Background and Objectives Fascial plane blocks are rapidly emerging to provide safe, feasible alternatives to epidural analgesia for thoracic and abdominal pain. We define a new option for chest wall and upper abdominal analgesia, termed the rhomboid intercostal and subserratus plane (RISS) block. The RISS tissue plane extends deep to the erector spinae muscle medially and deep to the serratus anterior muscle laterally. We describe a 2-part proof-of-concept study to validate the RISS block, including a cadaveric study to evaluate injectate spread and a retrospective case series to assess dermatomal coverage and analgesic efficacy. Methods For the cadaveric portion of the study, bilateral ultrasound-guided RISS blocks were performed on 6 fresh cadavers with 30 mL of 0.5% methylcellulose with india ink. For the retrospective case series, we present 15 patients who underwent RISS block or RISS catheter insertion for heterogeneous indications including abdominal surgery, rib fractures, chest tube–associated pain, or postoperative incisional chest wall pain. Results In the cadaveric specimens, we identified staining of the lateral branches of the intercostal nerves from T3 to T9 reaching the posterior primary rami deep to the erector spinae muscle medially. In the clinical case series, dermatomal coverage was observed in the anterior hemithorax with visual analog pain scores less than 5 in patients who underwent both single-shot and continuous catheter infusions. Conclusions Our preliminary cadaveric and clinical data suggest that RISS block anesthetizes the lateral cutaneous branches of the thoracic intercostal nerves and can be used in multiple clinical settings for chest wall and upper abdominal analgesia. Accepted for publication March 10, 2018. Address correspondence to: Hesham Elsharkawy, MD, MBA, MSc, Department of General Anesthesia and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Ave, Mail Code E31, Cleveland, OH 44195 (e-mail: elsharh@ccf.org). H.E. has received unrestricted educational funding from PAJUNK (Norcross, GA) and consultant fees from Pacira Pharmaceuticals, Inc. Those companies had no input into any aspect of the present project design or manuscript preparation. The authors declare no conflict of interest. All images are created and used with permission of Cleveland Clinic Center for Medical Art and Photography. 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 Web site (www.rapm.org). Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.
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Παρασκευή 31 Αυγούστου 2018
Behavioural responses to environmental hypercapnia in two eusocial species of African mole rats
Abstract
Damaraland and naked mole rat are eusocial mammals that live in crowded burrows in which CO2 is elevated. These species are thought to be highly tolerant of CO2 but their behavioural responses to hypercapnia are poorly understood. We hypothesized that Damaraland and naked mole rats would exhibit blunted behavioural responses to hypercapnia and predicted that their activity levels would be unaffected at low to moderate (2–5%) CO2 but increased at > 7% CO2. To test this, we exposed Damaraland and naked mole rats to stepwise increases in environmental CO2 (0–10%) and measured activity, exploratory behaviour, and body temperature. Surprisingly, we found that both species exhibited no differences in movement velocity, distance travelled, zone transitions (exploration), or body temperature at any level of environmental hypercapnia. Conversely, when carbonic anhydrase was inhibited with acetazolamide (50 mg kg−1 intraperitonially, to increase whole-animal acidosis), exploration was significantly elevated relative to hypercapnic controls in both species at all levels of inhaled CO2, and naked mole rat body temperature decreased in > 7% CO2. We conclude that both species are largely non-responsive to environmental CO2, and that this tolerance may be dependent on bicarbonate buffering at the level of the kidney or within the blood.
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What Should We Do About Habitual Caffeine Use in Athletes?
Abstract
Caffeine is a well-established ergogenic aid, demonstrated to enhance performance across a wide range of capacities through a variety of mechanisms. As such, it is frequently used by both athletes and non-athletes alike. As a result, caffeine ingestion is ubiquitous in modern society, with athletes typically being exposed to regular non-supplemental caffeine through a variety of sources. Previously, it has been suggested that regular caffeine use may lead to habituation and subsequently a reduction in the expected ergogenic effects, thereby blunting caffeine's performance-enhancing impact during critical training and performance events. In order to mitigate this expected performance loss, some practitioners recommended a pre-competition withdrawal period to restore the optimal performance benefits of caffeine supplementation. However, at present the evidence base exploring both caffeine habituation and withdrawal strategies in athletes is surprisingly small. Accordingly, despite the prevalence of caffeine use within athletic populations, formulating evidence-led guidelines is difficult. Here, we review the available research regarding habitual caffeine use in athletes and seek to derive rational interpretations of what is currently known—and what else we need to know—regarding habitual caffeine use in athletes, and how athletes and performance staff may pragmatically approach these important, complex, and yet under-explored phenomena.
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Juvenile Idiopathic Arthritis: A Focus on Pharmacologic Management
Juvenile idiopathic arthritis is a chronic condition that affects many pediatric patients. It is a prevalent disease and has become the most common rheumatologic disease of childhood. The condition encompasses multiple different forms of chronic arthritides classified based on the location and number of joints affected as well as the presence or lack of a number of different inflammatory markers. The exact etiology is unknown but is thought to be multifactorial with genetic, humoral, and environmental factors playing a key role.
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A Case Study of a Child With Mitochondrial Disease
A 4-year-old girl recently diagnosed with epilepsy presented to her pediatric advanced practice registered nurse (APRN) in a primary care clinic with 2 weeks of increased seizure activity after a medication change from carbamazepine to valproic acid. Symptoms also included a sudden increase in lethargy, ataxia, and drowsiness. She is co-managed by a pediatric neurologist for seizure control who was currently away from the office. Associated test results included a normal valproic acid level, elevated ammonia and liver function (Table 1), and an abnormal electroencephalogram reading; indicating a generalized process with ongoing focal-like features.
