Τρίτη, 12 Ιουνίου 2018

Clinical and MRI changes of puborectalis and iliococcygeus after a short period of intensive pelvic floor muscles training with or without instrumentation

Abstract

Purpose

This study evaluates the impact of a 3-week period of intensive pelvic floor muscles training (PFMT), with or without instrumentation, on clinical and static magnetic resonance imaging (MRI) changes of puborectalis (PR) and iliococcygeus (IL) muscles.

Methods

24 healthy young women were enrolled in the study and 17 achieved the 9 sessions of 30 min training exercises and conducted all assessments. Participants were randomly assigned in two training groups: voluntary contractions combined with hypopressive exercises (HYPO) or biofeedback exercises combined with transvaginal electrical stimulations (ELEC). Clinical and T2-weighted MRI assessments were realized before and after training.

Results

Modified Oxford Grading System (MOGS) scores for left PR and perineal body significantly increased in the two groups (p = 0.039, p = 0.008), but MOGS score for right PR significantly increased only in HYPO (p = 0.020). Muscle volumes of right and left IL significantly decreased (p = 0.040, p = 0.045) after training as well as signal intensities of right and left PR (p = 0.040, p = 0.021) and thickness of right and left IL at mid-vagina location (p = 0.012, p = 0.011).

Conclusions

A short period of intensive PFMT induces clinical and morphological changes in PFMs at rest suggesting a decrease in IL volume and adipose content of PR. Although the results suggested that an intensive non-instrumented PFMT is as effective as an instrumented training, future controlled studies with greater sample sizes are needed to establish the relative and absolute effectiveness of each of the two interventions.



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Characteristics of Resistance Mechanisms and Molecular Epidemiology of Fluoroquinolone-Nonsusceptible Salmonella enterica Serovar Typhi and Paratyphi A Isolates from a Tertiary Hospital in Dhaka, Bangladesh

Microbial Drug Resistance, Ahead of Print.


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Phenotypic and Molecular Characterization of Methicillin-Resistant Staphylococcus aureus Clones Carrying the Panton-Valentine Leukocidin Genes Disseminating in Iranian Hospitals

Microbial Drug Resistance, Ahead of Print.


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Improved Targeting and Tumor Retention of a Newly Synthesized Antineoplaston A10 Derivative by Intratumoral Administration: Molecular Docking, Technetium 99m Radiolabeling, and In Vivo Biodistribution Studies

Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.


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Anticipatory and compensatory postural adjustments in people with low back pain: a systematic review and meta-analysis,

Despite altered anticipatory (APAs) and compensatory postural adjustments (CPAs) being hypothesized to contribute to the onset and persistence of low back pain (LBP), results from studies comparing people with and without LBP are conflicting.

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The Effect of Psychosocial Measures of Resilience and Self-Efficacy in Patients with Neck and Lower Back Pain

Psychosocial risk factors may predispose to progression of back and neck pain to chronic pain or disability. Resilience (the ability to recover from stress) and pain self-efficacy (confidence that one can perform daily activities despite pain) are important psychometric properties shown to affect health and illness.

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Management of haemostatic alterations and associated disorders in cirrhosis in Spain: a national survey

knowledge of haematological abnormalities in cirrhosis has greatly improved in recent years.

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Student and Parent Perspectives on Severe Food Allergies at College

Constant vigilance to manage severe food allergies (FAs) can lead to high stress. Additional stress may develop during life-course transitions, such as the transition to college. However, few studies have evaluated everyday and FA-related stress in college students with FA and their parents. This analysis examined experiences of 26 college students with FA and their parents.

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Two-way mixed-effects methods for joint association analysis using both host and pathogen genomes [Statistics]

Infectious diseases are often affected by specific pairings of hosts and pathogens and therefore by both of their genomes. The integration of a pair of genomes into genome-wide association mapping can provide an exquisitely detailed view of the genetic landscape of complex traits. We present a statistical method, ATOMM (Analysis...

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CFH and VIPR2 as susceptibility loci in choroidal thickness and pachychoroid disease central serous chorioretinopathy [Genetics]

Central serous chorioretinopathy (CSC) is a common disease affecting younger people and may lead to vision loss. CSC shares phenotypic overlap with age-related macular degeneration (AMD). As recent studies have revealed a characteristic increase of choroidal thickness in CSC, we conducted a genome-wide association study on choroidal thickness in 3,418...

