Δευτέρα, 20 Αυγούστου 2018

Editorial Board

Publication date: September 2018

Source: International Journal of Psychophysiology, Volume 131

Author(s):



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International Organization of Psychophysiology

Publication date: September 2018

Source: International Journal of Psychophysiology, Volume 131

Author(s):



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Academy News – August PM&R

As the primary medical society for the specialty of PM&R, your Academy is focused on moving the specialty and you forward. Our mission is to lead the advancement of physiatry's impact throughout health care. Your Academy will ensure that:

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Morbidity and Mortality Rounds in Rehabilitation—Benefits for Enhancing Quality Beyond Just the “M&M”

Morbidity and Mortality Rounds (MMRs) have long been employed in acute care hospitals to review and learn from medical errors, particularly those that resulted in significant patient harm [1-3]. With the ever-increasing focus on patient safety in health care, MMRs have been adopted across many specialties as a forum for critical incident review using a systems-based approach to identify root causes of quality and safety gaps, and improve future care delivery [4-6]. However, the literature contains only 2 reports of MMRs introduced into rehabilitation settings [7,8].

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Copyright Page



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Information for Authors



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Table of Contents



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Spanish Translated Abstracts



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Editorial Board



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Functional Interactions Between rsks-1/S6K, glp-1/Notch, and Regulators of Caenorhabditis elegans Fertility and Germline Stem Cell Maintenance

The proper accumulation and maintenance of stem cells is critical for organ development and homeostasis. The Notch signaling pathway maintains stem cells in diverse organisms and organ systems. In Caenorhabditis elegans, GLP-1/Notch activity prevents germline stem cell (GSC) differentiation. Other signaling mechanisms also influence the maintenance of GSCs, including the highly-conserved TOR substrate ribosomal protein S6 kinase. Although C. elegans bearing either a null mutation in rsks-1/S6K or a reduction-of-function (rf) mutation in glp-1/Notch produce half the normal number of adult germline progenitors, virtually all these single mutant animals are fertile. However, glp-1(rf) rsks-1(null) double mutant animals are all sterile, and in about half of their gonads, all GSCs differentiate, a distinctive phenotype associated with a significant reduction or loss of GLP-1 signaling. How rsks-1/S6K promotes GSC fate is unknown. Here, we determine that rsks-1/S6K acts germline-autonomously to maintain GSCs, and that it does not act through Cyclin-E or MAP kinase in this role. We found that interfering with translation also enhances glp-1(rf), but that regulation through rsks-1 cannot fully account for this effect. In a genome-scale RNAi screen for genes that act similarly to rsks-1/S6K, we identified 56 RNAi enhancers of glp-1/Notch sterility, many of which were previously not known to interact functionally with Notch. Further investigation revealed six candidates that, by genetic criteria, act linearly with rsks-1/S6K. These include genes encoding translation-related proteins, cacn-1/Cactin, an RNA exosome component and a Hedgehog-related ligand. We found that additional Hedgehog-related ligands may share functional relationships with glp-1/Notch and rsks-1/S6K in maintaining germline progenitors.



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A Novel Mutation in brain tumor Causes Both Neural Over-Proliferation and Neurodegeneration in Adult Drosophila

A screen for neuroprotective genes in Drosophila melanogaster led to the identification of a mutation that causes extreme, progressive loss of adult brain neuropil in conjunction with massive brain overgrowth. We mapped the mutation to the brain tumor (brat) locus, which encodes a tripartite motif-NCL-1, HT2A, and LIN-41 (TRIM-NHL) RNA-binding protein with established roles limiting stem cell proliferation in developing brain and ovary. However, a neuroprotective role for bratin the adult Drosophila brain has not been described previously. The new allele, bratcheesehead (bratchs), carries a mutation in the coiled-coil domain of the TRIM motif, and is temperature-sensitive. We demonstrate that mRNA and protein levels of neural stem cell genes are increased in heads of adult bratchs mutants and that the over-proliferation phenotype initiates prior to adult eclosion. We also report that disruption of an uncharacterized gene coding for a presumptive prolyl-4-hydroxylase strongly enhances the over-proliferation and neurodegeneration phenotypes. Together, our results reveal an unexpected role for brat that could be relevant to human cancer and neurodegenerative diseases.



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Identification of Candidate Genes Controlling Black Seed Coat and Pod Tip Color in Cowpea (Vigna unguiculata [L.] Walp)

Seed coat color is an important part of consumer preferences for cowpea (Vigna unguiculata [L.] Walp). Color has been studied in numerous crop species and has often been linked to loci controlling the anthocyanin biosynthesis pathway. This study makes use of available resources, including mapping populations, a reference genome, and a high-density single nucleotide polymorphism genotyping platform, to map the black seed coat and purple pod tip color traits, with the gene symbol Bl, in cowpea. Several gene models encoding MYB domain protein 113 were identified as candidate genes. MYB domain proteins have been shown in other species to control expression of genes encoding enzymes for the final steps in the anthocyanin biosynthesis pathway. PCR analysis indicated that a presence/absence variation of one or more MYB113 genes may control the presence or absence of black pigment. A PCR marker has been developed for the MYB113 gene Vigun05g039500, a candidate gene for black seed coat color in cowpea.



