Can Ultrasound-Guided S1 Transforaminal Epidural Injection Using the In-plane Approach and Color Doppler Imaging Be a Safer Alternative to Lumbar Inter-laminar Epidural Injection?

No abstract available

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Evidence-Based Physiatry: Topical Analgesics for Acute and Chronic Pain in Adults - An Overview of Cochrane Reviews

No abstract available

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Acute Phase Predictors of 6-Month Functional Outcome in Italian Stroke Patients Eligible for In-Hospital Rehabilitation

Purpose The aim of the study was to assess early poststroke prognostic factors in patients admitted for postacute phase rehabilitation. Methods A 1-yr multicenter prospective project was conducted in four Italian regions on 352 patients who were hospitalized after a first stroke and were eligible for postacute rehabilitation. Clinical data were collected in the stroke or acute care units (acute phase), then in rehabilitation units (postacute phase), and, subsequently, after a 6-mo poststroke period (follow-up). Clinical outcome measures were represented using the Barthel Index and the modified Rankin Scale. Univariate and multivariate analyses were performed to identify the most important prognostic index. Results Modified Rankin Scale score, minor neurologic impairment, and early out-of-bed mobilization (within 2 days after the stroke) proved to be important factors related to a better recovery according to Barthel Index (power of prediction = 37%). Similarly, age, premorbid modified Rankin Scale score, and early out-of-bed mobilization were seen to be significant factors in achieving better overall participation and activity according to the modified Rankin Scale (power of prediction = 48%). Barthel Index at admission and certain co-morbidities were also significant prognostic factors correlated with a better outcome. Conclusions According to the Barthel Index and modified Rankin Scale, early mobilization is an early predictor of favorable outcome. To Claim CME Credits Complete the self-assessment activity and evaluation online at https://ift.tt/1l80W45 CME Objectives Upon completion of this article, the reader should be able to: (1) Incorporate prognostic factors of good clinical outcomes after stroke in developing treatment plans for patients admitted to rehabilitation; (2) Identify acute phase indicators associated with favorable 6-mo outcome after stroke; and (3) Recognize the cut-off for early mobilization linked to better outcome in stroke survivors admitted to rehabilitation. Level Advanced Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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Outcome Trends of Adult Cancer Patients Receiving Inpatient Rehabilitation: A 13-Year Review

Objective This study describes characteristics and trends of inpatient rehabilitation among cancer patients within the United States over a 13-yr period. Design This was a retrospective study of data from the Uniform Data System for Medical Rehabilitation from 2002 to 2014. Patients older than 17 yrs admitted to inpatient rehabilitation facilities with a diagnosis of malignant cancer were included. Trends of rehabilitation outcomes including length of stay, Functional Independence Measure (FIM) Instrument scores, and discharge location were examined. Results Data from 115,570 cancer patients were evaluated. Mean age was 66 ± 14 yrs and 49% were women. Mean length of stay decreased over time (2002: 14 days to 2014: 13 days; P 70%) were discharged to the community. Conclusions Cancer patients receiving acute inpatient rehabilitation demonstrated significant improvements in functional outcomes from admission to discharge. Cancer patients became more independent in important activities of daily living, thereby potentially reducing caregiver burden and ensuring safer discharges back to the community. This study suggests potential benefit of inpatient rehabilitation for appropriate cancer patients.

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Effects of Cane Use and Position on Performance of the Sit-to-Stand Task in Stroke Patients

Objective The aim of the study was to examine the effect of cane use and cane positions on the sit-to-stand performance of stroke patients. Design In a crossover study, 30 stroke patients performed sit-to-stand test in seven situations in a random sequence: without a cane, three positions with a regular cane (parallel to the ankle, parallel to the 5th toe, and 10 cm in front of the 5th toe), and the same three positions with a quad cane. The peak vertical ground reaction force and maximum vertical cane support force during sit-to-stand were recorded. Results Using a cane significantly reduced the peak ground reaction force by 3% to 9% of body weight compared with that without a cane (P = 0.000–0.023). Different cane positions strongly influenced the maximum cane support force and peak ground reaction force. When the cane was closer to the ankle, the maximal cane support force increased by 6.7% to 8.6% of body weight, which resulted in a decrease in the peak ground reaction force. Conclusions Both types of cane reduced lower limbs' load during sit to stand. When the cane was closer to the trunk, the load on legs was lessened, whereas the load on the upper limb increased. Upper limb's load during sit to stand was greater when using quad cane than using regular cane.

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Bilateral Patellar Tendon Tears After a Fall From Standing Position: Do You Mind Systemic Diseases and Medications?

No abstract available

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Anatomic Relationship Between the Hook of the Hamate and the Distal Transverse Carpal Ligament: Implications for Ultrasound-Guided Carpal Tunnel Release

Objective During ultrasound-guided carpal tunnel release, osseous landmarks may supplement direct visualization of the distal transverse carpal ligament (dTCL) to ensure a complete release. The purpose of this study was to determine the relationship between the apex of the hook of the hamate (aHH) and the dTCL within the transverse safe zone (TSZ) of the carpal tunnel. Design Twenty unembalmed cadaveric specimens were dissected to determine the aHH-dTCL distance and the aHH-SPA distance (the distance between the aHH and the superficial palmar arch) at the ulnar and radial limits of the TSZ (the distance between the hook of the hamate or ulnar artery to the median nerve). Results The aHH-dTCL distance averaged 11–12 mm across the TSZ (maximum, 18.2 mm), whereas the aHH-SPA distance was significantly greater on the radial side of the TSZ compared with the ulnar side (22.6 ± 3.6 mm vs. 14.0 ± 4.0 mm). Conclusions The dTCL lies approximately 11–12 mm distal to the aHH across the TSZ, with an upper limit of 18.2 mm. Along with direct sonographic visualization of the dTCL, the aHH can be used with other osseous landmarks to estimate the position of the dTCL during ultrasound-guided carpal tunnel release.

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Evidence-Based Physiatry and Social Media: Two New Sections

No abstract available

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Relationship of Spinal Cord Injury Level and Duration to Peak Aerobic Capacity With Arms-Only and Hybrid Functional Electrical Stimulation Rowing

Objective The aim of the study was to assess the relationship of spinal cord injury level and duration to peak aerobic capacities during arms-only rowing compared with hybrid Functional Electrical Stimulation (FES)-rowing. Design Comparison of peak aerobic capacity (VO2), peak ventilation, peak respiratory exchange ratio, and peak heart rate were measured during arms-only rowing and FES-rowing obtained from graded exercise tests. Results Peak aerobic values were strongly related to injury level and injury duration for both arms-only rowing (r = 0.67, P

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Long-Term Retention of Musculoskeletal Ultrasound Training During Residency

The Accreditation Council for Graduate Medical Education and the American Board of Physical Medicine and Rehabilitation developed milestones for evaluation of resident physicians that include proper musculoskeletal ultrasound examination of major joints. To date, there have been no published data demonstrating acquisition and retention of these skills and correlation with the milestone evaluation. The investigators developed and implemented a curriculum in musculoskeletal ultrasound examination for Physical Medicine and Rehabilitation residents at a large academic medical center. The investigators chose the following six joints for training and evaluation: ankle, elbow, hip, knee, shoulder, and wrist/hand. The program included: (1) didactic lectures on anatomy and ultrasound technique; (2) peer-led demonstrations of the procedure on a standardized patient (SP); (3) individual practice on standardized patients; (4) faculty observation and feedback; (5) review sessions and additional practice; and (6) assessment of skills in an objective structured clinical examination. From 2013 to 2017, 30 physical medicine and rehabilitation residents were trained and evaluated. The results, based on objective structured clinical examination scores, showed that most residents achieved the appropriate level of competency for their year. A blended, standardized curriculum in musculoskeletal ultrasound instruction with assessment by an objective structured clinical examination can be used to evaluate musculoskeletal ultrasound skills and can help align this education with residency milestones.

