Perceived Fatigability: Utility of a Three-Dimensional Dynamical Systems Framework to Better Understand the Psychophysiological Regulation of Goal-Directed Exercise Behaviour

Abstract

A three-dimensional framework of perceived fatigability emphasises the need to differentiate between the qualitatively distinct inputs of sensory-discriminatory, affective-motivational and cognitive-evaluative processes that shape the perceptual milieu during prolonged endurance exercise. This article reviews the framework's utility to better understand how cause–effect relationships come to be and how perception–action coupling underpins pacing behaviour and performance fatigability. Preliminary evidence supports the hypotheses that perceived strain plays a primary role in trajectory regulation of pacing behaviour, core affect plays a primary and mediatory role in behavioural performance regulation, and the mindset shift associated with an action crisis plays a primary role in the intensity dependent volitional self-regulatory control of conflicting motivational drives. The constructs hypothesised to underpin perceived fatigability are systematically linked, context-dependent, constraint-based, distinguishable and show proportional continuous interdependency. They are further interrelated with dynamic changes in pacing behaviour, performance fatigability and physiological disturbance. Appropriate measurement selections for the subordinate constructs perceived physical strain, perceived mental strain, valence, arousal, action crisis and flow state are discussed. To better understand the non-proportional discontinuous effects of fatigue on discrete shifts in thought states and mindsets, non-linear dynamical systems theory is introduced as an unbiased overarching theory of governing principles in the temporal evolution of complex systems. This provides the opportunity to discuss the bio-psycho-social fatigue phenomenon from a dynamical and holistic perspective. The proposed framework offers a sophisticated alternative to the Gestalt concept of perceived exertion and comprehensively accounts for the psychophysiological processes that determine pacing behaviour and performance. It has the potential to enrich theory development and facilitate a deeper understanding of the psychophysiological regulation of goal-directed exercise behaviour.

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A Conversation with Jose Gomez Marquez, Little Devices Lab, MIT

3D Printing and Additive Manufacturing, Volume 5, Issue 3, Page 181-183, September 2018.


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High-Efficiency High-Resolution Multimaterial Fabrication for Digital Light Processing-Based Three-Dimensional Printing

3D Printing and Additive Manufacturing, Volume 5, Issue 3, Page 185-193, September 2018.


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Reference gene validation for normalization of RT-qPCR assay associated with germination and survival of rice under hypoxic condition

Abstract

Study on expression of genes for the traits associated with hypoxia tolerance during the germination demands robust choice of reference genes for transcript data normalization and gene validation through real-time quantitative polymerase chain reaction (RT-qPCR). However, reliability and stability of reference genes across different rice germplasms under hypoxic condition have not been accessed yet. Stability performance of reference genes such as eukaryotic elongation factor 1 α (eEF1α), ubiquitin 10 (UBQ10), glyceraldehyde 3-phosphate dehydrogenase (GAPDH), 18S ribosomal RNA (18SrRNA), 25S ribosomal RNA (25SrRNA), β-tublin (β-TUB), actin11 (ACT11), ubiquitin C (UBC), eukaryotic elongation factor 4 α (eIF4α), and ubiquitin5 (UBQ5) was accessed through statistical algorithms like geNorm, NormFinder, Comparative ΔCt method_, BestKeeper, and RefFinder in three rice germplasms (KHO, RKB, and IR-64) with varied level of tolerance to hypoxic condition during germination. Among all genes used, OsGAPDH was found to be the most suitable reference gene under hypoxic condition. The performance of the highest-ranking reference gene (OsGAPDH) in terms of stability based on statistical algorithms was further validated for its reliability and stability through RT-qPCR with hypoxia-induced target gene OsTTP7. The identified stable housekeeping gene could be used as internal control for gene expression analysis in rice under hypoxia.

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Correction to: The study of human Y chromosome variation through ancient DNA

The following sentence on the 11th page of the article.

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The American Thyroid Association Sonographic Classification System Can Stratify the Risk of Malignancy for Indeterminate Thyroid Nodules

Clinical Thyroidology, Volume 30, Issue 9, Page 426-428, September 2018.


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Patients with Benign Thyroid Disorders Report Impairments in Sex Life

Clinical Thyroidology, Volume 30, Issue 9, Page 405-407, September 2018.


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Needle Biopsy of Thyroid Nodules Is Best Performed Using Capillary Action Techniques Rather than Suction

Clinical Thyroidology, Volume 30, Issue 9, Page 418-421, September 2018.


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Therapy-Induced Hypothyroidism Reduces Long-Term Post-treatment Cardiovascular Morbidity and Mortality in Graves’ Disease and Toxic Multinodular Goiter

Clinical Thyroidology, Volume 30, Issue 9, Page 408-411, September 2018.


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If High Circulating Levels of Biotin Are Commonly Affecting Thyroid-Function Tests, Shouldn't Something Be Done About It?

Clinical Thyroidology, Volume 30, Issue 9, Page 401-404, September 2018.


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Some Patients Do Not Undergo Subsequent Evaluation Following an Abnormally Suppressed TSH

Clinical Thyroidology, Volume 30, Issue 9, Page 412-414, September 2018.


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Integrating AJCC-TNM, ATA-IRS, and Patient Age Improves Survival Predictions for Thyroid Cancer

Clinical Thyroidology, Volume 30, Issue 9, Page 422-425, September 2018.


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Quantitative Uptake of Sestamibi Differentiates Type 1 from Type 2 Amiodarone-Induced Thyrotoxicosis

Clinical Thyroidology, Volume 30, Issue 9, Page 415-417, September 2018.


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Is Survival the Optimal End Point for Determining Appropriate Extent of Surgery in Medullary Thyroid Cancer?

Clinical Thyroidology, Volume 30, Issue 9, Page 429-432, September 2018.


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Concomitant use of opioids and benzodiazepines in the outpatient setting: A retrospective study

Benzodiazepines have been identified as a concurrent factor in opioid related deaths. Although the dangers of concomitant administration of opioids and benzodiazepines are well documented, implementation of this knowledge into practice may be lagging behind.

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Reconsidering Sham in Transcutaneous Vagus Nerve Stimulation studies

In their most recent study, Keute and colleagues demonstrated that transcutaneous vagus nerve stimulation (tVNS) induced a GABAergic neuromodulation during automatic motor inhibition (Keute et al., 2018). They chose to monitor the Negative Compatibility Effect (NCE) as a behavioral marker of automatic motor inhibition. Nevertheless, the tVNS-induced increase of NCE found was totally unexpected, going into the opposite direction of the decrease they had hypothesized, according to previous results.

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Effects of gait support in patients with spinocerebellar degeneration by a wearable robot based on synchronization control

Spinocerebellar degeneration (SCD) mainly manifests a cerebellar ataxic gait, leading to marked postural sway and the risk of falling down. Gait support using a wearable robot is expected to be an effective so...

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Diet-induced obesity and associated disorders are prevented by natural bioactive type 1 fish collagen peptides (Naticol®) treatment

Abstract

To fight against metabolic disorders such as insulin resistance, new alimentary behaviors are developed. For instance, hyperproteined, gluten-free, or collagen-enriched diets could be preconized in order to reduce the consequences of obesity. In this aim, this study evaluates the potential effects of warm sea fish collagen peptides (Naticol®) on representative metabolic and inflammatory parameters. For that, male C57Bl6/J mice fed with either a chow- (CD) or high-fat diet (HFD) were submitted or not to specific collagen peptides in drinking water (4 g/kg bw/d) for 20 weeks. Weight, body composition, glucose tolerance, and insulin sensitivity were followed up. Effects of fish collagen peptides on various blood parameters reflecting the metabolism status were also measured (free fatty acids, triglycerides, cholesterol, hormones) together with adipocyte inflammation. Results showed that HFD-fed mice supplemented by fish collagen peptides exhibited a significant lower increase in body weight as soon as the twelfth week of treatment whereas no effect of the peptide was observed in CD fed mice. In line with this result, a weaker increase in fat mass in HFD-fed mice supplemented with Naticol® at both 9 and 18 weeks of treatment was also observed. In spite of this resistance to obesity promoted by fish collagen peptides treatment, no difference in glucose tolerance was found between groups whereas mice treated with Naticol® exhibited a lower basal glycemia. Also, even if no effect of the treatment on adipocyte lipolysis was found, a decrease of inflammatory cytokines was retrieved in collagen-supplemented group arguing for a potential better insulin sensitivity. Altogether, these results need to be completed but are the first describing a benefic role of warm sea fish collagen peptides in a context of metabolic disease paving the route for a potential utilization in human obesity-associated disorders.