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Technical development of transcutaneous electrical nerve inhibition using medium-frequency alternating current

Innovative technical approaches to controlling undesired sensory and motor activity, such as hyperalgesia or spasticity, may contribute to rehabilitation techniques for improving neural plasticity in patients ...

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Underwater endoscopic mucosal resection of a large jejunal polyp by single-balloon enteroscopy in a patient with Peutz-Jeghers syndrome



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Epidemiology of Inflammatory Bowel Disease in the Republic of San Marino: the “EPIMICI − San Marino” Study

The burden of Crohn's disease (CD) and ulcerative colitis (UC) has never been estimated in the Republic of San Marino, the third smallest Nation of the World.

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Chronic use of statins and risk of post-ERCP acute pancreatitis (STARK): Study protocol for an international multicenter prospective cohort study

Acute pancreatitis (AP) is the most common complication after endoscopic retrograde cholangiopancreatography (ERCP). Statins have been traditionally associated to an increased risk of AP, however, recent evidence suggests that statins may have a protective role against this disease.

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Allogeneic mesenchymal stromal cells for refractory luminal Crohn’s disease: A phase I–II study

Crohn's disease (CD) is a complex chronic relapsing disease involving abnormal systemic and mucosal immune responses against intraluminal antigens, favoured by microbial factors and alteration of the mucosal barrier. A key role in its pathogenesis is played by the imbalance between proinflammatory T helper (Th)1/Th17 cells and regulatory T lymphocytes (Treg), resulting in activation of macrophages and B cells, and recruitment of circulating leukocytes into the gut. Mesenchymal stromal cells (MSCs) exert potent immunomodulatory effects and exhibit interesting properties for tissue repair [1].

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Prognostic stratification of resected pancreatic ductal adenocarcinoma: past, present, and future

Pancreatic ductal adenocarcinoma (PDAC) is the digestive cancer with the poorest prognosis, with a 5-year overall survival rate of 7%. Complete surgical resection followed by adjuvant chemotherapy is the only treatment with curative intent. However, many patients with an apparently localized disease who may undergo primary tumor resection already have micro-metastatic disease and will promptly develop metastases. Considering the significant rate of morbidity and mortality upon pancreatic surgery, the pre-operative identification of patients with an aggressive disease is therefore a major clinical issue.

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Effective cholangioscopic management of a patient with type IV Mirizzi syndrome

Mirizzi syndrome (MS), a complication of gallstones in which the common hepatic duct (CHD) is obstructed by extrinsic compression from the cystic duct or gallbladder, is classified into four types, according to the degree of cholecysto-biliary fistulization.

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A single trial may be used for measuring muscle strength with dynamometers in individuals with stroke: A cross-sectional study

The mean of three trials is commonly employed to report measures of muscle strength after a stroke. However, only a single trial showed to provide consistent and reliable results regarding dynamometric measures of grip, pinch, and trunk strength in individuals with stroke. Nevertheless, there were not found any studies that investigated whether only a single trial could also be used for the assessment of strength of the upper and lower-limb muscles.

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Impact of neck position on the probability of common carotid artery puncture during ultrasound guided stellate ganglion block

The carotid artery must be avoided during stellate ganglion block. However, the information on optimal neck position during the ultrasound guided approach is limited.

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A review of botulinum toxin A for the treatment of neurogenic bladder

Prior to FDA approval of intradetrusor botulinum toxin (BoTA) injections for the treatment of neurogenic bladder, patients had limited treatment options including 'off-label' use of pharmacotherapies (anti-cholinergics, beta agonists, and alpha-blockers) or invasive interventions including bladder augmentation and urinary diversion procedures. Herein, we provide a comprehensive, literature review detailing the salient clinical literature which led to FDA approval of intradetrusor BoTA for neurogenic bladder, Patients with neurogenic detrusor overactivity and detrusor sphincter dyssynergia have been shown in randomized studies to benefit significantly from intradetrusor BoTA injection with regards to the following parameters: improved voided volume, improved bladder pressure and urodynamic parameters, reduced incidence of urinary tract infection, and improved quality of life.

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Underwater endoscopic mucosal resection of a large jejunal polyp by single-balloon enteroscopy in a patient with Peutz-Jeghers syndrome



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Epidemiology of Inflammatory Bowel Disease in the Republic of San Marino: the “EPIMICI − San Marino” Study

The burden of Crohn's disease (CD) and ulcerative colitis (UC) has never been estimated in the Republic of San Marino, the third smallest Nation of the World.

