Cross-education does not accelerate the rehabilitation of neuromuscular functions after ACL reconstruction: a randomized controlled clinical trial

Abstract

Purpose

Cross-education reduces quadriceps weakness 8 weeks after anterior cruciate ligament (ACL) surgery, but the long-term effects are unknown. We investigated whether cross-education, as an adjuvant to the standard rehabilitation, would accelerate recovery of quadriceps strength and neuromuscular function up to 26 weeks post-surgery.

Methods

Group allocation was randomized. The experimental (n = 22) and control (n = 21) group received standard rehabilitation. In addition, the experimental group strength trained the quadriceps of the non-injured leg in weeks 1–12 post-surgery (i.e., cross-education). Primary and secondary outcomes were measured in both legs 29 ± 23 days prior to surgery and at 5, 12, and 26 weeks post-surgery.

Results

The primary outcome showed time and cross-education effects. Maximal quadriceps strength in the reconstructed leg decreased 35% and 12% at, respectively, 5 and 12 weeks post-surgery and improved 11% at 26 weeks post-surgery, where strength of the non-injured leg showed a gradual increase post-surgery up to 14% (all p ≤ 0.015). Limb symmetry deteriorated 9–10% more for the experimental than control group at 5 and 12 weeks post-surgery (both p ≤ 0.030). One of 34 secondary outcomes revealed a cross-education effect: Voluntary quadriceps activation of the reconstructed leg was 6% reduced for the experimental vs. control group at 12 weeks post-surgery (p = 0.023). Both legs improved force control (22–34%) and dynamic balance (6–7%) at 26 weeks post-surgery (all p ≤ 0.043). Knee joint proprioception and static balance remained unchanged.

Conclusion

Standard rehabilitation improved maximal quadriceps strength, force control, and dynamic balance in both legs relative to pre-surgery but adding cross-education did not accelerate recovery following ACL reconstruction.

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Impact of ischaemia–reperfusion cycles during ischaemic preconditioning on 2000-m rowing ergometer performance

Abstract

Purpose

Although ischaemic preconditioning (IPC), induced by cycles of transient limb ischaemia and reperfusion, seems to improve exercise performance, the optimal duration of ischaemia–reperfusion cycles is not established. The present study investigated the effect of ischaemia–reperfusion duration within each IPC cycle on performance in a 2000-m rowing ergometer test.

Methods

After incremental and familiarization tests, 16 trained rowers (mean ± SD: age, 24 ± 11 years; weight, 74.1 ± 5.9 kg; \(\dot{V}{\text{O}}_}\) peak, 67.2 ± 7.4 mL·kg⁻¹·min⁻¹) were randomly submitted to a 2000-m rowing test preceded by intermittent bilateral cuff inflation of the lower limbs with three cycles of ischaemia–reperfusion, lasting 5 min (IPC-5) or 10 min (IPC-10) at 220 or 20 mmHg (control). Power output, \(\dot{V}{\text{O}}_}\) , heart rate, blood lactate concentration, pH, ratings of perceived exertion (RPE), and near-infrared spectroscopy-derived measurements of the vastus lateralis muscle were continuously recorded.

Results

No differences among treatments were found in the 2000-m test (control: 424 ± 17; IPC-5: 425 ± 16; IPC-10: 424 ± 17 s; P = 0.772). IPC-10 reduced the tissue saturation index and oxy-haemoglobin concentration during exercise compared with control. The power output during the last 100-m segment was significantly lower with IPC-10. The IPC treatments increased the heart rate over the first 500 m and decreased the pH after exercise. No alterations were observed in \(\dot{V}{\text{O}}_}\) , blood lactate, or RPE among the trials.

Conclusion

In conclusion, IPC does not improve the 2000-m rowing ergometer performance of trained athletes regardless of the length of ischaemia–reperfusion cycles.

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BLAST-XYPlot Viewer: A Tool for Performing BLAST in Whole-Genome Sequenced Bacteria/Archaea and Visualize Whole Results Simultaneously

One of the most commonly used tools to compare protein or DNA sequences against databases is BLAST. We introduce a web tool that allows the performance of BLAST-searches of protein/DNA sequences in whole-genome sequenced bacteria/archaea, and displays a large amount of BLAST-results simultaneously. The circular bacterial replicons are projected as horizontal lines with fixed length of 360, representing the degrees of a circle. A coordinate system is created with length of the replicon along the x-axis and the number of replicon used on the y-axis. When a query sequence matches with a gene/protein of a particular replicon, the BLAST-results are depicted as an "x,y" position in a specially adapted plot. This tool allows to visualization of the results from the whole data to a particular gene/protein in real time with low computational resources.

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Development of Diagnostic SNP Markers To Monitor Hybridization Between Sika Deer (Cervus nippon) and Wapiti (Cervus elaphus)

Sika deer (Cervus Nippon) and wapiti (Cervus elaphus) are closely related species and their hybridization can result in significant allele-shift of their gene pool. Additive genetic effects and putative heterotic effects of their hybridization on growth performance could confer considerable economic advantage in deer farming. Here, we used double-digest restriction site-associated DNA sequencing technology (ddRAD-seq) and detected ~320,000 genome-wide SNPs from 30 captive individuals: 7 sika deer, 6 wapiti and 17 F1 hybrids (reciprocal cross). By screening observed heterozygosity of each SNP across four taxonomic groups, we report for the first time a resource of 2,015 putative diagnostic SNP markers (species-specific SNPs for sika deer and wapiti), which can be used to design tools for assessing or monitoring the degree of hybridization between sika deer and wapiti. These ddRAD-seq data and SNP datasets are also valuable resources for genome-wide studies, including trait discovery for breeders of domestic deer.