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The ACEs Connection
While we do not routinely publish book reviews in this Journal, there is one book that I would like to draw to your attention: The Deepest Well: Healing the Long-term Effects of Childhood Adversity by Dr. Nadine Burke Harris (Harris, 2018).
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Skin Deep: Simplifying Practice Guidelines for Children With Atopic Dermatitis
Atopic dermatitis (AD) is a common chronic inflammatory skin disorder in children. Often called eczema, AD is a papulosquamous eruption often characterized by pruritus and then the typical distribution and morphology of the rash (Saavedra et al., 2013). Thus, an idiom often used by health care professionals to describe AD is "the itch that rashes." Two leading organizations jointly authored an update on AD in 2012 (Schneider et al., 2013), and a third published several guidelines for the management of AD (Eichenfield et al., 2013, 2014, 2015; Sidbury et al., 2014).
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Fostering Resiliency in Children, Families and our Profession
I grew up in Miami during a quiet, sleepy time. We rode bicycles, climbed trees, and played Olympic-level hide and go seek in lush neighborhood gardens. We skinned our knees and scraped our elbows. I was more ragamuffin than photoshoot-ready most days. It is easy to romanticize childhood as being carefree, but trauma and stress occur universally. For some, it is the loss of a loved one or beloved pet, others experience natural disasters, and some experience or witness violence, abuse, and/or neglect.
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Reciprocal F1 Hybrids of Two Inbred Mouse Strains Reveal Parent-of-Origin and Perinatal Diet Effects on Behavior and Expression
Parent-of-origin effects (POE) in mammals typically arise from maternal effects or imprinting. In some instances, such POE have been associated with psychiatric disorders, as well as with changes in a handful of animal behaviors. However, POE on complex traits such as behavior remain largely uncharacterized. Moreover, although both behavior and epigenetic effects are known to be modified by perinatal environmental exposures such as nutrient deficiency, the architecture of such environment-by-POE is mostly unexplored. To study POE and environment-by-POE, we employ a relatively neglected but especially powerful experimental system for POE-detection: reciprocal F1 hybrids (RF1s). We exposed female NOD/ShiLtJxC57Bl/6J and C57Bl/6JxNOD/ShiLtJ mice, perinatally, to one of four different diets, then after weaning recorded a set of behaviors that model psychiatric disease. Whole-brain microarray expression data revealed an imprinting-enriched set of 15 genes subject to POE. The most-significant expression POE, on the non-imprinted gene Carmil1 (a.k.a. Lrrc16a), was validated using qPCR in the same and in a new set of mice. Several behaviors, especially locomotor behaviors, also showed POE. Bayesian mediation analysis suggested Carmil1 expression suppresses behavioral POE, and that the imprinted gene Airn suppresses POE on Carmil1 expression. A suggestive diet-by-POE was observed on percent center time in the open field test, and a significant diet-by-POE was observed on one imprinted gene,Mir341, and on 16 non-imprinted genes. The relatively small, tractable set of POE and diet-by-POE detected on behavior and expression here motivates further studies examining such effects across RF1s on multiple genetic backgrounds.
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Nerve ultrasound findings differentiate Charcot-Marie-Tooth disease (CMT) 1A from other demyelinating CMTs
Charcot-Marie-Tooth disease (CMT) is the most common inherited neuromuscular disorder and encompasses a heterogeneous group of motor-sensory length-dependent polyneuropathies. Clinical phenotypes, modes of inheritance and nerve conduction study (NCS) still guide genetic testing (Rossor et al., 2016). CMT type 1 (CMT1) represents nearly 80% of all genetically confirmed cases (Fridman et al., 2015) and includes autosomal dominant or X-dominant neuropathies defined as "demyelinating" according to ulnar/median motor nerve conduction velocity (MNCV) ≤38 m/s with preserved compound motor action potentials (CMAP) (Rossor et al., 2016).
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Towards closed-loop deep brain stimulation for freezing of gait in Parkinson’s disease
Freezing of gait (FOG) is a highly debilitating symptom of advanced Parkinson's disease (PD) during which patients experience a sudden inability to take a step while walking, turning or when attempting to initiate gait, often resulting in falls (Nutt et al. 2011). FOG has a complex and heterogeneous pathophysiology whereby the impaired habitual control of gait in PD becomes vulnerable to interference from consecutive processing across motor, cognitive and limbic cortico-striatal circuits in the absence of striatal dopamine, whilst the ability to apply executive control over gait diminishes as a result of progressing extra-nigral neuropathology (Bohnen and Jahn 2013; Lewis and Shine 2016).
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Evidence for a differential visual M300 brain response in gamblers
In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013), the section including substance-related addictions was modified to incorporate behavioral addictions, namely addictions that do not include ingestion of a psychoactive substance (Grant et al. 2010). This amendment was a result of accumulating evidence that behavioral and substance-related addictions have many commonalities in phenomenology, epidemiology, neurobiological mechanisms, and response to treatment (Potenza 2008; Grant et al.
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Effect of Epileptiform Abnormality Burden on Neurologic Outcome and Antiepileptic Drug Management After Subarachnoid Hemorrhage
Epileptiform abnormalities (EAs) including seizures, periodic and rhythmic patterns, and sporadic discharges are seen in electroencephalogram (EEG) recordings in up to 20% percent of patients with aneurysmal subarachnoid hemorrhage (aSAH) (Claassen et al., 2006). The presence of periodic discharges and seizures has been linked to worse functional and cognitive outcomes (Claassen et al., 2006; De Marchis et al., 2016). Nevertheless, there is limited and conflicting data on how the burden and subtype of EAs influence outcome in patients with aSAH (Crepeau et al., 2013).
