Τετάρτη, 12 Σεπτεμβρίου 2018

Do GWAS and studies of heterozygotes for NPC1 and/or NPC2 explain why NPC disease cases are so rare?

Abstract

Early onset Niemann-Pick C diseases are extremely rare, especially Niemann-Pick C2. Perhaps unusually for autosomal recessive diseases, heterozygotes for mutations in NPC1 manifest many biological variations. NPC2 deficiency has large effects on fertility. These features of NPC1 and NPC2 are reviewed in regard to possible negative selection for heterozygotes carrying null and hypomorphic alleles.



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Clinical study of combined mirror and extracorporeal shock wave therapy on upper limb spasticity in poststroke patients

Mirror therapy is a simple, inexpensive, and patient-oriented method that has been shown to reduce phantom sensations and pain caused by amputation and improve range of motion, speed, and accuracy of arm movement and function. Extracorporeal shock wave therapy (ESWT) is a new, reversible, and noninvasive method for the treatment of spasticity after stroke. To investigate the therapeutic effect of the combination of mirror and extracorporeal shock wave therapy on upper limb spasticity in poststroke patients. We randomly assigned 120 patients into four groups: A, B, C, and D. All groups received conventional rehabilitation training for 30 min per day, five times a week, for 4 weeks. Moreover, participants in groups A, B, and C also added mirror therapy, ESWT, and a combination of mirror and ESWT, respectively, for 20 min per day. Motor recovery and spasticity were measured using Fugl–Meyer assessment and modified Ashworth scale. The differences in the Fugl–Meyer assessment and modified Ashworth scale scores in group C were significantly greater than those of group D at all observed time points after treatment and were significantly greater than those of groups A and B (P

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Education in Anesthesia: How to Deliver the Best Learning Experience

No abstract available

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Provider Education and Vaporizer Labeling Lead to Reduced Anesthetic Agent Purchasing With Cost Savings and Reduced Greenhouse Gas Emissions

Anesthetic agents are known greenhouse gases with hundreds to thousands of times the global warming impact compared with carbon dioxide. We sought to mitigate the negative environmental and financial impacts of our practice in the perioperative setting through multidisciplinary staff engagement and provider education on flow rate reduction and volatile agent choice. These efforts led to a 64% per case reduction in carbon dioxide equivalent emissions (163 kg in Fiscal Year 2012, compared with 58 kg in Fiscal Year 2015), as well as a cost savings estimate of $25,000 per month. Accepted for publication August 1, 2018. Funding: K.L.Z. receives nonclinical time for her role as Medical Director of Sustainability for UW Health. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Karin L. Zuegge, MD, Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792. Address e-mail to zuegge@wisc.edu. © 2018 International Anesthesia Research Society

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The Perioperative Management of Ascending Aortic Dissection

Acute aortic syndromes are a distinct group of pathologies involving the wall of the aorta that present acutely and can be potentially fatal unless treated in a timely fashion. The syndrome is dominated by aortic dissections, which comprise ≥95% of all such presentations. Those involving the ascending aorta are particularly lethal and require specific and early surgical treatment compared to dissections involving other parts of the aorta. The surgical repair of an ascending aortic dissection presents multiple challenges to the anesthesiologist. Thoughtful management throughout the perioperative period is critical for minimizing the significant morbidity and mortality associated with this condition. In this narrative review, we provide an overview of the perioperative management of patients presenting for the surgical repair of an ascending aortic dissection. Preoperative discussion focuses on assessment, hemodynamic management, and risk stratification. The intraoperative section includes an overview of anesthetic management, transesophageal echocardiographic assessment, and coagulopathy, as well as surgical considerations that may influence anesthetic management. Accepted for publication July 17, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Madhav Swaminathan, MD, MMCi, FASE, FAHA, Department of Anesthesiology, Duke University Medical Center, Box 3094 DUMC/5691F HAFS, Durham, NC 27710. Address e-mail to madhav.swaminathan@duke.edu. © 2018 International Anesthesia Research Society

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In Response

No abstract available

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Trainability of Application of the Correct Cricoid Force: Time to Rely on Devices?

