Antimicrobial Resistance in Commensal Escherichia coli Isolated from Pigs and Pork Derived from Farms Either Routinely Using or Not Using In-Feed Antimicrobials

Microbial Drug Resistance, Volume 24, Issue 7, Page 1054-1066, September 2018.


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Parkin: one of the guardians of mitochondrial function and skeletal muscle contractility

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


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Timing is everything: maternal circadian rhythms and the developmental origins of health and disease

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


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Adaptation of myocardial twist in the remodelled athlete's heart is not related to cardiac output

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


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Hypothalamic DNA methylation in rats with dihydrotestosterone‐induced polycystic ovary syndrome: effects of low‐frequency electro‐acupuncture

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


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Activation of PD-1 Protects Intestinal Immune Defense Through IL-10/miR-155 Pathway After Intestinal Ischemia Reperfusion

Abstract

Background

To date, mechanisms of intestinal immunoglobulin (Ig) dysfunction following intestinal ischemia/reperfusion (I/R) remain unclear. Programmed death 1 (PD-1) is associated with immune responses of lymphocytes.

Aim

We aimed to verify the hypothesis that activation of PD-1 may improve intestinal immune dysfunction by regulating IL-10/miR-155 production after intestinal IR injury.

Methods

Intestinal I/R injury was induced in mice by clamping the superior mesenteric artery for 1 h followed by 2-h reperfusion. PD-L1 fusion Ig, anti-interleukin (IL)-10 monoclonal antibody (mAb), and microRNA (miR)-155 agomir were administered. PD-1 expression, IL-10 mRNA, and protein expression in Peyer's patches (PP) CD4⁺ cells were measured. MiR-155 levels, tumor necrosis factor (TNF)-α and IL-1β concentration, and activation-induced cytidine deaminase (AID), a key enzyme for intestinal immune antibodies, in PP tissues were measured, respectively. Importantly, the production and cecal bacteria-binding capacity of IgA and IgM were detected.

Results

Intestinal I/R led to decreased PD-1 expression, imbalanced production, and impaired bacteria-binding capacity of IgA and IgM. Activating PD-1 by PD-L1 Ig facilitated IL-10 synthesis, then decreased miR-155 levels, and subsequently promoted AID expression and reduced TNF-α, IL-1β concentration. Upregulation of AID improved the disruptions of intestinal immune barrier caused by IgA and IgM dysfunction. Anti-IL-10 mAb and miR-155 agomir abolished the protective effects of PD-L1 Ig on the intestinal immune defense.

Conclusion

Activation of PD-1 with PD-L1 Ig relieves intestinal immune defensive injury through IL-10/miR-155 pathway following intestinal I/R attack. PD-1, IL-10, and miR-155 may be potential targets for the damages of intestinal barrier and immunity.

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An Increased Chromosome 7 Copy Number in Endoscopic Bile Duct Biopsy Specimens Is Predictive of a Poor Prognosis in Cholangiocarcinoma

Abstract

Background

The ability of fluorescence in situ hybridization (FISH) assays in endoscopic transpapillary bile duct biopsy specimens to predict the prognosis of cholangiocarcinoma (CCA) has not been elucidated.

Aims

We aimed to clarify the association between the results of UroVysion FISH assays and the prognosis of CCA.

Methods

We retrospectively reviewed 49 specimens obtained by transpapillary forceps biopsy from consecutive patients with CCA. The copy numbers of chromosomes 3, 7, and 17 were evaluated by FISH assay using UroVysion. We compared the overall survival (OS) of CCA patients with and without increased copy numbers of chromosomes 3, 7, and 17. Furthermore, we evaluated the association between OS and the clinicopathological parameters of CCA patients.

Results

The OS was significantly shorter in patients with than without an increased chromosome 7 copy number (log-rank p = 0.015; median OS 11.9 vs. 20.7 months). In the univariate analyses, age (p = 0.012), ECOG performance status (p = 0.046), tumor stage (p = 0.046), surgery (p = 0.006), and an increased chromosome 7 copy number (p = 0.017) were significantly associated with OS. The multivariate analysis revealed that an increased chromosome 7 copy number (hazard ratio, 2.46; 95% CI 1.15–5.27; p = 0.021) and advanced clinical stage (hazard ratio, 2.26; 95% CI 1.11–4.63; p = 0.025) were independently predictive of a poor OS.

Conclusions

Detection by FISH assay of an increased chromosome 7 copy number in transpapillary forceps biopsy specimens is predictive of a poor prognosis in CCA patients.

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The 10 fundamental principles of lay resuscitation: Recommendations by the German Resuscitation Council

No abstract available

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Lung protection during one-lung ventilation: Another piece in the puzzle

No abstract available

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An observational study of skill retention and practice adoption after a workshop on ultrasound-guided neuraxial anaesthesia

No abstract available

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Protective ventilation during anaesthesia reduces major postoperative complications after lung cancer surgery: A double-blind randomised controlled trial