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Emotional misattribution: Facial muscle responses partially mediate behavioral responses in the emotion misattribution procedure

Psychophysiology, EarlyView.


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John T. Cacioppo (1951–2018)

Psychophysiology, EarlyView.


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What's in a blush? Physiological blushing reveals narcissistic children's social‐evaluative concerns

Psychophysiology, EarlyView.


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Clinical implication of FMR1 intermediate alleles in a Spanish population

Clinical Genetics, Volume 94, Issue 1, Page 153-158, July 2018.


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Issue Information ‐ Editorial Board

logo-header-1526603583437.png

Clinical Genetics, Volume 94, Issue 1, Page 1-1, July 2018.


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Discovery of 4 exonic and 1 intergenic novel susceptibility loci for leprosy

Clinical Genetics, EarlyView.


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Association between glutathione S‐transferase gene M1 and T1 polymorphisms and chronic obstructive pulmonary disease risk: A meta‐analysis

Clinical Genetics, EarlyView.


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Bilateral cerebellar cysts and cerebral white matter lesions with cortical dysgenesis: Expanding the phenotype of LAMB1 gene mutations

Clinical Genetics, EarlyView.


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Overlapping but distinct roles for NOTCH receptors in human cardiovascular disease

Clinical Genetics, EarlyView.


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Further audiovestibular characterization of DFNB77, caused by deleterious variants in LOXHD1, and investigation into the involvement of Fuchs corneal dystrophy

Clinical Genetics, EarlyView.


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Pathogenetic implication of fusion genes in acute promyelocytic leukemia and their diagnostic utility

Clinical Genetics, EarlyView.


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Genetic analysis of adult leukoencephalopathy patients using a custom‐designed gene panel

Clinical Genetics, EarlyView.


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Refining the phenotype associated with biallelic DNAJC21 mutations

Clinical Genetics, EarlyView.


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Influence of graviceptor stimulation initiated by off‐vertical axis rotation on ventilation

Experimental Physiology, EarlyView.


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Effects of losartan and allopurinol on cardiorespiratory regulation in obstructive sleep apnoea

Experimental Physiology, EarlyView.


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Efficacy of prophylactic dexmedetomidine in preventing postoperative junctional ectopic tachycardia in pediatric cardiac surgery patients: A systematic review and meta‐analysis

Pediatric Anesthesia, EarlyView.


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Low‐dose dexmedetomidine as an adjuvant to propofol infusion for children in MRI: A double‐cohort study

Pediatric Anesthesia, EarlyView.


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The Ayre's T‐piece turns 80: A 21st century review

Pediatric Anesthesia, EarlyView.


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Percutaneous endoscopic gastrostomy vs surgical gastrostomy in infants with congenital heart disease

Pediatric Anesthesia, EarlyView.


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Utility of gabapentin in meeting physical therapy goals following posterior spinal fusion in adolescent patients with idiopathic scoliosis

Pediatric Anesthesia, Volume 28, Issue 6, Page 558-563, June 2018.


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Arterial line cannulation in children: Is it time for guidelines?

Pediatric Anesthesia, Volume 28, Issue 6, Page 564-565, June 2018.


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Issue Information

Pediatric Anesthesia, Volume 28, Issue 6, Page i-iii,479, June 2018.


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Augmented reality for intravenous access in an autistic child with difficult access

Pediatric Anesthesia, Volume 28, Issue 6, Page 569-570, June 2018.


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An in vitro analysis of the dead space in 5 supraglottic airway devices intended for use in small children and infants

Pediatric Anesthesia, Volume 28, Issue 6, Page 570-572, June 2018.


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Reducing laryngeal mask airway cuff pressure: A quality improvement project

Pediatric Anesthesia, Volume 28, Issue 6, Page 568-569, June 2018.


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Investigating understanding in pediatric anesthesia informed consent

Pediatric Anesthesia, Volume 28, Issue 6, Page 565-566, June 2018.