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The Median to Ulnar Cross-Sectional Surface Area Ratio in Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) is the most common focal neuropathy worldwide and is among the most common reasons for electrodiagnostic consultation(Hobson-Webb and Padua, 2016). The current reference standard for CTS diagnosis includes history and physical examination as well as electrodiagnostic studies. However, it is well recognized that electrodiagnostic testing has certain limitations; while it can identify the site of compression, it may be painful and does not provide anatomic information (Cartwright et al.
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Sudomotor dysfunction is frequent and correlates with disability in Friedreich ataxia
Friedreich ataxia (FRDA) is considered the most prevalent autosomal recessive ataxia worldwide with estimated prevalence of 3/100,000. The disease is common in Caucasian populations, but practically absent in sub-saharan regions and in the Far East. In 95% of the cases, the underlying cause is a homozygous expansion of a (GAA) repeat in intron 1 of FXN at 9q21.1 (Koeppen, 2011; Durr et al, 1996; Campuzano et al, 1996; Fogel and Perlman, 2007). This leads to a transcriptional abnormality that results in the lack of frataxin, a mitochondrial protein related to iron homeostasis (Campuzano et al, 1997).
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New Evidence for Structural Integration across the Cartilage-Vertebral Endplate Junction and its Relation to Herniation
Both cartilaginous and bony material present in herniated tissue suggests that failure can involve both cartilaginous and vertebral-endplates. How structural integration is achieved across the junction between these two distinct tissue regions via its fibril and mineral components is clearly relevant to the modes of endplate failure that occur.
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Nomogram prediction of individual prognosis of patients with acute-on-chronic hepatitis B liver failure
The current definitions and etiologies of acute-on-chronic liver failure (ACLF) are clearly very different between East and West.
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Nomogram prediction of individual prognosis of patients with acute-on-chronic hepatitis B liver failure
The current definitions and etiologies of acute-on-chronic liver failure (ACLF) are clearly very different between East and West.
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Exploratory Factor Analysis of the Mishel Uncertainty in Illness Scale Among Adolescents and Young Adults With Chronic Medical Conditions
To identify a developmentally relevant factor structure of the Mishel Uncertainty in Illness Scale–Community form (MUIS-C) among adolescents and young adults with chronic medical conditions.
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NAEMSP president part of Fentanyl Safety Panel Discussion in Washington D.C.
WASHINGTON — Today Deputy Attorney General Rod J. Rosenstein delivered remarks at the Office of Justice Programs in Washington D.C. regarding the rollout of Fentanyl: The Real Deal, a training video created by a Federal Interagency Working Group and coordinated by the National Security Council. The Bureau of Justice Assistance presented the video and hosted a panel comprised of first...
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3 benefits of a community paramedicine program
A treatment-based approach can help your agency provide more appropriate care, reduce costly transports and benefit your staff as well as the patients you serve
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Editorial Board
Experimental Physiology, Volume 103, Issue 9, Page 1287-1289, 1 September 2018.
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Simultaneous resections of left lung cancer and esophageal schwannoma using video‐assisted thoracoscopic surgery: A case report
Asian Journal of Endoscopic Surgery, EarlyView.
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Recent advancements of robotic surgery for kidney cancer
Asian Journal of Endoscopic Surgery, EarlyView.
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Non–exposed endoscopic wall‐inversion surgery for pediatric gastrointestinal stromal tumor: A case report
Asian Journal of Endoscopic Surgery, EarlyView.
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Astrocyte‐mediated PAD: A new twist to a complicated tale?
The Journal of Physiology, Volume 0, Issue ja, -Not available-.
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Issue Information
The Journal of Physiology, Volume 596, Issue 17, Page 3813-3814, 1 September 2018.
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“Compliance” to exercise: How much is really needed for a healthy heart (and mind)?
The Journal of Physiology, Volume 0, Issue ja, -Not available-.
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After-action report: Tactical EMS lessons from terror attack
Training rescue task force medics and SWAT medics for responding to mass casualty incidents
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Mastering the Art of Collaboration: Supporting Family Caregivers of Mental Health Patients by Service Providers in Iran
Abstract
Responsive support systems, designed and promoted by policy makers, are critical in supporting family caregivers. The purpose of this study was to explore viewpoints of service providers in supporting family caregivers of mental health patients in Iran. In this qualitative study, a purposive sample of 29 service providers and policy makers consented to participate in semi-structured interviews. Data were analyzed through qualitative content analysis and three main categories and seven sub-categories were identified. The main categories were: interpersonal collaboration, intra-organization collaboration and inter-sectorial collaboration. A common theme in this study was that service providers play a key role in coordinating responsive support services for Iranian family caregivers of mental health patients across all levels. The increasing complexity of the health care system and resource limitations have created complex problems, which require the use of participatory approaches by the various specialties, disciplines and departments to provide complementary services and mutual support. This approach is the best way of ensuring that service users receive the most relevant services from the right service providers in the right place as and when needed.
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Locating QTLs controlling overwintering seedling rate in perennial glutinous rice 89-1 ( Oryza sativa L.)