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Chronic use of statins and risk of post-ERCP acute pancreatitis (STARK): Study protocol for an international multicenter prospective cohort study

Acute pancreatitis (AP) is the most common complication after endoscopic retrograde cholangiopancreatography (ERCP). Statins have been traditionally associated to an increased risk of AP, however, recent evidence suggests that statins may have a protective role against this disease.

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Allogeneic mesenchymal stromal cells for refractory luminal Crohn’s disease: A phase I–II study

Crohn's disease (CD) is a complex chronic relapsing disease involving abnormal systemic and mucosal immune responses against intraluminal antigens, favoured by microbial factors and alteration of the mucosal barrier. A key role in its pathogenesis is played by the imbalance between proinflammatory T helper (Th)1/Th17 cells and regulatory T lymphocytes (Treg), resulting in activation of macrophages and B cells, and recruitment of circulating leukocytes into the gut. Mesenchymal stromal cells (MSCs) exert potent immunomodulatory effects and exhibit interesting properties for tissue repair [1].

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Prognostic stratification of resected pancreatic ductal adenocarcinoma: past, present, and future

Pancreatic ductal adenocarcinoma (PDAC) is the digestive cancer with the poorest prognosis, with a 5-year overall survival rate of 7%. Complete surgical resection followed by adjuvant chemotherapy is the only treatment with curative intent. However, many patients with an apparently localized disease who may undergo primary tumor resection already have micro-metastatic disease and will promptly develop metastases. Considering the significant rate of morbidity and mortality upon pancreatic surgery, the pre-operative identification of patients with an aggressive disease is therefore a major clinical issue.

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Effective cholangioscopic management of a patient with type IV Mirizzi syndrome

Mirizzi syndrome (MS), a complication of gallstones in which the common hepatic duct (CHD) is obstructed by extrinsic compression from the cystic duct or gallbladder, is classified into four types, according to the degree of cholecysto-biliary fistulization.

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Macaque remains from the early Pliocene of the Iberian Peninsula

Publication date: Available online 20 August 2018

Source: Journal of Human Evolution

Author(s): David M. Alba, Eric Delson, Jorge Morales, Plini Montoya, Gregorio Romero

Abstract

Macaques dispersed out of Africa into Eurasia in the framework of a broader intercontinental faunal exchange that coincided in time with the sea level drop associated with the Messinian Salinity Crisis. They are first recorded in Europe (Italy and Spain) by the latest Miocene, being subsequently recorded all over Europe, albeit sparsely, throughout the Pliocene and Pleistocene. These fossil European macaques are attributed to several (sub)species of the extant Barbary macaque (Macaca sylvanus). In Iberia, fossil macaques are best documented by Macaca sylvanus florentina from various Early Pleistocene sites, whereas their published Pliocene record is very scarce. Here we report the oldest post-Messinian occurrence of macaques in the Iberian Peninsula, based on the description and metrical comparisons of two upper teeth (a male canine and a third molar of two different individuals) from the early Pliocene (MN14, 5.0–4.9 Ma) site of Puerto de la Cadena (Murcia, SE Spain). The male C1 is fully comparable in morphology with those of extant and fossil M. sylvanus, and larger than those of Mesopithecus. The M3, in turn, displays the typical papionin morphology that characterizes the dentally-conservative genus Macaca—thereby discounting an alternate assignment to either the extinct colobine monkey Mesopithecus or the more dentally-derived papionin Theropithecus. Dental size and proportions of the M3 further support an attribution to an extinct subspecies of M. sylvanus instead of the larger papionin Paradolichopithecus. Mostly on biochronologic grounds, the two macaque teeth from Puerto de la Cadena are here assigned to Macaca sylvanus cf. prisca, albeit tentatively, given the lack of clear-cut criteria to distinguish this subspecies from the younger Macaca sylvanus florentina. The described material represents the oldest well-dated Pliocene record of macaques in Iberia, predating the record of Paradolichopithecus by almost 1.5 million years.



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Why your EMS agency needs near-miss reporting

Near-miss reporting can help build a culture of safety in your agency and improve the EMS profession as a whole

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Community paramedicine could ease the opioid epidemic

Using community paramedicine resources to monitor opioid-addicted patients detoxing at home could relieve the burden on EMS and ERs

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Retired firefighter-paramedic shares career experiences in memoir

Veteran first responder Conrad Gonzalez wrote "10-96 … We're on the Way," which includes 40 stories about saving lives

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Association of 25-hydroxyvitamin D with liver cancer incidence and chronic liver disease mortality in Finnish male smokers of the ATBC study

Cancer Epidemiology, Biomarkers & Prevention

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Contralateral repeated bout effect after eccentric exercise on muscular activation

Abstract

Purpose

The purpose of this study was to investigate the contralateral and ipsilateral repeated bout effects of eccentric contractions (ECCs) on muscle fiber activation using transverse relaxation time (T2) of magnetic resonance imaging (MRI).

