded. The sheriff reported ...

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Constitutional Implications of Firearm Restrictions for Veterans with Fiduciaries



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Atlantic Safety Products, Inc. Orange Lightning® Exam Glove Certified to NFPA 1999-2018

PITTSFIELD, N.H. — Atlantic Safety Products, Inc. is pleased to announce that their Orange Lightning® Examination Glove is now certified to NFPA-1999-2018. The standard specifies the design, performance, testing and certification requirements for new single use and multi-use emergency medical protective clothing, gloves, footwear and face protection devices. The company has a reputation of ...

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Atlantic Safety Products, Inc. adds more Fentanyl Resistant Gloves to their product line

PITTSFIELD, N.H. — Atlantic Safety Products, Inc. is pleased to announce that their Orange Lightning® and InTouch® B311 Nitrile Gloves passed permeation testing for fentanyl per ASTM Standard D 6978-05. The tests were conducted for 240 minutes on each glove specimen and there was no material breach on either glove during this time. These two gloves join their Black Lightning® Glove ...

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In Response

No abstract available

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Activation of Melatonin Receptors by Ramelteon Induces Cardioprotection by Postconditioning in the Rat Heart

imageActivation of melatonin receptors protects the heart against ischemia-reperfusion injury. Ramelteon, a clinically used drug for insomnia, acts via activation of melatonin receptors. We investigated whether ramelteon induces acute infarct size reduction by postconditioning. Male Wistar rats were randomized to 6 groups. Hearts were treated with melatonin and ramelteon at the beginning of reperfusion. The melatonin receptor inhibitor luzindole was administered with and without melatonin and ramelteon, respectively. Ramelteon reduced infarct size to the same extent as melatonin. Both effects were completely abolished by luzindole. The results show for the first time that ramelteon induces cardioprotection by postconditioning.

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Finding the Whey to Improve Surgical Outcomes: Perioperative Nutrition Screening and Intervention

imageNo 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

imageThe 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.

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Contribution of different tarsal attachment devices to the overall attachment ability of the stink bug Nezara viridula

Abstract

The tarsal attachment devices of the southern green stink bug Nezara viridula, a cosmopolitan pest of different crops, encompass a pair of claws, distal pretarsal smooth pulvilli, and a proximal hairy pad on the ventral basitarsus. To evaluate the role of these attachment devices in generating attachment, behavioural experiments testing locomotion of insects with ablated pulvilli, shaved hairs and cut-off claws were performed. Using traction force experiments, insect attachment performance was evaluated on artificial substrates characterised by different roughness and on two substrates with different surface energies in the air and under water. To examine the contact area of attachment devices during resting, pulling and inverted walking, intact insects and those without claws were video-recorded using a high-speed camera. The present data reveal a great involvement of pulvilli in insect attachment on all the tested surfaces, while the hairy pad seems to have a role in producing friction forces only on smooth surfaces and on surfaces with intermediate roughness. The hairy pad was revealed to be important in adhesion to hydrophobic substrates under water, a function that could be relevant for N. viridula insects in consideration that many plant leaves tend to have hydrophobic surfaces and may be often covered by water film.



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Enhanced Recovery After Surgery: Is It Time to Drive Patient-Reported Outcomes Through Robust Measurement?

No abstract available

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Textbook of Rapid Response Systems: Concept and Implementation, 2nd ed

No abstract available

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Perioperative Nutrition: A High-Impact, Low-Risk, Low-Cost Intervention

No abstract available

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No Guts, No Recovery: A Rational Approach to Postoperative Gastrointestinal Dysfunction

imageNo abstract available

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Standardization of the Classification of Impaired Postoperative Gastric Function Within the Enhanced Recovery Pathways

No abstract available

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Use of Regional Anesthesia for Outpatient Surgery Within the United States: A Prevalence Study Using a Nationwide Database

imageBACKGROUND: Regional anesthesia is of benefit for outpatient surgery given its demonstrated improvement in analgesia and decrease in complications, resulting in shorter average recovery room times and lower hospital readmission rates. Unfortunately, there are few epidemiological studies outlining the overall utilization of peripheral nerve blocks (PNBs) in this setting. Therefore, the primary objective of this study was to report the overall utilization of several types of PNBs among all candidate cases in the outpatient setting within the United States. METHODS: We identified all cases from the National Anesthesia Clinical Outcomes Registry that were performed as an outpatient surgery. We reported the frequency of various types of PNBs among all candidate cases, defined as cases that potentially could have received a PNB. Changes in prevalence of PNB utilization from 2010 to 2015 were analyzed by using logistic regression. RESULTS: Of the 12,911,056 outpatient surgeries in the National Anesthesia Clinical Outcomes Registry, 3,297,372 (25.5%) were amenable to a PNB. However, the overall PNB frequency was only 3.3% of the possible cases. The overall utilization for PNB of the brachial plexus, sciatic nerve, and femoral nerve were 6.1%, 1.5%, and 1.9%, respectively. The surgical procedures generating the highest volume of PNBs were shoulder arthroscopies and anterior cruciate ligament reconstruction, in which 41% and 32% received a PNB, respectively. During this time period, there was a significant increase in overall PNB utilization for both single-injection and continuous PNB (P

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Worldwide Standards of Practice for Anesthesia

No abstract available

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Is It Time to Reconsider the Concepts of “Universal Donor” and “ABO Compatible” Transfusions?

imageNo abstract available

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Old Ways Do Not Open New Doors: Norepinephrine for First-Line Treatment of Spinal Hypotension

No abstract available

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Can Lung Ultrasound Be the First-Line Tool for Evaluation of Intraoperative Hypoxemia?

No abstract available

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From Invention to Innovation: Bringing Perioperative Physiological Closed-Loop Systems to the Bedside

No abstract available

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In Response

No abstract available

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By FAER Means or Foul: The Road to Advancement for the Academic Anesthesiologist

No abstract available

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The Evolving Dilemma of Factor XI in Pregnancy: Suggestions for Management

imageA case of a patient with severe factor XI (FXI) deficiency who presented for her seventh labor and delivery is presented. The nature of FXI deficiency, its prevalence, and issues related to genetic screening are discussed. Published literature on the topic is reviewed, including criteria that were developed to assess bleeding, laboratory tools used to estimate bleeding risk, and available treatments. Within the context of this challenging clinical dilemma, specific recommendations are provided for the antepartum, intrapartum, and postpartum stages of pregnancy. These include recommendations that take into account both FXI levels and history of any abnormal bleeding. While there are effective treatments available, it is important to consider that institutional multidisciplinary protocols are needed to manage this complex disorder. More work is needed to define the best management protocols.