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Effects of functional electrical stimulation-cycling on shoulder pain and subluxation in patients with acute–subacute stroke: a pilot study

Functional electrical stimulation (FES)-cycling is a technique used to provide voluntary muscle contraction during a functional task. The aims were primarily to determine the effects of FES-cycling on shoulder pain and subluxation, and secondarily to evaluate the improvement of upper extremity motor function in patients with acute–subacute stroke patient. In this prospective trial, 21 patients with acute–subacute stroke, randomly assigned into the FES-cycling group or the standard rehabilitation program (control group). Analyses of shoulder subluxation were carried out by radiography. The numeric rating scale was used to evaluate the intensity of pain, Fugl-Meyer and Frenchay arm tests for motor function, and functional independence measure for functional status. The outcome data were evaluated at baseline and at the end of 4-week treatment. Intragroup comparisons showed improvement of acromiohumeral distance, Fugl-Meyer assessment, and functional independence measure in both groups after treatment. In intergroup comparison, FES-cycling group exerted better outcomes in shoulder pain compared with the control group (P=0.015). Correlation analyses demonstrated only positive correlation between shoulder subluxation and pain (P=0.022). FES-cycling was superior to standard rehabilitation therapy for shoulder pain relief in patients with acute–subacute stroke. Therefore, combining FES-cycling with a standard rehabilitation program alleviates shoulder pain and may prevent development of shoulder subluxation over time. Correspondence to Eda Gurcay, MD, Gaziler Physical Medicine and Rehabilitation Education and Research Hospital, 06800 Ankara, Turkey Tel: +90 312 291 1403; fax: +90 312 291 1009; e-mail: dredagurcay@gmail.com Received August 3, 2018 Accepted September 3, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Manual function of the unaffected upper extremity can affect functional outcome after stroke

Traditionally, motor deficits of ipsilesional side, generally considered as the unaffected side, have been investigated less and the influence of the impairment is unknown. To evaluate the association between the manual function test (MFT) of nonparetic limb and poststroke functional outcome. We conducted a retrospective analysis of 71 hemiplegic patients with stroke. MFT on both sides was routinely measured at admission and 1 month later after admission by an experienced occupational therapist. The parameters of functional outcome after stroke were measured with the total score of functional independence measure (FIM) and the self-care subscore of FIM. Age, initial cognitive function, and MFT of the affected hand and unaffected hand were each significant factors for independently predicting short-term functional outcome after stroke. Linear regression analysis showed that initial MFT score of unaffected side is a significant predictor for 1 month follow-up subscore FIM (P

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Reliability and validity of the shortened Singapore versions of the Chedoke Arm and Hand Activity Inventory

Upper limb deficits are common sequelae after a stroke and negatively affect daily living and quality of life. The use of outcome measures to evaluate upper limb function is essential to assess sensorimotor recovery and to determine the effectiveness of rehabilitation. The aim of this study was to estimate the construct validity and inter-rater reliability of three shortened versions of the Singapore version of the Chedoke Arm and Hand Activity Inventory (CAHAI-SG) comprising seven, eight, and nine test items. The sample consisted of 55 inpatients with acute/subacute stroke to whom the CAHAI-SG, Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and the Action Research Arm Test (ARAT) were administered. To estimate convergent and discriminative construct validity, Spearman's rank correlation coefficient and 95% confidence intervals were computed for CAHAI-SG scores with FMA-UE and ARAT scores. Reliability was estimated using intraclass correlation coefficient (relative reliability) and the standard error of measurement (absolute reliability). Convergent validity with the FMA-UE was 0.79, 0.80, and 0.81 for seven-item, eight-item, and nine-item versions of the CAHAI-SG, respectively, and 0.81 with the ARAT for all shortened versions. Discriminative validity with the FMA-UE pain subscale was between 0.37 and 0.38. The absolute reliability was 3.09, 3.65, and 3.98, and relative reliability was 0.96, 0.95, and 0.96 for the seven-item, eight-item, and nine-item versions, respectively. All shortened versions of the CAHAI-SG demonstrated similar psychometric properties to the full (13 item) version, meaning clinicians may use these shorter versions that require less time to administer and score. Correspondence to Silvana X. Choo, BASc (OT), School of Rehabilitation Science, McMaster University, Institute of Applied Health Sciences, 1400 Main Street West, Room 308, Hamilton, Ontario L8S 2R8, Canada Tel: +1 905 525 9140 x26410; e-mail: silvana.choo.xinyi@sgh.com.sg Received June 16, 2018 Accepted August 31, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Protective effects of Brazilian propolis supplementation on capillary regression in the soleus muscle of hindlimb-unloaded rats

Abstract

The protective effects of Brazilian propolis on capillary regression induced by chronically neuromuscular inactivity were investigated in rat soleus muscle. Four groups of male Wistar rat were used in this study; control (CON), control plus Brazilian propolis supplementation (CON + PP), 2-week hindlimb unloading (HU), and 2-week hindlimb unloading plus Brazilian propolis supplementation (HU + PP). The rats in the CON + PP and HU + PP groups received two oral doses of 500 mg/kg Brazilian propolis daily (total daily dose 1000 mg/kg) for 2 weeks. Unloading resulted in a decrease in capillary number, luminal diameter, and capillary volume, and an increase in the expression of anti-angiogenic factors, such as p53 and TSP-1, within the soleus muscle. Brazilian propolis supplementation, however, prevented these changes in capillary structure due to unloading through the stimulation of pro-angiogenic factors and suppression of anti-angiogenic factors. These results suggest that Brazilian propolis is a potential non-drug therapeutic agent against capillary regression induced by chronic unloading.

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Chronic intestinal pseudo-obstruction due to al amyloidosis: a case report and literature review

Abstract

A 59-year-old woman presented to our hospital with a 6-month history of nausea, weight loss, and abdominal distension. Physical examination revealed abdominal distension without tenderness, and edema, numbness, and multiple peripheral neuropathy in the limbs. Blood test results showed anemia, hypoproteinemia, and hypoalbuminemia. Immunoelectrophoresis detected kappa-type Bence-Jones protein in both the serum and urine. Bone marrow examination did not reveal an increase of plasma cells. Computed tomography showed intestinal distension and retention of intestinal contents. No obstructive intestinal lesions were observed. Lower gastrointestinal endoscopy showed a decrease in the vascular visibility of the rectal mucosa. Histological findings showed amyloid deposition, which was positive for amyloid light-chain (AL) κ. Thus, she was diagnosed with chronic intestinal pseudo-obstruction (CIPO) due to gastrointestinal and neurological involvement of AL amyloidosis. Her abdominal symptoms were gradually improved by the insertion of an ileus tube and medication. Although we recommended chemotherapy for stopping her disease progression, she did not want to receive it. She died 1 year later because of her pneumonia. We should keep in mind that amyloidosis is an important cause of CIPO. Histopathological examination by endoscopic biopsy is required for exact diagnosis and appropriate treatment for CIPO due to amyloidosis.

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Benchmarks of significant change after aphasia rehabilitation

Publication date: Available online 18 September 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Natalie Gilmore, Michaela Dwyer, Swathi Kiran

Abstract

Objective

To establish benchmarks of significant change for aphasia rehabilitation outcome measures (i.e., Western Aphasia Battery-Aphasia Quotient [WAB-AQ], Communicative Effectiveness Index [CETI], Boston Naming Test [BNT]) and assess if those benchmarks significantly differed across subgroups (i.e., time post onset, dose frequency, treatment type).

Data Sources

A comprehensive literature search of 12 databases, reference lists of previous reviews, and evidence-based practice materials was conducted.

Study Selection

Randomized-controlled trials, quasi-experimental studies, single-subject design, and case studies that used a standardized outcome measure to assess change were included. Titles and full-text articles were screened using a dual review process. 78 studies met criteria for inclusion.

Data Extraction

Data were extracted independently and 25% of extractions were checked for reliability. All included studies were assigned quality indicator ratings and an evidence level.

Data Synthesis

Random-effects meta-analyses were conducted separately for each study design group (i.e., within/between group comparisons). For within group designs, the summary effect size after aphasia rehabilitation was 5.03 points (95% confidence interval: 3.95-6.10, p < .001) on the WAB-AQ, 10.37 points (6.08-14.66, p < .001) on the CETI and 3.30 points (2.43-4.18, p < .001) on the BNT. For between group designs, the summary effect size was 5.05 points (1.64-8.46, p = .004) on the WAB-AQ, and .55 points (-1.33, 2.43, p = .564) on the BNT, the latter of which was not significant. Subgroup analyses for the within group designs showed no significant differences in the summary effect size as a function of dose frequency, or treatment type.

Conclusions

This study established benchmarks of significant change on three standardized outcome measures used in aphasia rehabilitation.

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Associations between depression, anxiety and medication adherence among patients with arterial hypertension: Comparison between persons exposed and non-exposed to radiation from the Semipalatinsk Nuclear Test Site

Publication date: December 2018

Source: Journal of Environmental Radioactivity, Volume 195

Author(s): Lyazzat Dyussenova, Lyudmila Pivina, Yuliya Semenova, Geir Bjørklund, Natalia Glushkova, Salvatore Chirumbolo, Tatyana Belikhina

Abstract

In this study, we investigated the association between depression, anxiety and medication adherence in patients with arterial hypertension living in East Kazakhstan region. The sample size included 795 patients, of whom 403 patients were exposed to radiation at the Semipalatinsk Nuclear Test Site from 1949 to 1989, while 395 patients were unexposed to radiation due to their very remote residence from the Site at the same period. Both exposed and unexposed patients showed no significant differences concerning body mass index, smoking habit, the presence of hypercholesterolemia, and hypertension grade. Patients with arterial hypertension previously exposed to radiation had significantly higher rates of low medication adherence, subclinical and clinical depression, situational anxiety of moderate and severe grade, and personal anxiety of moderate grade. A logistic regression analysis allowed us to identify the presence of significant positive association between medication adherence and anxiety in exposed patients (OR = 4041 (95%CI:1709–9556) p = 0.001) and marginal association (OR = 2998 (95%CI:1008–8915) p = 0.048) between the same parameters in unexposed patients. It might prove to be useful to introduce psychological and medical counseling with an emphasis on strengthening of medication adherence and to inform the local population about radiation effects and dosimetry data.