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Impaired Cognitive Performance in Endothelial Nitric Oxide Synthase Knockout Mice After Ischemic Stroke: A Pilot Study

Objectives Cognitive dysfunction and dementia are common following ischemic stroke. Endothelial nitric oxide synthase (eNOS) has been found to play an important role in neurologic function and cognition. The purpose of the present study was to assess the specific role of eNOS in cognitive performance after stroke. Design Male wild-type and mice lacking eNOS (eNOS−/−) underwent middle cerebral artery occlusion or sham-surgery. Primary outcomes were repeated measures of neurologic score, limb asymmetry, sensory/motor function, and spatial memory/learning assessed at intervals up to 28 days postsurgery. Group differences in brain microglia activation and infiltration and levels of interferon-gamma were examined. Results There was no genotype × surgery interaction effect on the pattern of change in neurologic score, limb asymmetry, or sensory motor function across the 28 days postsurgery. In the Morris water maze, eNOS−/− middle cerebral artery occlusion mice displayed learning and memory deficits not evident in wild-type middle cerebral artery occlusion mice. Poorer spatial memory and learning in eNOS−/− middle cerebral artery occlusion mice was associated with a reduction in the number of activated microglia in the striatum on the lesion side and decreased brain tissue levels of interferon-gamma. Conclusions This study's data support a role for eNOS in cognitive performance after stroke. This finding may lead to the development of novel interventions to treat poststroke cognitive deficits.

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Spinal Cord Injury by Direct Damage During CT-Guided C7 Transforaminal Epidural Steroid Injection

Cervical transforaminal epidural steroid injection (TFESI) under the guidance of computed tomography (CT) can offer great anatomical resolution and precise needle placement in the axial plane. However, some complications, including blood pressure surge, allergic reactions, vasovagal syncope, and cerebral infarct, have been reported after CT-guided cervical TFESI. We report the first case of iatrogenic spinal cord injury during a CT-guided cervical TFESI. A 67-year-old woman, upon receiving TFESI on Lt. C7, experienced an electrical shock-like sensation throughout the body. The patient complained of weakness in the left upper and lower extremities (manual muscle testing grade: 2–4) and neuropathic pain (numeric rating scale: 9) in the left upper and lower extremities. Cervical magnetic resonance imaging (MRI) performed 9 days after TFESI showed a high T2 signal at the left side of the spinal cord from levels C5 to C7, and an electrophysiological study performed 14 days after TFESI revealed corresponding findings with cervical MRI. Three months after finishing treatment with a high dose of intravenous methylprednisolone, the patient's motor weakness improved, but it did not recover fully.

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Quantifying Effect of Onabotulinum Toxin A on Passive Muscle Stiffness in Children with Cerebral Palsy Using Ultrasound Shear Wave Elastography

Objective A pilot study was conducted to longitudinally quantify effect of onabotulinum toxin A (BoNT-A) on passive muscle properties in children with cerebral palsy using ultrasound shear wave elastography. Design This was a prospective longitudinal cohort study. Results Between 1 and 3 mos post-BoNT-A, a significant improvement in the shear modulus of the lateral gastrocnemius was found at 10-degrees plantar flexion (PF) (−7.57 [−10.98, −5.07], P = 0.02) and 0-degrees PF (−14.74 [−18.21, −9.38], P = 0.03). There was a notable, but nonsignificant, difference in shear modulus at 20-degrees PF, 10-degrees PF, and 0-degrees PF between pre-BoNT-A and 1 mo post-BoNT-A. Pre-BoNT-A shear modulus was not significantly different from 3 mos post-BoNT-A at all foot positions. No significant differences in ankle passive range of motion or spasticity were found. Conclusion Despite no significant change in ankle range of motion or spasticity, shear wave elastography was able to detect a difference in lateral gastrocnemius passive muscle properties in children with cerebral palsy after BoNT-A injections. The difference in passive muscle properties resolved by 3 mos post-BoNT-A.

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Bilateral Patellar Tendons Tears After a Fall From Standing Position

No abstract available

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Effects of Anodal Transcranial Direct Current Stimulation on Somatosensory Recovery After Stroke: A Randomized Controlled Trial

Objective Objective: The aim of this study was to evaluate the effect of anodal transcranial direct current stimulation over the primary somatosensory cortex on the recovery of somatosensation, motor function, and the activities of daily living in patients with subacute stroke. Design This study was a prospective, randomized sham controlled, double-blinded study. Patients with subacute stroke having somatosensory deficits (N = 24) were enrolled and assigned randomly to the anodal and sham stimulation groups. Patients received 10 consecutive anodal or sham transcranial direct current stimulations over the primary somatosensory cortex on the side of the stroke lesion. Before and after each stimulation session, Nottingham sensory assessments, Semmes Weinstein monofilaments examination, and manual function tests were performed, and modified Brunnstrom classification, modified Barthel index, and functional ambulation categories were assessed. Results Although there was no clear significant difference between the two groups, when the changes from baseline to posttreatment evaluation were compared between the groups, a partially significant improvement was observed in the anodal stimulation group compared with the sham stimulation group. Interestingly, the tactile sensation of the unaffected side also improved. Moreover, the greater improvement in activities of daily living function was observed in the anodal stimulation group too. Conclusion Anodal transcranial direct current stimulation over the primary somatosensory cortex may be a useful adjuvant therapy for the recovery of somatosensation and activities of daily living function in patients with sensory deficits after stroke.

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Sonographic Evaluation of the Posterior Interosseous Nerve in a Patient With Wrist Drop

No abstract available

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Hepatitis C virus antibodies are absent among high risk group of health care workers in Damascus Hospital

Publication date: Available online 20 June 2018
Source:Arab Journal of Gastroenterology
Author(s): Hoda Alhamoudi, Nawras Alhalabi, Mouhammed Zein, Nazir Ibrahim
Background and study aimsLiver disease caused by hepatitis C virus (HCV) is one of the most serious health issues worldwide. The prevalence of HCV among health care workers (HCWs) is higher than normal population. Our aim is to determine the seroprevalence of HCV among this high-risk group in Damascus Hospital, Syria in 2016.Subjects and methodsDuring March 2016, anonymous testing for HCV was offered to 150 residents and physicians from different departments (Surgery, otolaryngology, gastroenterology, anaesthesiology and laboratory) in Damascus Hospital using fourth-generation enzyme-linked immunosorbent assay (ELISA). In addition, each participant was interviewed and answered a comprehensive questionnaire which includes questions on potential hazards, risk factors and the level of awareness about the disease and its ways of transmission.ResultsSurprisingly, all samples tested negative for anti-HCV antibodies, though many participants were already exposed to many risk factors especially as HCWs.ConclusionHCV is not a main issue regarding its prevalence among HCWs in Damascus Hospital. Nevertheless, it is still necessary to develop a mandatory well-organized program to increase the awareness among HCWs and develop stricter prevention policies especially about bloodborne diseases transmitted occupationally.