No abstract available

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Short and long-term impact of remifentanil on thermal detection and pain thresholds after cardiac surgery: A randomised controlled trial

BACKGROUND The clinical relevance of the suggested hyperalgesic effects of remifentanil is still unclear, especially in the long term. OBJECTIVE The current study evaluated the impact of remifentanil on thermal thresholds 3 days and 12 months after surgery, measured with Quantitative Sensory Testing. DESIGN A prospective, single-blind, randomised controlled trial. SETTING A tertiary care teaching hospital in The Netherlands, from 2014 to 2016. PATIENTS A total of 126 patients aged between 18 and 85 years, undergoing cardiothoracic surgery via sternotomy (coronary artery bypass grafts and/or valve replacement) were included. Exclusion criteria were BMI above 35 kg m−2, history of cardiac surgery, chronic pain conditions, neurological conditions, allergy to opioids or paracetamol, language barrier and pregnancy. INTERVENTIONS Patients were allocated randomly to receive intra-operatively either a continuous remifentanil infusion or intermittent intra-operative fentanyl as needed in addition to standardised anaesthesia with propofol and intermittent intravenous fentanyl at predetermined time points. MAIN OUTCOME MEASURES Warm and cold detection and pain thresholds 3 days and 12 months after surgery. In addition the use of remifentanil, presence of postoperative chronic pain, age, opioid consumption and pre-operative quality of life were tested as a predictor for altered pain sensitivity 12 months after surgery. RESULTS Both warm and cold detection, and pain thresholds, were not significantly different between the remifentanil and fentanyl groups 3 days and 12 months after surgery (P > 0.05). No significant predictors for altered pain sensitivity were identified. CONCLUSION Earlier reports of increased pain sensitivity 1 year after the use of remifentanil could not be confirmed in this randomised study using Quantitative Sensory Testing. This indicates that remifentanil plays a minor role in the development of chronic thoracic pain. Still, the relatively high incidence of chronic thoracic pain and its accompanying impact on quality of life remain challenging problems. TRIAL REGISTRY REGISTRATION ClinicalTrials.gov identifier NCT02031016. TRIAL REGISTRATION The study was registered at EudraCT (ref: 2013-000201-23) and ClinicalTrials.gov (https://ift.tt/2Mq69Sn). This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. https://ift.tt/OBJ4xP Correspondence to Catherijne A.J. Knibbe, Department of Clinical Pharmacy, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands Tel: +31 30 609 26 12; e-mail: c.knibbe@antoniusziekenhuis.nl Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (https://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

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Depression Characterization and Race among Stroke Survivors Receiving Inpatient Rehabilitation

Race and ethnicity play a significant role in post-stroke outcomes. This brief report describes the presence of depression among stroke survivors who received inpatient rehabilitation and whether depression differs by race. Data from eRehabData® and electronic medical records were analyzed for patients who received rehabilitation after an acute ischemic or hemorrhagic stroke. Of 1501 stroke patients, 61.3% were White, 33.9% were African American (AA) and 4.8% were of other race/ethnic backgrounds. By retrospective clinical review, depression was documented for 29.7% of stroke patients. Pre-morbid versus new onset of post-stroke depression was documented for 13.4% and 21.6% of Whites, 7.5% and 11.5% of AA, and 0% and 16.7% of patients of other race/ethnic groups. Compared with Whites, AA and people of other races had a lower odds of post-stroke depression (AA adjusted odds ratio [OR]=0.52, 95% confidence interval [CI]=0.41-0.68; other races OR=0.37, 95% CI=0.19-0.71), after adjusting for all other significant risk factors identified in the bivariate analysis (sex, hyperlipidemia, cognitive deficit, neglect). Depression was documented for one in three stroke survivors who received inpatient rehabilitation, and highest among Whites especially for pre-stroke depression. Addressing depression in rehabilitation care needs to consider individual patient characteristics and pre-stroke health status. Corresponding author: Janet Prvu Bettger, ScD, FAHA; DUMC 2919, 40 Medicine Circle, Durham, NC, 27710; Office: 919-613-0379; Email: janet.bettger@duke.edu Funding Disclosure: This work was supported in part by NIH NR25GM102739, NIH/NINR P30NR014139, and institutional grants from Duke University School of Nursing and Cannon Research Center Carolinas Medical Center Author Disclosures or Conflicts of Interest: Nothing disclose from any author Previous Dissemination: Preliminary findings for this study were presented by Gabrielle M Harris at the International Stroke Conference on February 12, 2015 in Nashville, Tennessee. The presentation was entitled: "Depression differs by race among stroke survivors receiving inpatient rehabilitation" and the abstract was published as Harris GM, Thomas JG, Nguyen V, Hirsch MA, Guerrier T, Hamm D, Pereira C, Bettger JP. Depression differs by race among stroke survivors receiving inpatient rehabilitation. Stroke 2015;46(Suppl 1):ATP129-ATP129. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Quantification and Description of Physical Exercise Performance