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Effects of cesium accumulation on chlorophyll content and fluorescence of Brassica juncea L.

Publication date: December 2018

Source: Journal of Environmental Radioactivity, Volume 195

Author(s): Yu Zhang, Gui-jian Liu

Abstract

The aim of our study was to investigate the toxicological mechanism of cesium on Indian mustard (Brassica juncea L.). The impact of cesium toxicity to plants was evaluated using phytophysiology and genetic methods. In this study, Brassica juncea was grown on Cs-contaminated Hoagland's nutrient solution, and chlorophyll content, chlorophyll fluorescence, and Cs bioaccumulation were measured. Transcriptome data was used to perform an in-depth analysis of the molecular mechanisms underlying the effects of Cs accumulation. The results showed that Cs accumulated up to 3586.70 mg kg⁻¹ in B. juncea treated with 100 mg L⁻¹ Cs. The chlorophyll content and several chlorophyll fluorescence parameters (F_v/F₀, F_v/F_m, ΦPS II, qP, and NPQ) significantly decreased under Cs exposure. The starting process of PSII was also inhibited under higher Cs conditions. These results indicate that excessive Cs can damage PS II in leaves, decreasing photochemical activity and the energy conversion rate. Further analysis revealed that Cs interfered with the expression of chloroplastic metabolic genes (25 up and 36 down) and inhibited the expression of PsaB, psbC, PetF, LHCA1, and LHCB5. The results indicate that stable Cs leads to abnormal expression of genes related to photosynthesis pathway, blocking the electron transport process from plastoquinone-QA to plastoquinone-QB, resulting in abnormal photosynthesis, which leads to abnormal growth of B. juncea.

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Michael Herbert Day (1927–2018)

Publication date: Available online 18 September 2018

Source: Journal of Human Evolution

Author(s): Leslie C. Aiello, Bernard A. Wood

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Technimount secures medical equipment to stretchers, ambulances and more

Held to the highest manufacturing standards, Technimount allows the EMS industry's most popular medical devices to be safely and easily secured to ambulances, stretchers and hospital equipment.

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The role of small intestinal bacterial overgrowth in cystic fibrosis: a randomized case-controlled clinical trial with rifaximin

Abstract

Background

Scientific literature shows a high prevalence of Small Intestinal Bacterial Overgrowth (SIBO) in patients with Cystic Fibrosis (CF). The role of SIBO in nutritional status and gastrointestinal symptoms in CF is not known. Our aim was to study epidemiology and clinical impact of SIBO while assessing the efficacy of rifaximin in eradicating SIBO in CF patients.

Methods

Symptoms questionnaire and Glucose Breath Test (GBT) were given to 79 CF patients (median age 19.6 years; 9.2–36.9). Subjects with a positive GBT were enrolled in a randomized controlled trial and received rifaximin 1200 mg for 14 days or no treatment. Questionnaire and GBT were repeated 1 month after the end of treatment or 45 days after the first negative GBT.

Results

Out of 79 patients, 25 were affected by SIBO (31.6%) with a significant correlation with lower BMI, SDS-BMI (p < 0.05) and serum albumin levels (p < 0.05), independently from pancreas insufficiency. Twenty-three patients took part in the randomized trial, 13 patients (56.5%) in rifaximin group and 10 patients (43.5%) in control group. Eradication rate of SIBO was 9/10 (90%) in rifaximin group and 2/6 (33.3%) in control group (p < 0.05). In the rifaximin group, gastrointestinal symptom improvement was observed in 4/5 patients aged ≤ 14 years and in 0/5 patients aged > 14 years (p < 0.05); in 2/6 patients in the control group.

Conclusions

CF patients show a high prevalence of SIBO, related to a poorer nutritional status. Rifaximin therapy is well tolerated and the results are promising in terms of efficacy in eradicating small intestinal bacterial overgrowth in CF.

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Auditory-vocal coupling in the naked mole-rat, a mammal with poor auditory thresholds

Abstract

Naked mole-rats are extremely social and extremely vocal rodents, displaying a wide range of functionally distinct call types and vocalizing almost continuously. Their vocalizations are low frequency, and a behavioral audiogram has shown that naked mole-rats, like other subterranean mammals, hear only low frequencies. Hence, the frequency range of their hearing and vocalizations appears to be well matched. However, even at low frequencies, naked mole-rats show very poor auditory thresholds, suggesting vocal communication may be effective only over short distances. However, in a tunnel environment where low frequency sounds propagate well and background noise is low, it may be that vocalizations travel considerable distances at suprathreshold intensities. Here, we confirmed hearing sensitivity using the auditory brainstem response; we characterized signature and alarm calls in intensity and frequency domains and we measured the effects of propagation through tubes with the diameter of naked mole-rat tunnels. Signature calls—used for intimate communication—could travel 3–8 m at suprathreshold intensities, and alarm calls (lower frequency and higher intensity), could travel up to 15 m. Despite this species' poor hearing sensitivity, the naked mole-rat displays a functional, coupled auditory-vocal communication system—a hallmark principle of acoustic communication systems across taxa.

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Computational tools to unmask transposable elements

Computational tools to unmask transposable elements

Computational tools to unmask transposable elements, Published online: 19 September 2018; doi:10.1038/s41576-018-0050-x

The repetitive nature of transposable elements (TEs) creates bioinformatic challenges that frequently result in them being disregarded ('masked') in analyses. As physiological and pathological roles for TEs become increasingly appreciated, this Review discusses bioinformatics tools dedicated to TE analysis, including for genomic annotation, TE classification, identifying polymorphisms and assessing likely functional impacts.

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Ubiquitin-specific peptidase 10 (USP10) inhibits hepatic steatosis, insulin resistance, and inflammation through Sirt6

Hepatology

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Correction to: A case–control study of the risk of upper gastrointestinal mucosal injuries in patients prescribed concurrent NSAIDs and antithrombotic drugs based on data from the Japanese national claims database of 13 million accumulated patients

The authors would like to correct the errors in the publication of the original article. The correction details are given below for your reading.

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The necessity to use selective NADPH oxidase inhibitors

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Atypical serious hematochezia and rare imaging feature in gastrointestinal tuberculosis

Abstract

A young patient had serious hematochezia for nearly 2 months without obvious cause. Abdominal CT images showed rare features such as serious hemorrhage and multiple miliary nodules in the small bowel. The colonoscopy showed multiple lymphoid follicles in the terminal ileum. The laparotomy showed adverse adhesion in the abdominal cavity and multiple miliary noduli in the surfaces of small bowel wall. The pathology suggested tuberculosis. This patient received anti-TB therapy and the condition improved gradually. There are many variants of GI tuberculosis demonstrating uncommon and rare imaging features. It turned to be difficult in diagnosis when it showed the rare appearance, such as the great amount of intestinal bleeding and multiple noduli in our case. The reason why gastrointestinal bleeding might be attributed to the invasiveness of submucosal vessels by the tuberculosis bacteria. And the multiple noduli on the bowel wall might be the granuloma formation. Therefore, from the experience of our case, gastrointestinal tract might also be the first and only involved site, and it may cause great amount of bleeding to a life danger, even in young people.

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Correction to: Triadic Interactions in MIECHV: Relations to Home Visit Quality

The article "Triadic interactions in MIECHV: Relations to home visit quality", written by Carla A. Peterson, Kere Hughes-Belding, Neil Rowe, Liuran Fan, Melissa Walter, Leslie Dooley, Wen Wang and Chloe Steffensmeier, was originally published electronically on the publisher's internet portal (currently SpringerLink) on 12 June 2018 without open access. With the author(s)' decision to opt for Open Choice the copyright of the article changed on 9 July 2018 to © The Author(s) 2018 and the article is forthwith distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

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Mother and Home Visitor Emotional Well-Being and Alignment on Goals for Home Visiting as Factors for Program Engagement

Abstract

Objectives Family engagement in home visiting (HV), as indicated by length of enrollment, is a major challenge as most families do not stay enrolled for the intended duration prescribed by HV models. This study examined maternal and visitor emotional well-being as factors for maternal satisfaction with the program in addressing reasons for enrolling in HV and program engagement and the role of their working alliance with the visitor as a mediator of this. Methods Longitudinal data were collected from 148 mothers and 54 visitors in 21 HV programs. Mothers completed surveys shortly after enrolling and 6 months later to assess attributes of the working alliance with their visitor. Visitors completed a survey to assess work-related well-being. HV program data were used to measure engagement. Results Mothers enrolled for multiple, diverse reasons, most often to promote child development and parenting (96%). Mothers' satisfaction with program efforts to address reasons for enrollment was highest for parenting (79%) and lowest for jobs and education (30%). Results of the mediational path model indicated that ratings of the visitor on goal alignment were positively associated with engagement. Maternal emotional availability and visitor work-related emotional exhaustion were negatively associated with engagement. Exploratory analyses suggested that ratings of the visitor on goal alignment were a stronger predictor of engagement for mothers with low emotional availability compared to other mothers. Conclusions for Practice Visitor alignment with mothers on goals and responsiveness to reasons for enrolling appear to be effective in promoting engagement. Individualizing services to reflect maternal goals and emotional capacity may be important strategies to address engagement challenges.