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Myocardial Postconditioning by the Melatonin Receptor Agonist Ramelteon: Putting Pieces to the Puzzle

imageNo abstract available

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Summative Objective Structured Clinical Examination Assessment at the End of Anesthesia Residency for Perioperative Ultrasound

imageWhile standardized examinations and data from simulators and phantom models can assess knowledge and manual skills for ultrasound, an Objective Structured Clinical Examination (OSCE) could assess workflow understanding. We recruited 8 experts to develop an OSCE to assess workflow understanding in perioperative ultrasound. The experts used a binary grading system to score 19 graduating anesthesia residents at 6 stations. Overall average performance was 86.2%, and 3 stations had an acceptable internal reliability (Kuder–Richardson formula 20 coefficient >0.5). After refinement, this OSCE can be combined with standardized examinations and data from simulators and phantom models to assess proficiency in ultrasound.

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AMR teams up with IAFC, ACEP to teach bystander CPR

The three organizations are working together to offer free training during National EMS Week

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rs11567842 SNP in SLC13A2 gene associates with hypocitraturia in Thai patients with nephrolithiasis

Abstract

Hypocitraturia is a profound risk for kidney stone formation and recurrence. Sodium-dicarboxylate cotransporter-1 (NaDC-1) is a main transporter responsible for citrate reabsorption in renal proximal tubules. To investigate an association of sodium-dicarboxylate cotransporter-1 (NaDC-1) polymorphism with hypocitraturia in Thai patients with nephrolithiasis (NL). Exonic SNPs in NaDC-1 were screened in peripheral blood DNA of 13 NL patients. The rs11567842 (A/G) variant was found and further genotyped in 145 NL patients and 115 non-stone forming controls. NL patients had significantly lower level of urinary citrate than the controls. Based on logistic regression, hypocitraturia was significantly associated with urinary stone formation (adjusted OR 8.34, 95% CI 4.63–15.04). Significant association of urinary citrate level with rs11567842 genotype was found only in the NL group. NL patients with GG genotype had significantly higher urinary citrate than those with AA and AG genotypes. GG carrying patients had significantly reduced risk for hypocitraturia (adjusted OR 0.15; 95% CI 0.05–0.48, AA as reference). In selected 15 calcium oxalate stone patients, AA carriers had significantly higher intrarenal NaDC-1 mRNA than GG and AG carriers. Homozygous GG of rs11567842 SNP in NaDC-1 gene was a protective genotype for hypocitraturia in kidney stone patients. The findings suggested that patients with AA genotypes were more susceptible to hypocitraturia than those with GG, hence carrying a higher risk for kidney stone recurrence.



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Substrate Metabolism During Ironman Triathlon: Different Horses on the Same Courses

Abstract

Ironman triathlons are ultra-endurance events of extreme duration. The performance level of those competing varies dramatically, with elite competitors finishing in ~ 8:00:00, and lower performing amateurs finishing in ~ 14–15:00:00. When applying appropriate values for swimming, cycling and running economies to these performance times, it is demonstrated that the absolute energy cost of these events is high, and the rate of energy expenditure increases in proportion with the athlete's competitive level. Given the finite human capacity for endogenous carbohydrate storage, minimising the endogenous carbohydrate cost associated with performing exercise at competitive intensities should be a goal of Ironman preparation. A range of strategies exist that may help to achieve this goal, including, but not limited to, adoption of a low-carbohydrate diet, exogenous carbohydrate supplementation and periodised training with low carbohydrate availability. Given the diverse metabolic stimuli evoked by Ironman triathlons at different performance levels, it is proposed that the performance level of the Ironman triathlete is considered when adopting metabolic strategies to minimise the endogenous carbohydrate cost associated with exercise at competitive intensities. Specifically, periodised training with low carbohydrate availability combined with exogenous carbohydrate supplementation during competition might be most appropriate for elite and top-amateur Ironman triathletes who elicit very high rates of energy expenditure. Conversely, the adoption of a low-carbohydrate or ketogenic diet might be appropriate for some lower performance amateurs (> 12 h), in whom associated high rates of fat oxidation may be almost completely sufficient to match the energy demands required.



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Predicting Risk of Suicide Among Individuals Who are Members of Higher-Risk Populations: Finding THE Needle in a Stack of Needles!



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3 things you should know about CPAP use in EMS

CPAP technology and practice in the prehospital environment has evolved for application beyond CHF and COPD

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Haemodilution and head-down tilting induce functional injury in the rat optic nerve: A model for peri-operative ischemic optic neuropathy

BACKGROUND Mechanisms of peri-operative ischaemic optic neuropathy remain poorly understood. Both specific pre-operative and intra-operative factors have been examined by retrospective studies, but no animal model currently exists. OBJECTIVES To develop a rodent model of peri-operative ischaemic optic neuropathy. In rats, we performed head-down tilt and/or haemodilution, theorising that the combination damages the optic nerve. DESIGN Animal study. SETTING Laboratory. ANIMALS A total of 36 rats, in four groups, completed the functional examination of retina and optic nerve after the interventions. INTERVENTIONS Anaesthetised groups (n>8) were supine (SUP) for 5 h, head-down tilted 70° for 5 h, head-down tilted/haemodiluted for 5 h or SUP/haemodiluted for 5 h. We measured blood pressure, heart rate, intra-ocular pressure and maintained constant temperature. MAIN OUTCOME MEASUREMENTS Retinal function (electroretinography), scotopic threshold response (STR) (for retinal ganglion cells) and visual evoked potentials (VEP) (for transmission through the optic nerve). We imaged the optic nerve in vivo and evaluated retinal histology, apoptotic cells and glial activation in the optic nerve. Retinal and optic nerve function were followed to 14 and 28 days after experiments. RESULTS At 28 days in head down tilted/haemodiluted rats, negative STR decreased (about 50% amplitude reduction, P = 0.006), VEP wave N2-P3 decreased (70% amplitude reduction, P = 0.01) and P2 latency increased (35%, P = 0.003), optic discs were swollen and glial activation was present in the optic nerve. SUP/haemodiluted rats had decreases in negative STR and increased VEP latency, but no glial activation. CONCLUSION An injury partly resembling human ischaemic optic neuropathy can be produced in rats by combining haemodilution and head-down tilt. Significant functional changes were also present with haemodilution alone. Future studies with this partial optic nerve injury may enable understanding of mechanisms of peri-operative ischaemic optic neuropathy and could help discover preventive or treatment strategies. Correspondence to Steven Roth, MD, Department of Anesthesiology, University of Illinois, 835 South Wolcott, Room E714, Chicago, IL 60612, USA Tel: +1 312 996 0052; e-mail: rothgas@uic.edu 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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Postoperative Analgesic Effect of Ultrasound-Guided Intermediate Cervical Plexus Block on Unipolar Sternocleidomastoid Release With Myectomy in Pediatric Patients With Congenital Muscular Torticollis: A Prospective, Randomized Controlled Trial