Methods

Eleven men (22.3 ± 2.9 years) performed two bouts of 30 maximal ECCs of the elbow flexors spaced 2 weeks apart. Initially, all subjects performed 30 ECCs for one arm (ECC1). After 2 weeks, they performed 30 ECCs for both ipsilateral arm (IL-RBE) and contralateral arm (CL-RBE). Measurements were maximal voluntary isometric contraction (MVC) torque, range of motion (ROM), muscle soreness, cross-sectional area (CSA), and T2 at before, immediately after, 1, 2, 3, and 5 days after ECCs.

Results

The loss of MVC torque, limited ROM, and developed muscle soreness and CSA were inhibited for IL-RBE and CL-RBE compared with ECC1 (p < 0.05). The acute T2, which is an indicator of the activation of muscle fibers, was longer for IL-RBE and CL-RBE than ECC1 (p < 0.05). Otherwise, no significant difference between IL-RBE and CL-RBE was observed in other measurements.

Conclusion

Our results suggest that one of the mechanisms for CL-RBE of ECCs is the increase in muscle fiber activation. In addition, the magnitude of protective effect for CL-RBE was similar to the IL-RBE in untrained young men.



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Influence of a self-regulated cognitive dual task on time to failure and complexity of submaximal isometric force control

Abstract

Purpose

To determine the effects of performing a self-regulated cognitive dual task on time to failure and neuromuscular force control during submaximal isometric contractions.

Methods

Fifteen young sedentary males performed isometric contractions at 50% of each individual's maximal voluntary contraction (MVC) under single-task (without cognitive load) and dual-task (with self-regulated mathematical task) conditions. Force signal complexity and biceps brachialis muscle activity were determined at the start, middle, and end of each trial. The slope of the linear regression of median frequency determined the rate of muscle fatigue. Force-task error was established as any amplitude percentage greater or less than 50% MVC.

Results

The dual-task condition resulted in a 42 s longer time to failure than the single-task condition. EMG amplitude did not differ between conditions. The rate of muscle fatigue was higher in the single-task (− 0.35%/s) than the dual-task (− 0.2%/s) condition. Force signal complexity was, on average, 22% lower in the dual-task condition. The dual-task condition, as compared to the single-task condition, elicited a higher rate of force-task error below (6.37 versus 4.76%) and over (2.11 versus 1.68%) the force threshold.

Conclusion

The dual-task condition resulted in a longer time to failure and decreased motor output complexity and fatigue rate when performing a submaximal force task. As the dual task also increased the force-task error, we suggest cognitive dual tasks as a possible strategy for delaying fatigue in sedentary young males when exerting submaximal isometric force, contributing to neuromuscular training when error in force control can be ignored.



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Determining the potential sites of neural adaptation to cross-education: implications for the cross-education of muscle strength

Abstract

Cross-education describes the strength gain in the opposite, untrained limb following a unilateral strength training program. Since its discovery in 1894, several studies now confirm the existence of cross-education in contexts that involve voluntary dynamic contractions, eccentric contraction, electrical stimulation, whole-body vibration and, more recently, following mirror feedback training. Although many aspects of cross-education have been established, the mediating neural mechanisms remain unclear. Overall, the findings of this review show that the neural adaptations to cross-education of muscle strength most likely represent a continuum of change within the central nervous system that involves both structural and functional changes within cortical motor and non-motor regions. Such changes are likely to be the result of more subtle changes along the entire neuroaxis which include, increased corticospinal excitability, reduced cortical inhibition, reduced interhemispheric inhibition, changes in voluntary activation and new regions of cortical activation. However, there is a need to widen the breadth of research by employing several neurophysiological techniques (together) to better understand the potential mechanisms mediating cross-education. This fundamental step is required in order to better prescribe targeted and effective guidelines for the clinical practice of cross-education. There is a need to determine whether similar cortical responses also occur in clinical populations where, perhaps, the benefits of cross-education could be best observed.



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Effects of normoxic and hypoxic exercise training on the bactericidal capacity and subsequent apoptosis of neutrophils in sedentary men