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Core temperature measurement through the gastric channel of the i‐gel®

Pediatric Anesthesia, Volume 28, Issue 6, Page 566-567, June 2018.


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Precision and efficacy of a new ultrasound‐guided pudendal nerve block technique in children

Pediatric Anesthesia, Volume 28, Issue 6, Page 572-572, June 2018.


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In this issue June 2018

Pediatric Anesthesia, Volume 28, Issue 6, Page 481-481, June 2018.


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Meta‐analysis of brain mechanisms of chewing and clenching movements

Journal of Oral Rehabilitation, EarlyView.


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Tongue pressure measurement in children with mouth‐breathing behaviour

Journal of Oral Rehabilitation, EarlyView.


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Cover Image

Journal of Oral Rehabilitation, Volume 45, Issue 7, Page i-i, July 2018.


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Response to letter to the editor: “Does the presence of an occlusal indicator product affect the contact forces between full dentitions?”

Journal of Oral Rehabilitation, Volume 45, Issue 7, Page 574-574, July 2018.


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Issue Information

Journal of Oral Rehabilitation, Volume 45, Issue 7, Page ii-iv, July 2018.


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Letter to the Editor regarding “Does the presence of an occlusal indicator product affect the contact forces between full dentitions?” by Mitchem, Katona and Moser

Journal of Oral Rehabilitation, Volume 45, Issue 7, Page 571-573, July 2018.


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Splinted and unsplinted overdenture attachment systems: A systematic review and meta‐analysis

Journal of Oral Rehabilitation, EarlyView.


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Effect of tongue‐palate contact mode on food transport during mastication

Journal of Oral Rehabilitation, EarlyView.


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Two repetitive bouts of intense eccentric‐concentric jaw exercises reduce experimental muscle pain in healthy subjects

Journal of Oral Rehabilitation, EarlyView.


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Neurophysiological evidence of the dynamic and adaptive pain‐motor interaction

The Journal of Physiology, EarlyView.


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Robust and accurate decoding of motoneuron behaviour and prediction of the resulting force output

The Journal of Physiology, EarlyView.


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Dichotomous parvalbumin interneuron populations in dorsolateral and dorsomedial striatum

The Journal of Physiology, EarlyView.


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The role of dichloroacetate in improving acute hypoxic tolerance and cardiac function: translation to failing hearts?

The Journal of Physiology, EarlyView.


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No sympathy for the hypoxic: the role of fetal oxygenation in autonomic dysfunction

The Journal of Physiology, EarlyView.


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A bright forecast for autoregulation monitoring?

The Journal of Physiology, EarlyView.


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The independent effects of hypovolaemia and pulmonary vasoconstriction on ventricular function and exercise capacity during acclimatisation to 3800 m

The Journal of Physiology, EarlyView.


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Intracellular rupture, exocytosis and actin interaction of endocytic vacuoles in pancreatic acinar cells: initiating events in acute pancreatitis

The Journal of Physiology, EarlyView.


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Impact of the 340B Pharmacy Program on Services and Supports for Persons Served by Hemophilia Treatment Centers in the United States

Abstract

Purpose Hemophilia Treatment Centers (HTCs) provide integrated and comprehensive services to individuals affected with rare bleeding disorders, such as hemophilia and Von Willebrand disease. Through the 340 Drug Pricing Program, HTCs may use pharmacy income to support clinical staff and patient services. The objective of this study was to describe the impact of the 340B program funding on services and support provided by HTCs to persons affected by rare bleeding disorders. Description Federally designated comprehensive HTCs with established 340B programs were invited to participate in a mailed survey in 2014. Participants were requested to report on 340B program-funded staff and services in the calendar year 2013. Assessment The 31 of 37 HTCs responding served over 10,000 individuals, or one-third of the national HTC patient population. The majority of responding HTCs reported that 340B program income supported over 90% of staff such as nurses, social workers, and physical therapists. Conclusion The results from this survey of 31 centers with established programs demonstrates the HTCs' reliance on 340B program support for vital comprehensive services, that are otherwise non-reimbursable, and highlights the importance of the 340B program in sustaining the high quality of care and in increasing access for a geographically dispersed, medically vulnerable population.



