New era of robotic surgical systems

Asian Journal of Endoscopic Surgery, EarlyView.


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Portable Infrared Pupillometer in Patients With Subarachnoid Hemorrhage: Prognostic Value and Circadian Rhythm of the Neurological Pupil Index (NPi)

Background: Portable automated infrared pupillometry is becoming increasingly popular. To generate an objective reference base, the Neurological Pupil index (NPi) which combines different values of the pupillary light reflex is being introduced into clinical practice. In this explorative study, we examined different aspects of the NPi in relation to clinical severity and outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). Materials and Methods: Patients with serial assessment of the NPi (NeurOptics pupillometer NPi-200, Irvine, CA) starting no later than day 2 after aSAH onset were included in the study. Relative numbers of pathologic NPi's, absolute NPi values, and their variances were compared according to aSAH clinical severity grade, functional outcome, and case fatality. The correlation between NPi and intracranial pressure, and NPi periodicity, were also examined. Results: In total, 18 patients with 4456 NPi values were eligible for inclusion in the analysis. The general trend of the NPi over time reflected the course of the neurological illness. Mean NPi tended to be lower in patients with clinically severe compared with nonsevere aSAH (3.75±0.40 vs. 4.56±0.06; P=0.171), and in patients with unfavorable compared with favorable outcomes (3.64±0.48 vs. 4.50±0.08; P=0.198). The mean variance of the NPi was higher in patients with severe compared with nonsevere aSAH (0.49±0.17 vs. 0.06±0.02; P=0.025). Pathologic NPi values were recorded more frequently in patients with severe compared with nonsevere aSAH (16.3%±8.8% vs. 0.0%±0.0%; P=0.002), and in those with unfavorable compared with favorable outcomes (19.2%±10.6% vs. 0.7%±0.6%; P=0.017). NPi was inversely correlated with intracranial pressure (Spearman r=−0.551, P

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New Developments in Psychological Wisdom Research: A Growing Field of Increasing Importance

Looking at the state of the world today, one cannot help but wonder what we need to do to ensure a positive and peaceful future for humanity. How is it possible that knowledge and information have become so much more accessible to people in many parts of the world, but we do not seem to have become any wiser? Sternberg (e.g., Reznitskaya & Sternberg, 2004; Sternberg, 2001) has long been arguing that we need to educate our children for more than just intelligence and knowledge—we need to figure out how to foster wisdom. Wisdom goes beyond intelligence and knowledge in that it includes aspects of self-reflection, openness, compassion, and morality (Glück, in press/a). In other words, it is what enables people to use their intelligence for the sake of a common good (Sternberg, in press). The complexity of wisdom, however, is also what makes it seem elusive to many academic psychologists. For a long time, wisdom psychology was viewed by many as a somewhat "esoteric" field with somewhat dubious research methods—after all, how would one measure such a multifaceted and vague construct?

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Dexamethasone Is Superior to Dexmedetomidine as a Perineural Adjunct for Supraclavicular Brachial Plexus Block: Systematic Review and Indirect Meta-analysis

BACKGROUND: Both dexamethasone and dexmedetomidine are effective peripheral nerve block (PNB) perineural adjuncts that prolong block duration. However, each is associated with side effects. With paucity of head-to-head comparisons of these adjuncts, the question of the best adjunct to mix with local anesthetics (LA) for PNB is unanswered. This meta-analysis aims to inform current practice and future research by identifying the superior adjunct by comparing dexamethasone and dexmedetomidine. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, trials comparing the combination of perineural dexamethasone or dexmedetomidine with LA to LA alone for PNB were sought. The Cochrane Risk of Bias Tool was used to assess the methodological quality of trials, and indirect or network meta-analyses using random-effects modeling were planned. We designated duration of analgesia as a primary outcome. Secondary outcomes included sensory and motor block durations, sensory and motor block onset times, and the risks of hypotension, sedation, and neurological symptoms. RESULTS: Fifty trials were identified, including only 1 direct comparison, precluding a network meta-analysis. Indirect meta-analysis of 49 trials (3019 patients) was performed. Compared to dexmedetomidine, dexamethasone prolonged the duration of analgesia by a mean difference (95% confidence interval [CI]) of 148 minutes (37–259 minutes) (P = .003), without prolonging sensory/motor blockade. Dexmedetomidine increased rates of hypotension (risk ratio [95% CI], 6.3 [1.5–27.5]; P = .01) and sedation (risk ratio [95% CI], 15.8 [3.9–64.6]; P = .0001). Overall risk of bias was moderate, and publication bias was noted, resulting in downgrading evidence strength. CONCLUSIONS: There is low-quality evidence that both adjuncts similarly prolong sensory/motor blockade. However, dexamethasone may be a superior adjunct; it improves the duration of analgesia by a statistically significant increase, albeit clinically modest, equivalent to 2.5 hours more than dexmedetomidine, without the risks of hypotension or sedation. Future direct comparisons are encouraged. Accepted for publication September 10, 2018. Funding: This work was supported by departmental funding from the Department of Anesthesia, Lausanne University Hospital, Lausanne, Switzerland (E.A.), and also from the Department of Anaesthesiology and Pain Medicine, and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada (F.W.A.). Conflicts of Interest: See Disclosures at the end of the article. 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 Faraj W. Abdallah, MD, Department of Anesthesiology and Pain Medicine, and Ottawa Hospital Research Institute, University of Ottawa, The Ottawa Hospital General Campus, 501 Smyth Rd, Ottawa, ON K1H 8L6, Canada. Address e-mail to FAbdallah@toh.ca. © 2018 International Anesthesia Research Society