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Work-Related Stressors Among Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Home Visitors: A Qualitative Study

Abstract

Background The Florida Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program delivers evidence-based home visiting services to over 1400 families each year. Home visitors are integral in providing resources for families to promote healthy pregnancy, child development, family wellness, and self-sufficiency. Due to the nature of this work, home visitors experience work-related pressures and stressors that can impact staff well-being and retention. Objectives The purpose of this study was to understand primary sources of work-related stress experienced by home visitors, subsequent effects on their engagement with program participants, and to learn of coping mechanisms used to manage stress. Methods In 2015, Florida MIECHV program evaluators conducted ten focus groups with 49 home visitors during which they ranked and discussed their top sources of work-related stress. Qualitative analysis was conducted to identify emergent themes in work-related stressors and coping/supports. Results Across all sites, the burden of paperwork and data entry were the highest ranked work-related stressors perceived as interfering with home visitors' engagement with participants. The second-highest ranked stressors included caseload management, followed by a lack of resources for families, and dangerous environments. Home visitors reported gratification in their helping relationships families, and relied on coworkers or supervisors as primary sources of workplace support along with self-care (e.g. mini-vacations, recreation, and counseling). Conclusions for practice Florida MIECHV home visitors across all ten focus groups shared similar work-related stressors that they felt diminished engagement with program participants and could impact participant and staff retention. In response, Florida MIECHV increased resources to support home visitor compensation and reduce caseloads, and obtained a competitive award from HRSA to implement a mindfulness-based stress reduction training statewide.

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Randomized Controlled Trial of Doula-Home-Visiting Services: Impact on Maternal and Infant Health

Abstract

Introduction Although home-visiting programs typically engage families during pregnancy, few studies have examined maternal and child health outcomes during the antenatal and newborn period and fewer have demonstrated intervention impacts. Illinois has developed an innovative model in which programs utilizing evidence-based home-visiting models incorporate community doulas who focus on childbirth education, breastfeeding, pregnancy health, and newborn care. This randomized controlled trial (RCT) examines the impact of doula-home-visiting on birth outcomes, postpartum maternal and infant health, and newborn care practices. Methods 312 young (M = 18.4 years), pregnant women across four communities were randomly assigned to receive doula-home-visiting services or case management. Women were African American (45%), Latina (38%), white (8%), and multiracial/other (9%). They were interviewed during pregnancy and at 3-weeks and 3-months postpartum. Results Intervention-group mothers were more likely to attend childbirth-preparation classes (50 vs. 10%, OR = 9.82, p < .01), but there were no differences on Caesarean delivery, birthweight, prematurity, or postpartum depression. Intervention-group mothers were less likely to use epidural/pain medication during labor (72 vs. 83%; OR = 0.49, p < .01) and more likely to initiate breastfeeding (81 vs. 74%; OR = 1.72, p < .05), although the breastfeeding impact was not sustained over time. Intervention-group mothers were more likely to put infants on their backs to sleep (70 vs. 61%; OR = 1.64, p < .05) and utilize car-seats at three weeks (97 vs. 93%; OR = 3.16, p < .05). Conclusions for practices The doula-home-visiting intervention was associated with positive infant-care behaviors. Since few evidence-based home-visiting programs have shown health impacts in the postpartum months after birth, incorporating doula services may confer additional health benefits to families.

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Correction to: Getting to the Warm Hand-Off: A Study of Home Visitor Referral Activities

The article "Getting to the Warm Hand-Off: A Study of Home Visitor Referral Activities", written by Jessica Goldberg, Jessica Greenstone Winestone, Rebecca Fauth, Melissa Colón and Maria Verónica Mingo, was originally published electronically on the publisher's internet portal (currently SpringerLink) on 02 June 2018 without open access. With the author(s)' decision to opt for Open Choice the copyright of the article changed on 17 July 2018 to © The Author(s) 2018 and the article is forthwith distributed under the terms of the Creative Commons Attribution 4.0 International License (https://ift.tt/1iwynXF), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

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Correction to: The Efficacy of Using Peer Mentors to Improve Maternal and Infant Health Outcomes in Hispanic Families: Findings from a Randomized Clinical Trial

The article "The Efficacy of Using Peer Mentors to Improve Maternal and Infant Health Outcomes in Hispanic Families: Findings from a Randomized Clinical Trial", written by Melanie Lutenbacher, Tonya Elkins, Mary S. Dietrich and Anais Riggs, was originally published electronically on the publisher's internet portal (currently SpringerLink) on 31 May 2018 without open access. With the author(s)' decision to opt for Open Choice the copyright of the article changed on 16 July 2018 to © The Author(s) 2018 and the article is forthwith distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

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Correction to: Introduction to the Special Issue on Taking Home Visiting to Scale: Findings from the Maternal, Infant, and Early Childhood Home Visiting Program State-Led Evaluations

The article "Introduction to the Special Issue on Taking Home Visiting to Scale: Findings from the Maternal, Infant, and Early Childhood Home Visiting Program State-Led Evaluations", written by Nicole Denmark, Kyle Peplinski, Mariel Sparr, Judy Labiner-Wolfe, Susan Zaid, Pooja Gupta and Kassie Mae Miller, was originally published electronically on the publisher's internet portal (currently SpringerLink) on 19 June 2018 without open access. With the author(s)' decision to opt for Open Choice the copyright of the article changed on 18 July 2018 to © The Author(s) 2018 and the article is forthwith distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

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Randomized Trial of a Training Program to Improve Home Visitor Communication around Sensitive Topics

Abstract

Introduction

Strong communication skills are necessary to engage families, perform accurate assessments, and motivate behavior change around sensitive issues encountered in home visiting.

Methods

A two-arm, cluster-randomized trial evaluated the impact of a trans-model communications training course for home visitors. Fourteen home visiting programs in Maryland were assigned to a training intervention (n = 7 programs; 30 visitors) or wait-list control group (n = 7 programs; 34 visitors). Independent observers assessed training fidelity. Visitor's attitudes, knowledge, and confidence were assessed through surveys. Their skills were assessed through coding of video-recorded visits with standardized mothers. Data were collected at baseline, within 2 weeks post-training, and at 2 months post-training. Regression models accounted for clustering within programs and controlled for characteristics on which study groups differed at baseline.

Results

Independent observers rated the training highly on fidelity and acceptability. Home visitors rated it as useful, consistent with their model, and worth the effort. Immediately following the training, the training group scored higher than the control group on a range of indicators in all domains—knowledge, attitudes, confidence, and skills in using motivational communication techniques. At 2 months post-training, impacts on knowledge and attitudes persisted; impacts on confidence and observed skill were attenuated.

Discussion

The training course showed favorable immediate impacts on knowledge, attitudes, confidence, and skills, and long-term impacts on home visitor knowledge and attitudes. The findings underscore the need for ongoing reinforcement of skills following training.

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Correction to: Work-Related Stressors Among Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Home Visitors: A Qualitative Study

The article "Work-Related Stressors Among Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Home Visitors: A Qualitative Study", written by Paige J. Alitz, Shana Geary, Pamela C. Birriel, Takudzwa Sayi, Rema Ramakrishnan, Omotola Balogun, Alison Salloum and Jennifer T. Marshall, was originally published electronically on the publisher's internet portal (currently SpringerLink) on 31 May 2018 without open access. With the author(s)' decision to opt for Open Choice the copyright of the article changed on 25 July 2018 to © The Author(s) 2018 and the article is forthwith distributed under the terms of the Creative Commons Attribution 4.0 International License (https://ift.tt/1iwynXF), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

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Correction to: Keeping Our Eyes on the Prize: Focusing on Parenting Supports Depressed Parents’ Involvement in Home Visiting Services

The article "Keeping Our Eyes on the Prize: Focusing on Parenting Supports Depressed Parents' Involvement in Home Visiting Services", written by Lorraine M. McKelvey, Shalese Fitzgerald, Nicola A. Conners Edge and Leanne Whiteside‑Mansell, was originally published electronically on the publisher's internet portal (currently SpringerLink) on 28 May 2018 without open access

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Computational tools to unmask transposable elements

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Predatory Open-Access Publishing in Anesthesiology