BACKGROUND Thoracic surgery for lung resection is associated with a high incidence of postoperative pulmonary complications. Controlled ventilation with a large tidal volume has been documented to be a risk factor for postoperative respiratory complications after major abdominal surgery, whereas the use of low tidal volumes and positive end-expiratory pressure (PEEP) has a protective effect. OBJECTIVE To evaluate the effects of ventilation with low tidal volume and PEEP on major complications after thoracic surgery. DESIGN A double-blind, randomised controlled study. SETTING A multicentre trial from December 2008 to October 2011. PATIENTS A total of 346 patients undergoing lobectomy or pneumonectomy for lung cancer. MAIN OUTCOME MEASURES The primary outcome was the occurrence of major postoperative complications (pneumonia, acute lung injury, acute respiratory distress syndrome, pulmonary embolism, shock, myocardial infarction or death) within 30 days after surgery. INTERVENTIONS Patients were randomly assigned to receive either lung-protective ventilation (LPV group) [tidal volume 5 ml kg−1 ideal body weight + PEEP between 5 and 8 cmH2O] or nonprotective ventilation (control group) (tidal volume 10 ml kg−1 ideal body weight without PEEP) during anaesthesia. RESULTS The trial was stopped prematurely because of an insufficient inclusion rate. Major postoperative complications occurred in 23/172 patients in the LPV group (13.4%) vs. 38/171 (22.2%) in the control group (odds ratio 0.54, 95% confidence interval, 0.31 to 0.95, P = 0.03). The incidence of other complications (supraventricular cardiac arrhythmia, bronchial obstruction, pulmonary atelectasis, hypercapnia, bronchial fistula and persistent air leak) was also lower in the LPV group (37.2 vs. 49.4%, odds ratio 0.60, 95% confidence interval, 0.39 to 0.92, P = 0.02).The duration of hospital stay was shorter in the LPV group, 11 [interquartile range, 9 to 15] days vs. 12 [9 to 16] days, P = 0.048. CONCLUSION Compared with high tidal volume and no PEEP, LPV combining low tidal volume and PEEP during anaesthesia for lung cancer surgery seems to improve postoperative outcomes. TRIALS REGISTRATION ClinicalTrials.gov number: NCT00805077.

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A comparison of the incidence of supraventricular arrhythmias between thoracic paravertebral and intercostal nerve blocks in patients undergoing thoracoscopic surgery: A randomised trial

BACKGROUND Postoperative supraventricular arrhythmias are common in patients after thoracoscopic lobectomy. Inadequate pain control has long been recognised as a significant risk factor for arrhythmias. The performance of ultrasound-guided (USG) thoracic paravertebral block (PVB) is increasing as an ideal technique for postoperative analgesia. OBJECTIVE We conducted this study to evaluate whether a single-shot USG thoracic PVB would result in fewer postoperative supraventricular tachycardias (SVT) than intercostal nerve blocks (ICNBs) after thoracoscopic pulmonary resection. DESIGN A randomised controlled study. SETTING A single university hospital. PATIENTS Sixty-eight patients undergoing thoracoscopic lobectomy were randomised into two equal groups of 34. INTERVENTIONS For postoperative pain control, all patients received a total of 0.3 ml kg−1 of a mixture containing 0.5% ropivacaine and 1/200 000 epinephrine after placement of needles for either a single thoracic PVB or two individual ICNBs, both guided by ultrasound. Data were obtained during the first 48 postoperative hours. MAIN OUTCOME MEASURES The primary outcome was the incidence of SVT after thoracoscopic pulmonary resection. RESULTS During the first 48 postoperative hours, the incidences of SVT and atrial fibrillation were lower in the USG thoracic PVB group (14.7 vs. 46.9%, P = 0.004 and 3.0 vs. 18.8%, P = 0.037, respectively). The requirement for β-receptor blockade was more frequent in the ICNBs group than in the PVB group (5.9 vs. 25%, P = 0.033). CONCLUSION After placement of the needle using ultrasound guidance, a single-shot thoracic PVB is a well tolerated and effective technique to reduce the incidences of postoperative SVT and atrial fibrillation in patients undergoing thoracoscopic pulmonary resection. TRIAL REGISTRATION https://ift.tt/2LGPFWU, registration number: ChiCTR-IOR-17010952.

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Improved lung recruitment and oxygenation during mandatory ventilation with a new expiratory ventilation assistance device: A controlled interventional trial in healthy pigs

BACKGROUND In contrast to conventional mandatory ventilation, a new ventilation mode, expiratory ventilation assistance (EVA), linearises the expiratory tracheal pressure decline. OBJECTIVE We hypothesised that due to a recruiting effect, linearised expiration oxygenates better than volume controlled ventilation (VCV). We compared the EVA with VCV mode with regard to gas exchange, ventilation volumes and pressures and lung aeration in a model of peri-operative mandatory ventilation in healthy pigs. DESIGN Controlled interventional trial. SETTING Animal operating facility at a university medical centre. ANIMALS A total of 16 German Landrace hybrid pigs. INTERVENTION The lungs of anaesthetised pigs were ventilated with the EVA mode (n=9) or VCV (control, n=7) for 5 h with positive end-expiratory pressure of 5 cmH2O and tidal volume of 8 ml kg−1. The respiratory rate was adjusted for a target end-tidal CO2 of 4.7 to 6 kPa. MAIN OUTCOME MEASURES Tracheal pressure, minute volume and arterial blood gases were recorded repeatedly. Computed thoracic tomography was performed to quantify the percentages of normally and poorly aerated lung tissue. RESULTS Two animals in the EVA group were excluded due to unstable ventilation (n=1) or unstable FiO2 delivery (n=1). Mean tracheal pressure and PaO2 were higher in the EVA group compared with control (mean tracheal pressure: 11.6 ± 0.4 versus 9.0 ± 0.3 cmH2O, P  0.99). Minute volume was lower in the EVA group compared with control (5.5 ± 0.2 versus 7.0 ± 1.0 l min−1, P = 0.02) with normoventilation in both groups (PaCO2 5.4 ± 0.3 versus 5.5 ± 0.3 kPa, P > 0.99). In the EVA group, the percentage of normally aerated lung tissue was higher (81.0 ± 3.6 versus 75.8 ± 3.0%, P = 0.017) and of poorly aerated lung tissue lower (9.5 ± 3.3 versus 15.7 ± 3.5%, P = 0.002) compared with control. CONCLUSION EVA ventilation improves lung aeration via elevated mean tracheal pressure and consequently improves arterial oxygenation at unaltered positive end-expiratory pressure (PEEP) and peak inspiratory pressure (PIP). These findings suggest the EVA mode is a new approach for protective lung ventilation.