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Prediction of Central Neuropathic Pain in Spinal Cord Injury Based on EEG Classifier

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Induced lumbosacral radicular symptom referral patterns: A descriptive study

Lumbosacral radicular symptoms are commonly evaluated in clinical practice. Level specific diagnosis is crucial for management. Clinical decisions are often made by correlating a patient's symptom distribution and imaging with sensory dermatomal maps. It is not uncommon for patients to describe non-dermatomal symptom patterns or for imaging to demonstrate pathology at levels not predicted by a dermatomal map. These observations suggest that the referred symptom distribution from lumbosacral nerve root provocation is different from dermatomal maps.

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Prophylactic perioperative dexamethasone decreases the incidence of post-operative c5 palsies following a posterior cervical laminectomy and fusion

Post-operative C5 Palsy is a well-known complication of cervical decompression procedures. Studies have shown that posterior laminectomy and fusions confer the greatest risk of C5 palsy. Despite this, pharmacologic preventive measures remain unknown. We hypothesize that prophylactic perioperative dexamethasone will decrease the rate of post-operative C5 palsy in patients undergoing a multilevel posterior cervical laminectomy and fusion.PURPOSE: The purpose of this study was to assess the safety and efficacy of prophylactic perioperative dexamethasone in decreasing the rate of post-operative C5 palsy.

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Five year follow-up of clinical and radiological outcomes of LP ESP elastomeric lumbar total disc replacement in active patients

The surgical treatment of degenerative disc disease (DDD) at the lumbar spine may involve fusion. TDR is an alternative treatment to avoid fusion related adverse events, specifically adjacent segment disease. New generation of elastomeric non-articulating devices have been developed to more effectively replicate the shock absorption and flexural stiffness of native disc.

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Return to work following surgery for lumbar radiculopathy: A systematic review

Informing patients about postoperative return to work (RTW) expectations is of utmost importance because of the influence of realistic expectations on RTW outcomes.

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Surgical treatment for severe and rigid scoliosis: A case-matched study between idiopathic scoliosis and syringomyelia-associated scoliosis

Treatment guidelines for severe and rigid syringomyelia-associated scoliosis (SRSMS) are limited. Typically, surgeons apply practice guidelines for severe and rigid idiopathic scoliosis (SRIS) to treat SRSMS. No study has directly compared the results of surgical treatment between patients with SRSMS and those with SRIS.

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A novel in vivo large animal model of lumbar spinal joint degeneration

Degenerative disc disease (DDD) is a common, widespread socio-economic problem. Appropriate large animal models of DDD are required for improved understanding and to serve as pre-clinical test beds for therapeutic strategies

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Patient-reported allergies predict postoperative outcomes and psychosomatic markers following spine surgery

Prior studies have shown that patient-reported allergies can be prognostic of poorer postoperative outcomes.

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These 3 body armor options keep EMS safety top of mind

Choose armor that gives your staff the comfort and flexibility they need to save more lives

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A Pilot Study of a Novel Automated Somatosensory Evoked Potential (SSEP) Monitoring Device for Detection and Prevention of Intraoperative Peripheral Nerve Injury in Total Shoulder Arthroplasty Surgery

Introduction: Peripheral nerve injury is a potentially devastating complication after total shoulder arthroplasty (TSA) surgery. This pilot study aimed to assess the feasibility of using an automated somatosensory evoked potential (SSEP) device to provide a timely alert/intervention to minimize intraoperative nerve insults during TSA surgery. Methods: A prospective, single-arm, observational study was conducted in a single university hospital. The attending anesthesiologist monitored the study participants using the EPAD automated SSEP device and an intervention was made if there was an alert during TSA surgery. The median, radial, and ulnar nerve SSEP on the operative arm, as well as the median nerve SSEP of the nonoperative arm were monitored for each patient. All patients were evaluated for postoperative neurological deficits 6 weeks postoperatively. Results: In total, 21 patients were consented and were successfully monitored. In total, 4 (19%) patients developed intraoperative abnormal SSEP signal changes in the operative arm, in which 3 were reversible and 1 was irreversible till the end of surgery. Median and radial nerves were mostly involved (3/4 patients). The mean cumulative duration of nerve insult (abnormal SSEP) was 21.7±26.2 minutes. Univariate analysis did not identify predictor of intraoperative nerve insults. No patients demonstrated postoperative peripheral neuropathy at 6 weeks. Conclusions: A high incidence (19%) of intraoperative nerve insult was observed in this study demonstrating the feasibility of using an automated SSEP device to provide a timely alert and enable an intervention in order to minimize peripheral nerve injury during TSA. Further randomized studies are warranted. The study (IRB #107438) was approved by Lawson Health Research Institute, Western University. Clinical trial registration #: NCT02237599 (www.clinicaltrials.gov). J.C. is the archival author. J.M.M. is member of Scientific Advisory Board of SafeOp Surgical, Hunt Valley, MD. J.C. and D.D. has no conflicts of interest to disclose. Address correspondence to: Jason Chui, MBChB, FANZCA, C3-106, University Hospital, 339 Windermere Road, London, ON, Canada N6A 5A5 (e-mail: Jason.chui@lhsc.on.ca). Received January 31, 2018 Accepted March 29, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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Under the Knife: The History of Surgery in 28 Remarkable Operations