Predatory publishing is an exploitative fraudulent open-access publishing model that applies charges under the pretense of legitimate publishing operations without actually providing the editorial services associated with legitimate journals. The aim of this study was to analyze this phenomenon in the field of anesthesiology and related specialties (intensive care, critical and respiratory medicine, pain medicine, and emergency care). Two authors independently surveyed a freely accessible, constantly updated version of the original Beall lists of potential, possible, or probable predatory publishers and standalone journals. We identified 212 journals from 83 publishers, and the total number of published articles was 12,871. The reported location of most publishers was in the United States. In 43% of cases (37/84), the reported location was judged as "unreliable" after being checked using the 3-dimensional view in Google Maps. Six journals were indexed in PubMed. Although 6 journals were declared to be indexed in the Directory of Open Access Journals, none were actually registered. The median article processing charge was 634.5 US dollars (interquartile range, 275–1005 US dollars). Several journals reported false indexing/registration in the Committee on Publication Ethics and International Committee of Medical Journal Editors registries and Google Scholar. Only 32% (67/212) reported the name of the editor-in-chief. Rules for ethics/scientific misconduct were reported in only 24% of cases (50/212). In conclusion, potential or probable predatory open-access publishers and journals are widely present in the broad field of anesthesiology and related specialties. Researchers should carefully check journals' reported information, including location, editorial board, indexing, and rules for ethics when submitting their manuscripts to open-access journals. Accepted for publication August 10, 2018. Funding: None. Conflicts of Interest: See Disclosures at the end of the article. Clinical trial number and registry URL: Not applicable. Reprints will not be available from the authors. Address correspondence to Andrea Cortegiani, MD, Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Via del vespro 129, 90127, Palermo, Italy. Address e-mail to cortegiania@gmail.com. © 2018 International Anesthesia Research Society

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Cardiac Pacing and Defibrillation in Pediatric and Congenital Heart Disease

No abstract available

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Ultrasound-Assisted Technology Versus the Conventional Landmark Location Method in Spinal Anesthesia for Cesarean Delivery in Obese Parturients: A Randomized Controlled Trial

BACKGROUND: Spinal anesthesia, which is commonly used in cesarean deliveries, is often difficult to perform in obese parturients because of poorly palpable surface landmarks and positioning challenges. This study aimed to evaluate the benefits of ultrasound-assisted technology for performing spinal anesthesia in obese parturients. METHODS: Parturients with a body mass index (BMI) ≥30 kg/m2 scheduled for elective cesarean delivery were randomized to undergo spinal anesthesia using the conventional landmark location technique (landmark group, n = 40) or prepuncture ultrasound examination (ultrasound group, n = 40). All participants underwent spinal anesthesia in the lateral position. The primary outcome was the first-attempt success rate. Secondary outcomes were the number of skin punctures and needle passes, procedure times, patient satisfaction, changes in the intended interspace, and incidence of complications. RESULTS: The ultrasound group had a significantly higher first-attempt success rate (87.5% vs 52.5%; P = .001), fewer cases requiring >10 needle passes (1 vs 17; P 10 needle passes (P = .231), spinal injection time (P = .081), or total procedure time (P = .729); however, more time was required to identify the needle insertion site in the ultrasound group (P 10 needle passes (P ≤ .01), and shorter procedure times, including the time required to identify the needle insertion site (P

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Society for Perioperative Assessment and Quality Improvement Reply to “American Society of Enhanced Recovery: Advancing Enhanced Recovery and Perioperative Medicine”

No abstract available

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In Response

No abstract available

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In Response

No abstract available

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A Predictive Model for Determining Patients Not Requiring Prolonged Hospital Length of Stay After Elective Primary Total Hip Arthroplasty

BACKGROUND: Hospital length of stay (LOS) is an important quality metric for total hip arthroplasty. Accurately predicting LOS is important to expectantly manage bed utilization and other hospital resources. We aimed to develop a predictive model for determining patients who do not require prolonged LOS. METHODS: This was a retrospective single-institution study analyzing patients undergoing elective unilateral primary total hip arthroplasty from 2014 to 2016. The primary outcome of interest was LOS less than or equal to the expected duration, defined as ≤3 days. Multivariable logistic regression was performed to generate a model for this outcome, and a point-based calculator was designed. The model was built on a training set, and performance was assessed on a validation set. The area under the receiver operating characteristic curve and the Hosmer–Lemeshow test were calculated to determine discriminatory ability and goodness-of-fit, respectively. Predictive models using other machine learning techniques (ridge regression, Lasso, and random forest) were created, and model performances were compared. RESULTS: The point-based score calculator included 9 variables: age, opioid use, metabolic equivalents score, sex, anemia, chronic obstructive pulmonary disease, hypertension, obesity, and primary anesthesia type. The area under the receiver operating characteristic curve of the calculator on the validation set was 0.735 (95% confidence interval, 0.675–0.787) and demonstrated adequate goodness-of-fit (Hosmer–Lemeshow test, P = .37). When using a score of 12 as a threshold for predicting outcome, the positive predictive value was 86.1%. CONCLUSIONS: A predictive model that can help identify patients at higher odds for not requiring a prolonged hospital LOS was developed and may aid hospital administrators in strategically planning bed availability to reduce both overcrowding and underutilization when coordinating with surgical volume. Accepted for publication August 15, 2018. Funding: None. 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 Rodney A. Gabriel, MD, MAS, Department of Anesthesiology, University of California, San Diego, 200 W Arbor Dr, MC 8770, San Diego, CA 92103. Address e-mail to ragabriel@ucsd.edu. © 2018 International Anesthesia Research Society

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Development and Multidisciplinary Preliminary Validation of a 3-Dimensional–Printed Pediatric Airway Model for Emergency Airway Front-of-Neck Access Procedures

BACKGROUND: Pediatric-specific difficult airway guidelines include algorithms for 3 scenarios: unanticipated difficult tracheal intubation, difficult mask ventilation, and cannot intubate/cannot ventilate. While rare, these instances may require front-of-neck access (FONA) to secure an airway until a definitive airway can be established. The aim of this study was to develop a pediatric FONA simulator evaluated by both anesthesiology and otolaryngology providers, promoting multidisciplinary airway management. METHODS: A 3-dimensional–printed tracheal model was developed using rescaled, anatomically accurate dimensions from a computerized tomography scan using computer-aided design software. The medical grade silicone model was incorporated into a mannequin to create a low-cost, high-fidelity simulator. A multidisciplinary team of anesthesiology, otolaryngology, and simulation experts refined the model. Experts in airway management were recruited to rate the realism of the model's characteristics and features and their own ability to complete specific FONA-related tasks. RESULTS: Six expert raters (3 anesthesiology and 3 otolaryngology) were identified for multidisciplinary evaluation of model test content validity. Analysis of response data shows null variance within 1 or both specialties for a majority of the content validity tool elements. High and consistent absolute ratings for each domain indicate that the tested experts perceived this trainer as a realistic and highly valuable tool in its current state. CONCLUSIONS: The ability to practice front-of-neck emergency airway procedures safely and subsequently demonstrate proficiency on a child model has great implications regarding both quality of physician training and patient outcomes. This model may be incorporated into curricula to teach needle cricothyroidotomy and other FONA procedures to providers across disciplines. Accepted for publication July 26, 2018. Funding: K.J.K, A.R.P., and C.L.R. are supported by National Institutes of Health grant T32 DC005356 (T32 Training Grant). This work is supported by a research grant funded by the University of Michigan Clinical Simulation Center. 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 David A. Zopf, MD, MS, Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109. Address e-mail to davidzop@med.umich.edu. © 2018 International Anesthesia Research Society

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Of Flies and Men

No abstract available

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HES or How to End Science

No abstract available

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Retrospective Cohort Study on the Optimal Timing of Orogastric Tube/Nasogastric Tube Insertion in Infants With Pyloric Stenosis

BACKGROUND: Hypertrophic pyloric stenosis in infants can cause a buildup of gastric contents. Orogastric tubes (OGTs) or nasogastric tubes (NGTs) are often placed in patients with pyloric stenosis before surgical management to prevent aspiration. However, exacerbation of gastric losses may lead to electrolyte abnormalities that can delay surgery, and placement has been associated with increased risk of postoperative emesis. Currently, there are no evidence-based guidelines regarding OGT/NGT placement in these patients. This study examines whether OGT/NGT placement before arrival in the operating room was associated with a longer time to readiness for surgery as defined by normalization of electrolytes. Secondary outcomes included time from surgery to discharge and ability to tolerate feeds by 6 hours postoperatively in patients with and without early OGT/NGT placement. METHODS: In this multicenter retrospective cohort study, data were extracted from the medical records of 481 patients who underwent pyloromyotomy for infantile hypertrophic pyloric stenosis from March 2013 to June 2016. Multivariable linear regression and Cox proportional hazard models were constructed to evaluate the association between placement of an OGT/NGT at the time of admission with increased time to readiness for surgery (defined as the time from admission to the first set of normalized laboratory values) and increased time from surgery to discharge. Multivariable logistic regression was used to evaluate the association between early OGT/NGT placement and the ability to tolerate oral intake at 6 hours postsurgery. Analyses were adjusted for site differences. RESULTS: Among patients admitted with electrolyte abnormalities, those with an OGT/NGT placed on presentation required more time until their serum electrolytes were at acceptable levels for surgery by regression analysis (19.2 hours difference; 95% confidence interval, 10.05–28.41; P

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Ventilator Alarms in Intensive Care Units: Frequency, Duration, Priority, and Relationship to Ventilator Parameters