Abstract
A new cold tolerant germplasm resource named glutinous rice 89-1 (Gr89-1, Oryza sativa L.) can overwinter using axillary buds, with these buds being ratooned the following year. The overwintering seedling rate (OSR) is an important factor for evaluating cold tolerance. Many quantitative trait loci (QTLs) controlling cold tolerance at different growth stages in rice have been identified, with some of these QTLs being successfully cloned. However, no QTLs conferring to the OSR trait have been located in the perennial O. sativa L. To identify QTLs associated with OSR and to evaluate cold tolerance. 286 F12 recombinant inbred lines (RILs) derived from a cross between the cold tolerant variety Gr89-1 and cold sensitive variety Shuhui527 (SH527) were used. A total of 198 polymorphic simple sequence repeat (SSR) markers that were distributed uniformly on 12 chromosomes were used to construct the linkage map. The gene ontology (GO) annotation of the major QTL was performed through the rice genome annotation project system. Three main-effect QTLs (qOSR2, qOSR3, and qOSR8) were detected and mapped on chromosomes 2, 3, and 8, respectively. These QTLs were located in the interval of RM14208 (35,160,202 base pairs (bp))–RM208 (35,520,147 bp), RM218 (8,375,236 bp)–RM232 (9,755,778 bp), and RM5891 (24,626,930 bp)–RM23608 (25,355,519 bp), and explained 19.6%, 9.3%, and 11.8% of the phenotypic variations, respectively. The qOSR2 QTL displayed the largest effect, with a logarithm of odds score (LOD) of 5.5. A total of 47 candidate genes on the qOSR2 locus were associated with 219 GO terms. Among these candidate genes, 11 were related to cell membrane, 7 were associated with cold stress, and 3 were involved in response to stress and biotic stimulus. OsPIP1;3 was the only one candidate gene related to stress, biotic stimulus, cold stress, and encoding a cell membrane protein. After QTL mapping, a total of three main-effect QTLs—qOSR2, qOSR3, and qOSR8—were detected on chromosomes 2, 3, and 8, respectively. Among these, qOSR2 explained the highest phenotypic variance. All the QTLs elite traits come from the cold resistance parent Gr89-1. OsPIP1;3 might be a candidate gene of qOSR2.
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Natural radioactivity studies in a paleontology site and paleoclimate interpretation of the last 8 Mya
Publication date: October 2018
Source: Journal of Environmental Radioactivity, Volumes 193–194
Author(s): Ιoanna Maria Zougrou, Stilianos Stoulos, Nikolaos Kantiranis, Lambrini Papadopoulou, Ioakeim Ioakeimidis, Maria Katsikini, Eleni Paloura, Evangelia Tsoukala
Abstract
Fossil bones and sediments from different horizons of the Upper Miocene paleontological site of Platania, Drama-Greece were studied using 238U, 235U, 232Th series and 40K measurements obtained by γ-spectroscopy. Additionally, SEM and XRF analysis was applied to bone and sediment samples while a lithological analysis of the sediments was also carried out. The 226Ra/238U ratios in the fossilization layers are attributed to the 238U depletion from the sediment and its incorporation into the fossils. The 226Ra/231Pa ratio indicates that the absorption of the isotopes started long before 4.2 Ma ago. The 232Th/40K profile demonstrate two distinct geological substrates, the lower corresponding to the Upper Miocene whereas the upper to the Upper Pleistocene–Holocene. Among them mediates a Mn-rich layer associated with the "Zanclean flood" during Pliocene. One layer above the "Glacial maximum event" during the Early Pleistocene was recorded. The natural radioactive sedimentary profile obtained reproduces the paleo-climatic conditions in Southeast Europe, which could be useful for the future.
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Auditory gamma oscillations predict global symptomatic outcome in the early stages of psychosis: a longitudinal investigation
Publication date: Available online 30 August 2018
Source: Clinical Neurophysiology
Author(s): Daisuke Koshiyama, Kenji Kirihara, Mariko Tada, Tatsuya Nagai, Mao Fujioka, Eriko Ichikawa, Kazusa Ohta, Motoko Tani, Maiko Tsuchiya, Akiko Kanehara, Kentaro Morita, Kingo Sawada, Jun Matsuoka, Yoshihiro Satomura, Shinsuke Koike, Motomu Suga, Tsuyoshi Araki, Kiyoto Kasai
Abstract
Objectives
The gamma-band auditory steady-state response (ASSR) is thought to reflect the function of parvalbumin-positive γ-aminobutyric acid (GABA)-ergic interneurons and may be a candidate biomarker in early psychosis. Although previous cross-sectional studies have shown that gamma-band ASSR is reduced in early psychosis, whether reduced gamma-band ASSR could be a predictor of the long-term prognosis remains unknown.
Methods
In this longitudinal study, we investigated the association between gamma-band ASSR reduction and future global symptomatic or functional outcome in early psychosis. We measured 40-Hz ASSR in 34 patients with recent-onset schizophrenia (ROSZ), 28 ultra-high risk (UHR) individuals, and 30 healthy controls (HCs) at baseline. After 1 to 2 years, we evaluated the global assessment of functioning (GAF) in the ROSZ (N = 20) and UHR (N = 20) groups.
Results
The 40-Hz ASSR was significantly reduced in the ROSZ and UHR groups. The attenuated 40-Hz ASSR was correlated with the future global symptomatic outcome in the ROSZ, but not in the UHR groups.
Conclusions
A reduction in the gamma-band ASSR after the onset of psychosis may predict symptomatic outcomes in early psychosis.
Significance
Gamma-band ASSR may be a potentially useful biomarker of the long-term prognosis in patients with recent-onset schizophrenia.
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Electrodiagnosis and nerve ultrasound: “Castor and Pollux” in the management of neuropathies
Publication date: Available online 31 August 2018
Source: Clinical Neurophysiology
Author(s): Luca Padua, Costanza Pazzaglia, Daniele Coraci
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The effects of aging on early stages of the auditory deviance detection system
Publication date: Available online 31 August 2018
Source: Clinical Neurophysiology
Author(s): Maryam Aghamolaei, Zahra Jafari, Sabine Grimm, Katarzyna Zarnowiec, Mojtaba Najafi-Koopaie, Carles Escera
Abstract
Objective
The aging effects on auditory change detection have been studied using the Mismatch Negativity (MMN) potential. However, recent studies have found earlier correlates of deviance detection at the level of the middle-latency response (MLR) and the effects of aging on this deviant-related response have not yet been clarified. The purpose of this study was to examine the effects of aging on both levels of the auditory deviance detection system.