No abstract available

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Identifying Barriers to Implementation of the National Partnership for Maternal Safety Obstetric Hemorrhage Bundle at a Tertiary Center: Utilization of the Delphi Method

BACKGROUND: In 2015, the National Partnership for Maternal Safety (NPMS) developed an obstetric hemorrhage consensus bundle to provide birthing facilities in the United States with consistent, validated practice guidelines for postpartum hemorrhage management. The process of implementing each bundle element at a large tertiary labor and delivery unit has not been described; we sought to identify practice deficiencies and perceived barriers to bundle implementation among multidisciplinary providers. METHODS: We conducted a prospective, cross-sectional, consensus-building study based on the Delphi method. A multidisciplinary expert panel comprised of anesthesiologists, obstetricians, nurses, and surgical technicians was assembled and participated in 4 sequential questionnaires. The first round identified bundle elements that experts determined as not currently adequate and perceived barriers to implementation. The second round established prioritization of elements within each professional group; and the third round ranked the elements with at least 60% agreement on feasibility of implementation and positive impact on patient care. The last round revealed responses across all 4 professional groups to derive a final consensus. Descriptive statistics were performed. RESULTS: A total of 38 experts completed the study (11 anesthesiologists, 11 obstetricians, 10 nurses, and 6 surgical technicians). While all 13 (100%) NPMS obstetric bundle elements were described as deficient in our labor and delivery unit by a provider in at least 1 discipline, consensus among at least 3 of the 4 disciplines was achieved for 6 element deficiencies. Barriers to implementation were determined. The initiatives that achieved consensus as possessing high patient impact and implementation feasibility were protocol-driven management, unit-based simulation drills, blood loss quantification, and team huddles and debriefings. CONCLUSIONS: The NPMS obstetric hemorrhage bundle was created to help guide practice and systems improvement for US birthing facilities. The Delphi method enabled identification of deficient elements and perceived barriers to element implementation, as well as group consensus on elements with highest patient impact and feasibility. Multidisciplinary group consensus can identify deficiencies and promote tangible, quality improvements in a large, tertiary-care labor and delivery unit. Institutions may utilize our described technique to guide implementation of future care bundles. Accepted for publication April 12, 2018. Funding: Departmental. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Institutional Research Ethics Board: Partners HealthCare Institutional Review Board, Partners Human Research Committee, 116 Huntington Ave, Suite 1002, Boston, MA 02116. Clinical trial number and registry URL: NCT03018119 https://ift.tt/2IIP98H. Reprints will not be available from the authors. Address correspondence to Annemaria De Tina, MD, FRCPC, Department of Anesthesiology, McMaster University, Third Floor, 237 Barton St E, Hamilton, ON L8L 2X2, Canada. Address e-mail to detinaa@mcmaster.ca. © 2018 International Anesthesia Research Society

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Organ Donation After Circulatory Death: Ethical Issues and International Practices

Donation after circulatory death (DCD) is an increasingly utilized practice that can contribute to reducing the difference between the supply of organs and the demand for organs for transplantation. As the number of transplanted organs from DCD donors continues to increase, there is an essential need to address the ethical aspects of DCD in institutional DCD protocols and clinical practice. Ethical issues of respecting the end-of-life wishes of a potential donor, respecting a recipient's wishes, and addressing potential conflicts of interest are important considerations in developing policies and procedures for DCD programs. Although there may be diversity among DCD programs in Europe, Australia, Israel, China, the United States, and Canada, addressing ethical considerations in these DCD programs is essential to respect donors and recipients during the altruistic and generous act of organ donation. Accepted for publication April 12, 2018. Funding: None. The author declares no conflicts of interest. Reprints will not be available from the author. Address correspondence to Barbara G. Jericho, MD, FASA, Department of Anesthesiology, University of Illinois Hospital and Health Sciences System, 1740 W Taylor St, Suite 3200, M\C 515, Chicago, IL 60612. Address e-mail to jericho@uic.edu. © 2018 International Anesthesia Research Society

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“Modified Dynamic Needle Tip Positioning” Short-Axis, Out-of-Plane, Ultrasound-Guided Radial Artery Cannulation in Neonates: A Randomized Controlled Trial

BACKGROUND: Radial artery cannulation is extremely challenging in neonatal patients. Herein, we compared the success rate of the modified dynamic needle tip positioning short-axis, out-of-plane, ultrasound-guided technique with that of the traditional palpation technique in neonatal radial artery cannulation. METHODS: Sixty term neonates undergoing major abdominal surgery were randomized into the ultrasound or palpation group via the sealed-envelope method. The ultrasound group underwent radial artery cannulation using an ultrasonic apparatus, while traditional palpation of arterial pulsation was used in the palpation group. The arterial diameter and depth were measured on ultrasound before the puncture. We recorded age, weight, sex, and other background characteristics. The primary outcomes included the first-attempt, total success rates, and the total puncture procedure duration. Secondary outcomes included the incidence of complications (hematoma and thrombosis). Data were compared between the 2 groups. RESULTS: Sixty term neonates were enrolled in the study. The success rates of the first attempt in the ultrasound and palpation groups were 40% (n = 30) and 10% (n = 30), respectively (P = .007; relative risk, 4.0; 95% confidence interval, 1.3–12.8). The total success rate was 96.7% in the ultrasound group and 60.0% in the palpation group (P = .001; relative risk, 1.61; 95% confidence interval, 1.19–2.17). The average time to accomplish radial artery cannulation in the ultrasound and palpation groups was 91.4 ± 55.4 and 284.7 ± 153.6 seconds, respectively (P