No abstract available

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Physiatry Reviews for Evidence in Practice (PREP)

No abstract available

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Multi-system balance training reduces injurious fall risk in Parkinson’s disease – A randomized trial

Previous studies have shown that balance training could reduce falls in people with Parkinson's disease (PD). However, it remains unclear whether exercise can reduce injurious falls. The objective of present study was to determine whether multi-system balance training could reduce injurious falls and modify targeted fall risk factors in PD non-fallers and single fallers. Participants were randomly assigned to an 8-week balance group [Experimental (EXP), N=41] or an upper limbs group [Control (CON), N=43]. Outcomes examined at post-training (Post) and 12-month follow-up (FU12m) were:1) injurious fall risk (ratio of non-injurious fallers to injurious fallers); 2) two potential fall risk factors based on Balance Evaluation Systems Test (BESTest) scores and dual-task timed-up-and-go (DTUG) times. At Post, results indicated that there were no injurious falls, and fewer EXP participants were found in high fall-risk cohorts based on BESTest scores and DTUG times (p

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Physiatry as a Leader for Post Acute Care in Integrated Healthcare Systems

As health care is being moved to a higher level of accountability, there has been a focus on improving outcomes through improving post acute care. The issues of cost and readmissions to acute care settings are very important, but the focus on patient function has not been foremost. Due to the fact that most post acute care needs are based on functional limitations, and that physiatrists are well versed in transitions of care, rehabilitation of patients back to community settings, team building, and leadership, it is appropriate for rehabilitation medicine to take a leadership role in the planning and development of post acute care services in the new integrated healthcare systems that are becoming prevalent in healthcare. This review discusses some of the issues in post acute care, the growth of the integrated health system model, and how there are opportunities and challenges for physiatric leadership to help develop these new models of care. Funding source: No external Funding Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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The motor unit number index (MUNIX) profile of patients with adult Spinal Muscular Atrophy

Spinal muscular atrophy (SMA) is a genetically determined lower motor neuron (LMN) disease caused by loss of function of the SMN1 gene on chromosome 5 (Finkel et al. 2015) (Lefebvre et al. 1995). The disease typically manifests with proximal and symmetrical muscle weakness and atrophy, and exhibits considerable clinical heterogeneity depending on SMN2 copy numbers (Mercuri et al. 2018). SMA type III and IV are considered slowly progressive forms of the disease, extending well into adulthood and characterized by acquisition of walking ability (Wang et al.

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SAPHO syndrome in pediatric patients with Inflammatory Bowel Disease treated with Infliximab



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An Unusual Retroperitoneal Endometriotic Cyst in a Young Woman



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Missed Opportunities in the Outpatient Pediatric Setting to Support Breastfeeding: Results From a Mixed-Methods Study

Outpatient pediatric providers play a crucial role in the promotion of breastfeeding. We conducted a mixed methods study to measure provider knowledge, attitudes, and current practices around breastfeeding counseling.

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SAPHO syndrome in pediatric patients with Inflammatory Bowel Disease treated with Infliximab



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An Unusual Retroperitoneal Endometriotic Cyst in a Young Woman



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IL-9 Alters Epithelial Barrier and E-cadherin in Eosinophilic Esophagitis

Background: Eosinophilic esophagitis (EoE) is a chronic Th2-assocated inflammatory condition accompanied by substantial impairments in epithelial barrier function and increased numbers of IL-9 expressing inflammatory cells. While IL-9 is known to affect barrier function in the intestine, the functional effects of IL-9 on the esophagus are unclear. Herein we aimed to understand the expression of the IL-9 receptor and effects of IL-9 on the epithelium in EoE. Methods: We used esophageal biopsies from pediatric EoE patients with active and inactive disease to analyze the expression of the IL-9 receptor, the adherens junction protein E-cadherin and the tight junction protein claudin-1. We treated primary human esophageal epithelial cells with IL-9 to understand its effects on E-cadherin expression and function. Results: Active EoE subjects had increased epithelial expression of IL-9 receptor mRNA and protein (p 