Background and Objectives Unipolar sternocleidomastoid release with myectomy (USRM) for correction of congenital muscular torticollis in pediatric patients produces moderate to severe postoperative pain. The objective of this trial was to examine the effect of ultrasound-guided intermediate cervical plexus block on postoperative pain after USRM. Methods Thirty-two patients (1–7 years old) were enrolled in this parallel-group, patient- and observer-blinded, randomized controlled trial. In the block group, 0.25% ropivacaine (0.2 mL/kg) was injected into the interfascial plane between the sternocleidomastoid muscle and the prevertebral fascia under ultrasound guidance at the fourth to fifth cervical vertebral level. The primary outcome measure was the face, legs, activity, cry, and consolability (FLACC) score at 5 minutes after entering the postanesthesia care unit (PACU), and secondary outcome measures were the FLACC score at discharge from the PACU and 3, 6, and 24 hours after operation and the use of rescue analgesic in the PACU and ward. Results The FLACC score at 5 minutes after admission to the PACU was significantly reduced (3 vs 8; median difference, 4; 95% confidence interval, 1–7; P = 0.044), and the fentanyl dose and the number of patients requiring rescue analgesics in the PACU were significantly lower (0.0 vs 0.5 μg/kg, P = 0.014; 5 [29.4%] vs 12 [75.0%], P = 0.032) in the block than in the control group. However, after discharge from PACU, there was no difference in FLACC scores and use of rescue analgesics between groups. Conclusions Ultrasound-guided intermediate cervical plexus block decreased immediate postoperative pain and opioid requirements in the PACU in pediatric patients who underwent USRM. Clinical Trial Registration This study was registered at ClinicalTrials.gov, identifier NCT02651311. Accepted for publication January 15, 2018. Address correspondence to: Yun Jeong Chae, MD, PhD, Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine 164, Worldcup-ro, Yeongtong-gu, Suwon 16499, Korea (e-mail: yjchae06@hotmail.com). This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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Ultrasound Assessment of Ice-Ball Formation by Cryoneurolysis Device in an Ex Vivo Model

Background and Objectives Real-time ice-ball formation during cryoneurolysis has sparsely been assessed with ultrasound (US). Cryoneurolysis in lower back pain syndrome represents a validated management option in cases of facet joint syndrome. Ultrasound may be a useful tool to perform facet joint cryodenervation. The objective of this study was to assess, ex vivo, the ability of US to assess the ice-ball formation of a cryoneurolysis device. Methods Ultrasound assessment of the ice-ball depiction was done using chicken muscle at 22°C in which several freezing cycles were performed with both 2.1- and 1.3-mm cryoprobes. For each freezing cycle, static images and dynamic videos were generated for both needle insertion and ice-ball formation with 18-, 11-, and 6-MHz transducers. The following data were assessed in each combination of cryoprobe and transducers: quality of needle tip visualization, quality of the ice-ball formation depiction, size of the ice ball, presence of a shadow cone, and usefulness of power Doppler mode to assess ice-ball formation. Results The 18- and 11-MHz linear transducers allowed to directly depict the formation of the ice ball. Visualization of the cone shadowing allowed indirect visualization of the ice ball with both 18- and 11-MHz transducers. However, the ice ball was not depicted (directly or indirectly) with the convex 6-MHz transducer, and power Doppler was the only way to indirectly monitor the ice ball during the freezing cycles. Conclusions Ultrasound is a useful tool to monitor the formation of ice ball during a cryoneurolysis freezing cycle. Power Doppler appears as the only option to monitor the ice ball with low-frequency transducers. This novel finding may be useful in cases of lumbar medial branch cryoneurolysis, an application we plan to assess in a future pilot prospective study. Accepted for publication January 15, 2018. Address correspondence to: Adrian Kastler, MD, PhD, Neuroradiology Unit, Centre Hospitalier Universitaire Grenoble Alpes, Bvd de la Chantourne CS 10217, 38043 Grenoble CEDEX 9, France (e-mail: kastler.radio@gmail.com). Attribution: This work should be attributed to the Radiology Unit of the Medical University of Innsbruck, Innsbruck, Austria. No financial sources have supported this work. The authors declare no conflict 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 Web site (www.rapm.org). Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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Nonoperating room anesthesia for gastrointestinal endoscopic procedures

Purpose of review To assess the trends in nonoperating room anesthesia (NORA) for gastrointestinal endoscopy over the past few years, and to describe alternative methods of delivering propofol sedation in selected low-risk patients. Recent findings The use of NORA for routine gastrointestinal endoscopic procedures has been rising steadily over the past decade in the United States, considerably increasing healthcare costs. Because of this, there have been attempts to develop nonanesthesiologist-administered propofol sedation methods in low-risk patients. There is controversy as to whether properly trained nonanesthesia personnel can use propofol safely via the modalities of nurse-administered propofol sedation, computer-assisted propofol sedation or nurse-administered continuous propofol sedation Summary The deployment of nonanesthesia-administered propofol sedation for low-risk procedures allows for optimal allocation of scarce anesthesia resources, which can be more appropriately used for more complex cases. This can address some of the current shortages in anesthesia provider supply, and can potentially reduce overall healthcare costs without sacrificing sedation quality. We also address the realm of anesthesia provider care for advanced endoscopic procedures including setup for administration of anesthesia, decision-making regarding placement of an endotracheal tube, and the potential need to move a challenging case to the operating room. Correspondence to Otto S. Lin, MD, Digestive Disease Institute, Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA 98101, USA. Tel: +1 206 625 7373x67694; fax: +1 206 341 1405; e-mail: Otto.Lin@vmmc.org Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Scheduling the nonoperating room anesthesia suite