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The Effect of Dexmedetomidine on Propofol Requirements During Anesthesia Administered by Bispectral Index-Guided Closed-Loop Anesthesia Delivery System: A Randomized Controlled Study

BACKGROUND: Dexmedetomidine, a selective α2-adrenergic agonist currently approved for continuous intensive care unit sedation, is being widely evaluated for its role as a potential anesthetic. The closed-loop anesthesia delivery system (CLADS) is a method to automatically administer propofol total intravenous anesthesia using bi-spectral index (BIS) feedback and attain general anesthesia (GA) steady state with greater consistency. This study assessed whether dexmedetomidine is effective in further lowering the propofol requirements for total intravenous anesthesia facilitated by CLADS. METHODS: After ethics committee approval and written informed consent, 80 patients undergoing elective major laparoscopic/robotic surgery were randomly allocated to receive GA with propofol CLADS with or without the addition of dexmedetomidine. Quantitative reduction of propofol and quality of depth-of-anesthesia (primary objectives), intraoperative hemodynamics, incidence of postoperative adverse events (sedation, analgesia, nausea, and vomiting), and intraoperative awareness recall (secondary objectives) were analyzed. RESULTS: There was a statistically significant lowering of propofol requirement (by 15%) in the dexmedetomidine group for induction of anesthesia (dexmedetomidine group: mean ± standard deviation 0.91 ± 0.26 mg/kg; nondexmedetomidine group: 1.07 ± 0.23 mg/kg, mean difference: 0.163, 95% CI, 0.04–0.28; P = .01) and maintenance of GA (dexmedetomidine group: 3.25 ± 0.97 mg/kg/h; nondexmedetomidine group: 4.57 ± 1.21 mg/kg/h, mean difference: 1.32, 95% CI, 0.78–1.85; P

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Interviewing in Social Science Research: A Relational Approach

No abstract available

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Perianesthetic and Anesthesia-Related Mortality in a Southeastern United States Population: A Longitudinal Review of a Prospectively Collected Quality Assurance Data Base

BACKGROUND: Perianesthetic mortality (death occurring within 48 hours of an anesthetic) continues to vary widely depending on the study population examined. The authors study in a private practice physician group that covers multiple anesthetizing locations in the Southeastern United States. This group has in place a robust quality assurance (QA) database to follow all patients undergoing anesthesia. With this study, we estimate the incidence of anesthesia-related and perianesthetic mortality in this QA database. METHODS: Following institutional review board approval, data from 2011 to 2016 were obtained from the QA database of a large, community-based anesthesiology group practice. The physician practice covers 233 anesthetizing locations across 20 facilities in 2 US states. All detected cases of perianesthetic death were extracted from the database and compared to the patients' electronic medical record. These cases were further examined by a committee of 3 anesthesiologists to determine whether the death was anesthesia related (a perioperative death solely attributable to either the anesthesia provider or anesthetic technique), anesthetic contributory (a perioperative death in which anesthesia role could not be entirely excluded), or not due to anesthesia. RESULTS: A total of 785,467 anesthesia procedures were examined from the study period. A total of 592 cases of perianesthetic deaths were detected, giving an overall death rate of 75.37 in 100,000 cases (95% CI, 69.5–81.7). Mortality judged to be anesthesia related was found in 4 cases, giving a mortality rate of 0.509 in 100,000 (95% CI, 0.198–1.31). Mortality judged to be anesthesia contributory were found in 18 cases, giving a mortality of 2.29 in 100,000 patients (95% CI, 1.45–3.7). A total of 570 cases were judged to be nonanesthesia related, giving an incidence of 72.6 per 100,000 anesthetics (95% CI, 69.3–75.7). CONCLUSIONS: In a large, comprehensive database representing the full range of anesthesia practices and locations in the Southeastern United States, the rate of perianesthestic death was 0.509 in 100,000 (95% CI, 0.198–1.31). Future in-depth analysis of the epidemiology of perianesthetic deaths will be reported in later studies. Accepted for publication April 20, 2018. Funding: Departmental. The authors declare no conflicts of interest. This study was presented in part at the International Anesthesia Research Society Annual Meeting, Washington, DC, May 6, 2017. Reprints will not be available from the authors. Address correspondence to Richard Pollard, MD, FASA, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215. Address e-mail to rpollard@bidmc.harvard.edu. © 2018 International Anesthesia Research Society

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Does Respiratory Variation in Inferior Vena Cava Diameter Predict Fluid Responsiveness in Mechanically Ventilated Patients? A Systematic Review and Meta-analysis