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Bilateral Mydriasis Secondary to Propofol Administration in a Patient With Hypertensive Cerebellar Hemorrhage

No abstract available

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Complexity, Variation, and the Ever-moving Cheese

imageNo abstract available

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Journal Club

No abstract available

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A Narrative Review of Adherence to Subarachnoid Hemorrhage Guidelines

imageOver the past 2 decades, a large number of guidelines for aneurysmal subarachnoid hemorrhage (aSAH) management have been proposed. The primary aim of these "evidence-based" guidelines is to improve the care of aSAH patients by summarizing and making current knowledge readily available to clinicians. However, an investigation into aSAH guidelines, their changes along time and their successful translation into clinical practice is still lacking. We performed a literature search of historical events and subarachnoid hemorrhage guidelines using the Entrez PubMed NIH, Embase, and Cochrane databases for articles published up to November of 2016. Data were summarized for guidelines on aSAH management and cross-sectional studies of their application. A total of 11 guidelines and 10 cross-sectional studies on aSAH management were analyzed. The use of nimodipine for the treatment of SAH is the only recommendation that remained consistent across guidelines over time (r=0.82; P

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Spurious Hypoxemia During Craniotomy

imageNo abstract available

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General Anesthesia and Young Brain: What is New?

Considering that growing population of very young children is exposed to general anesthesia every year, it is of utmost importance to understand how and whether such practice may affect the development and growth of their very immature and vulnerable brains. Compelling evidence from animal studies suggests that an early exposure to general anesthesia is detrimental to normal brain development leading to structural and functional impairments of neurons and glia, and long-lasting impairments in normal emotional and cognitive development. Although the evidence from animal studies is overwhelming and confirmed across species examined from rodents to non–human primates, the evidence from human studies is inconsistent and not conclusive at present. In this review we focus on new developments in animal studies of anesthesia-induced developmental neurotoxicity and summarize recent clinical studies while focusing on outcome measures and exposure variables in terms of their utility for assessing cognitive and behavioral development in children.

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Epidural Blood Patch in Children Under Anesthesia: Is There an Indication for Neuromonitoring?

imageNo abstract available

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Endovascular Treatment of Acute Ischemic Stroke Under General Anesthesia: Predictors of Good Outcome

imageBackground: The choice of anesthetic technique, general anesthesia (GA) versus Monitored Anesthesia Care, may impact the outcome of patients undergoing endovascular treatment of acute ischemic stroke (AIS). The aim of this study was to identify the factors associated with good discharge outcome in patients receiving GA for AIS. Materials and Methods: Electronic medical records of patients above 18 years old who underwent endovascular treatment of AIS under GA at a Comprehensive Stroke Center from 2010 to 2014 were reviewed. Good outcome was defined as discharge modified Rankin Score 0 to 2 and poor outcome as modified Rankin Score 3 to 6; logistic regression analysis was performed to examine the association between the clinical characteristics and the outcome. Results: In total, 88 patients (56 males), aged 63±15 years with median National Institute of Health Stroke Scale (NIHSS) score 16 (range, 4 to 38) were included. Nineteen (22%) patients had good outcome and 78 (88%) had systolic blood pressure below the guideline recommended 140 mm Hg under GA. After adjusting for age and NIHSS score, the independent predictors of good discharge outcomes were higher maximum end-tidal carbon dioxide (odds ratio [OR], 1.14; confidence interval [CI], 1.02-1.28; P=0.02) and extubation after endovascular treatment (OR, 26.31; CI, 4.80-144.12; P

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Cerebral Sinus Thrombosis in Parturient

imageNo abstract available

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Scheduled Intravenous Acetaminophen Improves Patient Satisfaction With Postcraniotomy Pain Management: A Prospective, Randomized, Placebo-controlled, Double-blind Study