Methods
MMN and MLR responses were recorded in 33 young and 29 older adults from 32 scalp electrodes during frequency oddball and swapped-oddball conditions.
Results
In the young group, modulation of MLR and a clear MMN response were observed, whereas in the aged group, no evidence of deviance detection was found at the level of MLR and the MMN amplitude was significantly diminished.
Conclusions
Based on the obtained results, aging affects both levels of the auditory deviance detection system which seems to be a result of deficit in regularity encoding along the auditory hierarchy.
Significance
The current findings suggest that age-related physiological changes result in deficits in regularity encoding, starting from early stages of processing. This might eventually affect stream segregation and induce difficulties in understanding speech in complex environments.
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Harvesting responses to single pulse electrical stimulation for presurgical evaluation in epilepsy
Publication date: Available online 31 August 2018
Source: Clinical Neurophysiology
Author(s): Geertjan Huiskamp, Dorien van Blooijs, Michelle van der Stoel
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Effect of subthalamic nucleus deep brain stimulation on visual scanning
Publication date: Available online 30 August 2018
Source: Clinical Neurophysiology
Author(s): Shin-ichi Tokushige, Shunichi Matsuda, Genko Oyama, Yasushi Shimo, Atsushi Umemura, Takuya Sasaki, Satomi Inomata-Terada, Akihiro Yugeta, Masashi Hamada, Yoshikazu Ugawa, Shoji Tsuji, Nobutaka Hattori, Yasuo Terao
Abstract
Objective
Deep brain stimulation (DBS) can provide insights into the workings of the basal ganglia (BG) by interfering with their function. In patients with Parkinson's disease (PD) treated with DBS of the subthalamic nucleus, we studied the effect of DBS on scanning eye movements.
Methods
In the visual memory task, subjects viewed images of various complexities for later recall. In visual search tasks, subjects looked for and fixated one odd target ring, embedded among 48 Landolt rings, which either stood out or not from the distractors. We compared the parameters of scanning saccades when DBS was on and off.
Results
In the visual memory task, DBS increased the amplitude of saccades scanning simple but not complex drawings. In the visual search tasks, DBS showed no effect on saccade amplitude or frequency.
Conclusions
Saccades when viewing simple images were affected by DBS since they are internally guided saccades, for which the involvement of BG is large. In contrast, saccades when viewing complex images or during visual search, made with the help of visual cues in the images (externally guided saccades) and less dependent on BG, were resistant to the effect of DBS.
Significance
DBS affects saccades differentially depending on the task.
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Effects of Noise and Age on the Infant Brainstem Response to Speech
Publication date: Available online 30 August 2018
Source: Clinical Neurophysiology
Author(s): Gabriella Musacchia, Silvia Ortiz-Mantilla, Cynthia P. Roesler, Sree Rajendran, Julie Morgan-Byrne, April A. Benasich
Abstract
Objective
Background noise makes hearing speech difficult for people of all ages. This difficulty can be exacerbated by co-occurring developmental deficits that often emerge in childhood. Sentence-type speech-in-noise (SIN) tests are available clinically but cannot be administered to very young individuals. Our objective was to examine the use of an electrophysiological test of SIN, suitable for infants, to track developmental trajectories.
Methods
Speech-evoked brainstem potentials were recorded from 30 typically-developing infants in quiet and +10 dB SNR background noise. Infants were divided into two age groups (7-12 and 18-24 months) and examined across development. Spectral power of the frequency following response (FFR) was computed using a fast Fourier Transform. Cross-correlations between quiet and noise responses were computed to measure encoding resistance to noise.
Results
Older infants had more robust FFR encoding in noise and had higher quiet-noise correlations than their younger counterparts. No group differences were observed in the quiet condition.
Conclusions
By two years of age, infants show less vulnerability to the disruptive effects of background noise, compared to infants under 12 months.
Significance
Speech-in-noise electrophysiology can be easily recorded across infancy and provides unique insights into developmental differences that tests conducted in quiet may miss.
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The impairing effect of dyspnea on response inhibition
Publication date: Available online 31 August 2018
Source: International Journal of Psychophysiology
Author(s): Josef Sucec, Michaela Herzog, Ilse Van Diest, Omer Van den Bergh, Andreas von Leupoldt
Abstract
Dyspnea (=breathlessness) is an aversive and threatening symptom in various prevalent diseases. Established treatment procedures aim for behavioral changes in dyspneic patients in order to treat dyspnea successfully. To achieve these behavioral changes, response inhibition as one key executive function for goal-directed behavior is an important prerequisite. However, the impact of dyspnea on response inhibition is widely unknown. Therefore, the present study aimed at testing whether experimentally induced dyspnea would impair response inhibition. Thirty-six healthy participants performed the color-word Stroop task during an unloaded baseline and a resistive load-induced dyspnea condition. Response inhibition was investigated using behavioral measures (reaction time, accuracy) and, based on literature, the late positive complex (LPC) in the electroencephalogram. Furthermore, the N400 was investigated in an exploratory analysis. The results showed significantly reduced accuracy for incongruent compared to congruent color-words in the Stroop task during the dyspnea condition (p < .001) which was paralleled by a smaller LPC and a more negative centro-parietal N400 for incongruent color-words during the dyspnea compared to the baseline condition (p < .05). Possibly, during dyspnea more neural resources are allocated towards the semantic processing of incongruent color-words indexed as the N400 which are then not available for the partly overlapping LPC as an index for response inhibition. These findings demonstrate that resistive load-induced dyspnea has an impairing effect on response inhibition in healthy participants, both in terms of behavioral performance and respective neural processing. This might impair treatment efforts aimed at behavioral changes in patients suffering from dyspnea.