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The feasibility of pressure measurement during an ultrasound-guided thoracic paravertebral block

No abstract available

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Efficacy and safety of dexmedetomidine in peripheral nerve blocks: A meta-analysis and trial sequential analysis

BACKGROUND The duration of analgesia provided by nerve blocks is limited if local anaesthetics are administered alone. Therefore, several additives, including dexmedetomidine (DEX), have been investigated in order to prolong postoperative analgesia following single-shot regional anaesthesia. OBJECTIVES The aim of this meta-analysis was to assess the efficacy and safety of the addition of perineural DEX to local anaesthetics compared with local anaesthetics alone or local anaesthetics combined with systemic administration of DEX. DESIGN A systematic review of randomised controlled trials (RCT) with meta-analysis, trial sequential analysis and assessment of the quality of evidence by the GRADE approach. DATA SOURCES The databases MEDLINE, CENTRAL and EMBASE (to May 2017) were systematically searched. ELIGIBILITY CRITERIA All RCTs investigating the efficacy and safety of perineural DEX combined with local anaesthetics compared with local anaesthetics alone or local anaesthetics in combination with systemic DEX in peripheral nerve blocks of adults undergoing surgery were included. RESULTS A total of 46 RCTs (3149 patients) were included. Patients receiving perineural DEX combined with local anaesthetics had a longer duration of analgesia than local anaesthetics alone [mean difference 4.87 h; 95% confidence interval (95% CI) 4.02 to 5.73; P 

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Ultrasound-guided single injection versus continuous sciatic nerve blockade on pain management and mobilisation after total knee arthroplasty (CoSinUS trial): A randomised, triple-blinded controlled trial

BACKGROUND Combining continuous femoral nerve blockade with single injection sciatic nerve blockade is standard peripheral nerve block practice for total knee arthroplasty (TKA) during the first 24 postoperative hours. OBJECTIVES To assess the analgesic benefits and mobilisation capability of continuous sciatic blockade in conjunction with continuous femoral nerve blockade for 72 h after arthroplasty. DESIGN Randomised, triple-blinded controlled trial. SETTING Single-Centre, German University Hospital. PATIENTS In total, 50 patients receiving continuous femoral nerve blockade (5 ml h−1 ropivacaine 0.2%) for TKA under general anaesthesia. INTERVENTIONS Patients were randomised to receive a sciatic nerve catheter with an initial dose of 10 ml ropivacaine 0.2% followed by either continuous double-blinded application of 5 ml h−1 ropivacaine 0.2% (CO) or 5 ml h−1 saline infusion (SIN). MAIN OUTCOME Measures primary endpoint: cumulative morphine consumption until 48 h postoperatively. Further endpoints included morphine consumption, pain scores, mobilisation, dynamometry until postoperative day 3. RESULTS Median [25th to 75th percentiles] cumulative morphine consumption at postoperative day 2 differed significantly between groups (CO 15 mg [11 to 25] versus SIN, 43 mg [27 to 67.5, P 

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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 prospective observational 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 REGISTRATION: Clinicaltrials.gov: NCT03044496

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Removal of entrapped epidural catheter: role of muscle relaxation

No abstract available

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Adding sufentanil to ropivacaine in continuous thoracic paravertebral block fails to improve analgesia after video-assisted thoracic surgery: A randomised controlled trial

BACKGROUND The benefit of adding opioid to a local anaesthetic for continuous thoracic paravertebral analgesia after video-assisted thoracic surgery (VATS) is unclear. OBJECTIVES To analyse the analgesic efficacy of ropivacaine and sufentanil in combination compared with ropivacaine alone after VATS. DESIGN A randomised, double-blinded, single-centre clinical trial. SETTING A tertiary university hospital between March 2010 and April 2014. PATIENTS Ninety patients were recruited, two were not included leaving 88 randomised into two groups. Eighteen patients were excluded from analysis and 70 completed the study. INTERVENTION To receive thoracic paravertebral analgesia with either 2 mg ml−1 ropivacaine and 0.25 μg ml−1 sufentanil (ropivacaine + sufentanil group) or 2 mg ml−1 ropivacaine alone (ropivacaine group) for 48 h postoperatively. Infusion rate was set at 0.15 ml kg−1 h−1 in both groups. MAIN OUTCOME MEASURES The primary endpoint was the mean total amount of self-administered morphine by the patients in each group at 48 h postoperatively. RESULTS The mean ± SD total amount of self-administered morphine was not significantly different between groups (53.1 ± 27.2 mg in the ropivacaine + sufentanil group vs. 58.8 ± 34.3 mg in the ropivacaine group; P = 0.72). No significant differences were found between the two groups in either pain scores at rest or during movement, in opioid-related adverse reactions, in patient satisfaction or length of hospital stay. CONCLUSION Adding 0.25 μg ml−1 sufentanil to 2 mg ml−1 ropivacaine in continuous thoracic paravertebral analgesia for VATS did not reduce morphine consumption or pain scores when compared with ropivacaine alone. We cannot recommend its use for routine clinical practice. Further studies analysing different concentrations and infusion rates of sufentanil are needed before a lack of efficacy can be confirmed. TRIAL REGISTRATION Clinical trial registrations: EudraCT: 2009-014832-38. ClinicalTrials.gov: NCT 01082744.