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Classification and Nutrition Management of Acute Pancreatitis in the Pediatric Intensive Care Unit

The aims of this retrospective cohort study were to classify the severity of patients admitted to the PICU with acute pancreatitis (AP) and to identify how many patients received appropriate nutritional management in accordance with more recent guidelines and the outcomes of those patients. Of the 54 children with AP, 12 (22.2%) had a primary diagnosis of AP (50% severe, 17% moderate) while 42 (77.8%) had a secondary diagnosis of AP (81% severe, 11.9% moderate). Just under half of the patients (48.1%) had enteral nutrition commenced before the third day of admission (50% with primary AP, 47.6% with secondary AP). The average time to initiation of enteral feeds was 2.3 days for those that received enteral nutrition. 51.8% of patients received parenteral nutrition (PN) (25% with primary AP, 59.5% with secondary AP). Most patients received enteral nutrition late and PN was overused in patients with AP admitted to the PICU. Address correspondence and reprint requests to Praveen S. Goday, MBBS, CNSC, Professor of Pediatrics, Pediatric Gastroenterology and Nutrition, Medical College of Wisconsin, 8701 Watertown Plank Road Milwaukee, WI 53226 (e-mail: pgoday@mcw.edu). Received 29 May, 2018 Accepted 20 August, 2018 Source of funding: None Declared. Authorship requirements: SC: Contributed to the design of the work, collected data, wrote the first draft and approved the final manuscript. MW: Contributed to the design of the work, helped with manuscript re-drafting and approved the final manuscript. SW: Contributed to the design of the work, helped with manuscript redrafting and approved the final manuscript. PSG: Contributed to the design of the work, interpretation of the data, helped with manuscript redrafting and approved the final manuscript. Conflicts of interests: PSG - Consultant for Nutricia, Member of Data and Safety Monitoring board, Shire Pharmaceuticals. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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There Is No Excuse for Mortality Due to Lack of Competency and Training of Paediatric Endoscopists in Gastrointestinal Bleeding Therapy in 2018

Acute upper gastrointestinal bleeding in children is possibly the last medical emergency which continues to lead to the death of a child due to the lack of competency/clinical judgement of the doctor, as opposed to the disease itself, leading to mortality despite optimum medical intervention. This is unacceptable in any circumstances in 2018. It occurs due to a number of conspiring factors including lack of appreciation of the clinical presentation requiring urgent endoscopic intervention; misapprehension of the urgency of timing required of such an intervention predicated on the severity of the gastrointestinal (GI) bleed; lack of application of a paediatric-specific validated score predicting for such endoscopic intervention; lack of skill in endo-haemostatic intervention techniques by paediatric endoscopists; poor training in such techniques among paediatric endoscopists; paucity of cases with lack of exposure of the paediatric endoscopist regularly to enable skills to be maintained, once acquired; reluctance of adult endoscopists in many centres to support paediatric GI bleeding services. In essence then the paediatric GI community urgently needs to identify centres of excellence to whom these children should be transferred. Transfer is safe in all but the most critical cases once stabilised with transfusion, octreotide/terlipressin and iv proton pump inhibitors. The resources are country-dependent but this is really no excuse. We must not let this parlous state of affairs continue. Solutions are explored in this Editorial and please let this serve as a call to action for all those involved in this continuing debacle in order to save "save-able" lives. Address correspondence and reprint requests to Mike Thomson, MD, Sheffield Children's Hospital, Weston Bank, Sheffield S10 2TH, UK (e-mail: mike.thomson@sch.nhs.uk). Received 10 February, 2018 Accepted 30 August, 2018 The author reports no conflicts of interest. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Causes of Treatment Failure In Children With Inflammatory Bowel Disease Treated With Infliximab: A Pharmacokinetic Study