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Ontogeny and phylogeny of the cercopithecine cranium: A geometric morphometric approach to comparing shape change trajectories
Publication date: Available online 31 August 2018
Source: Journal of Human Evolution
Author(s): Evan A. Simons, Stephen R. Frost, Michelle Singleton
Abstract
While the analysis of ontogenetic trajectories is common in geometric morphometrics (GM), the simultaneous comparison of several trajectories can be unwieldy and is, in some cases, unable to make use of one of the main advantages of GM, visualization. Furthermore, due to the paucity of the paleontological record, analyses of trajectories are often limited to extant taxa. We address these issues by presenting a method for visualizing the similarities and differences of cranial ontogenetic trajectories among taxa and a method for reconstructing ancestral ontogenetic trajectories, so that these differences can be investigated in a phylogenetic context. We also tested for the presence of phylogenetic signal in the ontogenetic trajectories themselves. Using an ontogenetic series of 522 crania, representing 17 cercopithecine species from 8 genera, we first calculated ontogenetic trajectories of cranial shape change for each species, and then entered these trajectories into a principal components analysis to produce a developmental shape-change trajectory PCA (δPCA). Then, through an augmentation of the phylomorphospace approach, we projected a molecular phylogeny onto the major axes of trajectory shape variation from the δPCA to produce an 'ontophylomorphospace,' using squared-change parsimony to reconstruct interior nodes. Through these procedures, we were able to determine that the δPCAs illustrate patterns of variation in these developmental trajectories in a visually intuitive manner that allows for easier comparisons among taxa. Through examination of the ontophylomorphospace, we found that African papionins exhibit extensive homoplasy in the evolution of cranial ontogenetic trajectories, and that Asian species of Macaca show highly derived ontogenetic trajectories relative to other cercopithecines. Additionally, we found no support for the presence of a phylogenetic signal in cranial ontogenetic trajectories. The δPCA and the ontophylomorphospace are ways in which to visualize and compare complex, multivariate shape transformations, both among extant taxa and over evolutionary time, respectively.
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The spatio-temporal distribution of archaeological and faunal finds at Liang Bua (Flores, Indonesia) in light of the revised chronology for Homo floresiensis
Publication date: Available online 31 August 2018
Source: Journal of Human Evolution
Author(s): Thomas Sutikna, Matthew W. Tocheri, J. Tyler Faith, Jatmiko, Rokus Due Awe, Hanneke J.M. Meijer, E. Wahyu Saptomo, Richard G. Roberts
Abstract
Liang Bua, the type site of Homo floresiensis, is a limestone cave on the Indonesian island of Flores with sedimentary deposits currently known to range in age from about 190 thousand years (ka) ago to the present. Recent revision of the stratigraphy and chronology of this depositional sequence suggests that skeletal remains of H. floresiensis are between ∼100 and 60 ka old, while cultural evidence of this taxon occurs until ∼50 ka ago. Here we examine the compositions of the faunal communities and stone artifacts, by broad taxonomic groups and raw materials, throughout the ∼190 ka time interval preserved in the sequence. Major shifts are observed in both the faunal and stone artifact assemblages that reflect marked changes in paleoecology and hominin behavior, respectively. Our results suggest that H. floresiensis and Stegodon florensis insularis, along with giant marabou stork (Leptoptilos robustus) and vulture (Trigonoceps sp.), were likely extinct by ∼50 ka ago. Moreover, an abrupt and statistically significant shift in raw material preference due to an increased use of chert occurs ∼46 thousand calibrated radiocarbon (14C) years before present (ka cal. BP), a pattern that continues through the subsequent stratigraphic sequence. If an increased preference for chert does, in fact, characterize Homo sapiens assemblages at Liang Bua, as previous studies have suggested (e.g., Moore et al., 2009), then the shift observed here suggests that modern humans arrived on Flores by ∼46 ka cal. BP, which would be the earliest cultural evidence of modern humans in Indonesia.
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Early dates for ‘Neanderthal cave art’ may be wrong
Publication date: Available online 30 August 2018
Source: Journal of Human Evolution
Author(s): Maxime Aubert, Adam Brumm, Jillian Huntley
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Commencing out of bed rehabilitation in critical care – what influences clinical decision-making?
Publication date: Available online 30 August 2018
Source: Archives of Physical Medicine and Rehabilitation
Author(s): Sue C. Berney, Joleen W. Rose, Linda Denehy, Catherine L. Granger, George Ntoumenopoulos, Elise Crothers, Bronwyn Steel, Sandy Clarke, Elizabeth H. Skinner
Objectives
To develop a decision tree that objectively identifies the most discriminative variables in the decision to provide out-of-bed rehabilitation, measure the impact of this decision and to identify the factors that intensive care unit (ICU) practitioners think most influential in that clinical decision.
Design
A prospective three-part study: i) consensus identification of influential factors in mobilization via survey, ii) development of an early rehabilitation decision tree and iii) measurement of practitioner mobilisation decision-making. Treating practitioners of patients expected to stay > 96h were asked if they would provide out-of-bed rehabilitation and rank factors that influenced this decision from an a priori defined list developed from a literature review and expert consultation.
Setting
Four tertiary metropolitan ICUs
Participants
Practitioners (ICU medical, nursing and physiotherapy staff)
Interventions
Not applicable
Main Outcomes
A decision tree was constructed using binary recursive partitioning to determine the factor that best classified patients suitable for out-of-bed rehabilitation. Descriptive statistics were used to describe practitioner and patient samples as well as patient adverse events associated with out-of-bed rehabilitation and the factors prioritised by ICU practitioners.