imageBackground: Postcraniotomy pain can be difficult to manage with opioids due to opioid-related side effects, including drowsiness, nausea/vomiting, confusion, and pupillary changes, potentially masking the signs of postoperative neurological deterioration. Intravenous (IV) acetaminophen, a nonopioid analgesic, has been reported to have opioid-sparing effects after abdominal and orthopedic surgeries. This study investigates whether IV acetaminophen has similar effects after craniotomy. Materials and Methods: In this prospective, randomized, placebo-controlled, double-blind clinical trial, 100 adult patients scheduled to undergo supratentorial craniotomy for excision of a brain mass were randomized to receive either IV acetaminophen or placebo preincision and then every 6 hours for a total of 24 hours after surgery. Total 24-hour opioid consumption, pain scores, satisfaction with overall pain management, time to meet postanesthesia care unit discharge criteria, and incidence of opioid-related side effects were compared. Results: There was no difference in the 24-hour postoperative opioid consumption in morphine equivalents between the IV acetaminophen group (median, 11 mg; n=45) and the placebo group (median, 10.1 mg; n=41). No statistically significant difference of visual analog scale pain score was observed between 2 treatment groups. Patient satisfaction with overall postoperative pain management was significantly higher in the IV acetaminophen group than the placebo group on a 1 to 10 scale (8.1±0.4 vs. 6.9±0.4; P=0.03). There was no significant difference in secondary outcomes, including the incidence of opioid-related side effects. Conclusions: IV acetaminophen, as adjunctive therapy for craniotomy procedures, did not show an opioid-sparing effect in patients for the 24 hours after craniotomy; however, it was associated with improved patient satisfaction regarding overall pain control.

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JNA Editorial – July 2018

No abstract available

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Ventilation With High or Low Tidal Volume With PEEP Does Not Influence Lung Function After Spinal Surgery in Prone Position: A Randomized Controlled Trial

imageBackground: Spinal surgery in the prone position is accompanied by increased intrathoracic pressure and decreased respiratory compliance. This study investigated whether intraoperative lung protective mechanical ventilation improved lung function evaluated with pulmonary function tests in patients at risk of postoperative pulmonary complications (PPCs) after major spinal surgery in the prone position. Methods: Seventy-eight patients at potential risk of PPCs were randomly assigned to the protective group (tidal volume; 6 mL/kg predicted body weight, 6 cm H2O positive end-expiratory pressure with recruitment maneuvers) or the conventional group (10 mL/kg predicted body weight, no positive end-expiratory pressure). The primary efficacy variables were assessed by pulmonary function tests, performed before surgery, and 3 and 5 days afterward. Results: Postoperative forced vital capacity (2.17±0.1 L vs. 1.91±0.1 L, P=0.213) and forced expiratory volume in 1 second (1.73±0.08 L vs. 1.59±0.08 L, P=0.603) at postoperative day (POD) 3 in the protective and conventional groups, respectively, were similar. Trends of a postoperative decrease in forced vital capacity (P=0.586) and forced expiratory volume in 1 second (P=0.855) were similar between the groups. Perioperative blood-gas analysis variables were comparable between the groups. Patients in the protective and conventional groups showed similar rates of clinically significant PPCs (8% vs. 10%, P>0.999). Conclusions: In patients at potential risk of developing PPCs undergoing major spinal surgery, we did not find evidence indicating any difference between the lung protective and conventional ventilation in postoperative pulmonary function and oxygenation.

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Safety of Sodium Bicarbonate for Control of ICP (Letter)

No abstract available

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Feasibility of Protective Ventilation During Elective Supratentorial Neurosurgery: A Randomized, Crossover, Clinical Trial

imageBackground: Traditional ventilation approaches, providing high tidal volumes (Vt), produce excessive alveolar distention and lung injury. Protective ventilation, employing lower Vt and positive end-expiratory pressure (PEEP), is an attractive alternative also for neuroanesthesia, when prolonged mechanical ventilation is needed. Nevertheless, protective ventilation during intracranial surgery may exert dangerous effects on intracranial pressure (ICP). We tested the feasibility of a protective ventilation strategy in neurosurgery. Materials and Methods: Our monocentric, double-blind, 1:1 randomized, 2×2 crossover study aimed at studying the effect size and variability of ICP in patients undergoing elective supratentorial brain tumor removal and alternatively ventilated with Vt 9 mL/kg—PEEP 0 mm Hg and Vt 7 mL/kg—PEEP 5 mm Hg. Respiratory rate was adjusted to maintain comparable end-tidal carbon dioxide between ventilation modes. ICP was measured through a subdural catheter inserted before dural opening. Results: Forty patients were enrolled; 8 (15%) were excluded after enrollment. ICP did not differ between traditional and protective ventilation (11.28±5.37, 11 [7 to 14.5] vs. 11.90±5.86, 11 [8 to 15] mm Hg; P=0.541). End-tidal carbon dioxide (28.91±2.28, 29 [28 to 30] vs. 28.00±2.17, 28 [27 to 29] mm Hg; P