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Risk communication in genetic counseling: Exploring uptake and perception of recurrence numbers, and their impact on patient outcomes

Clinical Genetics, EarlyView.


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Adjusted Intensive Care Infection Score (ICISΔ)—A new approach for prediction of ascitic fluid infection in patients with cirrhosis

Early and accurate diagnosis is the key to improving survival in cirrhotic patients with ascitic fluid infection.

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Sodium nitroglycerin induces middle cerebral artery vasodilatation in young, healthy adults

Experimental Physiology, EarlyView.


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Perioperative outcomes and management in midface advancement surgery: a multicenter observational descriptive study from the Pediatric Craniofacial Collaborative Group

Pediatric Anesthesia, EarlyView.


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Time to consider the contact force during photoplethysmography measurement during pediatric anesthesia: A prospective, nonrandomized interventional study

Pediatric Anesthesia, EarlyView.


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Correlation of Measurements of the Pre-arthritic Hip between Plain Radiography and Computed Tomography

Prior studies have compared radiographic and computed tomography (CT) imaging for evaluation of pre-arthritic hip pain. However, the inter-modality, inter-rater, and intra-rater consistencies of those parameters have not been investigated.

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Phenol neurolysis for management of shoulder spasticity in early recovery from traumatic brain injury – a case report

This case describes a 16-year-old boy who suffered a severe traumatic brain injury. The patient gradually recovered but developed debilitating spasticity mainly in left triceps muscle, abnormal positioning of shoulder girdle complex, and shoulder pain. Phenol (6%) was injected to axillary and radial nerves under guidance of electrical stimulation and ultrasound imaging at 10 weeks after initial injury. After injection, triceps spasticity and shoulder pain was immediately reduced and abnormal positions of shoulder girdle complex and elbow joint gradually returned to functional limits over 2 weeks.

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Unilateral movement preparation causes task‐specific modulation of TMS responses in the passive, opposite limb

The Journal of Physiology, EarlyView.


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Cigarette smoke directly impairs skeletal muscle function through capillary regression and altered myofibre calcium kinetics in mice

The Journal of Physiology, EarlyView.


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Corrigendum

The Journal of Physiology, EarlyView.


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Issue Information

The Journal of Physiology, Volume 596, Issue 12, Page 2267-2268, 15 June 2018.


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Wavelet pressure reactivity index: a validation study

The Journal of Physiology, EarlyView.


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Setting the pace for labour

The Journal of Physiology, EarlyView.


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Preterm growth restriction and bronchopulmonary dysplasia: the vascular hypothesis and related physiology

The Journal of Physiology, EarlyView.


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Sex differences in diaphragmatic fatigue: the cardiovascular response to inspiratory resistance

The Journal of Physiology, EarlyView.


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Comparison of device‐supported sensorimotor training and splint intervention for myofascial temporomandibular disorder pain patients

Journal of Oral Rehabilitation, EarlyView.


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Gender differences in temporomandibular disorders in adult populational studies: A systematic review and meta‐analysis

Journal of Oral Rehabilitation, EarlyView.


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Patient satisfaction with occlusal scheme of conventional complete dentures: A randomised clinical trial (Part II)

Journal of Oral Rehabilitation, EarlyView.


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Analysis of Virulence Factors and Antimicrobial Resistance in Salmonella Using Molecular Techniques and Identification of Clonal Relationships Among the Strains

Microbial Drug Resistance, Ahead of Print.


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Streptococcus pneumoniae: Antimicrobial Resistance and Serotypes of Strains Carried by Children and Causing Invasive Disease in the Faroe Islands

Microbial Drug Resistance, Ahead of Print.


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Molecular Characterization of Carbapenem-Resistant Acinetobacter baumannii in the Intensive Care Unit of Uruguay's University Hospital Identifies the First rmtC Gene in the Species

Microbial Drug Resistance, Ahead of Print.


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Skeletal Muscle Glycogen Content at Rest and During Endurance Exercise in Humans: A Meta-Analysis

Abstract

Background

Skeletal muscle glycogen is an important energy source for muscle contraction and a key regulator of metabolic responses to exercise. Manipulation of muscle glycogen is therefore a strategy to improve performance in competitions and potentially adaptation to training. However, assessing muscle glycogen in the field is impractical, and there are no normative values for glycogen concentration at rest and during exercise.

Objective

The objective of this study was to meta-analyse the effects of fitness, acute dietary carbohydrate (CHO) availability and other factors on muscle glycogen concentration at rest and during exercise of different durations and intensities.

Data Source and Study Selection

PubMed was used to search for original articles in English published up until February 2018. Search terms included muscle glycogen and exercise, filtered for humans. The analysis incorporated 181 studies of continuous or intermittent cycling and running by healthy participants, with muscle glycogen at rest and during exercise determined by biochemical analysis of biopsies.

Data Analysis

Resting muscle glycogen was determined with a meta-regression mixed model that included fixed effects for fitness status [linear, as maximal oxygen uptake ( \(\dot{V}\) O_2max) in mL·kg⁻¹·min⁻¹] and CHO availability (three levels: high, ≥ 6 g·kg⁻¹ of CHO per day for ≥ 3 days or ≥ 7 g·kg⁻¹ CHO per day for ≥ 2 days; low, glycogen depletion and low-CHO diet; and normal, neither high nor low, or not specified in study). Muscle glycogen during exercise was determined with a meta-regression mixed model that included fixed effects for fitness status, resting glycogen [linear, in mmol·kg⁻¹ of dry mass (DM)], exercise duration (five levels, with means of 5, 23, 53 and 116 min, and time to fatigue), and exercise intensity (linear, as percentage of \(\dot{V}\) O_2max); intensity, fitness and resting glycogen were interacted with duration, and there were also fixed effects for exercise modes, CHO ingestion, sex and muscle type. Random effects in both models accounted for between-study variance and within-study repeated measurement. Inferences about differences and changes in glycogen were based on acceptable uncertainty in standardised magnitudes, with thresholds for small, moderate, large and very large of 25, 75, 150 and 250 mmol·kg⁻¹ of DM, respectively.

