Κυριακή, 26 Αυγούστου 2018

Urgent Repositioning After Venous Air Embolism During Intracranial Surgery in the Seated Position: A Case Series

Background: Venous air embolism (VAE) is a well-described complication of neurosurgical procedures performed in the seated position. Although most often clinically insignificant, VAE may result in hemodynamic or neurological compromise resulting in urgent change to a level position. The incidence, intraoperative course, and outcome in such patients are provided in this large retrospective study. Methods: Patients undergoing a neurosurgical procedure in the seated position at a single institution between January 2000 and October 2013 were identified. Corresponding medical records, neurosurgical operative reports, and computerized anesthetic records were searched for intraoperative VAE diagnosis. Extreme VAE was defined as a case in which urgent seated to level position change was performed for patient safety. Detailed examples of extreme VAE cases are described, including their intraoperative course, VAE management, and postoperative outcomes. Results: There were 8 extreme VAE (0.47% incidence), 6 during suboccipital craniotomy (1.5%) and 2 during deep brain stimulator implantation (0.6%). VAE-associated end-expired CO2 and mean arterial pressure reductions rapidly normalized following position change. No new neurological deficits or cardiac events associated with extreme VAE were observed. In 5 of 8, surgery was completed. Central venous catheter placement and aspiration during VAE played no demonstrable role in patient outcome. Conclusions: Extreme VAE during seated intracranial neurosurgical procedures is infrequent. Extreme VAE-associated CO2 exchange and hemodynamic consequences from VAE were transient, recovering quickly back to baseline without significant neurological or cardiopulmonary morbidity. The authors have no funding or conflicts of interest to disclose. Address correspondence to: Arnoley S. Abcejo, MD, Department of Anesthesiology, Mayo Clinic, Rochester, MN 200 1st St SW, Rochester, MN 55905 (e-mail: Abcejo.Arnoley@mayo.edu). Received April 11, 2018 Accepted July 19, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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Coping Flexibility as Predictor of Distress in Persons With Spinal Cord Injury

Publication date: Available online 25 August 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Tijn van Diemen, Ilse J.W. van Nes, Jan H.B. Geertzen, Marcel W.M. Post

Abstract
Objectives

Examine whether coping flexibility at admission to first spinal cord injury (SCI) rehabilitation was predictive of distress 1 year after discharge.

Design

Longitudinal inception cohort study.

Setting

Rehabilitation center.

Participants

Of the 210 people admitted to their first inpatient SCI rehabilitation program, 188 met the inclusion criteria. n=150 (80%) agreed to participate; the data of participants (N=113) with a complete dataset were used in the statistical analysis.

Interventions

Not applicable.

Main Outcome Measures

Coping flexibility was operationalized by (1) flexible goal adjustment (FGA) to given situational forces and constraints and (2) tenacious goal pursuit (TGP) as a way of actively adjusting circumstances to personal preference. The Assimilative-Accommodative Coping Scale was used to measure FGA and TGP. The Hospital Anxiety and Depression Scale was used to assess distress.

Results

Scores on FGA and TGP measured at admission were negatively associated with the scales depression (r= −.33 and −.41, respectively) and anxiety (r= −.23 and −.30, respectively) 1 year after discharge. All demographic and injury-related variables at admission together explained a small percentage of the variance of depression and anxiety. FGA, TGP, and the interaction term together explained a significant additional 16% of the variance of depression and 10% of anxiety.

Conclusions

The tendency to pursue goals early postonset of the injury seems to have a protecting effect against distress 1 year after discharge. People with low TGP may experience protection against distress from high FGA.



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The Development of a New Computer-Adaptive Test to Evaluate Strain in Caregivers of Individuals With TBI: TBI-CareQOL Caregiver Strain

Publication date: Available online 25 August 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Noelle E. Carlozzi, Michael A. Kallen, Phillip A. Ianni, Elizabeth A. Hahn, Louis M. French, Rael T. Lange, Tracey A. Brickell, Robin Hanks, Angelle M. Sander

Abstract
Objective

To develop a new measure of caregiver strain for use in caregivers of individuals with traumatic brain injury (TBI), Traumatic Brain Injury Caregiver Quality of Life (TBI-CareQOL) Caregiver Strain.

Design

Qualitative data, literature reviews, and cross-sectional survey study.