Abstract

Phagocytosis and oxidative burst are essential mechanisms of innate immunity by which neutrophils eliminate invading pathogens. Afterwards, phagocytic neutrophils are dissipated by facilitating apoptosis to control inflammation. This study investigates how exercise training with or without hypoxic exposure affects the bactericidal activity and subsequent apoptosis of neutrophils following strenuous exercise. A total of 60 healthy, sedentary men were randomly divided into four groups (n = 15 in each group), who were exposed to 21% O2 [normoxic control (NC)] or 15% O2 [hypoxic control (HC)] at rest or were trained at 50% of peak work rate at 21% O2 [normoxic training (NT)] or 15% O2 [hypoxic training (HT)] for 30 min/day, 5 days/week for 4 weeks. Before the intervention, acute strenuous exercise (SE) enhanced the phagocytosis of Escherichia coli (E. coli) by neutrophils and the release of neutrophil oxidant products in response to E. coli, accompanied by increases in the expression of adhesion molecules (CD62L, CD11b, and CD11a), an opsonic receptor (FcγIIIBR), and complement receptors (C1qRp and CD5aR) on neutrophils. Subsequently, the SE facilitated caspase-3 activation and phosphatidylserine exposure in E. coli-stimulated neutrophils. Furthermore, 4 weeks of HT promoted the expressions of adhesion molecules and opsonic/complement receptors on neutrophils, and it also augmented the bactericidal and apoptotic activities of neutrophils at rest or after SE. However, NT, HC, and NC did not influence these neutrophil-related immune responses to strenuous exercise. Therefore, we conclude that the HT regimen effectively promotes the bactericidal capacity of neutrophils, and facilitates their subsequent apoptosis both at rest and following SE.



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Assessing changes in tissue oxygenation by near-infrared spectroscopy following brachial plexus block for arteriovenous fistula surgery: A prospective observational pilot study

BACKGROUND Near-infrared spectroscopy (NIRS) can be used to measure tissue oxygen saturation (StO2) in different sites and in a wide range of clinical scenarios. Peripheral regional anaesthesia induces vascular changes causing increased arterial blood flow and venodilatation, but its effect on StO2 is still under debate. This is especially so for patients undergoing arteriovenous fistula surgery, wherein latest data suggest an improved outcome under brachial plexus block (BPB) compared with local anaesthesia, but no data are available. OBJECTIVE The aim of this study was to investigate changes in StO2 following BPB prior to arteriovenous fistula surgery using NIRS. DESIGN A pilot study. SETTING A secondary teaching hospital from August 2016 to March 2017. PATIENTS Fifteen patients undergoing arteriovenous fistula surgery. INTERVENTION Ultrasound-guided BPB in 15 patients undergoing arteriovenous fistula surgery. OUTCOME MEASURES StO2 at baseline and compared with baseline and the contralateral arm following BPB measured using NIRS of the thenar eminence (NIRSth). RESULTS Baseline values of StO2 assessed by NIRSth were 42.6 ± 7.7% in the arteriovenous fistula arm and 42.7 ± 9.7% in the contralateral arm. There was no significant difference between the two. Five minutes after BPB, there was a significant increase in StO2 of the blocked arm, compared with the control arm expressed as difference of absolute values (7.1 ± 9.7%). At 60 min, an absolute difference of 21.0 ± 13.5% was reached. The absolute increase in StO2 of the blocked arm compared with baseline reached significance after 5 min (8.8 ± 4.6%) and increased up to 23.2 ± 8.2% after 60 min. CONCLUSION NIRSth indicates that BPB significantly increases StO2 of the arteriovenous fistula arm in patients undergoing haemodialysis. TRIAL REGISTRY NUMBER (S) Clinicaltrials.gov: NCT03044496 Correspondence to Dr Jonas Keuler, MD, Department of Anaesthesiology and Intensive Care Medicine, Marienhospital Stuttgart, Böheimstraße 37, Stuttgart 70199, Germany Tel: +49 711 6489 2716; e-mail: jonas.d.keuler@gmail.com © 2018 European Society of Anaesthesiology

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Peri-operative respiratory adverse events in children with upper respiratory tract infections allowed to proceed with anaesthesia: The French national study

BACKGROUND Peri-operative respiratory adverse events (PRAEs) in paediatric patients with upper respiratory tract infections (URTIs) remain inadequately explored in patients allowed to proceed to anaesthesia and surgery. OBJECTIVE To determine the incidence and risk factors of PRAE in children with URTI allowed to proceed to anaesthesia. DESIGN Multicentre cohort study performed over 6 months in France. SETTING Sixteen centres with dedicated paediatric anaesthetists. PATIENTS Eligible patients were aged from 0 to 18 years with URTI symptoms on admission or a history of such over the preceding 4 weeks. MAIN OUTCOMES The primary outcome of the study was to determine predictors of PRAE. Secondary outcomes were: predictors of peri-operative arterial desaturation and of the decision to proceed with anaesthesia and surgery in children with URTI. RESULTS Overall, 621 children were included and 489 (78.7%) anaesthetised. Of those anaesthetised, 165 (33.5%) and 97 (19.8%) experienced PRAE and arterial desaturation, respectively. Factors predictive of PRAE included patient age, tracheal intubation and the absence of midazolam premedication. Factors predictive of peri-operative arterial desaturation included patient age, anaesthetist experience, endoscopic procedures and the presence of other PRAE. Factors predicting proceeding to anaesthesia in the context of URTI included anaesthetist experience, emergency procedures and the absence of severe URTI symptoms. CONCLUSION The risk of PRAE in patients anaesthetised in the presence of URTI was similar to previous publications – close to 30%. In the light of our findings, first, current rescheduling indications should be questioned, and second, further medical and organisational strategies should be investigated to reduce PRAE in children with URTI. TRIAL REGISTRATION The study was registered in the European Networks of Centers for Pharmacoepidemiology and Pharmacovigilance (EUPAS16436). Correspondence to Souhayl Dahmani, MD, PhD, Department of Anaesthesia and Intensive Care, Robert Debre University Hospital, Assistance Publique-des Hôpitaux de Paris, 48 Boulevard Serurier, 75019 Paris, France Tel: +00 33 1 40 03 41 83; fax: +00 33 1 40 03 20 00; e-mail: souhayl.dahmani@rdb.aphp.fr 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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Dexmedetomidine mitigates sevoflurane-induced cell cycle arrest in hippocampus