Purpose of review Nonoperating room anesthesia (NORA) and procedural services often are associated with dispersed geographic settings and small volumes of cases. These lead to scheduling challenges that, if not managed well, result in decreased patient and healthcare team satisfaction and reduced efficiency. This review describes recent studies and provides examples on how NORA scheduling issues have been addressed. Recent findings Increased use of blocked time for consolidated NORA services can lead to sufficiently large volumes of cases that allow improved scheduling and maintain patient and healthcare team satisfaction and better efficiency of care. In general, patients and proceduralists find that service blocks offered at least once every 2 weeks are acceptable. With the ability to perform the full scope of perioperative practices such as preoperative assessment and postoperative management, anesthesiologists are well positioned to lead NORA services. There is a rising expectation for both graduate medical education experiences and continuing education in quality improvement for NORA services. Summary Many factors play a role in successful scheduling of NORA services. Increasing consolidation of services, the use of block scheduling, and leadership by anesthesiologists can help improve patient and healthcare team satisfaction and practice efficiencies. Correspondence to Mary E. Warner, MD, Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, 1-121 Charlton Building, Rochester, MN 55905 USA. Tel: +1 507 284 9698; e-mail: warner.mary@mayo.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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The future of anesthesia for interventional radiology

Purpose of review To review novel procedures in interventional radiology and describe anesthetic implications. Recent findings Noninvasive treatment options for patients who are nonsurgical candidates are on the rise. The complication rate for patients receiving anesthesia in the interventional radiology suite is higher than other nonoperating room anesthetizing locations. The investigative use of catheter-directed thrombolysis for acute submassive pulmonary embolism will likely lead to an increased demand for anesthesia assistance. Treatment of prostate cancer with high-intensity focused ultrasound with MRI guidance is an alternative to surgical treatment and has unique anesthetic implications. With advances in technology, interventional radiologists have expanded their treatment armamentarium for benign and malignant bony lesions and thus the need for anesthesia assistance. Summary As the complexity of procedures and patients increases, the demand for anesthesia support in interventional radiology rises. As novel techniques are being developed, anesthesiologists must be mindful of the increased complication rate in interventional radiology and work in a multidisciplinary approach to improve patient safety. Correspondence to Annie Amin, MD, Department of Anesthesia and Critical Care, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637, USA. E-mail: aamin@dacc.uchicago.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Regression: The Apple Does Not Fall Far From the Tree

Researchers and clinicians are frequently interested in either: (1) assessing whether there is a relationship or association between 2 or more variables and quantifying this association; or (2) determining whether 1 or more variables can predict another variable. The strength of such an association is mainly described by the correlation. However, regression analysis and regression models can be used not only to identify whether there is a significant relationship or association between variables but also to generate estimations of such a predictive relationship between variables. This basic statistical tutorial discusses the fundamental concepts and techniques related to the most common types of regression analysis and modeling, including simple linear regression, multiple regression, logistic regression, ordinal regression, and Poisson regression, as well as the common yet often underrecognized phenomenon of regression toward the mean. The various types of regression analysis are powerful statistical techniques, which when appropriately applied, can allow for the valid interpretation of complex, multifactorial data. Regression analysis and models can assess whether there is a relationship or association between 2 or more observed variables and estimate the strength of this association, as well as determine whether 1 or more variables can predict another variable. Regression is thus being applied more commonly in anesthesia, perioperative, critical care, and pain research. However, it is crucial to note that regression can identify plausible risk factors; it does not prove causation (a definitive cause and effect relationship). The results of a regression analysis instead identify independent (predictor) variable(s) associated with the dependent (outcome) variable. As with other statistical methods, applying regression requires that certain assumptions be met, which can be tested with specific diagnostics. Accepted for publication April 2, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Thomas R. Vetter, MD, MPH, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Health Discovery Bldg, Room 6.812, 1701 Trinity St, Austin, TX 78712. Address e-mail to thomas.vetter@austin.utexas.edu. © 2018 International Anesthesia Research Society

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We’ve Had Our Fill of Magill

No abstract available

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Neuromonitoring Techniques: Quick Guide for Clinicians and Residents

No abstract available

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Remifentanil Induces Cardio Protection Against Ischemia/Reperfusion Injury by Inhibiting Endoplasmic Reticulum Stress Through the Maintenance of Zinc Homeostasis

BACKGROUND: Although it is well known that remifentanil (Rem) elicits cardiac protection against ischemia/reperfusion (I/R) injury, the underlying mechanism remains unclear. This study tested if Rem can protect the heart from I/R injury by inhibiting endoplasmic reticulum (ER) stress through the maintenance of zinc (Zn2+) homeostasis. METHODS: Isolated rat hearts were subjected to 30 minutes of regional ischemia followed by 2 hours of reperfusion. Rem was given by 3 consecutive 5-minute infusions, and each infusion was followed by a 5-minute drug-free perfusion before ischemia. Total Zn2+ concentrations in cardiac tissue, cardiac function, infarct size, and apoptosis were assessed. H9c2 cells were subjected to 6 hours of hypoxia and 2 hours of reoxygenation (hypoxia/reoxygenation [H/R]), and Rem was given for 30 minutes before hypoxia. Metal-responsive transcription factor 1 (MTF1) overexpression plasmids were transfected into H9c2 cells 48 hours before hypoxia. Intracellular Zn2+ level, cell viability, and mitochondrial injury parameters were evaluated. A Zn2+ chelator N,N,N′,N′-tetrakis-(2-pyridylmethyl) ethylenediamine (TPEN) or an ER stress activator thapsigargin was administrated during in vitro and ex vivo studies. The regulatory molecules related to Zn2+ homeostasis and ER stress in cardiac tissue, and cardiomyocytes were analyzed by Western blotting. RESULTS: Rem caused significant reversion of Zn2+ loss from the heart (Rem + I/R versus I/R, 9.43 ± 0.55 vs 7.53 ± 1.18; P

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Global Health: Issues, Challenges, and Global Action

No abstract available

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Whole Blood for Resuscitation in Adult Civilian Trauma in 2017: A Narrative Review

After a hiatus of several decades, the concept of cold whole blood (WB) is being reintroduced into acute clinical trauma care in the United States. Initial implementation experience and data grew from military medical applications, followed by more recent development and data acquisition in civilian institutions. Anesthesiologists, especially those who work in acute trauma facilities, are likely to be presented with patients either receiving WB from the emergency department or may have WB as a therapeutic option in massive transfusion situations. In this focused review, we briefly discuss the historical concept of WB and describe the characteristics of WB, including storage, blood group compatibility, and theoretical hemolytic risks. We summarize relevant recent retrospective military and preliminary civilian efficacy as well as safety data related to WB transfusion, and describe our experience with the initial implementation of WB transfusion at our level 1 trauma hospital. Suggestions and collective published experience from other centers as well as ours may be useful to those investigating such a program. The role of WB as a significant therapeutic option in civilian trauma awaits further prospective validation. Accepted for publication April 3, 2018. Funding: Departmental. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Evan G. Pivalizza, MD, Department of Anesthesiology, University of Texas Health McGovern Medical School, Houston, TX. Address e-mail to evan.g.pivalizza@uth.tmc.edu. © 2018 International Anesthesia Research Society

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Flupirtine Is an Effective Analgesic: Is the Associated Rare Liver Injury a Limiting Factor to Its Use?