Objectives: Anti-tumor necrosis factor antibodies have led to a revolution in the treatment of inflammatory bowel diseases (IBD), however a sizable proportion of patients do not respond to therapy. There is increasing evidence suggesting that treatment failure may be classified as mechanistic, pharmacokinetic, or immune-mediated. Data regarding the contribution of these factors in children with IBD treated with infliximab (IFX) are still incomplete. The aim was to assess the causes of treatment failure in a prospective cohort of pediatric patients treated with IFX. Methods: This observational study considered 49 pediatric (median age 14.4) IBD patients (34 Crohn's disease, 15 ulcerative colitis) treated with IFX. Serum samples were collected at 6, 14, 22 and 54 weeks, before IFX infusions. IFX and anti-infliximab antibodies (AIA) were measured using ELISA assays. Disease activity was determined by PCDAI or PUCAI. Results: Clinical remission, defined as a clinical score 3.11 μg/ml emerged as the strongest predictor of sustained clinical remission. AIA concentrations were correlated inversely with IFX concentrations and directly with adverse reactions. Conclusions: Most cases of therapeutic failure were associated with low serum drug levels. IFX trough levels at the end of induction are associated with sustained long-term response. Address correspondence and reprint requests to Gabriele Stocco, Department of Life Sciences, University of Trieste, via Fleming 22, I-34127 Trieste, Italy (e-mail: stoccog@units.it). Received 26 February, 2018 Accepted 16 July, 2018 Samuele Naviglio and Doriana Lacorte: these authors contributed equally to the article. Stefano Martelossi: at present: Dipartimento Materno Infantile, Ospedale Ca' Foncello, Treviso, Italy Declaration of funding: None Conflict of interest: None Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Development and Pilot Implementation of a Nutrition Curriculum and Rotation in Pediatric Gastroenterology Fellowships

Structured nutrition rotations are rarely offered in pediatric gastroenterology fellowships. The NASPGHAN Nutrition Committee developed a curriculum to serve as the basis for a rotation in clinical nutrition. We worked directly with five fellowship programs to tailor the experience to individual institutions. As part of our pilot study, fellows completed knowledge assessments and self-assessment of comfort level at the start and end of the experience. We saw a trend in improvement of comfort level and increase in mean score on knowledge assessments, but the differences did not meet statistical significance. Fellows who completed the rotation had an increase in comfort level in all topics with most dramatic increase in nutrition management of cystic fibrosis, refeeding syndrome, and cholestasis. Objective measures of nutrition knowledge attainment and use of programmatic feedback to continually improve the learners' experience will help expand the nutrition curriculum to a broader audience. Address correspondence and reprint requests to Praveen S. Goday, MBBS, CNSC, Professor of Pediatrics, Pediatric Gastroenterology and Nutrition, Medical College of Wisconsin, 8701 Watertown Plank Road Milwaukee, WI 53226 (e-mail: pgoday@mcw.edu). Received 31 May, 2018 Accepted 6 August, 2018 Conflicts of Interest: PSG - Consultant for Nutricia, Member of Data and Safety Monitoring board, Shire Pharmaceuticals. The other authors have no conflicts of interest to declare. Source of Funding: None Declared Authorship requirements: AS: Contributed to the design of the work, collected data, wrote the first draft, and approved the final manuscript CJ: Contributed to the design of the work, analyzed data, helped with manuscript re-drafting, and approved the final manuscript PSG: Contributed to the design of the work, interpretation of the data, helped with manuscript redrafting, and approved the final manuscript Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Direct-acting antiviral Therapy Is Safe and Effective in Pediatric Chronic Hepatitis C: The Public Health Perspective

Objectives: We assessed the efficacy of decentralised public health services and safety of direct-acting antiviral agents (DAAs) in the treatment of pediatric CHC in the Mukh-Mantri Punjab Hepatitis C Relief Fund, a public-health initiative for prevention and control of chronic hepatitis C(CHC) in Punjab, India. Methods: Consecutive children with CHC [age ≥12 to

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Early Life Factors and Eosinophilic Esophagitis: Building the Evidence

No abstract available

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Hyperbaric Inside Observer - Phelps Memorial Hospital Center

Compensation Negoitiable Hyperbaric Technician- Westchester Phelps Memorial Hospital (PHELP), Tarrytown, NY Requisition: 001VJ2 Function: Nursing Support Shift type: Per Diem Shift: Day Job Hours: 8:00 AM – 4:00 PM Prepares patients for Hyperbaric Oxygen Therapy (HBO) treatments. Assists clinical staff with patient examination and treatment, documents patient care records. Operates and cleans Hyperbaric ...