Results

The resting glycogen concentration in the vastus lateralis of males with normal CHO availability and \(\dot{V}\) O_2max (mean ± standard deviation, 53 ± 8 mL·kg⁻¹·min⁻¹) was 462 ± 132 mmol·kg⁻¹. High CHO availability was associated with a moderate increase in resting glycogen (102, ± 47 mmol·kg⁻¹; mean ± 90% confidence limits), whereas low availability was associated with a very large decrease (− 253, ± 30 mmol·kg⁻¹). An increase in \(\dot{V}\) O_2max of 10 mL·kg⁻¹·min⁻¹ had small effects with low and normal CHO availability (29, ± 44 and 67, ± 15 mmol·kg^-1, respectively) and a moderate effect with high CHO availability (80, ± 40 mmol·kg⁻¹). There were small clear increases in females and the gastrocnemius muscle. Clear modifying effects on glycogen utilisation during exercise were as follows: a 30% \(\dot{V}\) O_2max increase in intensity, small (41, ± 20 mmol·kg⁻¹) at 5 min and moderate (87–134 mmol·kg⁻¹) at all other timepoints; an increase in baseline glycogen of 200 mmol·kg⁻¹, small at 5–23 min (28–59 mmol·kg⁻¹), moderate at 116 min (104, ± 15 mmol·kg⁻¹) and moderate at fatigue (143, ± 33 mmol·kg⁻¹); an increase in \(\dot{V}\) O_2max of 10 mL·kg⁻¹·min⁻¹, mainly clear trivial effects; exercise mode (intermittent vs. continuous) and CHO ingestion, clear trivial effects. Small decreases in utilisation were observed in females (vs. males: − 30, ± 29 mmol·kg⁻¹), gastrocnemius muscle (vs. vastus lateralis: − 31, ± 46 mmol·kg⁻¹) and running (vs. cycling: − 70, ± 32 mmol·kg⁻¹).

Conclusion

Dietary CHO availability and fitness are important factors for resting muscle glycogen. Exercise intensity and baseline muscle glycogen are important factors determining glycogen use during exercise, especially with longer exercise duration. The meta-analysed effects may be useful normative values for prescription of endurance exercise.

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Randomized controlled trial of robot-assisted gait training with dorsiflexion assistance on chronic stroke patients wearing ankle-foot-orthosis

Robot-assisted ankle-foot-orthosis (AFO) can provide immediate powered ankle assistance in post-stroke gait training. Our research team has developed a novel lightweight portable robot-assisted AFO which is ca...

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Impaired consciousness through a focal lesion under the left posteromedial cortex

Publication date: August 2018
Source:Clinical Neurophysiology, Volume 129, Issue 8
Author(s): Hiroshi Fujioka, Eiichirou Urasaki, Katsuhiro Yamashita




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Refining the splice region

Refining the splice region

Refining the splice region, Published online: 19 June 2018; doi:10.1038/s41576-018-0028-8

A study in Genome Research reports the impact of genetic variation near splice sites on human disease and may help prioritize and functionally interpret newly identified variants.

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Tumor-Suppressive Function of miR-30d-5p in Prostate Cancer Cell Proliferation and Migration by Targeting NT5E

Cancer Biotherapy and Radiopharmaceuticals, Volume 33, Issue 5, Page 203-211, June 2018.


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The Effect of Computed Tomography-Guided 125I Radioactive Particle Implantation in Treating Cancer and Its Pain

Cancer Biotherapy and Radiopharmaceuticals, Volume 33, Issue 5, Page 176-181, June 2018.


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On Reviewing

Cancer Biotherapy and Radiopharmaceuticals, Volume 33, Issue 5, Page 167-168, June 2018.


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Exploration of a F(ab′)2 Fragment as the Targeting Agent of α-Radiation Therapy: A Comparison of the Therapeutic Benefit of Intraperitoneal and Intravenous Administered Radioimmunotherapy

Cancer Biotherapy and Radiopharmaceuticals, Volume 33, Issue 5, Page 182-193, June 2018.


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Effects of hsa_circRBM23 on Hepatocellular Carcinoma Cell Viability and Migration as Produced by Regulating miR-138 Expression

Cancer Biotherapy and Radiopharmaceuticals, Volume 33, Issue 5, Page 194-202, June 2018.


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Evaluation of a Multilevel Intervention to Reduce Preterm Birth Among Black Women in Newark, New Jersey: A Controlled Interrupted Time Series Analysis

Abstract

Objective To evaluate the effectiveness of a multilevel intervention, Healthy Babies are Worth the Wait (HBWW), in reducing preterm birth (PTB) and very preterm birth (VPTB) among black women in Newark, NJ. Methods HBWW is a program linking the local March of Dimes office, providers, community-based organizations, and public health institutions to increase uptake of evidence based preterm birth interventions. We used birth certificate data before (2009–2011) and after (2012–2015) the introduction of HBWW in Newark. We estimated differences in PTB and VPTB between these periods among black women in Newark and compared them to rate differences among black women in the rest of NJ (difference-in-differences). We used interrupted time series analysis (ITSA) to examine declines in PTB and VPTB following the introduction of HBWW controlling for secular trends. All models adjusted for maternal age, education and parity. Results PTB declined in Newark 1.1 case per 100 (95% confidence interval (CI) − 2.3, 0) and in the rest of NJ 0.5 case per 100 (− 1.4, 0.4) (difference-in-differences = 0.6 fewer cases per 100 in Newark, 95% CI − 1.6, 0.3). VPTB declined in both Newark (− 0.6 cases per 100, 95% CI − 1.0, 0) and the rest of NJ (− 0.2 cases per 100, 95% CI − 0, 0.3) (difference-in-differences = 0.4 fewer cases per 100 in Newark, 95% CI − 0.9, 0). However, using ITSA the downward VPTB trend in Newark was not different from the rest of NJ or pre-intervention trends. Conclusions for Practice Our study supports the importance of critically evaluating and advancing complex interventions to reduce PTB among black women.

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Introduction to the Special Issue on Taking Home Visiting to Scale: Findings from the Maternal, Infant, and Early Childhood Home Visiting Program State-Led Evaluations

Abstract

The Maternal, Infant and Early Childhood Home Visiting (MIECHV) Program is a two-generation approach to supporting healthy families through home visits during pregnancy and early childhood. All states and territories receiving MIECHV funding are encouraged to evaluate their programs. This special issue highlights evaluations from 11 awardees—Arkansas, Florida, Illinois, Iowa, Maryland, Massachusetts, Michigan, New Jersey, Oregon, Pennsylvania, and Tennessee. With the wide expansion of home visiting since the onset of MIECHV, the state-led evaluations contribute to the understanding of replication and scale-up of evidence-based home visiting.

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Mental Fatigue Impairs Endurance Performance: A Physiological Explanation

Abstract

Mental fatigue reflects a change in psychobiological state, caused by prolonged periods of demanding cognitive activity. It has been well documented that mental fatigue impairs cognitive performance; however, more recently, it has been demonstrated that endurance performance is also impaired by mental fatigue. The mechanism behind the detrimental effect of mental fatigue on endurance performance is poorly understood. Variables traditionally believed to limit endurance performance, such as heart rate, lactate accumulation and neuromuscular function, are unaffected by mental fatigue. Rather, it has been suggested that the negative impact of mental fatigue on endurance performance is primarily mediated by the greater perception of effort experienced by mentally fatigued participants. Pageaux et al. (Eur J Appl Physiol 114(5):1095–1105, 2014) first proposed that prolonged performance of a demanding cognitive task increases cerebral adenosine accumulation and that this accumulation may lead to the higher perception of effort experienced during subsequent endurance performance. This theoretical review looks at evidence to support and extend this hypothesis.