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Modified half-the-air technique for continuous pressure monitoring during lumbar plexus block

No abstract available

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Spinal anaesthesia with chloroprocaine 1% versus total intravenous anaesthesia for outpatient knee arthroscopy: A randomised controlled trial

BACKGROUND Both general and spinal anaesthesia with short-acting local anaesthetics are suitable and reliable for knee arthroscopy as an ambulatory procedure. Chloroprocaine (CP) 1% seems to be the ideal spinal local anaesthetic for this indication. OBJECTIVE The aim of this study was to compare spinal anaesthesia using CP 1% with general for outpatient knee arthroscopy with regard to procedure times, occurrence of pain, patient satisfaction and recovery, and also costs. DESIGN A randomised controlled single-centre trial. SETTING University Medical Centre Mannheim, Department of Anaesthesiology and Surgical Intensive Care Medicine, Mannheim, Germany. April 2014 to August 2015. PATIENTS A total of 50 patients (women/men, 18 to 80 years old, ASA I to III) undergoing outpatient knee arthroscopy were included. A contra-indication to an allocated anaesthetic technique or an allergy to medication required in the protocol led to exclusion. INTERVENTIONS Either general anaesthesia with sufentanil, propofol and a laryngeal mask for airway-management or spinal with 40-mg CP 1% were used. We noted procedure times, patient satisfaction/recovery and conducted a 7-day follow-up. MAIN OUTOMES Primary outcome was duration of stay in the day-surgery centre. Secondary outcomes were first occurrence of pain, patient satisfaction, quality of recovery and adverse effects. In addition, we analysed treatment costs. RESULTS Spinal had faster recovery than general anaesthesia with patients reaching discharge criteria significantly earlier [117 min (66 to 167) versus 142 min (82 to 228), P = 0.0047]. Pain occurred significantly earlier in the general anaesthesia group (P = 0.0072). Costs were less with spinal anaesthesia (cost ratio spinal: general 0.57). Patients felt significantly more uncomfortable after general anaesthesia (P = 0.0096). CONCLUSION Spinal anaesthesia with 40-mg CP 1% leads to a significantly earlier discharge and is cheaper compared with general. TRIAL REGISTRATION German Clinical Trials Register, www.drks.de, identifier: DRKS00005989.

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e-learning: the anaesthesiology media lab of Yale University School of Medicine

No abstract available

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Nepotism in publication of medical literature! does it exist? may be it does!!

Mridul M Panditrao

Anesthesia: Essays and Researches 2018 12(3):609-610



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Possible bias in the publication trends of high impact factor anesthesiology and gastroenterology journals –an analysis of 5 years' data

Basavana Goudra, Divakara Gouda, Gowri Gouda, Akash Singh, Alan Balu, Prabhakara Gouda

Anesthesia: Essays and Researches 2018 12(3):611-617

Background: We hypothesize that being an editorial board member (EBM) in a high impact factor specialty medical journal increases the chances of publishing in the same journal. Materials and Methods: The publication trends of the first five EBMs in the five highest impact factor Anesthesiology and Gastroenterology journals were analyzed. Preceding 5 years' publications appearing on PubMed were grouped into as follows: number of publications in the journal in which the EBM serves (N1), number of publications by the same author in the other four highest impact factor (IF) journals (N2) and number of publications in all the other journals (N3). We evaluated the probability of the observed distribution of publications in the five highest IF journals happening by chance alone, assuming that all the EBMs had the same opportunity of publishing in any of these journals. The probability of publishing in their own journal was assumed to be one fifth. Results: The EBMs published their manuscripts in their own journal at a very high frequency. Encompassing all ten journals, the calculated P value for such a distribution was <0.001. In two journals, Anesthesia and Analgesia and Anaesthesia, the EBMs' publications in their journal were more than twice the cumulative total in the remaining four journals. In three of the five gastroenterology journals analyzed, combined publications of the five EBMs were greater in their own journal than the remaining four journals combined. Conclusions: Despite proclaimed fair peer review process, EBMs seem to get preference in their own journals.

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Role of lignocaine nebulization as an adjunct to airway blocks for awake fiber-optic intubation: A comparative study

Manish Khandelwal, Varun Kumar Saini, Sandeep Kothari, Gaurav Sharma

Anesthesia: Essays and Researches 2018 12(3):735-741

Context: Airway management is a crucial skill and area of concern for the anesthesiologist. Awake fiber-optic intubation (AFOI) remains the gold standard in managing difficult airway. Anaesthetizing the airway along with psychological assurance is the mainstay for Preparation of AFOI. Different topical and regional techniques have been developed to subdue reflexes and facilitate AFOI. Aim: This randomized controlled study was performed to evaluate the effectiveness of using lignocaine nebulization in addition to specific airway blocks for AFOI. Methodology: This was a comparative study conducted in 60 patients with difficult airway (LEMON score >2) and randomly allocated into two groups of 30 each. Group LB and Group NB received nebulization of 2% lignocaine 4 mL and 0.9% normal saline 4 mL, respectively. Both groups were then given airway blocks as bilateral superior laryngeal (2% lignocaine 1–2 mL each) and transtracheal (2% lignocaine 4 mL) block. Two puffs of 10% lignocaine to nose and postnasal space on each side were given in both groups. Fiber-optic bronchoscopy (FOB)-guided tracheal intubation was Performed. Vital parameters, side effects, bronchoscopy-guided intubation time and other parameters as intubation grading scale, patient comfort score, satisfaction score were recorded. Chi-square test and unpaired t-test were used for statistical analysis. Results: Statistically, no significant differences were found in hemodynamic parameters, demographics, intubation time, and intubation grading scale in both groups. However, overall patient comfort and satisfaction score was better in Group LB. Conclusion: Upper airway blocks provide adequate anesthesia for awake FOB, but when lignocaine nebulization is added to these blocks, it improves the quality of anesthesia and patient satisfaction.