No abstract available

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Do Not Opiate! Anesthesiologists Must Be Prepared to Care for Patients Who Sign a “Nonopioid Directive”

No abstract available

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Complications in Anesthesia, 3rd ed

No abstract available

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Granular cell tumor of the pancreas diagnosed by endoscopic ultrasound-guided fine-needle aspiration

Abstract

A 68-year-old woman was referred to our hospital for the treatment of bile duct stone, pancreatic tumor, and pancreatic cysts. First, bile duct stone was removed using endoscopic retrograde cholangiopancreatography. By abdominal contrast-enhanced computed tomography, a 12-mm diameter tumor was found in the pancreatic body. The tumor was isodense compared with the surrounding pancreatic parenchyma in the non-contrast phase and poorly enhanced in the arterial phase; it exhibited gradual enhancement from the portal vein phase to the late phase. Numerous pancreatic cysts were also observed by contrast-enhanced computed tomography. By magnetic resonance imaging, the tumor was hypointense in T1-weighted images, isointense in T2-weighted images, and hyperintense in diffusion-weighted images. By magnetic resonance cholangiopancreatography, the main pancreatic duct was not dilated, and pancreatic cysts communicated with the main pancreatic duct. The pancreatic cysts were diagnosed as branch-type intraductal papillary mucinous neoplasm. Histopathologic assessment of the specimens obtained by endoscopic ultrasound-guided fine-needle aspiration revealed the tumor as benign pancreatic granular cell tumor. The patient was followed up without surgical resection. On contrast-enhanced computed tomography at 6 months after admission, the tumor did not show any changes in diameter or characteristics.



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Candidemia after endoscopic therapy with lumen-apposing metal stent for pancreatic walled-off necrosis

Abstract

Necrotizing pancreatitis remains a challenging and unpredictable condition accompanied by various complications. Endoscopic ultrasound-guided transmural drainage and necrosectomy have become the standard treatment for patients with walled-off necrosis (WON). Endoscopic therapy via lumen-apposing metal stents (LAMS) with large diameters has shown success in the management of pancreatic fluid collections, but there are few data on specific complications of that therapy. We report a case of infected WON and concomitant fungemia following LAMS placement and necrosectomy. In addition, a systematic literature review of current related studies has been provided.



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Postoperative recurrence from tract seeding after use of EUS–FNA for preoperative diagnosis of cancer in pancreatic tail

Abstract

A 50-year-old male underwent abdominal computed tomography at a city hospital in Japan, which revealed a tumor 38 mm in diameter in the tail of the pancreas. Based on findings from endoscopic ultrasonography-guided fine needle aspiration using a 22-gauge needle with a side hole, the tumor was diagnosed as an invasive ductal carcinoma. The patient was referred to our hospital and underwent a distal pancreatectomy. Esophagogastroduodenoscopy performed as part of a medical checkup at another hospital 2 years later revealed a 20-mm-sized submucosal tumor in the posterior wall of the upper body of the stomach. Examination of a biopsy specimen obtained from the top of the lesion revealed adenocarcinoma. Partial resection of the stomach was performed and pathological findings showed an adenocarcinoma in all layers of the stomach wall, consistent with recurrence derived from needle tract seeding of the previously excised cancerous tumor from the pancreatic tail. Additional experimentation performed for confirmation with an agar model showed that agar on the deep side leaked to the shallow side following puncture with a needle with a side hole used with a slow-pull technique.



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Successful endoscopic sphincterotomy for choledocholithiasis in a patient with severe hemophilia A and inhibitors

Abstract

Endoscopic sphincterotomy (ES) is a standard procedure for bile duct stone removal. However, the safety of ES in patients with hemophilia remains unknown. We treated a 46-year-old man who had choledocholithiasis and severe hemophilia A with high-responding inhibitors during immune tolerance induction therapy. Since coagulation factor VIII inhibitors neutralize and inactivate endogenous and exogenous factor VIII, bleeding risk is higher in hemophilia A patients with inhibitors than in those without inhibitors. With adequate pre- and post-procedure monitoring of the clotting factor and supplemented clotting factor, the patient could safely undergo ES without bleeding complications. ES can be also an effective and safe first-line therapy for choledocholithiasis in patients with hemophilia and inhibitors under the condition of appropriate management.



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Two-step progression of varenicline-induced autoimmune hepatitis

Abstract

We describe a rare case of drug-induced hepatitis due to the smoking cessation agent varenicline in a 46-year-old Asian woman. The liver injury progressed in two steps. First, the liver injury started in the absence of viral/autoimmune responses, and withdrawal of varenicline lowered the increase in the levels of liver enzymes immediately. Such findings suggested varenicline-induced liver injury. Second, hepatitis recurred in association with conversion of antinuclear antibody from negative to positive about 8 weeks after the initial episode. Histology upon recurrence of liver injury revealed interface hepatitis with lymphocytic and lymphoplasmacytic portal inflammatory infiltrates extending into lobules. Such findings suggested autoimmune hepatitis. Corticosteroid treatment was effective for recurrent hepatitis. The clinical course suggests that varenicline caused drug-induced liver injury and subsequent autoimmune hepatitis. Some autoimmune changes were probably involved in the mechanism of varenicline-induced liver injury.



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Influencing health behavior change related to musculoskeletal conditions: The need to expand the evidence base and the case for multi-theory model (MTM)

No abstract available

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Comorbidities and Mobility in Lower Limb Prosthesis Users