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Federal pursuit of anti-kickback statute takes millions from local EMS

Expert witness commentary on the recent Paramedics Plus litigation, in which the government alleged violations of the federal Anti-Kickback Statute

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Paramedic - Lawrence County EMS

Provides advanced life support care to the sick and injured and safely transports customers of all ages to a medical facility. In addition, the paramedic assists with other services and events as directed by Lawrence County Emergency Medical Service

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Use of propofol for prevention of post-delivery nausea during cesarean section: a double-blind, randomized, placebo-controlled trial

Abstract

Purpose

Nausea and vomiting are common, undesirable symptoms during cesarean section. We conducted this study to assess the antiemetic properties of propofol for the prevention and immediate treatment of post-delivery nausea and vomiting during cesarean section under combined spinal–epidural anesthesia.

Methods

Eighty women undergoing elective cesarean delivery under combined spinal–epidural anesthesia were randomized to receive either propofol at a plasma concentration of 1000 ng/mL or normal saline immediately after clamping of the umbilical cord. The incidence of post-delivery nausea and vomiting, patients requiring rescue antiemetic, bispectral index, sedation score, and the incidence of hypotension were assessed intraoperatively. Satisfaction and neonatal behavioral neurological assessments were evaluated postoperatively.

Results

The incidence of nausea was significantly lower in the propofol group compared to the placebo group (25% versus 60%, P < 0.001). The incidence of retching and vomiting showed no significant difference between the two groups. Propofol 20 mg as a rescue antiemetic was significantly effective in both the groups. Satisfaction level of patients and obstetricians in the propofol group was higher than in the placebo group. There was no statistical difference in the incidence of hypotension between the two groups both pre- and post-delivery. There was no difference in postoperative neonatal behavioral neurological assessment between groups.

Conclusion

Propofol at a plasma concentration of 1000 ng/mL significantly reduced the incidence of post-delivery nausea compared to placebo, but had no effect on reducing retching or vomiting episodes during cesarean section.



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The girl with Neanderthal and Denisovan parents

The girl with Neanderthal and Denisovan parents

The girl with Neanderthal and Denisovan parents, Published online: 12 September 2018; doi:10.1038/s41576-018-0054-6

A study in Nature characterizes the genome of Denisova 11 and reveals her to be a first-generation offspring of Neanderthal and Denisovan parents, thereby providing direct evidence of genetic mixing between genetically distinct groups of archaic hominins.

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Otolaryngological features in a cohort of patients affected with 22q11.2 deletion syndrome: A monocentric survey

American Journal of Medical Genetics Part A, EarlyView.


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Management of hepatitis C virus infection in patients with chronic kidney disease: position statement of the joint committee of Italian association for the study of the liver (AISF), Italian society of internal medicine (SIMI), Italian society of infectious and tropical disease (SIMIT) and Italian society of nephrology (SIN)

Hepatitis C virus (HCV) infection is now considered a systemic disease due to the occurrence of extra-hepatic manifestations. Among these, the renal involvement is frequent. HCV infection, in fact, is strongly associated with proteinuria and chronic kidney disease (CKD) and negatively affects the prognosis of renal patients. In the last few years, availability of more specific and effective drugs against HCV has dramatically changed the clinical course of this disease. These drugs may provide further advantages in the CKD population as a whole by reducing progression of renal disease, mortality rate and by increasing the survival of graft in renal transplant recipients.

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Management of hepatitis C virus infection in patients with chronic kidney disease: position statement of the joint committee of Italian association for the study of the liver (AISF), Italian society of internal medicine (SIMI), Italian society of infectious and tropical disease (SIMIT) and Italian society of nephrology (SIN)

Hepatitis C virus (HCV) infection is now considered a systemic disease due to the occurrence of extra-hepatic manifestations. Among these, the renal involvement is frequent. HCV infection, in fact, is strongly associated with proteinuria and chronic kidney disease (CKD) and negatively affects the prognosis of renal patients. In the last few years, availability of more specific and effective drugs against HCV has dramatically changed the clinical course of this disease. These drugs may provide further advantages in the CKD population as a whole by reducing progression of renal disease, mortality rate and by increasing the survival of graft in renal transplant recipients.