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Refining the splice region

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Assessing ventilatory threshold in individuals with motor-complete spinal cord injury

Publication date: Available online 18 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Jason S. Au, Arjun Sithamparapillai, Katharine D. Currie, Andrei V. Krassioukov, Maureen J. MacDonald, Audrey L. Hicks
ObjectiveTo assess the feasibility of measuring ventilatory threshold (VT) in higher-level, motor-complete spinal cord injury (SCI) using four different analysis methods based on non-invasive gas exchange.DesignObservational.SettingLaboratory testing.ParticipantsIndividuals with C4-T6 motor-complete SCI (16 paraplegia, 22 tetraplegia; American Spinal Injury Association Impairment Scale A/B; 42±10 years of age).InterventionsNot applicable.Main OutcomeVentilatory threshold from a graded arm cycling test to volitional exhaustion using four methods: ventilatory equivalents, excess CO2, V-Slope, and combined method.ResultsVT could be identified in all individuals with paraplegia, but in only 68% of individuals with tetraplegia. Individuals without observable VT completed the graded exercise test with lower ventilatory rate, peak power output, and V̇O2peak (all P<0.05), compared to those with a detectable VT. Bland-Altman plots indicate minimal bias between methods (range: 0.01 to 0.03 L/min), with 95% limits of agreement of the difference within 0.25 L/min. Absolute V̇O2 at VT with individual methods were all correlated to peak power output (r>0.74; P<0.01) and V̇O2peak (r>0.91; P<0.01), with negligible differences between methods.ConclusionsThe assessment of VT is a feasible alternative to peak exercise testing for aerobic fitness in individuals with higher-level, motor-complete SCI, although care should be taken when interpreting VT in individuals with tetraplegia who have lower cardiorespiratory fitness and lower peak power outputs.



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Do Predictive Relationships Exist Between Postural Control and Falls Efficacy in Unilateral Transtibial Prosthesis Users?

Publication date: Available online 18 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Cleveland T. Barnett, Natalie Vanicek, David F. Rusaw
ObjectiveTo assess whether variables from a postural control test relate to and predict falls efficacy in prosthesis users.DesignTwelve-month within and between subjects repeated measures design. Participants performed the Limits of Stability (LOS) test protocol at study baseline and at 6-month follow-up. Participants also completed the Falls Efficacy Scale-International (FES-I) questionnaire, reflecting the fear of falling, and reported the number of falls monthly between study baseline and 6-month follow-up, and additionally at 9- and 12-month follow-ups.SettingUniversity biomechanics laboratories.ParticipantsA group of active unilateral transtibial prosthesis users of primarily traumatic etiology (PROS) (n=12) with at least one year of prosthetic experience and age and gender matched control participants (CON) (n=12).InterventionsNot applicable.Main Outcome Measure(s)Postural control variables derived from centre of pressure data obtained during the LOS test, which was performed on and reported by the Neurocom Pro Balance Master, namely; reaction time (RT), movement velocity (MVL), endpoint (EPE) and maximum (MXE) excursion and directional control (DCL). Number of falls and total FES-I scores.ResultsDuring the study period, the PROS group had higher FES-I scores (U = 33.5, p =0.02), but experienced a similar number of falls, compared to the CON group. Increased FES-I score were associated with decreased EPE (R=-0.73, p=0.02), MXE (R=-0.83, p<0.01) and MVL (R=-0.7, p=0.03) in the PROS group, and DCL (R=-0.82, p<0.01) in the CON group, all in the backwards direction.ConclusionsStudy baseline measures of postural control, in the backwards direction only, are related to and potentially predictive of subsequent 6-month FES-I scores in relatively mobile and experienced prosthesis users.



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Letter to the Editor – Response

Publication date: Available online 18 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Simon Decary, François Desmeules




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Association of Interindividual Variation in Plasma Oxytocin With Postcesarean Incisional Pain

Oxytocin has known antinociceptive effects and is upregulated perinatally. This pilot study investigated the association of plasma oxytocin and postcesarean incisional pain. Plasma samples from 18 patients undergoing elective cesarean delivery were drawn at 1 hour preoperatively and 1 and 24 hours postoperatively and analyzed by using enzyme-linked immunosorbent assay. Pain was assessed at 1 day, 8 weeks, 3 months, and 6 months postoperatively. Incisional pain at 24 hours was inversely correlated with 1- and 24-hour oxytocin levels, with higher plasma oxytocin associated with lower pain (ρ, −0.52 and −0.66; P

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Parasympathetic Tone Activity Evaluation to Discriminate Ketorolac and Ketorolac/Tramadol Analgesia Level in Swine

BACKGROUND: Evaluation of nociceptive–antinociceptive balance during general anesthesia is still challenging and routinely based on clinical criteria. Analgesic drug delivered may be optimized with parasympathetic tone activity (PTA) monitor. This study compares ketorolac and ketorolac/tramadol balance analgesia using a PTA monitor. METHODS: Pain intensity response was assessed using a 0–100 numerical state scale (PTA) after nociceptive stimuli in pigs under stable sevoflurane anesthesia. Bispectral index, heart rate, noninvasive blood pressure, and respiratory parameters were also measured. Animals were divided into 3 groups: without analgesia, ketorolac, and ketorolac/tramadol. Mean values or mean areas under the curve (AUC) in selected time periods were compared over time and between groups through a mixed-model repeated measures analysis of variance and nonparametric Kruskal-Wallis tests, followed by Bonferroni or Dunn's multiple comparisons. RESULTS: It was observed a significant decrease in the PTA AUC mean value after application of the stimulus in animals treated without analgesia and only with ketorolac. The PTA AUC mean value in the control group was significantly lower than the corresponding mean in ketorolac group. The ketorolac/tramadol group showed the highest PTA AUC mean values, significantly different from those obtained for the other 2 groups, with no significant differences detected over time. Bispectral index means showed no statistically significant differences either over time periods or between different treatment groups. Heart rate showed only a statistically significant increase in AUC mean between without analgesia and ketorolac/tramadol group, in the time period after the stimulus application. Noninvasive blood pressure means showed no statistically significant differences over time and between treatment groups. CONCLUSIONS: This study shows that a low dose combination of ketorolac and tramadol is sufficient to block the pain responses induced with a needle holder in pigs 20 minutes after its administration. The PTA monitor was able to clearly recognize the analgesic level between treatments and may be used to optimize analgesic drug delivered. Accepted for publication May 10, 2018. Funding: This work is supported by European Investment Funds by FEDER/COMPETE/POCI–Operacional Competitiveness and Internacionalization Programme, under Project POCI-01-0145-FEDER-006958 and National Funds by FCT–Portuguese Foundation for Science and Technology, under the project UID/AGR/04033/2013. 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. Reprints will not be available from the authors. Address correspondence to Carlos J. Leitão, DVM, Center for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), University of Trás-os-Montes and Alto Douro (UTAD), 5001-801 Vila Real, Portugal. Address e-mail to carlos.leitão.35@gmail.com. © 2018 International Anesthesia Research Society

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Comparison of Broadband and Discrete Wavelength Near-Infrared Spectroscopy Algorithms for the Detection of Cytochrome aa3 Reduction