Ventilator alarms have long been presumed to contribute substantially to the overall alarm burden in the intensive care unit. In a prospective observational study, we determined that each ventilator triggered an alarm cascade of up to 8 separate notifications once every 6 minutes. In 1 intensive care unit with different ventilator manufacturers, the distribution of high-priority alarms was manufacturer dependent with 8.6% of alarms from 1 type and 89.8% of alarms from another type of ventilator. Alarm limits were not a function of patient-specific ventilator settings. Accepted for publication August 17, 2018. Funding: Supported, in part, by a grant from the Association for the Advancement of Medical Instrumentation (AAMI). 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 Maria M. Cvach, DNP, RN, FAAN, Department of Integrated Healthcare Delivery, Johns Hopkins Health System, Room 631, 1830 Bldg, 1830 E Monument St, Baltimore, MD 21287. Address e-mail to mcvach@jhmi.edu. © 2018 International Anesthesia Research Society

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Comparison of 7 Different Sensors for Detecting Low Respiratory Rates Using a Single Breath Detection Algorithm in Nonintubated, Sedated Volunteers

BACKGROUND: Numerous technologies are used to monitor respiratory rates in nonintubated patients. No technology has emerged as the standard. The primary aim of this study was to assess the limits of agreement between a reference sensor signal (respiratory inductance plethysmography bands) and 7 alternative sensor signals (nasal capnometer, nasal pressure transducer, oronasal thermistor, abdominal accelerometer, transpulmonary electrical impedance, peritracheal microphone, and photoplethysmography) for measuring low respiratory rates in sedated, nonintubated, supine volunteers. A unified approach based on a single breath detection algorithm was applied to each sensor to facilitate comparison. We hypothesized that all of the sensor signals would allow detection of low (80% of data points within ±2 breaths per minute. Impedance and photoplethysmograph signals had 58% and 64%, respectively. CONCLUSIONS: A unified approach can be applied to a variety of sensor signals to estimate respiratory rates in spontaneously breathing, nonintubated, sedated volunteers. However, detecting clinically relevant low respiratory rates (

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Too Early to Jump Ship on Whole Blood for Hemorrhagic Trauma?

No abstract available

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In Response

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Effects of Intraoperative Infusion of Esmolol on Systemic and Pulmonary Inflammation in a Porcine Experimental Model of Lung Resection Surgery

BACKGROUND: Lung resection surgery (LRS) is associated with systemic and pulmonary inflammation, which can affect postoperative outcomes. Activation of β-adrenergic receptors increases the expression of proinflammatory and anti-inflammatory mediators, and their blockade may attenuate the systemic inflammatory response. The aim of this study was to analyze the effect of a continuous perioperative intravenous perfusion of esmolol on postoperative pulmonary edema in an experimental model of LRS requiring periods of one-lung ventilation (OLV). METHODS: Twenty-four large white pigs were randomly assigned to 3 groups: control (CON), esmolol (ESM), and sham. The ESM group received an intravenous esmolol bolus (0.5 mg/kg) and then an esmolol infusion (0.05 mg·kg−1·minute−1) throughout the procedure. The CON group received the same volume of 0.9% saline solution as the ESM group plus a continual infusion of saline. The sham group underwent a left thoracotomy without LRS or OLV. At the end of the LRS, the animals were awakened, and after 24 hours, they underwent general anesthesia again. Lung biopsies and plasma samples were obtained to analyze the levels and expression of inflammatory mediators, and the animals also received a bronchoalveolar lavage. RESULTS: At 24 hours after the operation, the ESM group had less lung edema and lower expression of the proinflammatory biomarkers tumor necrosis factor (TNF) and interleukin (IL)-1 compared to the CON group for both lung lobes. For the mediastinal lobe biopsies, the mean difference and 95% confidence interval (CI) between the groups for edema, TNF, and IL-1 were 14.3 (95% CI, 5.6–23.1), P = .002; 0.19 (95% CI, 0.07–0.32), P = .002; and 0.13 (95% CI, 0.04–0.22), P = .006, respectively. In the left upper lobe, the mean differences for edema, TNF, and IL-1 were 12.4 (95% CI, 4.2–20.6), P = .003; 0.25 (95% CI, 0.12–0.37), P

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Addition of Infiltration Between the Popliteal Artery and the Capsule of the Posterior Knee and Adductor Canal Block to Periarticular Injection Enhances Postoperative Pain Control in Total Knee Arthroplasty: A Randomized Controlled Trial

BACKGROUND: Periarticular injections (PAIs) are becoming a staple component of multimodal joint pathways. Motor-sparing peripheral nerve blocks, such as the infiltration between the popliteal artery and capsule of the posterior knee (IPACK) and the adductor canal block (ACB), may augment PAI in multimodal analgesic pathways for knee arthroplasty, but supporting literature remains rare. We hypothesized that the addition of ACB and IPACK to PAI would lower pain on ambulation on postoperative day (POD) 1 compared to PAI alone. METHODS: This triple-blinded randomized controlled trial included 86 patients undergoing unilateral total knee arthroplasty. Patients either received (1) a PAI (control group, n = 43) or (2) an IPACK with an ACB and modified PAI (intervention group, n = 43). The primary outcome was pain on ambulation on POD 1. Secondary outcomes included numeric rating scale (NRS) pain scores, patient satisfaction, and opioid consumption. RESULTS: The intervention group reported significantly lower NRS pain scores on ambulation than the control group on POD 1 (difference in means [95% confidence interval], −3.3 [−4.0 to −2.7]; P

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In Response

No abstract available

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The degree of adherence to CONSORT reporting guidelines for the abstracts of randomised clinical trials published in anaesthesia journals: A cross-sectional study of reporting adherence in 2010 and 2016

BACKGROUND Abstracts are intended to be concise summaries of the entire randomised clinical trial (RCT). Despite their importance, few studies have examined the reporting quality of abstracts in the anaesthesiology literature. OBJECTIVES To examine the quality of RCT abstract reporting according to the CONSORT for Abstracts guidelines and determine whether recommended items omitted from the abstract were present in the body of the article. DESIGN A cross-sectional study of RCTs. SETTING This study was performed at the University of Western Ontario and University Hospital, London Health Sciences Centre. PARTICIPANTS All RCTs meeting inclusion criteria that were published in 2010 or 2016 in six general anaesthesiology journals (Anaesthesia, Anesthesia & Analgesia, Anesthesiology, British Journal of Anaesthesia, Canadian Journal of Anesthesia and European Journal of Anaesthesiology). MAIN OUTCOME MEASURES The 16 checklist items from the CONSORT for Abstracts statement were used to create a convenience score as a proxy for RCT abstract reporting quality, with each criterion measured as being reported in abstract, not reported in abstract but reported in full-text article, or not reported in abstract or full-text article. RESULTS Of the 395 RCTs identified, 219 were published in 2010 and 176 were published in 2016. Out of the maximum possible score of 16, the median abstract score increased from 4 points [interquartile range (IQR): 3 to 5] in 2010 to 6 points [IQR: 5 to 8] in 2016. Although most checklist items showed improvement from 2010 to 2016, around 75% of RCTs in 2016 met fewer than half of the 16 items with no RCTs reporting all 16 items in the abstract. A majority of the RCTs had the information present in the full-text. In 2016, only 71 out of 176 (40%) of RCTs reported outcomes conforming to the CONSORT guidelines (with an effect size and a confidence interval around the effect size) in the Abstract. CONCLUSION Abstracts for many anaesthesiology RCTs are incomplete selective summaries of the entire article. Correspondence to Dr Philip M. Jones, MD, MSc, Rm C3–110 - University Hospital, London Health Sciences Centre, 339 Windermere Rd, London, ON N6A 5A5, Canada, Tel: +1 519 685 8500 x36306; e-mail: pjones8@uwo.ca 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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How current transfusion practices in geriatric patients with hip fracture still differ from current guidelines and the effects on outcome: A retrospective observational study

BACKGROUND Transfusion guidelines have become increasingly restrictive. We investigated actual transfusion practices in geriatric hip fracture patients, why they differ from current guidelines and how this affects outcome. OBJECTIVES The primary aim was to examine transfusion timing, evaluate how many red blood cell (RBC) transfusions are in keeping with and how this affects morbidity (infection, cardiac events and delirium), mortality and length of stay (LOS). Our secondary aim was to test the hypothesis that guidelines were more likely to be guidelines are more likely to deviate with consecutive transfusions or before discharge. DESIGN A retrospective observational study. SETTING The Luzerner Kantonsspital, a major trauma centre, over a 12-month period from 1 February 2015 to 31 January 2016. PATIENTS All patients over 70 years of age admitted to the Luzerner Kantonsspital with hip fractures over a 12-month period in 2015 to 2016 were included. RESULTS 156 patients were included, and 141 units of RBCs were transfused. All pre and intra-operative transfusions were according to guidelines; 110 transfusions were postoperative and 37 of these were not according to guidelines. Patients who were transfused had longer LOS in hospital (P = 0.002) and an odds ratio (OR) of 2.7 of contracting an infection (P = 0.04) in comparison with patients who were not transfused. No significant differences in mortality, LOS or morbidity were found between patients transfused according to guidelines and more liberal thresholds. Guidelines were more likely to be deviated from within the last 2 days before discharge than prior to this (58 vs. 24%, P = 0.03). Furthermore, 24 stable patients received two consecutive RBC units resulting in posttransfusion haemoglobin values of between 83 and 124 g l−1. CONCLUSION Most RBC transfusions occur postoperatively, many still according to liberal transfusion thresholds, in particular shortly before discharge and as part of consecutive transfusions. Transfused patients had longer LOS and more infections than patients not transfused, but there was no difference in mortality, LOS or morbidity between patients transfused according to current guidelines and those where guidelines were deviated from. Correspondence to Dr Evelyn Leuzinger, Department of Anaesthesia, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland Tel: + 41 55 205 1111; e-mail: evelynctsa@gmail.com 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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Evidence-Based Physiatry: Pediatric Neuromuscular Rehabilitation in the Era of Precision Medicine