Objective To determine the impact of comorbidities on mobility in patients with lower limb prostheses. Design Cohort database chart review examining mobility in lower limb prosthesis users grouped according to comorbidities. Regression models were used to determine significant predictor comorbidities for mobility. General linear univariate models were implemented to investigate differences in mobility among cohorts (n=596). Results Patient age and history of stroke, peripheral vascular disease, and anxiety/panic disorders were predictors of decreased mobility. After adjusting for covariates, the differences in mobility reported by patients over age 65 years was compared to those under age 65, in addition we compared those with history of peripheral vascular disease to those without. The comparative analyses for both categories did not satisfy the minimal clinically important difference. There were no significant differences when comparing overall comorbid health after adjusting for covariates. Conclusion Clinicians should consider patient age and history of stroke, peripheral vascular disease, or anxiety/panic disorders when optimizing a lower limb prosthesis users' mobility as these variables may be predictive of modest but clinically meaningful decreased prosthetic mobility. By contrast, common comorbid health conditions such as arthritis, COPD, congestive heart failure, and diabetes do not appear predictive of decreased mobility among lower limb prosthesis users. 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. Corresponding Author: Shane R. Wurdeman, PhD, Department of Clinical and Scientific Affairs, 11155 S. Main St. Hanger Clinic, Houston, TX, USA 77025, Email: swurdeman@hanger.com, Phone: 512-777-3800; Fax: 512-605-2786 Author Disclosures: Support for this work was partially provided by a Small Grant Award (EB-043016) from the American Orthotics and Prosthetics Association. The results of this study were recently presented as part of a symposium on outcomes at the American Congress of Rehabilitation Medicine in October 2017. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Pharmacogenomics in Papua New Guineans: unique profiles and implications for enhancing drug efficacy while improving drug safety

imagePapua New Guinea (PNG) can be roughly divided into highland, coastal and island peoples with significant mitochondrial DNA differentiation reflecting early and recent distinct migrations from Africa and East Asia, respectively. Infectious diseases such as tuberculosis, malaria and HIV severely impact on the health of its peoples for which drug therapy is the major treatment and pharmacogenetics has clinical relevance for many of these drugs. Although there is generally little information about known single nucleotide polymorphisms in the population, in some instances, their frequencies have been shown to be higher than anywhere worldwide. For example, CYP2B6*6 is over 50%, and CYP2C19*2 and *3 are over 40 and 25%, respectively. Conversely, CYP2A6*9, 2B6*2, *3, *4 and *18, and 2C8*3 appear to be much lower than in Whites. CYP2D6 known variants are unclear, and for phase II enzymes, only UGT2B7 and UGT1A9 data are available, with variant frequencies either slightly lower than or similar to Whites. Although almost all PNG people tested are rapid acetylators, but which variant(s) define this phenotype is not known. For HLA-B*13:01, HLA-B*35:05 and HLA-C*04:01, the frequencies show some regioselectivity, but the clinical implications with respect to adverse drug reactions are not known. There are minimal phenotype data for the CYPs and nothing is known about drug transporter or receptor genetics. Determination of genetic variants that are rare in Whites or Asians but common in PNG people is a topic of both scientific and clinical importance, and further research needs to be carried out. Optimizing the safety and efficacy of infectious disease drug therapy through pharmacogenetic studies that have translation potential is a priority.

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The hemodynamic response to constant dobutamine infusion: the effect of ADRB1 389 polymorphism and sex

imageObjectives Prolonged activation of the β-1 adrenergic receptor (ADRB1) is associated with receptor desensitization. This process has been suggested to have important pathophysiological and clinical implications in conditions such as congestive heart failure. The contribution of genetic factors to this process is a patient of ongoing research. We have previously shown that the ADRB1 389 polymorphism affects the response to incremental dose infusion of the ADRB agonist dobutamine. The aim of the current study was to determine whether the ADRB1 389 polymorphism affects the hemodynamic response to constant dose infusion of dobutamine in healthy patients. Patients and methods Healthy patients were recruited according to their ADRB1 49 and 389 genotypes [15 Arg389Arg, 10 Gly389Arg, and 10 Gly389Gly patients (all Ser49Ser), 21 men and 14 women]. Following a standardized protocol of dose increase, 6 mcg/kg/min dobutamine was infused over 2 h. Heart rate (HR), blood pressure (BP), and active plasma renin (PR) were measured. Standardized exercise (1 min) was performed at three time points during infusion. Results In all patients, resting systolic BP was significantly decreased during infusion [144.4±11.5 vs. 140.3±12.2 mmHg (mean±SD), P=0.007]. There was no change in HR, and PR following 120 min of dobutamine infusion. ADRB1 389 genotypes were not associated with HR, systolic BP, and PR changes during dobutamine infusion (all P>0.05, repeated measures analysis of variance). Sex was associated with response to dobutamine. Among women, but not in men, resting HR significantly increased, and diastolic blood pressure (DBP) significantly decreased during dobutamine infusion [HR: 76.0±7.3 to 86.3±17.5 beats per minute (P=0.023), and DBP 78.5±8.49 mmHg to 72.36±6.16 (P=0.041) (repeated measures analysis of variance)]. Conclusion In healthy patients, the ADRB1 389 genotype was not associated with hemodynamic changes during constant dobutamine infusion. In women, but not in men, HR significantly increased and DBP decreased during 2 h of infusion.

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Germline genome-wide association studies in women receiving neoadjuvant chemotherapy with or without bevacizumab

imageNeoadjuvant chemotherapy (NAC) for breast cancer is widely utilized, and we performed genome-wide association studies (GWAS) to determine whether germ-line genetic variability was associated with benefit in terms of pathological complete response (pCR), disease-free survival, and overall survival in patients entered on the NSABP B-40 NAC trial, wherein patients were randomized to receive, or not, bevacizumab in addition to chemotherapy. Patient DNA samples were genotyped with the Illumina OmniExpress BeadChip. Replication was attempted with genotyping data from 1398 HER2-negative patients entered on the GeparQuinto NAC study in which patients were also randomized to receive, or not, bevacizumab in addition to chemotherapy. A total of 920 women from B-40 were analyzed, and 237 patients achieved a pCR. GWAS with three phenotypes (pCR, disease-free survival, overall survival) revealed no single nucleotide polymorphisms (SNPs) that were genome-wide significant (i.e. P≤5E−08) signals; P values for top SNPs were 2.04E−07, 5.61E−08, and 5.63E−08, respectively, and these SNPs were not significant in the GeparQuinto data. An ad-hoc GWAS was performed in the patients randomized to bevacizumab (457 patients with 128 pCR) who showed signals on chromosome 6, located within a gene, CDKAL1, that approached, but did not reach, genome-wide significance (top SNP rs7453577, P=2.97E−07). However, this finding was significant when tested in the GeparQuinto data set (P=0.04). In conclusion, we identified no SNPs significantly associated with NAC. The observation, in a hypothesis-generating GWAS, of an SNP in CDKAL1 associated with pCR in the bevacizumab arm of both B-40 and GeparQuinto requires further validation and study.