BACKGROUND: We performed a systematic review and meta-analysis of studies investigating the diagnostic accuracy of respiratory variation in inferior vena cava diameter (ΔIVC) for predicting fluid responsiveness in patients receiving mechanical ventilation. METHODS: MEDLINE, EMBASE, the Cochrane Library, and Web of Science were screened from inception to February 2017. The meta-analysis assessed the pooled sensitivity, specificity, diagnostic odds ratio, and area under the receiver operating characteristic curve. In addition, heterogeneity and subgroup analyses were performed. RESULTS: A total of 12 studies involving 753 patients were included. Significant heterogeneity existed among the studies, and meta-regression indicated that ventilator settings were the main sources of heterogeneity. Subgroup analysis indicated that ΔIVC exhibited better diagnostic performance in the group of patients ventilated with tidal volume (TV) ≥8 mL/kg and positive end-expiratory pressure (PEEP) ≤5 cm H2O than in the group ventilated with TV 5 cm H2O, as demonstrated by higher sensitivity (0.80 vs 0.66; P = .02), specificity (0.94 vs 0.68; P 5 cm H2O, this threshold was 14% ± 5%. CONCLUSIONS: ΔIVC shows limited ability for predicting fluid responsiveness in distinct ventilator settings. In patients with TV ≥8 mL/kg and PEEP ≤5 cm H2O, ΔIVC was an accurate predictor of fluid responsiveness, while in patients with TV 5 cm H2O, ΔIVC was a poor predictor. Thus, intensivists must be cautious when using ΔIVC. Accepted for publication April 16, 2018. Funding: This study was supported by the grants from Sun Yat-Sen University Clinical Research 5010 Program (2007015). The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). X. Si and H. Xu contributed equally and share first authorship. Reprints will not be available from the authors. Address correspondence to Xiangdong Guan, PhD, MD, Department of Surgical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan No. 2 Rd, Guangzhou, People's Republic of China. Address e-mail to guanxiangdong1962@163.com. © 2018 International Anesthesia Research Society

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Halving the Volume of AnaConDa: Evaluation of a New Small-Volume Anesthetic Reflector in a Test Lung Model

BACKGROUND: Volatile anesthetics are increasingly used for sedation in intensive care units. The most common administration system is AnaConDa-100 mL (ACD-100; Sedana Medical, Uppsala, Sweden), which reflects volatile anesthetics in open ventilation circuits. AnaConDa-50 mL (ACD-50) is a new device with half the volumetric dead space. Carbon dioxide (CO2) can be retained with both devices. We therefore compared the CO2 elimination and isoflurane reflection efficiency of both devices. METHODS: A test lung constantly insufflated with CO2 was ventilated with a tidal volume of 500 mL at 10 breaths/min. End-tidal CO2 (EtCO2) partial pressure was measured using 3 different devices: a heat-and-moisture exchanger (HME, 35 mL), ACD-100, and ACD-50 under 4 different experimental conditions: ambient temperature pressure (ATP), body temperature pressure saturated (BTPS) conditions, BTPS with 0.4 Vol% isoflurane (ISO-0.4), and BTPS with 1.2 Vol% isoflurane. Fifty breaths were recorded at 3 time points (n = 150) for each device and each condition. To determine device dead space, we adjusted the tidal volume to maintain normocapnia (n = 3), for each device. Thereafter, we determined reflection efficiency by measuring isoflurane concentrations at infusion rates varying from 0.5 to 20 mL/h (n = 3), for each device. RESULTS: EtCO2 was consistently greater with ACD-100 than with ACD-50 and HME (ISO-0.4, mean ± standard deviations: ACD-100, 52.4 ± 0.8; ACD-50, 44.4 ± 0.8; HME, 40.1 ± 0.4 mm Hg; differences of means of EtCO2 [respective 95% confidence intervals]: ACD-100 − ACD-50, 8.0 [7.9–8.1] mm Hg, P

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Perioperative Peripheral Nerve Injury After General Anesthesia: A Qualitative Systematic Review

Perioperative peripheral nerve injury (PNI) is a well-recognized complication of general anesthesia that continues to result in patient disability and malpractice claims. However, the multifactorial etiology of PNI is often not appreciated in malpractice claims given that most PNI is alleged to be due to errors in patient positioning. New advances in monitoring may aid anesthesiologists in the early detection of PNI. This article reviews recent studies of perioperative PNI after general anesthesia and discusses the epidemiology and potential mechanisms of injury and preventive measures. We performed a systematic literature search, reviewed the available evidence, and identified areas for further investigation. We also reviewed perioperative PNI in the Anesthesia Closed Claims Project database for adverse events from 1990 to 2013. The incidence of perioperative PNI after general anesthesia varies considerably depending on the type of surgical procedure, the age and risk factors of the patient population, and whether the detection was made retrospectively or prospectively. Taken together, studies suggest that the incidence in a general population of surgical patients undergoing all types of procedures is

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Anesthesia and Neurotoxicity

No abstract available

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Fecal Microbial Transplant in Children With Ulcerative Colitis: A Randomized, Double Blinded, Placebo-Controlled Pilot Study Retraction

No abstract available

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Hypothermia Decreases O2 Cost for ex vivo Contraction in Mouse Skeletal Muscle