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The girl with Neanderthal and Denisovan parents



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Substitution of artificial colloids for fresh frozen plasma in pediatric cardiopulmonary bypass surgery

Pediatric Anesthesia, EarlyView.


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Determining the extent of the dural sac for the performance of caudal epidural blocks in newborns

Pediatric Anesthesia, EarlyView.


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

Publication date: Available online 12 September 2018

Source: Clinical Neurophysiology

Author(s): Chaojun Zheng, Nie Cong, Wei Lei, Yu Zhu, Dongqing Zhu, Hongli Wang, Feizhou Lu, Robert Weber, Jianyuan Jiang

Abstract
Objective

To clarify the effectiveness of anterior cervical fusion (ACF) in the treatment of Hirayama disease (HD).

Methods

Sixty-nine HD ptients who accepted ACF procedures underwent dynamic F-waves before and soon after operation, and 36 of the 69 patients underwent pre- and postoperative magnetic resonance imaging (MRI). Motor unit number estimation, handgrip strength (HGS) and disabilities of arm, shoulder and hand (DASH) were performed in these 36 HD patients and in the other 24 patients who accepted neither neck-collar support nor operation, and these tests were reassessed about one year after initial test.

Results

Postoperatively, dynamic F-wave abnormalities were observed in fewer HD cases (2/69 vs. 25/69), and neck-flexion MRI abnormalities decreased significantly (P<0.05). Compared with motor unit loss in patients who were untreated, follow-up analysis demonstrated no differences in motor unit, HGS or DASH in HD patients who underwent operation (P>0.05), and mild recovery of motor units was observed in patients with preoperative abnormal dynamic F-waves (P<0.05).

Conclusions

ACF procedures can immediately remove neck-flexion abnormalities and prevent or delay the progression of HD.

Significance

ACF procedures may provide effective, reliable and alternative methods for the treatment of HD, especially in HD patients with functional evidence of neck-flexion abnormalities.



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Importance of mediastinal screening-based observation during endoscopic ultrasound to examine gastrointestinal pathologies

Abstract

In all endoscopic ultrasound (EUS) examinations performed at our hospital, the heart, vasculature, and mediastinal lymph nodes from the esophagus are observed after checking for gastrointestinal pathologies. Since the introduction of EUS using a convex linear-array echoendoscope at our hospital in April 2015, EUS examinations have been performed in 371 cases for examining pancreaticobiliary diseases, submucosal tumors, and other pathologies during the 3-year period, till March 2018. We diagnosed 2 patients with asymptomatic cardiovascular disease while observing the mediastinum during EUS examination to examine identified pancreaticobiliary disease. No subjective symptoms associated with cardiovascular disease were observed and the respective conditions had not been identified previously in either case. One case involved a left atrial myxoma while the other involved a saccular aortic aneurysm in the thoracic aorta. A left atrial tumor resection and aortic replacement surgery were performed in each case. Their postoperative courses have been favorable. As cardiovascular diseases are often life-threatening, as in the present 2 cases, observational screening of the cardiovascular system from the esophagus should also be performed during EUS examinations just as the pharyngeal region is examined during upper gastrointestinal endoscopy.



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Research Analysis: Intubation curriculum increases first pass success

A study of over 5,000 intubations demonstrates the value of continuous quality improvement

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Accumulation of 152+154Eu(III) by Aspergillus sydowii and Trichoderma harzianum

Publication date: October 2018

Source: Journal of Environmental Radioactivity, Volumes 193–194

Author(s): Shenghong Rao, Jun Liang, Wencheng Song

Abstract

Radionuclides-resistant filamentous fungi were isolated from radionuclides' contaminated soils. Effects of contact time, mycelia dosage, pH, ionic strength and thiol compounds on 152+154Eu(III) accumulation on two kinds of filamentous fungi (Aspergillus sydowii and Trichoderma harzianum, denoted as A. sydowii and T. harzianum, respectively) were investigated by batch techniques. The maximum tolerance to Eu(III) concentration of A. sydowii and T. harzianum reached 3000 mg/L and 3500 mg/L, and the Eu(III) accumulation on A. sydowii and T. harzianum can be fitted better with the pseudo-second-order kinetic model, respectively. Filamentous fungi were characterized by FT-IR and acid base titrations, and morphological structures of mycelia changed obviously under Eu(III) stress by SEM and TEM analysis. The results suggested that filamentous fungi could play an important role in the migration and transformation of radionuclides in the environment.