Setting

Three TBI Model Systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility.

Participants

Caregivers (N=560) of civilians (n=344) or service members/veterans (SMVs) with TBI (n=216).

Interventions

Not applicable.

Main Outcome Measure

TBI-CareQOL Caregiver Strain Item Bank.

Results

Exploratory and confirmatory factor analyses, a graded response model (GRM) and differential item functioning supported the retention of 33 items in the final measure. GRM calibration data was used to inform the selection of a 6-item static short form, and to program the TBI-CareQOL Caregiver Strain computer-adaptive test (CAT). CAT simulation analyses indicated a 0.97 correlation between the CAT scores and the full item-bank. Three-week test-retest reliability was strong (r=0.83).

Conclusions

The new TBI-CareQOL Caregiver Strain CAT and corresponding 6-item short form were developed using established rigorous measurement development standards; this is the first self-reported measure developed to evaluate caregiver strain in caregivers of individuals with TBI.



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CIRCE element evolved for the coordinated transcriptional regulation of bacterial duplicate groELs

Publication date: Available online 26 August 2018

Source: Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms

Author(s): Li Zhuo, Zheng Zhang, Zhuo Pan, Duo-hong Sheng, Wei Hu, Yue-zhong Li

Abstract

Chaperonin groEL genes are duplicated in approximately 20% of bacteria, and the duplicates are differentially transcribed due to their divergent functions. The coordinated regulation of this differential transcription is as yet undetermined. In this study, we reported that the controlling inverted repeat of chaperone expression (CIRCE) element (the HrcA-binding site located upstream of the promoter) evolved for the transcriptional regulation of duplicate groELs. CIRCE composition and locations were found to be phylogenetically conserved in bacterial taxa. Myxococcus xanthus DK1622 has two CIRCE elements (CIRCE1groESL1 and CIRCE2groESL1) in the promoter region of groESL1 and one CIRCE element (CIRCEgroEL2) before groEL2. We also found that negative HrcA and positive σ32 regulators coordinated the transcription of duplicate groELs, and that the double deletion in DK1622 eliminated transcriptional differences and reduced the heat-shock responses of groELs. In vitro binding assays showed that HrcA protein binding was biased towards CIRCE1groESL1, followed by CIRCEgroEL2, but that HrcA proteins failed to bind with CIRCE2groESL1. Mutation experiments revealed that single-nucleotide mutations in the inverted repeat regions changed the HrcA-binding abilities of CIRCEs. We constructed an in vivo transcription-regulation system in Escherichia coli to pair each of the regulators with a groEL promoter. The results indicated that the transcriptional regulation performed by HrcA and σ32 was biased towards the groEL2 and groEL1 promoters, respectively. Based on promoter-sequence characteristics, we proposed a model of the coordinated regulation of the transcription of duplicate groELs in M. xanthus DK1622.

Graphical abstract

Unlabelled Image



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Diversity analysis of Plio-Pleistocene large mammal communities in the Omo-Turkana Basin, eastern Africa

Publication date: Available online 25 August 2018

Source: Journal of Human Evolution

Author(s): Andrew Du, Zeresenay Alemseged

Abstract

Knowing how the diversity of large mammal communities changes across space and time provides an important ecological framework for studying hominin evolution. However, diversity studies that apply methods currently used by neoecologists are rare in paleoanthropology and are also challenging due to diversity's unusual statistical properties. Here, we apply up-to-date analytical methods for understanding how species- and genus-level large mammalian diversity in the Omo-Turkana Basin changed through time and across space at multiple spatiotemporal scales (within each formation:102−3 km2 and 104−5 years; and within the basin as a whole: 103 km2 and 105 years). We found that, on average, Koobi Fora's large mammal community was more diverse than Nachukui's, which in turn was more diverse than Shungura's. Diversity was stable through time within each of these formations (alpha diversity), as was diversity in the basin as a whole (gamma diversity). Compositional dissimilarity between these three formations (beta diversity) was relatively low through time, with a 0.6 average proportion of shared species, suggesting dispersal acted to homogenize the region. Though alpha and gamma diversity were fairly stable through time, we do observe several notable peaks: during the KBS Member in Koobi Fora (30% increase), the Lokalalei Member in Nachukui (120% increase), and at 1.7 Ma in the entire basin (100% increase). We conclude by (1) demonstrating that habitat heterogeneity was an important factor influencing alpha diversity within each of the three formations, and (2) hypothesizing that diversity stability may have been driven by equilibrial dynamics in which overall diversity was constrained by resource availability, implying biotic interactions were an important factor in structuring the communities that included hominins as members. Our findings demonstrate the need to quantify how large mammal diversity changes across time and space in order to further our understanding of hominin ecology and evolution.