Abstract

Background

Epidemiologic studies suggest the possibility of a modestly elevated risk of adverse neurodevelopmental outcomes in children exposed to anesthesia during early childhood. Sevoflurane is widely used in pediatric anesthetic practice because of its rapid induction and lower pungency. However, it is reported that sevoflurane leads to the long-term cognitive impairment. Some evidence revealed that the selective α2-adrenoreceptor agonist dexmedetomidine (DEX) exerts neuroprotective effects in various brain injury models of animals. But the role of DEX on sevoflurane-induced neuro-damage remains elusive.

Materials and methods

In our study, we isolated the hippocampal neuron cells from newborn neonatal rats and verified the purity of neurons by immunocytochemistry. We employed the flow cytometry and western blot to examine the effect of sevoflurane, DEX and α2-adrenergic receptor antagonist yohimbine on cell cycle distribution.

Results

Immunocytochemistry results showed the purity of neurons > 94%, which provided a good model for neural pharmacology experiments. The exposure of sevoflurane-induced cell cycle arrest at S phase and suppressed the expression of brain-derived neurotrophic factor (BDNF) and tyrosine kinase B (TrkB). The addition of DEX suppressed sevoflurane-induced cell cycle arrest and the inhibitory of BDNF and TrkB expression. But the function of DEX was partly blocked by a α2 adrenergic receptor blocker yohimbine.

Conclusion

Sevoflurane suppressed neuron cell proliferation via inhibiting the expression of BDNF and TrkB, and DEX relieved the neurotoxicity induced by sevoflurane via α2 adrenergic receptor. These findings provided new evidence that DEX exerted as a neuroprotective strategy in sevoflurane-induced neuro-damage, and provided new basis for the clinical application of DEX.



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The tendinous septum of the semispinalis capitis muscle spatially separates the dorsal ramus between C3 and C4

Abstract

Local anesthetic injection into the medial head of the semispinalis capitis muscle can anesthetize the greater occipital nerve (GON) and third occipital nerve (TON) simultaneously (greater and third occipital nerve block: GTO block). Alternatively, inter-semispinal plane (ISP) block can anesthetize the dorsal rami of the cervical spinal nerves from C4 to T4. The GON, TON, and the dorsal rami of the inferior level cannot be blocked with a single injection. To elucidate this phenomenon from an anatomical standpoint, we performed an ISP block either alone or with a GTO block using water-based acrylic dye in three thiel-embalmed cadavers. Both dyes were clearly separated by the tendinous septum running obliquely inside the semispinalis capitis muscle (SCA). The tendinous septum of the SCA may have a relatively strong connection with the dorsal edge of the semispinalis cervicis muscle, and this structure may stem the injectate spread. Therefore, the GON and TON, running through the medial head of the SCA, and the dorsal rami of the inferior level are spatially separated by the tendinous septum, and cannot be blocked with a single injection.



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How many squat–stand manoeuvres to assess dynamic cerebral autoregulation?

Abstract

Purpose

Squat–stand manoeuvres (SSMs) have been used to induce blood pressure (BP) changes for the reliable assessment of dynamic cerebral autoregulation. However, they are physically demanding and thus multiple manoeuvres can be challenging for older subjects. This study aimed to determine the minimum number of SSMs required to obtain satisfactory coherence, thus minimising the subjects' workload.

Method

20 subjects performed SSMs at a frequency of 0.05 Hz. End-tidal CO2, cerebral blood flow velocity, heart rate, continuous BP and the depth of the squat were measured. 11 subjects returned for a repeat visit. The time points at which subjects had performed 3, 6, 9, 12 and 15 SSMs were determined. Transfer function analysis was performed on files altered to the required length to obtain estimates of coherence and the autoregulation index (ARI).

Results

After three SSMs, coherence (0.05 Hz) was 0.93 ± 0.05, and peaked at 0.95 ± 0.02 after 12 manoeuvres. ARI decreased consecutively with more manoeuvres. ARI was comparable across the two visits (p = 0.92), but coherence was significantly enhanced during the second visit (p < 0.01). The intra-subject coefficients of variation (CoV) for ARI remained comparable as the number of manoeuvres varied.