Graphical abstract

Image 1



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Incidence of progression of persistent non-dysplastic Barrett's esophagus to malignancy

Clinical Gastroenterology and Hepatology

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Efficacy and safety of induction therapy with calcineurin inhibitors in combination with vedolizumab in patients with refractory ulcerative colitis

Clinical Gastroenterology and Hepatology

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Association between plasma level of collagen type III alpha 1 chain and development of strictures in pediatric patients with Crohn's disease

Clinical Gastroenterology and Hepatology

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Numbers and features of patients with a diagnosis of celiac disease without duodenal biopsy, based on a national survey

Clinical Gastroenterology and Hepatology

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Evidence-Based Treatment Strategies in Youth Mental Health Services: Results from a National Survey of Providers

Abstract

Previous surveys indicate infrequent use of evidence-based treatment (EBT) manuals in usual care youth mental health, but the extent to which providers use core and common EBT strategies and what contextual factors impact EBT strategy implementation need further study. In a national, multidisciplinary survey of 1092 youth-serving providers, providers reported regular use of many EBT strategies. Provider learning theory orientation, more recent degree, more standardized and ongoing assessment use, more positive attitudes toward innovation and evidence, fewer low-income clients, and perceptions that their agency valued quality care and provided fewer training resources predicted more frequent EBT strategy use.



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Complex and spatially segregated auditory inputs of the mouse superior colliculus

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


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TRPV1 and BDKRB2 receptor polymorphisms can influence the exercise pressor reflex

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


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Sweating distribution and active sweat glands on the scalp of young males in hot-dry and hot-humid environments

Abstract

Purpose

We investigated the effects of humidity on regional sweating secretion and active sweat gland density on the scalp during passive heating in hot environments.

Methods

Eight male subjects shaved their heads prior to expose to dry (30%RH; H30%) and humid (85%RH; H85%) conditions at an air temperature of 32 °C. Total sweat rate, local sweat rates (frontal, vertex, temporal, and occipital regions), active sweat glands on the scalp (2 frontal, 2 parietal, 2 temporal, 1 occipital, and 1 vertex), and rectal and skin temperatures were measured during leg immersion in 42 °C water for 60 min.

Results

(1) Total sweat rates were greater for H30% (179.4 ± 35.6 g h−1) than for H85% (148.1 ± 27.2 g h−1) (P < 0.05). (2) Scalp sweat secretion tended to be greater in the H85% than the H30%. (3) Head sweat rates were greater on the frontal than on the vertex for both humidity conditions (P < 0.05). (4) Active sweat gland density on the scalp was greater for H85% (82 ± 13 glands cm−2) than for H30% (62 ± 17 glands cm−2) (P < 0.05). (5) No significant difference was found in rectal temperature between H30% and H85%, whereas mean skin temperature was significantly lower for H30% (34.8 ± 0.7 °C) than for the H85% condition (36.0 ± 0.3 °C) (P < 0.05).

Conclusions

These results indicate that the thermoregulatory sweating responses for the scalp region were significantly increased in the hot-humid condition compared to the hot-dry condition. Among the regions on the scalp surface, the vertex was the least sensitive to the change in humidity.



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Research Analysis: Intubation curriculum increases first pass success

A study of over 5,000 intubations demonstrates the value of continuous quality improvement

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Cover Image

Journal of Oral Rehabilitation, Volume 45, Issue 10, Page i-i, October 2018.


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Issue Information

Journal of Oral Rehabilitation, Volume 45, Issue 10, Page ii-iv, October 2018.


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Cervical instability in patients with Trisomy 21: The eternal gamble

Pediatric Anesthesia, EarlyView.


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Ultrasound assessment of the prevalence of increased gastric contents and volume in elective pediatric patients: A prospective cohort study

Pediatric Anesthesia, EarlyView.


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Efficacy of liposomal bupivacaine in pediatric patients undergoing spine surgery

Pediatric Anesthesia, EarlyView.


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