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Intraoperative meditation music as an adjunct to subarachnoid block for the improvement of postoperative outcomes following cesarean section: A randomized placebo-controlled comparative study

Madhuri S Kurdi, Vinod Gasti

Anesthesia: Essays and Researches 2018 12(3):618-624

Context: Music therapy is a nonpharmacological modality which can provide promising results for postcesarean section recovery. Aims: The aim of this study was to compare the effects of two types of intraoperative meditation music with control group on postcesarean section pain, anxiety, nausea, vomiting, and psychological maternal wellbeing. Settings and Design: A prospective, randomized, controlled study was conducted on 189 patients. Patients and Methods: The inclusion criteria were the American Society of Anaesthesiologists physical status classes 1E and 2E women aged over 18 years posted for emergency cesarean section under spinal anesthesia. The exclusion criteria were patients with hearing/ear abnormalities and psychiatric disorders. Patients were randomly allocated into three groups – soothing meditation music (M) group, binaural beat meditation music (B) group, and control (C) group – where no music was played. After intervention, data were collected and statistically analyzed. Statistical Analysis Used: Student's t-test was applied for calculation of normative distribution and Mann–Whitney U-test for nonnormative distribution. Nominal categorical data between the groups were compared using Chi-squared test. P <0.05 indicated a statistically significant difference. Results: Both intraoperative meditation music groups had statistically significant less postoperative pain and anxiety and a better overall psychological wellbeing as compared to the control. There was no statistically significant difference in the occurrence and severity of postoperative nausea and vomiting across all three groups. Conclusions: Intraoperative meditation music as good adjunct to spinal anesthesia can improve a cesarean section patient's postoperative experience by reducing postoperative pain, anxiety, and psychological wellbeing.

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Comparative study between magnesium sulfate and lidocaine for controlled hypotension during functional endoscopic sinus surgery: A randomized controlled study

Mohamed Ahmed Hamed

Anesthesia: Essays and Researches 2018 12(3):715-718

Background: Intraoperative bleeding impairs surgical field visibility during functional endoscopic sinus surgery (FESS); several methods have been used to decrease blood loss and improve surgical field, one of them is usage of hypotensive anesthetic agents. Aim: We intended to compare magnesium sulfate with lidocaine, regarding their efficiency in inducing controlled hypotension and providing a better surgical field exposure during FESS and the influence of their usage on extubation time. Settings and Design: This study design was a prospective randomized controlled double-blinded clinical study. Patients and Methods: Eighty adult patients with patients' physical status ASA Classes I and II, aged 20–50 years scheduled for FESS were randomly divided into two study groups; each group contains 40 patients: Group L received lidocaine 2 mg/kg/h with maximum of 200 mg/h starting at induction of anesthesia and continuing until the end of surgery and Group M received an iv bolus of magnesium sulfate 50mg/kg in a total of 100ml saline over 10 min followed by infusion of 15mg/kg/h until the end of surgery; patients were observed for the quality of the surgical field, blood loss, and extubation time. Statistical Analysis Used: Student's t-test or Mann–Whitney's U, Chi-square, or Fisher's exact tests were used. Results: Group L showed a significant decrease in blood loss (P = 0.01), better surgical field clarity (P = 0.002), and shorter extubation time (P = 0.001) than Group M, but there was no statistically significant difference between the two study groups as regards hemodynamics. Conclusion: We concluded that both magnesium sulfate and lidocaine successfully induced controlled hypotension in patients undergoing FEES, but lidocaine provided better surgical field clarity and shorter extubation time.

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Quantification of Circulating miR-125b-5p Predicts Survival in Chronic Hepatitis B Patients with Acute-on-Chronic Liver Failure

To analyze the role of serum miR-125b-5p in reflecting liver damage and predicting outcomes in chronic hepatitis B (CHB) patients with acute-on-chronic liver failure (ACLF).

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CAN anterior cervical fusion procedures prevent the progression of the natural course of Hirayama disease? An ambispective cohort analysis

Hirayama disease (HD) is a special neurological disease that is characterised by muscular weakness and atrophy in the upper extremities without sensory involvement (Hirayama, 2008; Zhou et al., 2010; Hassan and Sahni, 2013). The main hypotheses for the aetiology of HD implicates chronic ischemia of cervical motor neurons caused by neck flexion (Hirayama et al., 1987; Imai et al., 1999; Zheng et al., 2016). Furthermore, some previous studies suggest that the disease progression of HD may stop at 2-4 years after the onset (Tan, 1985; Tashiro et al., 2006; Huang et al., 2008).

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Popliteal Artery Entrapment Syndrome – Return to Sport Considerations: A Case Report

This is a case of a 19-year-old female collegiate field hockey player with left leg pain, numbness and tingling. A comprehensive workup including dynamic ultrasound, Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiogram (MRA) revealed a type VI functional popliteal artery entrapment syndrome (PAES). There are many options for treatment of functional PAES including activity modification, botulinum toxin injection, and surgery. To the authors knowledge there is no published return to sport recommendation for post-surgical functional PAES .