Results
There were 1520 practitioner decisions representing 472 individual patient decisions. Practitioners classified patients suitable for out-of-bed rehabilitation on 149 occasions and not suitable on 323 occasions. Decision tree analysis showed the presence of an endotracheal tube (ETT) and sedation state were the only discriminative variables that predicted patient suitability for rehabilitation. In contrast, medical staff and nurses reported that ventilator status was the most influential factor in their decision not to provide rehabilitation whilst physiotherapists ranked sedation most highly. The presence of muscle weakness did not inform the decision to provide rehabilitation.
Conclusion
These results confirm previous observational reports that the presence of an ETT remains a major obstacle to the provision of rehabilitation for critically ill patients. Despite rehabilitation being effective for improving muscle strength, the presence of muscle weakness did not influence the decision to provide rehabilitation.
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Improving Outcomes for Critically Ill Cardiovascular Patients through Increased Physical Therapy Staffing
Publication date: Available online 30 August 2018
Source: Archives of Physical Medicine and Rehabilitation
Author(s): Joshua K. Johnson, Bryan Lohse, Haley A. Bento, Christopher S. Noren, Robin L. Marcus, Joseph E. Tonna
ABSTRACT
Objective
To examine the effect of increasing physical therapy staff in a cardiovascular ICU (CVICU) on temporal measures of physical therapy interventions and on outcomes important to patients and hospitals.
Design
Retrospective pre/post subgroup analysis from a quality improvement initiative.
Setting
Academic medical center.
Participants
Cardiovascular patients in either a baseline (N=52) or quality improvement period (N=62) with a CVICU length of stay (LOS) ≥ 7 days and use of any one of the following: mechanical ventilation, continuous renal replacement therapy, or mechanical circulatory support.
Interventions
The six-month quality improvement initiative increased CVICU-dedicated physical therapy staff from two to four.
Main Outcome Measures
Changes in physical therapy delivery were examined using the frequency and daily duration of physical therapy intervention. Post-CVICU LOS was the primary outcome. CVICU LOS, mobility change, and discharge level of care were secondary outcomes. A secondary analysis of hospital survivors was also conducted.
Results
Compared to those in the baseline period, cardiovascular patients in the quality improvement period participated in physical therapy for an additional 9.6 minutes (95% confidence interval [CI]: 1.9, 17.2) per day for all patients and 15.1 minutes (95% CI: 7.6, 22.6) for survivors. Post-CVICU LOS decreased 2.2 (95% CI: -6.0, 1.0) days for all patients and 2.6 days (95% CI: -5.3, 0.0) for survivors. CVICU LOS decreased 3.6 days (95% CI: -6.4, -0.8) for all patients and 3.1 days (95% CI: -6.4, -0.9) for survivors. Differences in mobility change and discharge level of care were not significant.
Conclusions
Additional CVICU-dedicated physical therapy staff was associated with increased physical therapy treatment and reductions in CVICU and post-CVICU LOS. The effects of each were greatest for hospital survivors.
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Comprehensive Neuropsychological Assessment of Cognitive Functioning of Adults with Lower Limb Amputation in Rehabilitation
Publication date: Available online 30 August 2018
Source: Archives of Physical Medicine and Rehabilitation
Author(s): Richard Lombard-Vance, Fiadhnait O'Keeffe, Deirdre Desmond, Robert Coen, Nicola Ryall, Pamela Gallagher
Objective
To establish a comprehensive profile of cognitive functioning in people engaged in lower limb amputation (LLA) rehabilitation.
Design
Cross-sectional study as part of a longitudinal prospective cohort.
Setting
A national, tertiary, rehabilitation hospital.
Participants
Adult volunteer participants (N=87) referred for comprehensive rehabilitation for major LLA were sampled from 207 consecutive admissions. Participants with both vascular (n=69) and non-vascular (n=18) LLA aetiologies were included.
Interventions
Not applicable
Main Outcome Measure(s)
Demographic and health information, and a battery of standardised neuropsychological assessments
Results
Compared to normative data, impairment was evident in overall cognitive functioning (p≤.003). Impairment was also evident in particular areas, including reasoning, psychomotor function, information processing, attention, memory, language/naming, visuospatial functions, and executive functions (all p≤.003 Holm-corrected). There were also higher frequencies of impaired functions across most aspects of functioning in this group, compared to expected frequencies in normative data (p≤.003 Holm-corrected). There were no significant differences in cognitive functioning between participants of vascular and non-vascular LLA aetiology.
Conclusions
Findings support the need for cognitive screening at rehabilitation admission regardless of aetiology. Administration of comprehensive neuropsychological assessment with a battery sensitive to vascular cognitive impairment is recommended in some cases, to generate an accurate and precise understanding of relative strengths and weaknesses in cognitive functioning. Cognitive functioning is a potential intervention point for improvement of rehabilitation outcomes for those with LLA and further research is warranted in this area.
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Editorial Board
Publication date: September 2018
Source: Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms, Volume 1861, Issue 9
Author(s):
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Sensory domain of the cell cycle kinase CckA regulates the differential DNA binding of the master regulator CtrA in Caulobacter crescentus
Publication date: Available online 31 August 2018
Source: Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms
Author(s): Sharath Narayanan, Lokesh Kumar, Sunish Kumar Radhakrishnan
Abstract
Sophisticated signaling mechanisms allow bacterial cells to cope with environmental and intracellular challenges. Activation of specific pathways ameliorates these challenges and thereby warrants integrity. Here, we demonstrate the pliability of the CckA-CtrA two component signaling system in the freshwater bacterium Caulobacter crescentus. Our forward genetic screen to analyze suppressor mutations that can negate the chromosome segregation block induced by the topoisomerase IV inhibitor, NstA, yielded various point mutations in the cell cycle histidine kinase, CckA. Notably, we identified a point mutation in the PAS-B domain of CckA, which resulted in increased levels of phosphorylated CtrA (CtrA~P), the master cell cycle regulator. Surprisingly, this increase in CtrA~P levels did not translate into a genome-wide increase in the DNA occupancy of CtrA, but specifically enriched its affinity for the chromosomal origin of replication, Cori, and for a very small sub-set of CtrA regulated promoters. We show that through this enhanced binding of CtrA to the Cori, cells are able to overcome the toxic defects rendered by stable NstA through a possible slow down in the chromosome replication cycle. Taken together, our work opens up an unexplored and intriguing aspect of the CckA-CtrA signal transduction pathway. The distinctive DNA binding nature of CtrA and its regulation by CckA might also be crucial for pathogenesis because of the highly conserved nature of the CckA-CtrA pathway in alphaproteobacteria.