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Epidural Injection of Platelet Rich Plasma for Postlumbar Puncture Headaches

imageNo abstract available

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Trends and Outcomes of Early Versus Late Percutaneous Endoscopic Gastrostomy Placement in Patients With Traumatic Brain Injury: Nationwide Population-based Study

imageBackground: Oral intake for traumatic brain injury (TBI) patients is often not an option because of facial trauma, swallowing dysfunctions, altered consciousness, etc. These patients often require percutaneous endoscopic gastrostomy (PEG) placement for nutrition support. To date, there is lack of studies examining the relationship between the timing of PEG placement and patient outcome in the TBI group. Methods: We conducted a population-based study in a retrospective cohort of TBI patients undergoing PEG, using the national inpatient sample for years 2011 to 2013. Results: A total of 96,625 patients were identified for TBI and 3343 of those patients received PEG. TBI patients who undergo an early or late PEG placement had a higher rate of in-hospital mortality, when compared with patients with a standard timing of PEG placement. Late PEG was preferably placed in patients with higher Charlson index and trauma-related comorbidities, and these patients had a higher incidence of complications, that is, sepsis, urinary tract infection, acute respiratory distress syndrome/pneumonia, and deep vein thrombosis/pulmonary embolism. When stratified by mortality-risk groups, early PEG was associated with higher rates of in-hospital mortality while standard PEG was associated with best mortality outcomes in low–mortality-risk group and moderate–mortality-risk group. Conclusions: The results of this study suggest that if a PEG placement is indicated for a TBI patient, a standard (7 to 14 d) timing may be associated with better patient outcomes. However, secondary to limitations associated with the use of administrative databases, further prospective studies are needed to establish clear guidelines regarding the optimal timing of placing PEG in TBI patients.

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A Pediatric Case With Takotsubo Cardiomyopathy and Neurogenic Pulmonary Edema Due to an Epidural Hemorrhage

imageNo abstract available

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Intraoperative Neurological Monitoring With Evoked Potentials During Carotid Endarterectomy Versus Cooperative Patients Under General Anesthesia Technique: A Retrospective Study

imageIntroduction: The best technique to evaluate contralateral carotid flow during carotid endarterectomy (CEA) is still debated; an accurate detection of efficient contralateral blood flow can avoid unnecessary shunt placement and its complications. The aim of this retrospective observational study was to evaluate and compare the safety and efficacy of general anesthesia with motor-evoked potential and somatosensory-evoked potentials (mSSEP and tcMEP) versus cooperative patients under general anesthesia (CPGA) technique for CEA. Primary outcome was the rate of technical failure. The procedural time and shunt incidence between the 2 neuromonitoring strategies were also analyzed. Patients and Methods: A total of 331 patients who consecutively underwent CEA were included (100 patients in the CPGA group and 231 in the mSSEP+tcMEP group). The anesthesia technique was customized according to the cerebral monitoring needs. Comparison between groups was performed along with risk analysis. Results: Electrophysiological monitoring seems to be a safe and effective strategy of neuromonitoring during CEA. Compared with the CPGA technique, it ensures fewer technical failures, reduces surgical and anesthesiological time and, moreover, it may reduce shunt risk/incidence. The incidence of shunt between the CPGA group and mSSEP+tcMEP was statistically different (CPGA 12%, mSSEP+tcMEP 5.2%; P=0.02), and the relative risk reduction in the mSSEP+tcMEP group, compared with the CPGA group, was 0.57. Conclusions: mSSEP and tcMEP neuromonitoring was associated with less technical failure and procedural time than asleep-awake-asleep strategy. The evoked potential neuromonitoring may be an alternative technique to awake clinical assessment during CEA.