BACKGROUND: Cytochrome aa3, the terminal component of the electron transport chain, absorbs near-infrared radiation (NIR) differentially depending on its oxidation state (Cytox), which can in theory be measured using near-infrared spectroscopy (NIRS) by relating light absorption at specific wavelengths to chromophore concentrations. Some NIRS algorithms use discrete wavelengths, while others analyze a band of NIR (broadband NIRS). The purpose of this study was to test the ability of discrete wavelength and broadband algorithms to measure changes in Cytox (primary outcome), and to determine whether or not a discreet wavelength NIRS algorithm could perform similarly to a broadband NIRS algorithm for the measurement of Cytox in a staged hypoxia–cyanide model (hypoxia and cyanide have oppositional effects on tissue saturation, but both cause cytochrome reduction). METHODS: Twenty Sprague-Dawley rats were anesthetized with isoflurane, intubated, and instrumented. Blood pressure, end-tidal carbon dioxide, and arterial oxygen saturation were measured. A halogen light source transmitted NIR transcranially. NIR from the light source and the skull was transmitted to 2 cooled charge-coupled device spectrometers. Rats were subjected to anoxia (fraction of inspired oxygen, 0.0) until arterial oxygen saturation decreased to 70%. After recovery, 5 mg/kg sodium cyanide was injected intravenously. The cycle was repeated until cardiac arrest occurred. Relative concentrations of hemoglobin and cytochrome aa3 were calculated using discreet wavelength and broadband NIRS algorithms. RESULTS: Hypoxia led to an increase in calculated deoxyhemoglobin (0.20 arbitrary units [AUs]; 95% confidence interval [CI], 0.17–0.22; P

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Development of a Rescue Echocardiography Protocol for Noncardiac Surgery Patients

Intraoperative transesophageal echocardiography (TEE) is a helpful diagnostic tool when hemodynamic compromise is encountered during noncardiac surgery. At our institution, a Rescue Echo Protocol was created to provide a structured means for requesting and performing a rescue TEE. We analyzed our institutional utilization of this service and found that it was used throughout the spectrum of patients' American Society of Anesthesiologists classifications and surgical services. We demonstrated that 72.9% of rescue examinations resulted in a change in management, supporting the use of TEE as a diagnostic tool during hemodynamic compromise. Accepted for publication April 12, 2018. Funding: None. Conflicts of Interest: See Disclosures at the end of the article. Reprints will not be available from the authors. Address correspondence to Genevieve E. Staudt, MD, Department of Pediatric Anesthesiology, Vanderbilt University Medical Center, Suite 3116, Nashville, TN 37232. Address e-mail to genevieve.e.staudt@vanderbilt.edu. © 2018 International Anesthesia Research Society

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Anesthesiology: Clinical Case Reviews

No abstract available

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A Randomized Trial of Continuous Noninvasive Blood Pressure Monitoring During Noncardiac Surgery

BACKGROUND: Intraoperative hypotension is associated with postoperative mortality. Early detection of hypotension by continuous hemodynamic monitoring might prompt timely therapy, thereby reducing intraoperative hypotension. We tested the hypothesis that continuous noninvasive blood pressure monitoring reduces intraoperative hypotension. METHODS: Patients ≥45 years old with American Society of Anesthesiologists physical status III or IV having moderate-to-high-risk noncardiac surgery with general anesthesia were included. All participating patients had continuous noninvasive hemodynamic monitoring using a finger cuff (ClearSight, Edwards Lifesciences, Irvine, CA) and a standard oscillometric cuff. In half the patients, randomly assigned, clinicians were blinded to the continuous values, whereas the others (unblinded) had access to continuous blood pressure readings. Continuous pressures in both groups were used for analysis. Time-weighted average for mean arterial pressure

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Change in V O 2max and time trial performance in response to high-intensity interval training prescribed using ventilatory threshold

Abstract

Completion of high-intensity interval training (HIIT) leads to significant increases in maximal oxygen uptake (VO_2max) and oxidative capacity. However, individual responses to HIIT have been identified as approximately 20–40% of individuals show no change in VO_2max, which may be due to the relatively homogeneous approach to implementing HIIT. Purpose: This study tested the effects of HIIT prescribed using ventilatory threshold (VT) on changes in VO_2max and cycling performance. Methods: Fourteen active men and women (age and VO_2max = 27 ± 8 year and 38 ± 4 mL/kg/min) underwent nine sessions of HIIT, and 14 additional men and women (age and VO_2max = 22 ± 3 year and 40 ± 5 mL/kg/min) served as controls. Training was performed on a cycle ergometer at a work rate equal to 130%VT and consisted of eight to ten 1 min bouts interspersed with 75 s of recovery. At baseline and post-testing, they completed progressive cycling to exhaustion to determine VO_2max, and on a separate day, a 5 mile cycling time trial. Results: Compared to the control group, HIIT led to significant increases in VO_2max (6%, p = 0.007), cycling performance (2.5%, p = 0.003), and absolute VT (9 W, p = 0.005). However, only 57% of participants revealed meaningful increases in VO_2max and cycling performance in response to training, and two showed no change in either outcome. Conclusions: A greater volume of HIIT may be needed to maximize the training response for all individuals.

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Radiocaesium transfer from volcanic soils to Swiss chard, cabbage and sweet corn

Publication date: December 2018
Source:Journal of Environmental Radioactivity, Volume 192
Author(s): Paulina Schuller, Alejandra Castillo, Gabriele Voigt, Natalia Semioshkina
The root uptake of radiocaesium by different plant parts of Swiss chard (Beta vulgaris L. var. cicla), cabbage (Brassica oleracea L. var. capitata) and sweet corn (Zea mays L. var. saccharata) and the potential influence of K-fertilising on the transfer behaviour was studied in allophanic volcanic soils (umbric andosol and dystric fluvisol) in Chile under temperate climate and heavy rainfall conditions (∼2660 mm y⁻¹) over several vegetation periods. The soils were spiked homogeneously to 0.20 m depth with 100 kBq ¹³⁴Cs m⁻² and activity concentrations measured. The transfer factor (TF, on a dry mass basis) to Swiss chard had a clear exponential decrease within each crop year for both soil types, either K-fertilised or unfertilised. The highest values of the TFs to Swiss chard were at the beginning of the harvests, and the half-times of TF decrease ranged between 52 and 137 d for umbric andosol and between 40 and 164 d for dystric fluvisol. Over the five seasons there was no consistent ageing effect based on TF in either soil types for the three studied crops. The effect of ¹³⁴Cs foliar uptake by Swiss chard from resuspended soil was estimated to account for about 70% (external leaves) and 30% (internal leaves) increase in the TF for the K-unfertilised umbric andosol, and showed an ambiguous behaviour for the K-fertilised umbric andosol. Consequently foliar uptake does not explain the 370 and 500% increase of the TF to Swiss chard leaves determined during the third growing period in the umbric andosol without and with K-fertilisation, respectively. Therefore an uncertainty factor of 3–5 is recommended to be taken into account when using this parameter for dose calculations. The TF to Swiss chard was found to be higher than previously reported values. The TF to cabbage and sweet corn plant parts was found to be within the range of previously reported values. Normal K-fertilisation resulted in about 2.4-fold reduction in ¹³⁴Cs TF to Swiss chard, 2.3-fold to sweet corn and 3.0-fold to cabbage.