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Post-mortem analysis of suicide victims shows ABCB1 haplotype 1236T–2677T–3435T as a candidate predisposing factor behind adverse drug reactions in females: Erratum

imageNo abstract available

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The Effects of Exercise, Aspirin, and Celecoxib in an Atherogenic Environment

Introduction Optimal vascular function is a hallmark of cardiovascular health. Specifically, the balance of vasoconstricting and vasodilating substances is recognized as a marker of vascular health. One of the greatest challenges to vascular health and vasodilatory balance is tumor necrosis factor alpha (TNFα) mediated inflammation. Uncovering effective strategies that maintain a vascular environment that is more vasodilatory and anti-thrombotic in the face of an inflammatory challenge is favorable. Purpose: To test the ability of various anti-thrombotic and pro-vasodilatory treatments, as well as combinations thereof, to prevent unfavorable changes in markers of endothelial dysfunction in human umbilical vein endothelial cells (HUVECs) when presented with an inflammatory challenge. Methods HUVECs were pre-treated with exercise-like levels of laminar shear stress (LSS), aspirin, celecoxib, and their combination prior to a TNFα challenge. Western blot analysis, as well as colorimetric assays were used to determine levels of eNOS and prostacyclin (6-keto PGF1α)/thromboxane (TXB2) metabolite ratio, respectively. Results Neither aspirin, nor celecoxib were effective in preventing TNFα-induced reduction in eNOS. Further, aspirin was unable to maintain baseline levels of prostacyclin/thromboxane ratio in the face of the inflammatory challenge. LSS, aspirin/LSS combination, and celecoxib/LSS combination were all able to prevent TNFα-induced alterations in eNOS levels and prostacyclin/thromboxane ratio. Conclusion Effective strategies to maintain a healthy endothelium and therefore resistance vessel health, need to include exercise-levels of shear stress to be effective. Author Correspondence: Heather Grimm, Ph.D., King's College, Sports Medicine Department, 133 North River St., Wilkes-Barre, PA 18711 The authors would like to thank the University of Illinois at Chicago and our Generosity by Indiegogo contributors for financial support of this study. The authors do not have any conflicts of interest that might bias the work. The results of the current study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation and do not constitute endorsement by the American College of Sports Medicine. Accepted for Publication: 16 April 2018 © 2018 American College of Sports Medicine

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Pulse Oximetry and Arterial Oxygen Saturation during Cardiopulmonary Exercise Testing

Introduction/Purpose Peripheral capillary oxygen saturation (SpO2) is used as surrogate for arterial blood oxygen saturation. We studied the degree of discrepancy between SpO2 and arterial oxygen (SaO2) and identified parameters that may explain this difference. Methods We included patients who underwent cardiopulmonary exercise testing (CPET) at Cleveland Clinic. Pulse oximeters with forehead probes measured SpO2 and arterial blood gas (ABG) samples provided the SaO2 both at rest and peak exercise. Results We included 751 patients, 54 ± 16 years old with 53 % of female gender. Bland-Altman analysis revealed a bias of 3.8% with limits of agreement of 0.3 to 7.9% between SpO2 and SaO2 at rest. A total of 174 (23%) patients had SpO2 >= 5% of SaO2, and these individuals were older, current smokers with lower FEV1 and higher PaCO2 and carboxyhemoglobin. At peak exercise (n=631), 75 (12%) SpO2 values were lower than the SaO2 determinations reflecting difficulties in the SpO2 measurement in some patients. The bias between SpO2 and SaO2 was 2.6% with limits of agreement between -2.9 to 8.1%. Values of SpO2 >= 5% of SaO2 (n=78, 12%) were associated with the significant resting variables plus lower heart rate, oxygen consumption and oxygen pulse. In multivariate analyses, carboxyhemoglobin remained significantly associated with the difference between SpO2 and SaO2 both at rest and peak exercise. Conclusion In the present study, pulse oximetry commonly underestimated the SaO2. Increased carboxyhemoglobin levels are independently associated with the difference between SpO2 and SaO2, a finding particularly relevant in smokers. Address for correspondence: Adriano Tonelli MD, 9500 Euclid Avenue A-90, Cleveland, Ohio, 44195. Email: tonella@ccf.org The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation, and statement that results of the present study do not constitute endorsement by ACSM. Funding Sources: A.R.T. is supported by NIH grant # R01HL130307. Conflict of Interest Statements: Mona Ascha BS: The author has no significant conflicts of interest with any companies or organization whose products or services may be discussed in this article. Anirban Bhattacharyya MD: The author has no significant conflicts of interest with any companies or organization whose products or services may be discussed in this article. Jose A Ramos RT: The author has no significant conflicts of interest with any companies or organization whose products or services may be discussed in this article. Adriano R Tonelli MD, MSc: The author has no significant conflicts of interest with any companies or organization whose products or services may be discussed in this article. Accepted for Publication: 25 April 2018 © 2018 American College of Sports Medicine

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Residual Force Enhancement is Attenuated in a Shortening Magnitude-dependent Manner

Introduction The isometric force attained after active stretch is greater than that attained in a purely isometric contraction. This property is referred to as residual force enhancement (RFE). Although RFE is thought to contribute to the enhanced force and power in stretch-shortening cycles (SSCs), it is unclear whether shortening that occurs after active stretch eliminates the RFE induced by active stretch. Therefore, we evaluated the influence of shortening on RFE. Methods Skinned rabbit soleus fibers (N = 43) were used for all tests. RFE was compared between the stretch only condition and the stretch-shortening cycle (SSC) condition. In the SSC conditions, shortening magnitudes were either 1% or 12.5% of fiber length. The final muscle length where RFE was evaluated was 3 μm for all trials. In the SSCs with 12.5% shortening, the isometric force before and after the SSC was also compared. Results RFE was similar between the stretch only (7.9 ± 2.7%) and the SSC with 1% shortening condition (7.1 ± 2.9%) (p = 0.316), while RFE was smaller in the SSC with 12.5% shortening (3.5 ± 2.4%) than the stretch only condition (8.4 ± 2.5%) (p

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Psychological and behavioral responses to interval and continuous exercise