No abstract available

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Physiatry Reviews for Evidence in Practice (PREP) Second Order Peer Reviews of Clinically Relevant Articles for the Physiatrist: Aspirin or Rivaroxaban for VTE Prophylaxis after Hip or Knee Arthroplasty

No abstract available

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The Role of Incentives in Long-Term Nutritional and Growth Studies in Children

Objectives: Available published advice on use of incentives is limited and generally refers to short term studies without longer follow-up, predominantly conducted in developed countries. We aim to summarise published information related to the use of incentives in long-term nutrition studies involving infants, children and adolescents and the views of researchers in the field, in order to provide guidance on acceptable incentives. Methods: We conducted a literature review and a short online survey of researchers regarding their opinions on the use of incentives in paediatric long-term (follow-up) clinical studies. Results: Responses from 38 researchers from 14 different countries indicated that 41% had used incentives to increase participation and 29% to 73%, depending on child age and type of procedure, thought incentives may be used to increase compliance with follow-up visits. A small number of respondents thought incentives would not be approved by national ethics boards. Conclusions: Based on the literature review and the survey results, and ESPGHAN working group concluded that incentives for children and adolescents up to the value of 30 euros, based on average EU income levels, may be offered as cash, vouchers or age appropriate gifts or toys, in addition to reimbursing expenses. Additional incentives may be offered if a study includes more burdening procedures, techniques that may appear frightening for younger children, or requires sustained participation (e.g. dietary diaries or activity monitoring). There was agreement that it is preferable to give toys or gifts rather than money to younger children. Address correspondence and reprint requests to Berthold Koletzko, MD PhD Dres.h.c, Professor of Paediatrics, LMU - Ludwig-Maximilians-Universität München, Dr. von Hauner Children's Hospital, Lindwurmstr. 4, 80337 München, Germany (e-mail: office.koletzko@med.lmu.de). Received 17 June, 2018 Accepted 27 August, 2018 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). The conflicts of interest disclosure and funding declaration: NFM, KK, MF and BK – none related to the topic. NFM acknowledges support of the Slovenian Research Agency (P3-0395: Nutrition and Public Health; L3-8213, L3-7538), European Food Safety Authority (EU Menu) and University Medical Centre Ljubljana, Slovenia. The work of CC is financially supported in part by the Commission of the European Communities Projects Early Nutrition (FP7-289346), MyNewGut (FP7 613979), DynaHEALTH (H2020-633595). Additional support has been received from Spanish Ministry of Economy and Competitiveness SFA2015-69265-C2-1-R and BFU2012-40254-C03-01. MF is supported by the Great Ormond Street Hospital Children's Charity. The work of BK is financially supported in part by the Commission of the European Communities, Projects Early Nutrition (FP7-289346), DYNAHEALTH (H2020-633595) and LIFECYCLE (H2020-SC1-2016-RTD), the European Research Council Advanced Grant META-GROWTH (ERC-2012-AdG 322605), the Erasmus Plus programmes "Early Nutrition eAcademy Southeast Asia - 573651-EPP-1-2016-1-DE-EPPKA2-CBHE-JP" and "Early Nutrition eAcademy Southeast Asia - 573651-EPP-1-2016-1-DE-EPPKA2-CBHE-JP" and " Capacity Building to Improve Early Nutrition and Health in South Africa - 598488-EPP-1-2018-1-DE-EPPKA2-CBHE-JP", and the EU Interreg Programme "Focus in CD - CE111". Additional support has been received from the German Ministry of Education and Research, Berlin (Grant Nr. 01 GI 0825), the German Research Council (Ko912/12-1) and the University of Munich Innovation Initiative. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Rapid Progression of Acute Pancreatitis to Acute Recurrent Pancreatitis in Children

Objective: Research is lacking on the natural history of acute pancreatitis (AP) progression to acute recurrent pancreatitis (ARP). The aim of this project was to study the progression from AP to ARP among pediatric patients with pancreatitis to better understand the presentation and natural history of pancreatitis. Methods: Patients presenting with AP were included in a prospective database in Research Electronic Data Capture. We enrolled 115 AP patients from March 2013 – November 2016. Physicians completed surveys regarding clinical data for patients with first attack of AP. Patients were followed prospectively, with data on progression entered when patients presented with ARP. Results: The most common etiologies for the first attack of AP were idiopathic (31%), toxic/drug related (23%), and biliary/gallstone (18%). Twenty of the 115 patients (17%) developed ARP during the follow up period. Seventy percent (14/20) of ARP patients progressed from AP to ARP within 5 months from first diagnosis. A comparison of patients who rapidly progressed to ARP within 3 months (n = 12) to those followed for more than 3 months without progression in 3 months (n = 97) revealed associations with a higher weight percentile for age (p = 0.045), male gender (p = 0.03) and presence of pancreatic necrosis during first AP attack (p = 0.004). Progression to ARP significantly differed by etiology group with genetics having the highest risk for ARP progression over time and patients with gallstone/biliary, viral/systemic, and obstructive (non-gallstone) having the lowest risk for ARP progression over time (p = 0.02). Conclusions: Most patients who progressed from AP to ARP progressed within five months. The presence of a higher weight percentile for age, male gender and pancreatic necrosis during the first AP attack are associated with rapid progression to ARP. Address correspondence and reprint requests to Maisam Abu-El-Haija, MD, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039 (e-mail: Maisam.haija@cchmc.org). Received 15 March, 2018 Accepted 17 August, 2018 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). Note: Katherine F. Sweeny, MD is now affiliated with the Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts. Funding Source: No external funding for this manuscript Financial disclosure: All authors have indicated they have no financial relationships relevant to the article to disclose. Conflicts of interest: All authors have no potential conflicts of interest to disclose. Clinical Trial Registration: N/A. Contributors Statement: Dr. Sweeny: Assisted in data collection, drafted the initial manuscript and edited the final manuscript for submission. Dr. Lin, Dr. Nathan, Dr. Denson and Dr. Husain: assisted in conceptualization of study design, assisted in data collection, reviewed and revised the manuscript and approved the final manuscript once submitted. Ms. Hornung: assisted in development of the database survey, analyzed the data, assisted in drafting the initial manuscript and approved the final manuscript once submitted. Mr. Thompson: assisted in database design, assisted in data collection, reviewed and revised the manuscript and approved the final manuscript once submitted. Dr. Abu-El-Haija: conceptualized and designed the database, directed and assisted in data collection, drafted the initial manuscript and approved the final manuscript once submitted. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Severe DGUOK Deficiency in Austria: A Six-Patient Series

Mutations in the nuclear gene DGUOK, encoding deoxyguanosine kinase, cause an infantile hepatocerebral type of mitochondrial depletion syndrome (MDS). We report 6 MDS patients harboring bi-allelic DGUOK mutations, of which 3 are novel, including a large intragenic Austrian founder deletion. One patient was diagnosed with hepatocellular carcinoma aged 6mo, supporting a link between mitochondrial DNA depletion and tumorigenesis; liver transplantation proved beneficial with regard to both tumor treatment and psychomotor development. Address correspondence and reprint requests to Andreas R. Janecke, MD, Department of Paediatrics I & Division of Human Genetics, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria (e-mail: Andreas.Janecke@i-med.ac.at). Received 23 April, 2018 Accepted 4 September, 2018 Funding: This work was supported by Jubiläumsfonds der Österreichischen Nationalbank (project 16678) and the E-Rare project GENOMIT, Austrian Science Fonds (I 2741-B26). Conflict of Interest: The authors declare 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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Diet and Exercise in Pediatric Liver Transplant Recipients: Behaviors and Association with Metabolic Syndrome