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Extended Kd distributions for freshwater environment

Publication date: December 2018
Source:Journal of Environmental Radioactivity, Volume 192
Author(s): Patrick Boyer, Claire Wells, Brenda Howard
Many of the freshwater Kd values required for quantifying radionuclide transfer in the environment (e.g. ERICA Tool, Symbiose modelling platform) are either poorly reported in the literature or not available. To partially address this deficiency, Working Group 4 of the IAEA program MODARIA (2012–2015) has completed an update of the freshwater Kd databases and Kd distributions given in TRS 472 (IAEA, 2010). Over 2300 new values for 27 new elements were added to the dataset and 270 new Kd values were added for the 25 elements already included in TRS 472 (IAEA, 2010). For 49 chemical elements, the Kd values have been classified according to three solid-liquid exchange conditions (adsorption, desorption and field) as was previously carried out in TRS 472. Additionally, the Kd values were classified into two environmental components (suspended and deposited sediments). Each combination (radionuclide x component x condition) was associated with log-normal distributions when there was at least ten Kd values in the dataset and to a geometric mean when there was less than ten values. The enhanced Kd dataset shows that Kd values for suspended sediments are significantly higher than for deposited sediments and that the variability of Kd distributions are higher for deposited than for suspended sediments. For suspended sediments in field conditions, the variability of Kd distributions can be significantly reduced as a function of the suspended load that explains more than 50% of the variability of the Kd datasets of U, Si, Mo, Pb, S, Se, Cd, Ca, B, K, Ra and Po. The distinction between adsorption and desorption conditions is justified for deterministic calculations because the geometric means are systematically greater in desorption conditions. Conversely, this distinction is less relevant for probabilistic calculations due to systematic overlapping between the Kd distributions of these two conditions.



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Emergence times and airway reactions during general anaesthesia with remifentanil and a laryngeal mask airway: A multicentre randomised controlled trial

BACKGROUND Avoidance of airway complications and rapid emergence from anaesthesia are indispensable for the use of a laryngeal mask airway (LMA). Evidence from adequately powered randomised studies with a low risk of bias for the optimal anaesthetic in this context is limited. OBJECTIVE We tested the hypothesis that when using remifentanil-based intra-operative analgesia, desflurane would be the most suitable anaesthetic: with noninferiority in the occurrence of upper airway complications and superiority in emergence times compared with sevoflurane or propofol. DESIGN A prospective, randomised, multicentre, partially double-blinded, three-arm, parallel-group study. SETTING Two university and two regional German hospitals, from February to October 2015. PATIENTS A total of 352 patients (age 18 to 75 years, ASA physical status I to III, BMI less than 35 kg m−2 and fluent in German) were enrolled in this study. All surgery was elective with a duration of 0.5 to 2 h, and general anaesthesia with a LMA was feasible. INTERVENTION The patients were randomised to receive desflurane, sevoflurane or propofol anaesthesia. MAIN OUTCOME MEASURES This study was powered for the primary outcome 'time to state date of birth' and the secondary outcome 'intra-operative cough'. Time to emergence from anaesthesia and the incidence of upper airway complications were assessed on the day of surgery. RESULTS The primary outcome was analysed for 343 patients: desflurane (n=114), sevoflurane (n=111) and propofol (n=118). The desflurane group had the fastest emergence. The mean (± SD) times to state the date of birth following desflurane, sevoflurane and propofol were 8.1 ± 3.6, 10.1 ± 4.0 and 9.8 ± 5.1 min, respectively (P 

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The LAS VEGAS risk score for prediction of postoperative pulmonary complications: An observational study

BACKGROUND Currently used pre-operative prediction scores for postoperative pulmonary complications (PPCs) use patient data and expected surgery characteristics exclusively. However, intra-operative events are also associated with the development of PPCs. OBJECTIVE We aimed to develop a new prediction score for PPCs that uses both pre-operative and intra-operative data. DESIGN This is a secondary analysis of the LAS VEGAS study, a large international, multicentre, prospective study. SETTINGS A total of 146 hospitals across 29 countries. PATIENTS Adult patients requiring intra-operative ventilation during general anaesthesia for surgery. INTERVENTIONS The cohort was randomly divided into a development subsample to construct a predictive model, and a subsample for validation. MAIN OUTCOME MEASURES Prediction performance of developed models for PPCs. RESULTS Of the 6063 patients analysed, 10.9% developed at least one PPC. Regression modelling identified 13 independent risk factors for PPCs: six patient characteristics [higher age, higher American Society of Anesthesiology (ASA) physical score, pre-operative anaemia, pre-operative lower SpO2 and a history of active cancer or obstructive sleep apnoea], two procedure-related features (urgent or emergency surgery and surgery lasting ≥ 1 h), and five intra-operative events [use of an airway other than a supraglottic device, the use of intravenous anaesthetic agents along with volatile agents (balanced anaesthesia), intra-operative desaturation, higher levels of positive end-expiratory pressures > 3 cmH2O and use of vasopressors]. The area under the receiver operating characteristic curve of the LAS VEGAS risk score for prediction of PPCs was 0.78 [95% confidence interval (95% CI), 0.76 to 0.80] for the development subsample and 0.72 (95% CI, 0.69 to 0.76) for the validation subsample. CONCLUSION The LAS VEGAS risk score including 13 peri-operative characteristics has a moderate discriminative ability for prediction of PPCs. External validation is needed before use in clinical practice. TRIAL REGISTRATION The study was registered at Clinicaltrials.gov, number NCT01601223. Correspondence to Ary Serpa Neto, MD, MSc, PhD, Department of Critical Care, Hospital Israelita Albert Einstein, 621 Albert Einstein Avenue, São Paulo, 03178-200 Brazil. Tel: +55 112 1511521; e-mail: aryserpa@terra.com.br Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (https://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

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Ancient teeth, phenetic affinities, and African hominins: Another look at where Homo naledi fits in

Publication date: Available online 19 June 2018
Source:Journal of Human Evolution
Author(s): Joel D. Irish, Shara E. Bailey, Debbie Guatelli-Steinberg, Lucas K. Delezene, Lee R. Berger
A new species of Homo, Homo naledi, was described in 2015 based on the hominin skeletal remains from the Dinaledi Chamber of the Rising Star cave system, South Africa. Subsequent craniodental comparative analyses, both phenetic and cladistic, served to support its taxonomic distinctiveness. Here we provide a new quantitative analysis, where up to 78 nonmetric crown and root traits of the permanent dentition were compared among samples of H. naledi (including remains from the recently discovered Lesedi Chamber) and eight other species from Africa: Australopithecus afarensis, Australopithecus africanus, Paranthropus boisei, Paranthropus robustus, Homo habilis, Homo erectus, Middle Pleistocene Homo sp., and Pleistocene and Holocene Homo sapiens. By using the mean measure of divergence distance statistic, phenetic affinities were calculated among samples to evaluate interspecific relatedness. The objective was to compare the results with those previously obtained, to assess further the taxonomic validity of the Rising Star hominin species. In accordance with earlier findings, H. naledi appears most similar dentally to the other African Homo samples. However, the former species is characterized by its retention and full expression of features relating to the main cusps, as well as the root numbers, with a near absence of accessory traits—including many that, based on various cladistic studies, are plesiomorphic in both extinct and extant African hominins. As such, the present findings provide additional support for the taxonomic validity of H. naledi as a distinct species of Homo.