Purpose To compare psychological responses to, and preferences for, moderate-intensity continuous training (MICT), high-intensity interval training (HIIT), and sprint interval training (SIT) among inactive adults; and to investigate the relationships between affect, enjoyment, exercise preferences, and subsequent exercise behavior over a 4-wk follow-up period. Methods Thirty inactive men and women (21.23±3.81 y), inexperienced with HIIT or SIT, completed three trials of cycle ergometer exercise in random order on separate days: MICT (45min continuous; ~70-75% of heart rate maximum (HRmax)); HIIT (10x1 min bouts at ~85-90%HRmax with 1-min recovery periods); and SIT (3x20-s "all-out" sprints with 2-min recovery periods). Perceived exertion (RPE), affect, and arousal were measured throughout the trials and enjoyment was measured post-exercise. Participants rank-ordered the protocols (#1-3) according to preference and logged their exercise over a 4-week follow-up. Results Despite elevated HR, RPE, and arousal during work periods (ps0.05). In-task affect was predictive of post-exercise enjoyment for each type of exercise (rs=0.32 to 0.47; ps0.05), respectively. Over the follow-up, participants completed more MICT (M=6.11±4.12) than SIT sessions (M=1.39±1.85; p0.05). Conclusion This study provides new evidence that a single session of HIIT and SIT can be as enjoyable and preferable as MICT among inactive individuals and that there may be differences in the exercise affect-behavior relationship between interval and continuous exercise. Corresponding author: Matthew Stork, School of Health and Exercise Sciences, University of British Columbia; Address: 3333 University Way, Kelowna, BC, Canada, V1V 1V7; Phone: 647-200-1410; Email: matthew.stork@ubc.ca The authors would like to thank the North American Society for the Psychology of Sport and Physical Activity for funding this project. We would also like to acknowledge the Social Sciences and Humanities Council for its support through a Joseph-Armand Bombardier Doctoral Canada Graduate Scholarship to Matthew J. Stork, which aided preparation of this manuscript. Conflict of Interest: None to declare. The results of the study do not constitute endorsement by ACSM and are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 8 May 2018 © 2018 American College of Sports Medicine

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Exercise Periodization over the Year Improves Metabolic Syndrome and Medication Use

Purpose We aimed to determine if yearly repeated exercise training reduces metabolic syndrome (MetS) and the use of medicines to control MetS components. Methods Fifty five MetS individuals were randomized into a TRAIN group that underwent two yearly programs of 16-week of high intensity interval training (HIIT) or a non-exercising CONT group. We measured the evolution of all five MetS components, cardiorespiratory fitness (CRF; assessed by VO2PEAK) and medicine use, at baseline (0 months), mid (12 months) and end-point (24 months). Testing took place 7 months after the last training session to assess the chronic effects of training. Results Daily physical activity (wrist-band activity monitors) and calorie intake (3-day nutritional diary) remained similar to baseline at 1 and 2 years in each group and were not different between groups. Blood triglycerides and glucose concentrations did not significantly varied in any group. However, waist circumference (WC) increased only in CONT after 2 years (107±2 to 111±3 cm; P=0.004). Mean arterial pressure (MAP) decreased in TRAIN (101±2 to 94±2 mmHg; P=0.002) while remained unchanged in CONT (98±2 to 99±2 mmHg; P=1.000) after 2 years. Starting from similar levels at baseline, after 2 years VO2PEAK was higher (2.32±0.14 vs. 1.98±0.11 L·min-1; P=0.049) and medicine use lower (1.27±0.22 vs. 2.23±0.43; P=0.043) in TRAIN than CONT. The reduction in MAP in TRAIN commanded a parallel reduction in MetS Z-score from baseline to 2 years (0.30±0.1 to 0.07±0.1; P=0.013). Conclusion Two yearly 16-week HIIT programs are enough exercise to chronically lower MetS while preventing the reductions in CRF associated to aging. Of clinical relevance, yearly exercise training halts the increase in medicine use that occurs in non-exercising MetS individuals. ClinicalTrials.gov identifier NCT03019796. Corresponding author: Ricardo Mora-Rodriguez. Exercise Physiology Lab at Toledo, University of Castilla-La Mancha, 45071 Toledo, Spain. Email: ricardo.mora@uclm.es We would like to state that the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute endorsement by ACSM. This study was partially funded by a grant from the Spanish Ministry of Economy, Industry and Competivity (DEP-2017-83244-R). The authors have no conflicts of interest. Accepted for Publication: 29 April 2018 © 2018 American College of Sports Medicine

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JNA Editorial – July 2018

No abstract available

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JNA Journal Club

No abstract available

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A 2Ma old baboon-like monkey from Northern Greece and new evidence to support the Paradolichopithecus – Procynocephalus synonymy (Primates: Cercopithecidae)

Publication date: Available online 18 May 2018
Source:Journal of Human Evolution
Author(s): Dimitris S. Kostopoulos, Franck Guy, Zoi Kynigopoulou, George D. Koufos, Xavier Valentin, Gildas Merceron
A new fossil cranium of a large papionin monkey from the Lower Pleistocene site of Dafnero-3 in Western Macedonia, Greece, is described by means of outer and inner morphological and metric traits using high-resolution micro-computed tomography. Comparisons with modern cercopithecids and contemporaneous Eurasian fossil taxa suggest that the new cranium could equally be ascribed to either the Eurasian Paradolichopithecus or to the East Asian Procynocephalus. The combination of the available direct and indirect fossil evidence, including the new cranium from Dafnero, revives an earlier hypothesis that considers these two sparsely documented genera as synonyms. The timing and possible causes of the rise and demise of Paradolichopithecus - Procynocephalus are discussed.



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Chemopreventive efficacy of the cyclooxygenase-2 (Cox-2) inhibitor, celecoxib, is predicted by adenoma expression of Cox-2 and 15-PGDH

Cancer Epidemiology, Biomarkers & Prevention

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Analysis of DNA methylation at specific loci in stool samples detects colorectal cancer and high-grade dysplasia in patients with inflammatory bowel disease

Clinical Gastroenterology and Hepatology

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A risk score to predict the development of hepatic encephalopathy in a population?based cohort of patients with cirrhosis

Hepatology

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Rebleeding vs thromboembolism after hospitalization for gastrointestinal bleeding in patients on direct oral anticoagulants

Clinical Gastroenterology and Hepatology

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Saliva production and enjoyment of real-food flavors in people with and without dysphagia and/or xerostomia

Dysphagia

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An imaging biomarker for assessing hepatic function in patients with primary sclerosing cholangitis

Clinical Gastroenterology and Hepatology

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Prospective cohort studies of dietary vitamin B6 intake and risk of cause-specific mortality

Clinical Nutrition

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The effect of glutamine supplementation on athletic performance, body composition, and immune function: A systematic review and a meta-analysis of clinical trials

Clinical Nutrition

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Serum exosomal long noncoding rnas ensg00000258332.1 and linc00635 for the diagnosis and prognosis of hepatocellular carcinoma

Cancer Epidemiology, Biomarkers & Prevention

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Long-term nuts intake and metabolic syndrome: A 13-year longitudinal population-based study

Clinical Nutrition

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Cholera epidemic in Yemen, 2016–18: An analysis of surveillance data

The Lancet Global Health

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