Introduction Evidence suggests that the energy efficiency of key ATPases involved in skeletal muscle contractile activity are improved in a hypothermic condition. However, it is unclear how a decrease in temperature affects skeletal muscle O2 consumption (mVO2) induced by muscle contraction. Methods Isolated mouse extensor digitorum longus (EDL) muscles were incubated in a temperature-controlled (37°C or 25°C) bath that included an O2 probe. EDL muscles from one limb were subjected to the measurement of resting mVO2, and the contralateral EDL muscles were used for the measurement of mVO2 with electrically-stimulated contraction. For the resting protocol, muscles were suspended at resting tension for 15 mins with continuous O2 recordings. For the contraction protocol, EDL muscles underwent ten electrically-stimulated isometric contractions with continuous O2 recordings for 15 mins. The rate of O2 disappearance was quantified as μmole O2 per minute and normalized to the wet weight of the muscle. Results Resting mVO2 was greater at 37°C than at 25°C, consistent with the idea that lower temperature reduces basal metabolic rate. Electrically-stimulated contraction robustly increased mVO2 at both 37°C and 25°C, which was sustained for ~3 min post-contraction. During that period, mVO2 was elevated ~5-fold at both 37°C and 25°C. Greater contraction-induced mVO2 at 37°C compared to 25°C occurred despite lower force generated at 37°C than at 25°C. Conclusion Together, O2 cost for muscle contraction (force-time integral per O2 consumed) was greater at 37°C than at 25°C. Levels of high-energy phosphates were consistent with greater energy demand at 37°C compared to 25°C. In conclusion, these results indicate that muscle contraction that occurs at subnormal temperature requires less O2 than at 37°C. These authors contributed equally for the study. Patrick J. Ferrara and Anthony R.P. Verkerke. Corresponding Author: Katsuhiko Funai, Ph.D. University of Utah, 15 North 2030 East, EIHG 3145, Salt Lake City, UT 84112, USA. Email: kfunai@health.utah.edu This work was funded by NIH grants DK095774, DK107397, and DK109888 to KF and AR070200 to JJB, and by American Heart Association grant 18PRE33960491 to ARPV. Conflict of Interest: We have no conflict of interest to report. The results of the present study do not constitute endorsement by ACSM and are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 14 May 2018 © 2018 American College of Sports Medicine

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Isometric versus Dynamic Measurements of Fatigue: Does Age Matter? A Meta-analysis

Purpose The assessment of power changes after fatiguing exercise provides important additional information about neuromuscular function compared to traditional isometric measurements, especially when exploring age-related changes in fatigability. Therefore, the aim of this review was to explore the effects of age on neuromuscular fatigue (NMF) when measured in isometric compared with dynamic contractions. The importance of central and peripheral mechanisms contributing to age-related NMF were discussed. Methods Medline, EMBASE, Cochrane Central Register of Controlled Trials, and SPORT Discus databases were searched. The combination of terms related to the intervention (fatiguing exercise), population (old people) and outcomes (isometric force and power) were used. This meta-analysis was registered on PROSPERO (CRD42016048389). Results Thirty-one studies were included. The meta-analyses revealed that force decrease was greater (there was more NMF) in young subjects than their older counterparts when fatigue was induced by isometric tasks (ES = 0.913, CI = 0.435 to 1.391, P

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Maternal Physical Activity and Sex Impact Markers of Hepatic Mitochondrial Health

Introduction Maternal exercise and physical activity during the gestational period can be protective against maternal high fat diet-induced hepatic steatosis in older offspring. However, it is unknown whether these protective effects are seen in younger offspring. Here we investigated whether maternal physical activity would attenuate maternal western diet (WD)-induced steatosis in young adult rats. Methods Female Wistar rats (7-8 weeks of age) were randomized into WD (42% fat, 27% sucrose) or normal chow diet (ND), and further randomized into physical activity (RUN) or sedentary (SED) conditions for a total of four groups. Dams returned to ND/SED conditions following parturition. Post-weaning, offspring were maintained in ND/SED conditions for 18 weeks. Results Maternal WD-induced increases in male offspring body mass was attenuated in the WD/RUN offspring (p

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Factors Contributing to Medial Tibial Stress Syndrome in Runners: A Prospective Study

Purpose Medial tibial stress syndrome (MTSS) is one of the most common overuse injuries sustained by runners. Despite the prevalence of this injury, risk factors for developing MTSS remain unclear. The purpose of this study was to prospectively evaluate differences in passive range of motion, muscle strength, plantar pressure distributions, and running kinematics between runners who developed MTSS and those who did not. Methods 24 NCAA Division 1 cross country runners participated in this study. Participants underwent a clinical exam documenting passive range of motion and muscle strength at the hips and ankles. Plantar pressure analysis was used to quantify mediolateral pressure balances while walking and 3D motion capture was used to quantify running kinematics. Participants were followed for a two year period during which time any runners who developed MTSS were identified by the team's certified athletic trainer. Results Runners who developed MTSS demonstrated tighter iliotibial bands (p=.046, ES=1.07), weaker hip abductors (p=.008, ES=1.51), more pressure under the medial aspect of their foot at initial foot contact(p=.001, ES=1.97), foot flat(p<.001 es="3.25)," and heel off greater contralateral pelvic drop peak amounts durations of rearfoot eversion during stance phase. a logistic regression p indicated that every increase in duration increased odds developing mtss by conclusions these findings demonstrate the development is multifactorial with passive range motion muscle strength plantar pressure distributions both proximal distal kinematics all playing role. we suggest coaches or sports medicine professionals screening runners for injury risk consider adopting comprehensive evaluation which includes areas. corresponding author: dr. james becker department health human hoseaus fitness center montana state university bozeman mt james.becker4 no funding was received this work. authors have conflicts interest to declare. results study are presented clearly honestly without fabrication falsification inappropriate data manipulation. present do not constitute endorsement american college medicine. accepted publication: may>