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Issue Information

Pediatric Anesthesia, Volume 28, Issue 8, Page ii-iv,681, August 2018.


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Cover Image

Pediatric Anesthesia, Volume 28, Issue 8, Page i-i, August 2018.


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Anesthesia consensus on clinical parameters for the timing of surgical repair in congenital diaphragmatic hernia

Pediatric Anesthesia, Volume 28, Issue 8, Page 751-752, August 2018.


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Accidental brachial plexus block during insertion of tunneled central line

Pediatric Anesthesia, Volume 28, Issue 8, Page 745-746, August 2018.


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Using sevoflurane in a pediatric patient with nemaline rod myopathy

Pediatric Anesthesia, Volume 28, Issue 8, Page 749-750, August 2018.


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Intranasal dexmedetomidine, as midazolam‐sparing drug, for MRI in preterm neonates

Pediatric Anesthesia, Volume 28, Issue 8, Page 747-748, August 2018.


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Innovative peripheral nerve blocks facilitated by ultrasound guidance

Pediatric Anesthesia, Volume 28, Issue 8, Page 684-685, August 2018.


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Cardiac pulmonary resuscitation in prone position. The best option for posterior fossa neurosurgical patients

Pediatric Anesthesia, Volume 28, Issue 8, Page 746-747, August 2018.


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Analgesic efficacy of dipyrone in children: Still an absence of evidence

Pediatric Anesthesia, Volume 28, Issue 8, Page 748-749, August 2018.


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In this issue August 2018

Pediatric Anesthesia, Volume 28, Issue 8, Page 683-683, August 2018.


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TRPV6 compound heterozygous variants result in impaired placental calcium transport and severe undermineralization and dysplasia of the fetal skeleton

American Journal of Medical Genetics Part A, EarlyView.


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Familial dominant epilepsy and mild pachygyria associated with a constitutional LIS1 mutation

American Journal of Medical Genetics Part A, EarlyView.


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Publication schedule for 2018

American Journal of Medical Genetics Part A, Volume 176, Issue 8, Page 1696-1696, August 2018.


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Nucleic Acid–Targeted Small Molecules have Therapeutic Potential in the Treatment of Spinal Muscular Atrophy: Small‐molecule drugs that can selectively bind RNA and modulate pre‐mRNA splicing have potential as a treatment strategy for human disease, including spinal muscular atrophy

American Journal of Medical Genetics Part A, Volume 176, Issue 8, Page 1698-1699, August 2018.


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In This Issue

American Journal of Medical Genetics Part A, Volume 176, Issue 8, Page 1700-1700, August 2018.


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Table of Contents, Volume 176A, Number 8, August 2018

American Journal of Medical Genetics Part A, Volume 176, Issue 8, Page 1693-1695, August 2018.


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Cover Image, Volume 176A, Number 8, August 2018

American Journal of Medical Genetics Part A, Volume 176, Issue 8, August 2018.


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Formate Supplementation May Prevent Some Neural Tube Defects that Prove Resistant to Folic Acid: Supplementation with formate rescued normal neural tube closure in more than three quarters of the embryos of novel folic acid‐resistant neural tube defect mouse models

American Journal of Medical Genetics Part A, Volume 176, Issue 8, Page 1697-1698, August 2018.


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Muscle memory: virtues of your youth?

The Journal of Physiology, EarlyView.


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Aging changes in biventricular cardiac function in male and female baboons (Papio Sp.)

The Journal of Physiology, Volume 0, Issue ja, -Not available-.


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Optimal dissection of a model circuit

The Journal of Physiology, Volume 0, Issue ja, -Not available-.


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Food texture: A potential dietary consideration for obesity prevention?

Experimental Physiology, EarlyView.


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Brainstem network pathology and impaired respiratory drive as successive signatures in a rat model of Parkinson's disease

Experimental Physiology, Volume 0, Issue ja, -Not available-.


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