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Life-threatening Tachyarrhythmia Following Intra-Arterial Milrinone for Cerebral Vasospasm

imageNo abstract available

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Effect of Albumin in Combination With Mannitol on Whole-blood Coagulation In Vitro Assessed by Thromboelastometry

imageBackground: Albumin and mannitol may interfere with hemostasis, but their coinfluence is unclear. We aimed to determine the effects of albumin alone and in combination with mannitol or Ringer acetate (RAC) on hemostasis in crossover in vitro study. Materials and Methods: From citrated fresh whole blood withdrawn from 10 volunteers, we prepared 2.5, 5, 10, 15, and 20 vol% dilutions of 4% albumin (Alb group). Each sample was thereafter diluted by 15% mannitol (Alb/Man group) or RAC (Alb/RAC group) at a ratio of 9:1. Using thromboelastometry, FibTEM (fibrinogen ROTEM) and ExTEM (extrinsic ROTEM) tests were performed. Results: A 20 vol%, but not 2.5 to 15 vol% dilution of albumin caused a prolonged clot formation time, α-angle decrease, and maximum clot firmness (MCF) weakening compared with undiluted sample (P

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Key role of rehabilitation in new CDC guidelines for the management of Duchenne Muscular Dystrophy

No abstract available

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Functional Impairments Associated with Patient Activation among Community-Dwelling Older Adults

Objectives Activity of Daily Living (ADL) stages and Instrumental Activity of Daily Living (IADL) stages demonstrated ordered associations with mortality, risk of hospitalization, and receipt of recommended care. This paper explores the associations of stages with three dimensions of patient activation: self-care efficacy, patient-doctor communication and health-information seeking. We hypothesized that higher ADL and IADL stages (greater limitation) are associated with a lower level of patient activation. Methods Patient activation factors were derived from the 2004 and 2009 Medicare Current Beneficiary Survey. In this cross-sectional study (N=8981), the associations of activity limitation stages with patient activation factors were assessed in latent factor models. Results Greater activity limitation was in general inversely associated with self-efficacy, patient-doctor communication and health information-seeking, even after adjusting for sociodemographic and clinical characteristics. For instance, the mean of self-care efficacy across ADL stages I-IV (mild, moderate, severe and complete limitation) compared to stage 0 (no limitation) decreased significantly by 0.17, 0.29, 0.34, and 0.60, respectively. Covariates associated with suboptimal patient activation were also identified. Discussion Our study identified multiple opportunities to improve patient activation, including providing support for older adults with physical impairments, at socioeconomic disadvantages, or with psychological or cognitive impairment. Disclosures: The research for this manuscript was supported by the grant from the National Institutes of Health (R01AG040105 and R01HD074756). There are no personal conflicts of interest of any of the authors, and no authors reported disclosures beyond the funding source. The opinions and conclusions of the authors are not necessarily those of the sponsoring agency. We certify that no party having a direct interest in the results of the research supporting this article has or will confer a benefit on us or on any organization with which we are associated. This material has not been previously presented at a meeting. Acknowledgement: We thank Sean Hennessy, PharmD, PhD, for his valuable input in this manuscript. Corresponding Author: Ling Na, PhD, Email: lingna2000@gmail.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Bone marrow fat physiology in relation to skeletal metabolism and cardiometabolic disease risk in children with cerebral palsy

Individuals with cerebral palsy (CP) exhibit neuromuscular complications and low physical activity levels. Adults with CP exhibit a high prevalence of chronic diseases, which is associated with musculoskeletal deficits. Children with CP have poor musculoskeletal accretion accompanied by excess bone marrow fat, which may lead to weaker bones. Mechanistic studies to determine the role of bone marrow fat on skeletal growth and maintenance, and how it relates to systemic energy metabolism among individuals with CP, are lacking. In this review, we highlight the skeletal status in children with CP and analyze the existing literature on the interactions among bone marrow fat, skeletal health, and cardiometabolic disease risk in the general population. Clinically vital questions are proposed, including: (1) Is the bone marrow fat in children with CP metabolically distinct from typically developing children in terms of its lipid and inflammatory composition? (2) Does the bone marrow fat suppress skeletal acquisition? (3) Or, does it accelerate chronic disease development in children with CP? (4) If so, what are the mechanisms? In conclusion, while inadequate mechanical loading may initiate poor skeletal development, subsequent expansion of bone marrow fat may further impede skeletal acquisition and increase cardiometabolic disease risk in those with CP. Address of correspondence: Daniel G. Whitney, PhD, Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI. Phone: 734-936-9474. Fax: 734-615-1770. e-mail: dgwhit@umich.edu All authors declare no conflict of interest. There has been no previous presentation of this work. Daniel G. Whitney is supported by the University of Michigan Advanced Rehabilitation Research Training Program in Community Living and Participation from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) (90AR5020-0200). Mark D. Peterson is funded by the National Institutes of Health (NIH) (1KO1 HD074706) and NIDILRR (90IF0102-01). Christopher M. Modlesky is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the NIH (R01 HD090126). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Triadic Interactions in MIECHV: Relations to Home Visit Quality