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First-line genomic diagnosis of mitochondrial disorders

First-line genomic diagnosis of mitochondrial disorders

First-line genomic diagnosis of mitochondrial disorders, Published online: 22 May 2018; doi:10.1038/s41576-018-0022-1

Current approaches for diagnosing mitochondrial disorders involve specialist clinical assessment, biochemical analyses and targeted molecular genetic testing. There is now a strong rationale for undertaking first-line genome-wide sequencing, accelerating the speed of diagnosis and avoiding the need for expensive and invasive investigations.

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The personal and clinical utility of polygenic risk scores

The personal and clinical utility of polygenic risk scores

The personal and clinical utility of polygenic risk scores, Published online: 22 May 2018; doi:10.1038/s41576-018-0018-x

Polygenic risk profiling can lead to actionable outcomes for individuals at high risk of developing a subset of common adult-onset polygenic diseases. The authors review recent studies that have demonstrated the utility of polygenic risk scores for disease risk stratification and their potential impact on early disease detection, prevention, therapeutic intervention and life planning.

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Precise detection of de novo single nucleotide variants in human genomes [Genetics]

The precise determination of de novo genetic variants has enormous implications across different fields of biology and medicine, particularly personalized medicine. Currently, de novo variations are identified by mapping sample reads from a parent–offspring trio to a reference genome, allowing for a certain degree of differences. While widely used, this...

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Reducing resistance allele formation in CRISPR gene drive [Genetics]

CRISPR homing gene drives can convert heterozygous cells with one copy of the drive allele into homozygotes, thereby enabling super-Mendelian inheritance. Such a mechanism could be used, for example, to rapidly disseminate a genetic payload in a population, promising effective strategies for the control of vector-borne diseases. However, all CRISPR...

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Suppressor mutation analysis combined with 3D modeling explains cohesin’s capacity to hold and release DNA [Genetics]

Cohesin is a fundamental protein complex that holds sister chromatids together. Separase protease cleaves a cohesin subunit Rad21/SCC1, causing the release of cohesin from DNA to allow chromosome segregation. To understand the functional organization of cohesin, we employed next-generation whole-genome sequencing and identified numerous extragenic suppressors that overcome either inactive...

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Emergency Reporting training is now eligible for GoArmyEd funding

GoArmyEd is an online portal used by over 122,000 Active Duty and Army Reserve students to help them achieve educational goals in a way that allows the Army to easily monitor and fund through the Army Tuition Assistance Program.

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First-line genomic diagnosis of mitochondrial disorders

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IAFC: Mobile technology can increase sudden cardiac arrest survival rates

The International Association of Fire Chiefs cited the PulsePoint app as a way to utilize responders and bystanders to increase sudden cardiac arrest survival

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The personal and clinical utility of polygenic risk scores

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Readmission after abdominal surgery for Crohn's disease: Identification of high-risk patients

Journal of Gastrointestinal Surgery

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Abnormal small intestinal epithelial microvilli in patients with Crohn's disease

Gastroenterology

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Impact of sustained virologic response with direct-acting antiviral treatment on mortality in patients with advanced liver disease

Hepatology

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Avatrombopag before procedures reduces need for platelet transfusion in patients with chronic liver disease and thrombocytopenia

Gastroenterology

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Next-generation sequencing analysis for gastric adenocarcinoma with enteroblastic differentiation: Emphasis on the relationship with hepatoid adenocarcinoma

Human Pathology

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Variation in interleukin 6 receptor gene associates with risk of Crohn’s disease and ulcerative colitis

Gastroenterology

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Temporary self-expandable metallic stent placement in post-gastrectomy complications

Gastric Cancer

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Fibrosis severity as a determinant of cause-specific mortality in patients with advanced nonalcoholic fatty liver disease

Gastroenterology

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The role of FDG-PET in detecting rejection after liver transplantation

Surgery

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Model to determine risk of pancreatic cancer in patients with new-onset diabetes

Gastroenterology

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Evaluating previous antibiotic use as a risk factor for acute gastroenteritis among children in Davidson County, Tennessee, 2014–2015

Journal of the Pediatric Infectious Diseases Society

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Challenges Associated with the Use of Policy to Identify and Manage Risk for Suicide and Interpersonal Violence Among Veterans and Other Americans

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Research Driven Policy: Is Financial Capacity Related to Dangerousness?

Abstract

Current Veterans administration policy directly links a Veteran's adjudged capacity to manage personal financial resources with their ability to purchase or possess a firearm, pursuant to the regulatory authority of the National Instant Criminal Background Check System (NICS). Preventing Veterans' suicide is a highly laudable public health objective. Effectively utilizing scientific research to "inform" public policy is equally important. The authors should be congratulated for their efforts. However, it is important in utilizing large set population-based data, especially social science data, to evaluate policy alternatives that there be substantial face (i.e., clinical) validity. Correlation does not necessarily represent causation.