Objective: To analyze the impact of physical activity and eating behaviors on precursors of cardiovascular disease—including overweight/obesity, hypertension, low HDL, and impaired glucose tolerance—in pediatric liver transplant (LT) recipients and matched controls. Method: Cross-sectional study of pediatric LT recipients 8–30 years, matched to controls from NHANES. Dietary intake assessed with 24-hour recall. Physical activity assessed by standardized questionnaires. LT recipients ≥12 years completed a confidential survey on alcohol consumption. Results: LT recipients (n = 90) were 0.9–24.7 years post-transplant. LT recipients and controls were equally likely to consume excess carbohydrates (32% vs 34%) and sugar, per age and gender-specific recommended dietary intake (RDA) guidelines. LT recipients spent more hours sedentary or on the computer daily and fewer days each week physically active for >60 minutes than controls. More overweight/obese LT recipients spent 3+ hours at the computer than non-overweight LT recipients (49% vs 27%; p = 0.02). Normal weight LT recipients spent more days doing vigorous activity each week (median 5 days, IQR 2–6) than did the overweight/obese LT recipients (median 3 days, IQR 2–4; p = 0.01). Among LT recipients, neither dietary intake nor physical activity were consistently associated with measures of hypertension, glucose intolerance, or dyslipidemia. Among LT adolescents and young adults (n = 38), 36% reported ever consuming alcohol; 38% of these reported significant alcohol consumption by frequency or quantity. Conclusions: Additional counseling during routine post-LT care on the importance of physical activity and healthy diet may be useful. However, it is unlikely that these factors alone explain the increased prevalence of metabolic syndrome components in pediatric LT recipients. Address correspondence and reprint requests to Emily R. Perito, MD, MAS, 550 16th Street, 5th Floor Box 0136, SF, CA 94143; E-mail: emily.perito@ucsf.edu; Julia H. Chambers, BS, University of California, San Francisco, San Francisco, United States; E-mail: julia.chambers@ucsf.edu Received 13 December, 2017 Accepted 29 August, 2018 Conflicts of interest disclosure: The authors have no relevant conflicts of interest to disclose. Funding Source: Supported by the NASPGHAN Mentored Summer Student Research Program (Ms. Chambers), an NIH-NIDDK K23 Career Development Award (K23 DK0990253-A101, Dr. Perito), AGA Emmet B. Keeffe Career Development Award in Clinical or Translational Research in Liver Disease (Dr. Perito), UCSF Liver Center Pilot Funding (Dr. Perito, P30 DK026743), and by the NIH-National Center for Advancing Translational Sciences (UCSF-CTSI Grant UL1 TR000004). Julia H. Chambers BS1 – Data analysis and interpretation, drafting manuscript, final approval for publishing Melissa Zerofsky, PhD2 – Data acquisition, Data analysis and interpretation, drafting manuscript, final approval for publishing Robert H. Lustig, MD, MSL2 – Project conception and design, data interpretation, manuscript revision, final approval for publishing Philip Rosenthal, MD2,3 – Project conception and design, data interpretation, manuscript revision, final approval for publishing Emily R. Perito, MD MAS2,4 – Project conception and design, data analysis and interpretation, manuscript drafting and revision, final approval for publishing © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Recurrent Abdominal Pain in Children: Is Colonoscopy Indicated?

Introduction: Recurrent abdominal pain in children is common, with most functional in origin. Colonoscopy has sometimes been performed to exclude pathology but its role is unclear. Our aim therefore was to assess the diagnostic yield and role of colonoscopy in these children. Methods: Retrospective review of consecutive colonoscopies in a tertiary pediatric hospital between November 2011 and October 2015 was undertaken. Only those with recurrent abdominal pain as an indication for procedure were included. Chart review of patients with pain was undertaken to ensure they fulfilled Rome IV criteria. Patient demographics, indication for procedure, and adjunct pre-procedure tests were noted. Statistical analyses were performed with SPSS software. Results: 652 colonoscopies were performed, of which 68 (10%) had abdominal pain as one of the indications; and was the sole indication in 15 (2%) patients. All 68 patients had pre-procedure serum inflammatory markers measured and 53% (36/68) had stool calprotectin. Positive histology was found in 10% (7/68) including Crohn disease (n = 3), polyps (n = 2), and microscopic colitis (n = 2). The remaining 61 patients had normal colonoscopy and ileocolonic biopsies. 5/36 patients had raised fecal calprotectin, and all had abnormal histology. Serum inflammatory markers were raised in 4 patients and all also had abnormal calprotectin. No patient with isolated abdominal pain had positive histology. Rectal bleeding was the only associated indication to predict abnormal histology (p = 0.019). Conclusions: Colonoscopy is likely not warranted in children with recurrent abdominal pain without bleeding, weight loss or altered bowel habit. Fecal calprotectin is useful in helping predict positive findings. Address correspondence and reprint requests to Harveen K. Singh, Dr, Department of Gastroenterology, Hepatology and Transplant, Lady Cilento Children's Hospital, 501 Stanley St, South Brisbane, Queensland, 4101, Australia (e-mail: Harveen.k.singh1@gmail.com). Received 12 April, 2018 Accepted 9 September, 2018 Sources of support- We have not received any funding or have any interest in any company or technology that could be perceived as a conflict of interest in this study. Authors Roles: Dr Harveen K Singh: Obtainment of ethics approval, collection and interpretation of data, statistical analysis and drafting of article. Dr Looi C Ee: Involvement in conception and design of article, interpretation of data, critical revision of article and final approval. The authors report 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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Hepatic Steatosis is Prevalent following Orthotopic Liver Transplantation in Children with Cystic Fibrosis

Objectives: Systematic study of allograft liver histology in children undergoing orthotopic liver transplantation (LT) for cystic fibrosis-related liver disease (CFLD). Methods: Retrospective clinicopathologic review of explants and allograft liver biopsies from 13 children and adolescents with CFLD. Results: In this study, the median age at LT for CFLD was 15.7 years. Notably, 10 of 13 (77%) CF explants had >5% steatosis and 8 of 13 (61.5%) demonstrated variable fibrosis. The median age, gender, type of transplant (liver vs liver-lung), pancreatic insufficiency (PI) status, BMI%ile, genotype and prevalence of diabetes were comparable in those with and without explant steatosis. More than half of allograft biopsies showed significant steatosis (17/31, 54.8%) and lobular inflammation (16/31, 51.6%). Hepatocyte ballooning was less frequent (5/31, 16.1%). Overall, 6 patients (46.2%) had allograft steatosis that worsened over time in 2 patients (33%). None had advanced fibrosis (≥stage 3). Patients with allograft steatosis had significantly more biopsies, were more likely to be 'liver only' recipients, had a shorter interval since transplant and higher BMI%ile (though

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Transient Elastography Measurements of Spleen Stiffness as a Predictor of Clinically Significant Varices in Children

Objectives: Investigate the use of spleen stiffness measurements (SSM), measured by transient elastograpghy (TE), for the prediction of clinically significant varices (CSV) in children with portal hypertension. Methods: This observational cohort study included children selected for endoscopy, as per department protocol, between September 2015- June 2016. Those included underwent single TE fibroscan for liver stiffness measurements (LSM) and SSM. Clinical and laboratory data were collected and variceal prediction scores were calculated at time of elastography. Results: In total 67 children (32 male) underwent TE. 52 children (25 male) had chronic liver disease (CLD), 15 (7 male) portal vein thrombosis (PVT). In all children SSM was the best predictor of CSV+ve, with an optimal cut-off value of 38.0kPa (AUROC = 0.92, sensitivity = 89%, specificity = 82%, p 

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A Lower 6MMP/6TG Ratio may be a Therapeutic Target in Pediatric Autoimmune Hepatitis

Background: Azathioprine(AZA) is the mainstay of maintenance therapy in pediatric autoimmune hepatitis(AIH). However, the use of thiopurines metabolites to individualize therapy and avoid toxicity has not been clearly defined. Methods: Retrospective analysis of children ≤18 years diagnosed with AIH between January 2001 and 2016. Standard definitions were used for treatment response and disease flare. Thiopurine metabolite levels were correlated with the corresponding LFT. Results: 56 children (32 female) were diagnosed with AIH at a median age of 11 years (IQR 9). No difference in 6-thioguanine-nucleotide (6-TG) levels [271(IQR 251) pmol/8 x 108 RBC vs. 224(IQR 147) pmol/8 x 108 RBC, p = 0.06] was observed in children in remission when compared to those who were not in remission. No correlation was observed between the 6-TG and ALT levels (r = - 0.179, p = 0.109) or between 6-methyl-mercaptopurine(6-MMP) and ALT levels (r = 0.139, p = 0.213). The 6-MMP/6–TG ratio was significantly lower in patients who were in remission [2(7) vs. 5(10), p = 0.04]. Using a quartile analysis, we found that having a ratio of

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Sex-Specific Changes in Physical Performance Following Military Training: A Systematic Review

Abstract

Introduction

Men and women joining the military undergo the same training, often in mixed-sex platoons. Given the inherent physiological and physical performance differences between men and women, it is reasonable to question whether sex differences exist in the adaptation to military training and, therefore, whether sex-specific training should be employed to optimise training adaptations.

Objective

To systematically review the literature evaluating changes in the physical performance of men and women following military training.

Methods

Six database sources were searched in addition to extensive secondary searching. Primary prospective intervention studies (all designs) evaluating physical training interventions in military populations, reporting pre- to post-training changes in physical fitness outcomes for both women and men, were included.

Results

We screened 3966 unique records. Twenty-nine studies (n = 37 study reports) were included, most of which were conducted in the USA and evaluated initial training for military recruits. Positive changes were more consistently observed in aerobic fitness and muscle strength (whole body and upper body) outcomes than lower body strength, muscle power or muscle endurance outcomes, following physical training. Relative pre- to post-training changes for all outcome measures tended to be greater in women than men although few statistically significant sex by outcome/time interactions were observed.

Conclusion

Improvements in some, but not all, performance components were observed following a period of military training. Largely, these improvements were not significantly different between sexes. Further prospective research is needed to evaluate sex-specific differences in the response to physical training in controlled conditions to improve military physical training outcomes for both sexes.

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