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5 concepts for building a resilient community before an act of mass violence
These concepts will yield more prepared, capable and resilient communities
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Airway inflammation and injury in children with prevalent weakly acidic gastroesophageal refluxes
Respiratory Medicine
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Diabetes mellitus and hyperglycemia control on the risk of colorectal adenomatous polyps: A retrospective cohort study
BMC Family Practice
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Relationship between obstructive lung disease and non-alcoholic fatty liver disease in the Korean population: Korea National Health and Nutrition Examination Survey, 2007–2010
International Journal of COPD
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Impact of Immigration and Duration of Residence in US on Length of Gestation Among Black Women in Newark, New Jersey
Abstract
Little is known about pregnancy outcomes of black immigrant women to the US. We surveyed 447 black women post-partum in two hospitals in Newark, NJ. Length of gestation was obtained from medical records. Covariates and information on immigration were collected by in-person interview. Risks ratios for preterm birth (< 37 weeks) comparing immigrant to US-born women were calculated using log-binomial regression. Associations with gestational age at delivery were estimated using linear regression. Multivariable models adjusted for socioeconomic and social/behavioral variables. Immigrant women relative to US-born women had a 60% lower risk of preterm birth (adjusted risk ratio = 0.4; 95% confidence interval (CI) 0.2, 0.8) and longer gestation (adjusted difference = 1.4 weeks, 95%CI 0.6, 2.1). Gestation was 1.9 weeks longer for recent immigrants compared to US-born women (95%CI 0.2, 3.6), whereas for those who lived in the US for at least 10 years there was no difference. The healthy immigrant effect found among black immigrants may erode with time in the US.
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Endoscopic ultrasound-guided treatment of pancreatic fluid collections with lumen apposing metallic stents: lessons learned
Abstract
Pancreatic fluid collections are common pancreatitis complications that frequently require drainage. Endoscopic ultrasound-guided placement of expandable lumen apposing metallic stents has recently emerged as an effective and less invasive treatment option. It is associated with less morbidity, lower costs, and faster clinical recovery than other therapeutic modalities. Nevertheless, this procedure may result in severe complications such as bleeding, buried stent syndrome, and prosthesis dislodgement (with perforation and peritoneal leakage). We performed 108 EUS-guided drainages with lumen apposing metallic stents for the treatment of pancreatic fluid collections with 8 complications and only two cases that required urgent surgical procedures resulting in one fatality. We present this two severe complications submitted to surgical treatment and discuss potential signs of alarm that must be taken under consideration before choosing a treatment modality.
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Impacts of an Integrated Medicaid Managed Care Program for Adults with Behavioral Health Conditions: The Experience of Illinois
Abstract
This study assessed the impact of the Integrated Care Program (ICP), a new Medicaid managed care model in Illinois, on health services utilization and costs for adults with behavioral health conditions. Data sources included Medicaid claims, encounter records, and state payment data for 28,127 persons with a behavioral health diagnosis. Difference-in-differences models, in conjunction with propensity score weighting, were used to compare utilization and costs between ICP enrollees and a fee-for-service (FFS) comparison group. The model considered the impact of the SMART Act, which restricted access to care for the comparison group. Before the SMART Act, ICP was associated with 2.8 fewer all-cause primary care visits, 34.6 fewer behavioral health-specific outpatient visits, and 2.5 fewer all-cause inpatient admissions per 100 persons per month, and $228 lower total costs per member per month relative to the FFS group. After the SMART Act, ICP enrollees had increased outpatient and dental services utilization without significantly higher costs. The relative increase in utilization was due primarily to decreased utilization in the restricted FFS group after the SMART Act. By the end of the study period, the ICP group had 13.3 more all-cause primary care visits, 1.5 more emergency department visits, and 1.4 more dental visits per 100 persons per month relative to the FFS program. A fully-capitated, integrated managed care program has the potential to reduce overall Medicaid costs for people with behavioral health conditions without negative effects on service utilization.
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Successful treatment of an esophageal perforation that occurred during endoscopic submucosal dissection for esophageal cancer using polyglycolic acid sheets and fibrin glue
Abstract
A 74-year-old female, who was diagnosed with superficial esophageal cancer, underwent endoscopic submucosal dissection (ESD) at another hospital, but a perforation occurred during the procedure. The perforation was closed with endoscopic clips, and the ESD was halted. The patient was referred to our hospital, and ESD was retried. There was severe fibrosis around the lesion, and injections into the submucosal layer were difficult. In addition, it was not possible to identify the submucosal layer, and making an oral-side incision caused a large perforation along the incision line. As continuing the submucosal dissection with an endoknife was considered difficult, the lesion was finally resected with hybrid ESD using a snare. The perforation was closed using polyglycolic acid (PGA) sheets and fibrin glue. Endoscopy performed 6 days later showed that the defect had been closed, and no contrast leakage was detected. Follow-up endoscopy conducted 3 months after the ESD showed ulcer healing at the dissection site and scar formation, but no residual tumor or esophageal stricture was noted. Our experience suggests that the use of PGA sheets with fibrin glue is a feasible, safe, and effective way of treating large esophageal perforations during ESD.
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