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Cranial vault thickness variation and inner structural organization in the StW 578 hominin cranium from Jacovec Cavern, South Africa

Publication date: Available online 21 May 2018
Source:Journal of Human Evolution
Author(s): Amélie Beaudet, Kristian J. Carlson, Ronald J. Clarke, Frikkie de Beer, Jelle Dhaene, Jason L. Heaton, Travis R. Pickering, Dominic Stratford
The Sterkfontein Caves site is one of the richest early hominin fossil localities in Africa. More specifically, the fossiliferous deposits within the lower-lying Jacovec Cavern have yielded valuable hominin remains; prominent among them is the Australopithecus partial cranium StW 578. Due to the fragmentary nature of the braincase, the specimen has not yet been formally assigned to a species. In this context, we employ microtomography to quantify cranial thickness and composition of StW 578 in order to assess its taxonomic affinity. As comparative material, we investigate 10 South African hominin cranial specimens from Sterkfontein (StW 505, Sts 5, Sts 25, Sts 71), Swartkrans (SK 46, SK 48, SK 49) and Makapansgat (MLD 1, MLD 10, MLD 37/38), attributed to either Australopithecus or Paranthropus, as well as 10 extant human and 10 extant chimpanzee crania. Thickness variation in and structural arrangement of the inner and outer cortical tables and the diploë are automatically assessed at regular intervals along one parasagittal and one coronal section. Additionally, topographic cranial vault thickness distribution is visualized using color maps. Comparisons highlight an absolutely and relatively thickened condition of the StW 578 cranial vault versus those of other South African Plio-Pleistocene hominins. Moreover, in StW 578, as well as in the Australopithecus specimens Sts 5 and Sts 71 from Sterkfontein, the diploic layer contributes substantially to cumulative vault thickness (i.e., >60%). Within the comparative sample investigated here, StW 505 and Sts 71 from Sterkfontein Member 4, both attributed to Australopithecus, most closely resemble StW 578 in terms of cranial vault thickness values, tissue proportions, and two- and three-dimensional distributions. Including additional Plio-Pleistocene Australopithecus and Paranthropus crania from South and East Africa in future studies would further help establish morphological variability in these hominin taxa.



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Dietary signals in the premolar dentition of primates

Publication date: Available online 21 May 2018
Source:Journal of Human Evolution
Author(s): Jeremiah E. Scott, Ryan M. Campbell, Luisa M. Baj, Maegan C. Burns, Mia S. Price, Jaime D. Sykes, Christopher J. Vinyard
Dietary adaptations specific to the premolar row remain largely undocumented across primates. This study examines how relative premolar size varies among broad dietary groups (i.e., folivores, frugivores, insectivores, hard-object feeders) using a phylogenetically and ecologically diverse sample of species. We quantified relative premolar size with shape ratios computed using mandibular length, body mass, palate area, and M¹ area to evaluate hypotheses that link variation in relative premolar size to differences in tooth loading, energy requirements, the probability of tooth-food-tooth contact during mastication, and shifts in preferred bite point. Our results revealed the following dietary signals. First, primate folivores have large premolar rows relative to palate area in comparison to frugivores and insectivores. This contrast is consistent with the hypothesis that folivores require large postcanine teeth relative to the size of the oral cavity to increase the probability of particle fracture during mastication. Second, hard-object feeders are distinct from other groups in having P⁴s that are large relative to their M¹s. This morphology is not associated with an increase in the size of the premolar row relative to mandibular length. This combination challenges the idea that hard-object feeders have large premolars as an adaptive response to resisting the loads incurred when processing mechanically challenging foods. We therefore interpret the large P⁴/M¹ ratios of hard-object feeders as indicating greater functional integration across the premolar-molar boundary owing to a mesial shift in preferred bite point. Finally, in a restricted subset of anthropoids, we found that, relative to mandibular length, premolar area increases with dietary elastic modulus (E) and toughness (R), indicating that relative premolar size is evolutionarily sensitive to food mechanical properties. Thus, our results show that relative premolar size is correlated with diet, highlighting the importance of this region for understanding the evolutionary history of primate dietary adaptations.



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Introduction of a modified double-lumen tube

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Relationship between fresh frozen plasma to packed red blood cell transfusion ratio and mortality in cardiovascular surgery

Abstract

Purpose

The aim of this study was to examine the relationship between FFP (fresh frozen plasma)/pRBC (packed red blood cell) transfusion ratio and outcomes in patients undergoing cardiovascular surgery.

Methods

This is a single center retrospective cohort study performed in a cardiovascular center. Patients undergoing cardiovascular surgery between January 2012 and October 2016 with or without massive transfusion (n = 1453). Patients' outcomes were compared based on FFP/pRBC transfusion ratio (FFP/pRBC > 1 or FFP/pRBC ≤ 1).

Results

In hospital mortality and rate of stroke and myocardial infarction was significantly higher in patients with less than 1 of FFP/pRBC transfusion ratio only in patients with massive transfusion (3.0 vs 8.8%, p = 0.001; 0.7 vs 6.4%, p < 0.001; 1.0 vs 3.2%, p = 0.047, respectively).

Conclusions

Higher FFP/RBC ratio was associated with reduced risk of death, stroke and myocardial infarction only in patients with cardiovascular surgery receiving massive transfusion. Clinicians should be aware that judicious FFP replacement plays a critical role in the successful management of massive transfusion in cardiac surgery.

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