Conclusions

This analysis can aid those designing SSM protocols, especially where participants are unable to tolerate a standard 5-min protocol or when a shorter protocol is needed to accommodate additional tests. We emphasise that fewer manoeuvres should only be used in exceptional circumstances, and where possible a full set of manoeuvres should be performed. Furthermore, these results need replicating at 0.10 Hz to ensure their applicability to different protocols.



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Elevated arterial lactate delays recovery of intracellular muscle pH after exercise

Abstract

Purpose

We evaluated muscle proton elimination following similar exercise in the same muscle group following two exercise modalities.

Methods

Seven rowers performed handgrip or rowing exercise for ~ 5 min. The intracellular response of the wrist flexor muscles was evaluated by 31P nuclear magnetic resonance spectroscopy, while arterial and venous forearm blood was collected.

Results

Rowing and handgrip reduced intracellular pH to 6.3 ± 0.2 and 6.5 ± 0.1, arterial pH to 7.09 ± 0.03 and 7.40 ± 0.03 and venous pH to 6.95 ± 0.06 and 7.20 ± 0.04 (P < 0.05), respectively. Arterial and venous lactate increased to 17.5 ± 1.6 and 20.0 ± 1.6 mM after rowing while only to 2.6 ± 0.8 and 6.8 ± 0.8 mM after handgrip exercise. Arterio-venous concentration difference of bicarbonate and phosphocreatine recovery kinetics (T50% rowing 1.5 ± 0.7 min; handgrip 1.4 ± 1.0 min) was similar following the two exercise modalities. Yet, intramuscular pH recovery in the forearm flexor muscles was 3.5-fold slower after rowing than after handgrip exercise (T50% rowing of 2 ± 0.1 vs. 7 ± 0.3 min for handgrip).

Conclusion

Rowing delays intracellular-pH recovery compared with handgrip exercise most likely because rowing, as opposed to handgrip exercise, increases systemic lactate concentration. Thus the intra-to-extra-cellular lactate gradient is small after rowing. Since this lactate gradient is the main driving force for intracellular lactate removal in muscle and, since pHi normalization is closely related to intracellular lactate removal, rowing results in a slower pHi recovery compared to handgrip exercise.



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Echo-guided invasive pain therapy: indications and limitations

Purpose of review The purposes of this review are to summarize the advantages and limitations of ultrasound-guided pain interventions, and to illustrate those interventions with peripheral, axial and musculoskeletal pain procedures. Recent findings With the capability of locating the interfascial plane, ultrasonography has led to the emergence of a series of plane blocks for the thoracoabdominal region in the recent decade. Ultrasonography for musculoskeletal procedures has been of growing interest because of the major advantage of direct visualization and scanning of various soft tissues and real-time spread in the injectate, thereby enhancing precision and efficacy, reducing risk of trauma and avoidance of radiation. For spine and intra-articular structures, ultrasonography is complicated by the bony shadow artefact and often deep location of the structure, making acquisition of ultrasound image challenging. Despite these difficulties, there is growing interest in applying ultrasonography for cervical spine and sacroiliac joint procedures. Summary Pain intervention under ultrasound guidance is particularly valuable in peripheral and musculoskeletal procedures. There is growing interest of its application in cervical spine and sacroiliac joint. More outcome studies are required in the future to make ultrasound-guided pain intervention as the established procedure. Correspondence to Philip Peng, MBBS, FRCPC, Founder (Pain Medicine), Department of Anesthesia and Pain Medicine, University of Toronto, University Health Network-Toronto Western Hospital, McL 2-405, 399 Bathurst Street, Toronto, ON, Canada M5T 2S8. Tel: +1 416 603 5118; fax: +1 416 603 6494; e-mail: Philip.peng@uhn.ca Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Drug selection for ambulatory procedural sedation

Purpose of review Ambulatory procedural sedation is used to relieve anxiety, pain and discomfort in a broad spectrum of patients during many types of diagnostic or therapeutic procedures. This review focuses on recent comparative studies of commonly used and new drugs for adult ambulatory sedation. Recent findings Midazolam and propofol are commonly used for ambulatory sedation. Their pharmacological properties offer many advantages and there is much experience with their use. Ketamine can be a useful addition to hypnotic drugs but the advantage of the use of ketofol (a mixture of propofol and ketamine) is, although often practiced, difficult to assess. Dexmedetomidine is a relatively new sedative drug and many studies suggest advantages. New findings about its effects, however, show that the hemodynamic consequences of the use of dexmedetomidine may last for several hours. New sedative drugs for procedural sedation are still being developed: remimazolam has many properties that would make it an ideal sedative and has been studied in a phase 3 study. Summary The properties that would constitute the ideal sedative have yet to be combined in one drug. The selection of the drugs used for ambulatory sedation depends on many factors such as procedure type, patient characteristics and the expectations of patients and the healthcare provider. Because of this, the literature cannot yet provide a definitive answer to the question which drug is best selected in a specific situation. Correspondence to Clemens R.M. Barends, MD, Department of Anaesthesiology, University of Groningen, University Medical Centre Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands. Tel: +31 50 361 6161; e-mail: c.r.m.barends@umcg.nl Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Rebound pain after regional anesthesia in the ambulatory patient