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Severe Leg Pain Following Spinal Cord Stimulator Implantation – A Case Report

Following spinal cord stimulator (SCS) implantation, post-operative pain is commonly incisional or neuropathic from neurological damage. Occasionally, this new pain may mimic symptoms due to pre-existing pathology. We present a case of immediate, severe, post-operative leg pain secondary to a lower extremity deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) after percutaneous SCS implantation for failed back syndrome. The risk factors of DVT after spine surgery and perioperative prophylaxis will be further discussed with a brief literature review.

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Ultrasonographic Evaluation of the Femoral Cartilage, Achilles Tendon and Plantar Fascia in Young Women Wearing High-heeled Shoes

Specific attention on the musculoskeletal impact of wearing high-heeled shoes (HHS) has mainly focused on knee osteoarthritis and the literature is limited to biomechanical changes. Herewith, the distal femoral cartilage (DFC) has not been morphologically studied. Additionally, although heel elevation is coupled with a shear stress at the heel and overloaded calf muscles, Achilles tendon and plantar fascia thicknesses have not been assessed either.

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Quantification of Circulating miR-125b-5p Predicts Survival in Chronic Hepatitis B Patients with Acute-on-Chronic Liver Failure

To analyze the role of serum miR-125b-5p in reflecting liver damage and predicting outcomes in chronic hepatitis B (CHB) patients with acute-on-chronic liver failure (ACLF).

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Global analysis of mutations driving microevolution of a heterozygous diploid fungal pathogen [Genetics]

Candida albicans is a heterozygous diploid yeast that is a commensal of the human gastrointestinal tract and a prevalent opportunistic pathogen. Here, whole-genome sequencing was performed on multiple C. albicans isolates passaged both in vitro and in vivo to characterize the complete spectrum of mutations arising in laboratory culture and...

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Telomere shortening is a hallmark of genetic cardiomyopathies [Genetics]

This study demonstrates that significantly shortened telomeres are a hallmark of cardiomyocytes (CMs) from individuals with end-stage hypertrophic cardiomyopathy (HCM) or dilated cardiomyopathy (DCM) as a result of heritable defects in cardiac proteins critical to contractile function. Positioned at the ends of chromosomes, telomeres are DNA repeats that serve as...

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Effect of remifentanil on postoperative nausea and vomiting: a randomized pilot study

Abstract

Opioid-related postoperative nausea and vomiting should not occur following remifentanil administration because of its relatively short time to elimination. However, studies have indicated that the incidence of postoperative nausea and vomiting associated with remifentanil is similar to that with other opioids. Hence, we aimed to determine whether intraoperative remifentanil itself is associated with postoperative nausea and vomiting when postoperative pain is managed without opioid use. In this prospective pilot study, 150 patients who underwent unilateral upper limb surgery under general anesthesia with brachial plexus block were included. Patients in the remifentanil and control groups received 0.5 µg/kg/min remifentanil and saline, respectively. Postoperative pain was managed using a brachial plexus block, non-steroidal anti-inflammatory drugs, and acetaminophen. The presence of postoperative nausea and vomiting within the first 24 h after anesthesia was assessed by an evaluator blinded to patient allocation. Eight patients were excluded from the final analysis, resulting in 72 and 70 patients in the remifentanil and control groups, respectively. Postoperative nausea and vomiting within 24 h after surgery occurred in 11 and 9 patients in the remifentanil and control groups, respectively. These data suggest that remifentanil use only minimally affects the incidence of postoperative nausea and vomiting under sevoflurane anesthesia.

UMIN Clinical Trials Registry identification number: UMIN000016110.

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Enjoy your day – buy a coffee’

A note left on the windshield of an ambulance blocking a driveway in England encouraged the EMS crew to enjoy their day, with money attached for a coffee stop

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The Effect of Angle and Velocity on Change of Direction Biomechanics: An Angle-Velocity Trade-Off

Abstract

Changes of direction (CODs) are key manoeuvres linked to decisive moments in sport and are also key actions associated with lower limb injuries. During sport athletes perform a diverse range of CODs, from various approach velocities and angles, thus the ability to change direction safely and quickly is of great interest. To our knowledge, a comprehensive review examining the influence of angle and velocity on change of direction (COD) biomechanics does not exist. Findings of previous research indicate the biomechanical demands of CODs are 'angle' and 'velocity' dependent and are both critical factors that affect the technical execution of directional changes, deceleration and reacceleration requirements, knee joint loading, and lower limb muscle activity. Thus, these two factors regulate the progression and regression in COD intensity. Specifically, faster and sharper CODs elevate the relative risk of injury due to the greater associative knee joint loading; however, faster and sharper directional changes are key manoeuvres for successful performance in multidirectional sport, which subsequently creates a 'performance-injury conflict' for practitioners and athletes. This conflict, however, may be mediated by an athlete's physical capacity (i.e. ability to rapidly produce force and neuromuscular control). Furthermore, an 'angle-velocity trade-off' exists during CODs, whereby faster approaches compromise the execution of the intended COD; this is influenced by an athlete's physical capacity. Therefore, practitioners and researchers should acknowledge and understand the implications of angle and velocity on COD biomechanics when: (1) interpreting biomechanical research; (2) coaching COD technique; (3) designing and prescribing COD training and injury reduction programs; (4) conditioning athletes to tolerate the physical demands of directional changes; (5) screening COD technique; and (6) progressing and regressing COD intensity, specifically when working with novice or previously injured athletes rehabilitating from an injury.