Abstract

Objectives This study was conducted to look inside home visits to examine active intervention ingredients used and their relations with ratings of home visit quality. In particular, triadic interactions that engage the home visitor, parent, and child together and provide a context for home visitors to facilitate parent-child interactions by observing, modeling and coaching behaviors that promote optimal child development were examined. Methods Observations were conducted to describe intervention activities (with the HVOF-R) and rate quality of home visit practices and engagement (with the HOVRS A+). Results Analyses revealed the majority of home visit time (71%) was spent in home visitor-parent interactions with only a small proportion of home visit time (17%) spent in triadic interactions and an even smaller proportion of time (2%) during which home visitors actively coached parent-child interactions. Amount of time spent in triadic interactions was related positively to quality ratings of home visit practices and engagement. Moreover, time spent coaching parent-child interactions uniquely predicted home visit quality after accounting for visit length and home visitor time spent observing and modeling. Conclusions for Practice Increasing the percentage of home visitors engage the parent and child in triadic interaction should be a focus for home visiting programs. Home visitors will likely need professional development and supervisory support to enhance their skills in coaching parent-child interactions during triadic interactions.



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Improving Clinical Proficiency Using a 3-Dimensionally Printed and Patient-Specific Thoracic Spine Model as a Haptic Task Trainer

Background and Objectives Advanced haptic simulators for neuraxial training are expensive, have a finite life, and are not patient specific. We sought to demonstrate the feasibility of developing a custom-made, low-cost, 3-dimensionally printed thoracic spine simulator model from patient computed tomographic scan data. This study assessed the model's practicality, efficiency as a teaching tool, and the transfer of skill set into patient care. Methods A high-fidelity, patient-specific thoracic spine model was used for the study. Thirteen residents underwent a 1-hour 30-minute training session prior to performing thoracic epidural analgesia (TEA) on patients. We observed another group of 14 residents who were exposed to the traditional method of training during their regional anesthesia rotation for thoracic epidural placement. The TEA was placed for patients under the supervision of attending anesthesiologists, who were blinded to the composition of the study and control groups. As a primary outcome, data were collected on successful TEAs, which was defined as a TEA that provided full relief of sensation across the entire surgical area as assessed by both a pinprick and temperature test. Secondary outcomes included whether any assistance from the attending physician was required and failed epidurals. Results A total of 27 residents completed the study (14 in the traditional training, 13 in the study group). We found that the residents who underwent training with the simulator had a significantly higher success rate (11 vs 4 successful epidural attempts, P = 0.002) as compared with the traditional training group. The control group also required significantly more assistance from the supervising anesthesiologist compared with the study group (5 vs 1 attempt requiring guidance). The number needed to treat (NNT) for the traditional training group was 1.58 patients over the study period with a 95% confidence interval of 1.55 to 1.61. Conclusions By using patient-specific, 3-dimensionally printed, thoracic spine models, we demonstrated a significant improvement in clinical proficiency as compared with traditional teaching models. Accepted for publication January 31, 2018. Address correspondence to: Robina Matyal, MD, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (e-mail: rmatyal1@bidmc.harvard.edu). Research support was provided by the Foundation for Anesthesia Education and Research Grant. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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Dedication

Publication date: Available online 11 June 2018
Source:Radiologic Clinics of North America
Author(s): Savvas Nicolaou, Mohammed F. Mohammed




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