Purpose of review Regional anesthesia is popular in ambulatory setting allowing safe and fast recovery. The problem of 'rebound pain', that is very severe pain when peripheral nerve block (PNB) wears off represents a clinically relevant problem and a cause of increased healthcare resource utilization. This review tries to make the point on a not so rare, unwanted and often neglected side effect of PNB. Recent findings The major finding is the lack of large prospective studies. Incidence of rebound pain is unknown but could reach 40% of patients at PNB resolution. To date, pathophysiological mechanisms remain debated: mechanical and chemical (proinflammatory effect of local anesthetics) nerve insult caused by PNB in predisposed patients (with severe preoperative pain, younger patients). Effective preventive strategies also are missing (e.g. role of analgesic adjuvants in PNB). Long-term consequences in term of functional recovery and persistent pain have not been demonstrated. Interview of patients has underlined the need of information and education about PNB and postoperative analgesia. Summary Patients' report of excruciating pain and major distress when PNB wears off questions the quality of current anesthesia practice in ambulatory setting. Rebound pain unanswered questions are challenging in the area of perioperative medicine. Correspondence to Patricia Lavand'homme, MD, PhD, Department of Anesthesiology, Cliniques Universitaires St Luc – University Catholic of Louvain, Av Hippocrate 10, B-1200, Brussels, Belgium. Tel: +32 2 764 18 21; fax: +32 2 764 36 99; e-mail: patricia.lavandhomme@uclouvain.be Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Neuromonitoring in the ambulatory anesthesia setting: a pro–con discussion

Purpose of review Various neurologically focused monitoring modalities such as processed electroencephalography (pEEG), tissue/brain oxygenation monitors (SbO2), and even somatosensory evoked responses have been suggested as having the potential to improve the well tolerated and effective delivery of care in the setting of outpatient surgery. The present article will discuss the pros and cons of such monitors in this environment. Recent findings There is a paucity of evidence from rigorous, well designed clinical trials demonstrating that the routine use of any neuromonitoring technique in an ambulatory surgery setting leads to meaningful cost savings or a reduction in morbidity or mortality. Summary The use of advanced neuromonitoring techniques (primarily pEEG) may be considered reasonable in two instances: for the prevention of intraoperative awareness during the administration of total intravenous anesthesia coupled with the use of a neuromuscular blocking drug, and for the prevention of relative drug overdose (and possibly postoperative delirium) in the elderly. Correspondence to Peter A. Goldstein, MD, C.V. Starr Laboratory for Molecular Neuropharmacology, Department of Anesthesiology, Weill Cornell Medicine, 1300 York Avenue, Room A-1050, New York, NY 10065, USA. Tel: +1 212 746 5325; fax: +212 746 4879; e-mail: pag204@med.cornell.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Evidence-Based Physiatry: Managing Low Back Pain Wisely

No abstract available

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The Incidence of Physiatry-Relevant Complications in Trauma Patients Admitted to an Urban Canadian Trauma Center

The objective of this study was to describe the incidence of complications in trauma patients that could be prevented, diagnosed, and / or managed by a consulting acute care physiatrist. Demographic and complication data were extracted by chart review of adult trauma patients admitted to a Canadian academic trauma center. Subjects were included if they had a diagnosis of traumatic brain injury, spinal cord injury, and / or multiple injuries resulting in an Injury Severity Score > 15. Means and standard deviations were calculated for continuous variables and frequencies for categorical data. Secondary analyses involved using Spearman's rho and Chi-Square analysis to examine relationships between the development of complications and various patient factors. A total of 286 individuals were included. The overall incidence of a PM&R-relevant complication was 32.9%. The complications with the highest incidence were pneumonia (15.5%), delirium (14.1%), and urinary tract infection (13.4%). Secondary analyses demonstrated associations between the development of complications with older age, the presence of co-morbidities, having both a traumatic brain injury and spinal cord injury, and length of stay. This study demonstrated that trauma patients may experience multiple complications that are of relevance to the consulting physiatrist. Post-Publication Correspondence to: Lawrence R. Robinson, St. John's Rehab, 285 Cummer Avenue, Room S125, Toronto, ON, Canada, M2M 2G1, Phone number: 1-416-226-6780, ext. 7274; Fax number: None, E-mail: Larry.Robinson@sunnybrook.ca Disclosures: The authors have no conflicts to declare. The project was funded by the Sunnybrook AHSC AFP Innovation Fund. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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