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Physiological resolution of periodic breath holding during heavy-intensity Fartlek exercise

Abstract

Purpose

The purpose was to compare the singular and combined effects of 5 s breath holds (BH) and 5 s sprints, every 30 s, during continuous high-intensity exercise, on ventilation ( \(\dot {VE}\) ), oxygen uptake ( \(\dot {V}\) O₂) and associated kinetics (τ), carbon dioxide production ( \(\dot {V}\) CO₂), and arterialized-capillary lactate concentration ([La⁻]).

Methods

Ten men (24 ± 3 years) performed 4–6 min ergometer protocols that included a step-transition from 20 W to a power output of 50% of the difference between lactate threshold and \(\dot {V}\) O₂ peak (Δ50%) including: (1) a continuous protocol (CONT) with free breathing, (2) an intermittent BH protocol (CONT-BH); repeated cycles of 5 s BH: 25 s free breathing, (3) a Fartlek protocol (Fartlek); repeated 5 s at peak aerobic power output: 25 s at Δ50%; (4) combining the 5 s Fartlek and CONT-BH protocol (Fartlek-BH). Breath-by-breath gas exchange, measured by mass spectrometry and turbine, was recorded.

Results

\(\dot {V}\) _E (L min⁻¹) was greater (p < 0.05) than CONT (90 ± 7) in all conditions CONT-BH (98 ± 16), Fartlek (105 ± 10), and Fartlek-BH (101 ± 19). \(\dot {V}\) O₂ and \(\dot {V}\) CO₂ (L min⁻¹) were unchanged in CONT-BH (2.73 ± 0.14 and 3.16 ± 0.38) and greater in Fartlek (2.85 ± 0.12 and 3.43 ± 0.16), compared to CONT (2.71 ± 0.12 and 3.12 ± 0.13). Whereas, \(\dot {V}\) CO₂ during Fartlek-BH was higher (3.28 ± 0.35) and \(\dot {V}\) O₂ was unchanged (2.73 ± 0.14). Fartlek-BH resulted in slower \(\dot {V}\) O₂ kinetics (62.2 ± 19 s) and greater blood lactate concentrations (11.5 ± 2.7 mM), compared to CONT (48.8 ± 12 s; 9.0 ± 2.3 mM, respectively).

Conclusions

It was demonstrated that the CONT-BH resulted in increased ventilation that sustained \(\dot {V}\) O₂. However, \(\dot {V}\) O₂ was restricted when an additional work was combined with the BH condition.

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An EEG nicotinic acetylcholine index to assess the efficacy of pro-cognitive compounds

Publication date: Available online 11 September 2018

Source: Clinical Neurophysiology

Author(s): Sonja Simpraga, Huibert D. Mansvelder, Geert Jan Groeneveld, Samantha Prins, Ellen P. Hart, Simon-Shlomo Poil, Klaus Linkenkaer-Hansen

Abstract

Objectives

Cognitive impairment models are used in clinical studies aimed at proving pharmacology of drugs being developed for Alzheimer's disease and other cognitive disorders. Due to rising interest in nicotinic agonists, we aimed to establish a method to monitor neurophysiological effects of modulating the nicotinic cholinergic system.

Methods

In a four-way cross-over study, eyes-closed rest EEG was recorded in 28 healthy subjects receiving mecamylamine—a nicotinic acetylcholine receptor (nAChR) antagonist, which induces temporary cognitive dysfunction in healthy subjects—with co-administration of placebo, nicotine or galantamine.

Results

Using machine learning to optimally contrast the effects of 30 mg of mecamylamine and placebo on the brain, we developed a nAChR index that consists of 10 EEG biomarkers and shows high classification accuracy (∼95% non-cross-validated, ∼70% cross-validated). Importantly, using the nAChR index, we demonstrate reversal of mecamylamine-induced neurophysiological effects due to 16 mg of galantamine as well as administering 21 mg of nicotine transdermally.

Conclusions

Our findings indicate that the mecamylamine challenge model jointly with the nAChR index—a measure of the nicotinic EEG profile—could aid future proof-of-pharmacology studies to demonstrate effects of nicotinic cholinergic compounds.

Significance

This novel measure for quantifying nicotinic cholinergic effects on the EEG could serve as a useful tool in drug development of pro-cognitive compounds.

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A case of gastric cancer with delayed onset of tumor reduction effect by nivolumab therapy

Abstract

Immune checkpoint inhibitors may have different clinical effects compared with conventional anticancer drugs. An 85-year-old male received chemotherapy for recurrent gastric cancer. As liver metastasis progressed, nivolumab was introduced as a fourth line treatment. Progression of liver metastasis in size was observed in CT after 3 courses of nivolumab therapy. Nivolumab treatment was discontinued, because the general condition of the patient also worsened. However, his general condition improved as hepatobiliary enzyme levels, inflammatory response, and tumor markers improved. Liver metastasis was shrinking on the image, so we resumed nivolumab therapy. To the authors' knowledge, this is the first case of pseudoprogression undergoing immunotherapy for gastric cancer. In this case, the antitumor effect was exhibited in a delayed manner and the tumor shrinkage was obtained.

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Golimumab in inflammatory bowel diseases: present and future scenarios

Abstract

Golimumab is the third anti-TNF agent approved for the treatment of ulcerative colitis. Despite initial success demonstrated by PURSUIT trials, only few real-life studies have been published evaluating its efficacy and safety in clinical practice. Its subcutaneous route and monthly administration represent an advantage in patient compliance, respectively, vs infliximab (intravenous) and adalimumab (two doses per month). The most important weakness of the molecule which often leads clinicians to choose another anti-TNF is the impossibility to dose escalate or reduce the frequency of administrations in case of secondary failure; ongoing studies are trying to solve this problem by monitoring drug levels and the eventual presence of neutralizing anti-drug antibodies. No advantage has still been demonstrated for combination therapy of golimumab with immunosuppressants and further studies are necessary to evaluate this aspect. Preliminary data also report golimumab efficacy in Crohn's disease with higher doses than in ulcerative colitis with an acceptable safety profile. Additional studies are needed in this field to confirm the initial findings.