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Onabotulinumtoxin-A injections into the salivary glands for spinal muscle atrophy type I: A prospective case series of four patients

Objective To investigate the safety and efficacy of Onabotulinum Toxin-A (BTX-A) injection to the salivary glands under ultrasound guidance for the treatment of sialorrhea in patients with spinal muscular atrophy type I (SMA I). Design: Prospective case series with four patients with SMA I who received BTX-A injection to parotid and submandibular glands for sialorrhea as part of clinical care. All four patients received validated surveys for measuring drooling, including objective measures of number of bib changes, and number of mouth wipes before injection and 4-6 weeks after injection. Research was limited to survey completion. Scales included the Drooling Severity and Frequency Scale and the Drooling Impact Scale as well as a new scale used in our clinic, the Posterior Drooling Scales looking at coughing/choking and number of aspiration pneumonias. Results: There were no adverse events. All four patients showed clinically significant improvements. The improvement in drooling using the DIS was statistically significant (Paired-t test, t=3.243, P=0.048). All patients improved with number of mouth wipes. Conclusion Ultrasound guided BTX-A injections to the salivary glands may be a safe and effective method of decreasing drooling in patients with SMA I. Corresponding Author: Hannah Aura Shoval, Children's Specialized Hospital, 1135 Broad Street, Clifton NJ, 07013, Email: hshoval@childrens-specialized.org This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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New Visions and Current Evidence for Safety in Anesthesia

No abstract available

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Misguided by INR in Liver Disease Patients? Implications for Clinicians Including Pain Proceduralists

No abstract available

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Factor XI Deficiency and Pregnancy: Abnormal Lab Values or Significant Risk?

No abstract available

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Now Serving a Trauma Victim Near You: Whole Blood for Civilian Trauma Resuscitation

No abstract available

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Diversity Versus Efficiency in Surgical Practice: Making Practical Sense of Complicated Science

No abstract available

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Burnout, Fatigue, Exhaustion: An Interdisciplinary Perspective on a Modern Affliction

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Transfusion of Aged Red Blood Cells in Liver Transplantation: Et tu, Brute?

No abstract available

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In Response

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New Technology, New Thinking

No abstract available

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Thermal A-δ Nociceptors, Identified by Transcriptomics, Express Higher Levels of Anesthesia-Sensitive Receptors Than Thermal C-Fibers and Are More Suppressible by Low-Dose Isoflurane

We investigated the effect of isoflurane on 2 main types of thermal nociceptors: A-δ and C-fibers. Surprisingly, 1% inhaled isoflurane led to a hyperalgesic response to C-fiber thermal stimulation, whereas responses to A-δ thermal stimulation were blunted. We explored the hypothesis that differences in withdrawal behavior are mediated by differential expression of isoflurane-sensitive proteins between these types of thermal nociceptors. Multiple transcriptomic databases of peripheral neurons were integrated to reveal that isoflurane-susceptible proteins Htr3a, Kcna2, and Scn8a were enriched in thermosensitive A-δ neurons. This exploratory analysis highlights the differing role that volatile anesthetics might have on nociceptors in the peripheral nervous system.

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If Only the Practice of Evidence-Based Medicine Was as Simple as Creating Guidelines…

No abstract available

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Essentials of Pain Medicine, 4th ed

No abstract available

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Anesthesiology and Palliative Care: Past, Present, and Future

No abstract available

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Integrative Pain Management Must Include Diet Considerations

No abstract available

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National Surgical Quality Improvement Program: What Can Anesthesiologists Learn From Surgical Outcomes?

No abstract available

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Reduced Ketobemidone Usage in Quadratus Lumborum Block Patients After Cesarean Delivery: Clinical Pharmacology Views

No abstract available

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Anesthesia Informatics Grows Up

No abstract available

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In Response

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STAT Calls: Real Data Could Improve Anesthesia Staffing Models

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Incidence and Risk Factors for Chronic Postoperative Opioid Use After Major Spine Surgery: A Cross-Sectional Study With Longitudinal Outcome

BACKGROUND: Chronic opioid use is a significant public health concern. Surgery is a risk factor for developing chronic opioid use. Patients undergoing major spine surgery frequently are prescribed opioids preoperatively and may be at risk for chronic opioid use postoperatively. The aim of this study was to investigate the incidence of and perioperative risk factors associated with chronic opioid use after major spine surgery. METHODS: The records of patients who underwent elective major spine surgery at the University of Virginia between March 2011 and February 2016 were retrospectively reviewed. The primary outcome was chronic opioid use through 12 months postoperatively. Demographic data, medical comorbidities, preoperative pain scores, and medication use including daily morphine-equivalent (ME) dose, intraoperative use of lidocaine and ketamine, estimated blood loss, postoperative pain scores and medication use, and postoperative opioid use were collected. Logistic regression models were used to examine factors associated with chronic opioid use. RESULTS: Of 1477 patient records reviewed, 412 patients (27.9%) were opioid naive and 1065 patients (72.3%) used opioids before surgery. Opioid data were available for 1325 patients, while 152 patients were lost to 12-month follow-up and were excluded. Of 958 preoperative opioid users, 498 (52.0%) remained chronic users through 12 months. There was a decrease in opioid dosage (mg ME) from preoperative to 12 months postoperatively with a mean difference of −14.7 mg ME (standard deviation, 1.57; 95% confidence interval [CI], −17.8 to −11.7). Among 367 previously opioid-naive patients, 67 (18.3%) became chronic opioid users. Factors associated with chronic opioid use were examined using logistic regression models. Preoperative opioid users were nearly 4 times more likely to be chronic opioid users through 12 months than were opioid-naive patients (odds ratio, 3.95; 95% CI, 2.51–6.33; P

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Generation of two transgenic amphioxus lines using the Tol2 transposon system

Publication date: Available online 18 June 2018
Source:Journal of Genetics and Genomics
Author(s): Chenggang Shi, Jing Huang, Shixi Chen, Guang Li, Yiquan Wang




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Advances in the development of molecular genetic tools for Mycobacterium tuberculosis

Publication date: Available online 18 June 2018
Source:Journal of Genetics and Genomics
Author(s): Chiranjibi Chhotaray, Yaoju Tan, Julius Mugweru, Md Mahmudul Islam, H.M. Adnan Hameed, Shuai Wang, Zhili Lu, Changwei Wang, Xinjie Li, Shouyong Tan, Jianxiong Liu, Tianyu Zhang
Mycobacterium tuberculosis, a clinically relevant Gram-positive bacterium of great clinical relevance, is a potentially lethal pathogen owing to its complex physiological characteristics and development of drug resistance. Several molecular genetic tools have been developed in the past few decades to study this microorganism. These tools have been instrumental in understanding how M. tuberculosis became a successful pathogen. Advanced molecular genetic tools have played a significant role in exploring the complex pathways involved in M. tuberculosis pathogenesis. Here, we review various molecular genetic tools used in the study of M. tuberculosis. Further, we discuss the applications of clustered regularly interspaced short palindromic repeat interference (CRISPRi), a novel technology recently applied in M. tuberculosis research to study target gene functions. Finally, prospective outcomes of the applications of molecular techniques in the field of M. tuberculosis genetic research are also discussed.



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