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Vestibular-related eye movements in the rat following selective electrical stimulation of the vestibular sensors

Abstract

Rats are the most commonly used species in the neurosciences; however, little is known about the effects of selective electrical stimulation of individual vestibular sensors, on their eye movements. This limits their use to study the effects of vestibular stimulation on the brain, and their use in further exploring novel technologies such as artificial vestibular implants. We describe the effects of electrical stimulation of each vestibular sensor on vestibular-related eye movement in rats and compared the results to other species. We demonstrated that each sensor is responsible for specific bilateral eye movements. We found that the eye movements in rats differed from other species. Although the results were similar when stimulating the horizontal canal ampulla, differences appeared when stimulating the vertical canal sensors. During utricular stimulation, the ipsilateral eye moved dorsally in most cases, while the contralateral eye usually moved either caudally, or in extorsion. Saccular stimulation usually moved the ipsilateral eye dorsally or ventrally, while the contralateral eye usually moved ventrally or caudally. This study provides the first data on the application of selective electrical vestibular stimulation in the rat to the study of vestibular-related eye movements.

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HDAC1 interacts with the p50 NF-κB subunit via its nuclear localization sequence to constrain inflammatory gene expression

Publication date: Available online 10 September 2018

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

Author(s): Tyrell N. Cartwright, Julie C. Worrell, Letizia Marchetti, Catríona M. Dowling, Amber Knox, Patrick Kiely, Jelena Mann, Derek A. Mann, Caroline L. Wilson

Abstract

The NF-κB p50 subunit is an important regulator of inflammation, with recent experimental evidence to support it also having a tumor suppressor role. Classically, p50 functions in heterodimeric form with the RelA (p65) NF-κB subunit to activate inflammatory genes. However, p50 also forms homodimers which actively repress NF-κB-dependent inflammatory gene expression and exert an important brake on the inflammatory process. This repressive activity of p50:p50 is thought to be in part mediated by an interaction with the epigenetic repressor protein Histone Deacetylase 1 (HDAC1). However, neither the interaction of p50 with HDAC1 nor the requirement of HDAC1 for the repressive activities of p50 has been well defined. Here we employed in silico prediction with in vitro assays to map sites of interaction of HDAC1 on the p50 protein. Directed mutagenesis of one such region resulted in almost complete loss of HDAC1 binding to p50. Transfected mutant p50 protein lacking the putative HDAC1 docking motif resulted in enhanced cytokine and chemokine expression when compared with cells expressing a transfected wild type p50. In addition, expression of this mutant p50 was associated with enhanced chemoattraction of neutrophils and acetylation of known inflammatory genes demonstrating the likely importance of the p50:HDAC1 interaction for controlling inflammation. These new insights provide an advance on current knowledge of the mechanisms by which NF-κB-dependent gene transcription are regulated and highlight the potential for manipulation of p50:HDAC1 interactions to bring about experimental modulation of chronic inflammation and pathologies associated with dysregulated neutrophil accumulation and activation.

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Risk factors for anastomotic recurrence after primary ileocaecal resection in Crohn’s disease

European Journal of Gastroenterology & Hepatology

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Severe liver failure rather than cirrhosis is associated with mortality in patients with infectious endocarditis: A retrospective case–control study

European Journal of Gastroenterology & Hepatology

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A systematic review and meta-analysis on outcomes and complications of percutaneous endoscopic vs radiologic gastrostomy for enteral feeding

Journal of Clinical Gastroenterology

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Oral vancomycin induces sustained deep remission in adult patients with ulcerative colitis and primary sclerosing cholangitis

European Journal of Gastroenterology & Hepatology

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High proportions of liver fibrosis and cirrhosis in an ageing population of people who use drugs in Amsterdam, The Netherlands

European Journal of Gastroenterology & Hepatology

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Smoking habits are strongly associated with colorectal polyps in a population-based case-control study

Journal of Clinical Gastroenterology

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Risk of colorectal cancer in chronic kidney disease: A systematic review and meta-analysis

Journal of Clinical Gastroenterology

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Racial disparities in the presentation and treatment of colorectal cancer: A statewide cross-sectional study

Journal of Clinical Gastroenterology

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Outcome and adverse events in patients with chronic hepatitis C treated with direct-acting antivirals: A clinical randomized study

European Journal of Gastroenterology & Hepatology

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Frequency of complications including death from coronary artery bypass grafting in patients with hepatic cirrhosis

The American Journal of Cardiology

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Disparities in peptic ulcer disease: A nationwide study

American Journal of Surgery

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Corrigendum

Clinical Genetics, Volume 94, Issue 3-4, Page 398-398, October 2018.


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Issue Information ‐ Editorial Board

Clinical Genetics, Volume 94, Issue 3-4, Page 281-281, October 2018.


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Clinical aspects of hereditary spastic paraplegia 76 and novel CAPN1 mutations

Clinical Genetics, EarlyView.


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GHSR constitutive activity impairs voltage‐gated calcium channel (CaV)‐dependent inhibitory neurotransmission in hippocampal neurons

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


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Somatic modulation of ectopic action potential initiation in distal axons

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


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Evidence‐based dentistry or meta‐analysis illness? A commentary on current publishing trends in the field of temporomandibular disorders and bruxism

Journal of Oral Rehabilitation, EarlyView.


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