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Airway Management and Clinical Outcomes in External Laryngeal Trauma: A Case Series

External laryngeal trauma is a rare but potentially fatal event that presents several management challenges. This retrospective observational case series conducted at a level-1 trauma center over a 12-year period consists of 62 cases of acute external laryngeal trauma. Patient demographics, mode and mechanisms of injury, presenting signs and symptoms, initial imaging results, airway management, time to surgical management, and 6-month outcomes including airway status, deglutition status, and voice quality were investigated. No difference was found in mortality or 6-month outcomes between patients requiring surgical repair and/or tracheostomy versus patients with less severe injuries managed conservatively. Accepted for publication August 30, 2018. Funding: None. The authors declare no conflicts of interest. Institutional review board Number and Contact Information: HUM00125057. 2800 Plymouth Rd, Bldg 520, Room 3214, Ann Arbor, MI 48109. E-mail: irbmed@umich.edu. Reprints will not be available from the authors. Address correspondence to Alexandra R. DePorre, MD, Department of Anesthesiology, Michigan Medicine, University of Michigan, 1H247 UH, 1500 E Medical Center Dr, Ann Arbor, MI 48109. Address e-mail to adeporre@med.umich.edu. © 2018 International Anesthesia Research Society

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Labor Pain's Relationship With Depression: From Whence, and What Shall be Done?

No abstract available

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Propofol Regulates Neural Stem Cell Proliferation and Differentiation via Calmodulin-Dependent Protein Kinase II/AMPK/ATF5 Signaling Axis

BACKGROUND: Propofol can cause degeneration of developing brain cells and subsequent long-term learning or memory impairment. However, at the early stage of embryonic development, the molecular mechanism of propofol-induced inhibition in neural stem cells (NSCs) neurogenesis is still unclear. The aim of this study was to determine the role of propofol in NSCs neurogenesis and, more importantly, to explore the underlying mechanism. METHODS: First, a single intraperitoneal injection of propofol was performed in pregnant mice, and 6 hours after administration of propofol, the hippocampus RNA and the protein of the embryos' brains was extracted to analyze the expression of neuron-specific markers. Second, the primary NSCs were isolated from the hippocampus of mouse embryonic brain and then treated with propofol for cell viability, immunostaining, and transwell assays; more importantly, we performed RNA sequencing (RNA-seq) and q-reverse transcription polymerase chain reaction assays to identify genes regulated by propofol; the Western blot, small interfering RNA (SiRNA), and luciferase reporter assays were used to study the effects of propofol on calmodulin-dependent protein kinase (CaMk) II/5' adenosine monophosphate-activated protein kinase (AMPK)/activating transcription factor 5 (ATF5) signaling pathway. RESULTS: Our results indicated that propofol treatment could inhibit the proliferation, migration, and differentiation of NSCs. The results of RNA-seq assays showed that propofol treatment resulted in downregulation of a group of Ca2+-dependent genes. The following mechanism studies showed that propofol regulates the proliferation, differentiation, and migration of NSCs through the CaMkII/phosphorylation of serine at amino acid position 485 (pS485)/AMPK/ATF5 signaling pathway. CONCLUSIONS: The results from study demonstrated that propofol inhibits the proliferation, differentiation, and migration of NSCs, and these effects are partially mediated by CaMkII/pS485/AMPK/ATF5 signaling pathway. Accepted for publication August 30, 2018. Funding: This research was supported by National Natural Science Foundation of China (Grant No. 81400930). 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 Jing Cang, MD, Department of Anesthesiology, Zhongshan Hospital, Fudan University, Xuhui Qu, Shanghai Shi 200032, China. Address e-mail to cangjing1998@126.com. © 2018 International Anesthesia Research Society

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Best Practices for Postoperative Brain Health: Recommendations From the Fifth International Perioperative Neurotoxicity Working Group

As part of the American Society of Anesthesiology Brain Health Initiative goal of improving perioperative brain health for older patients, over 30 experts met at the fifth International Perioperative Neurotoxicity Workshop in San Francisco, CA, in May 2016, to discuss best practices for optimizing perioperative brain health in older adults (ie, >65 years of age). The objective of this workshop was to discuss and develop consensus solutions to improve patient management and outcomes and to discuss what older adults should be told (and by whom) about postoperative brain health risks. Thus, the workshop was provider and patient oriented as well as solution focused rather than etiology focused. For those areas in which we determined that there were limited evidence-based recommendations, we identified knowledge gaps and the types of scientific knowledge and investigations needed to direct future best practice. Because concerns about perioperative neurocognitive injury in pediatric patients are already being addressed by the SmartTots initiative, our workshop discussion (and thus this article) focuses specifically on perioperative cognition in older adults. The 2 main perioperative cognitive disorders that have been studied to date are postoperative delirium and cognitive dysfunction. Postoperative delirium is a syndrome of fluctuating changes in attention and level of consciousness that occurs in 20%–40% of patients >60 years of age after major surgery and inpatient hospitalization. Many older surgical patients also develop postoperative cognitive deficits that typically last for weeks to months, thus referred to as postoperative cognitive dysfunction. Because of the heterogeneity of different tools and thresholds used to assess and define these disorders at varying points in time after anesthesia and surgery, a recent article has proposed a new recommended nomenclature for these perioperative neurocognitive disorders. Our discussion about this topic was organized around 4 key issues: preprocedure consent, preoperative cognitive assessment, intraoperative management, and postoperative follow-up. These 4 issues also form the structure of this document. Multiple viewpoints were presented by participants and discussed at this in-person meeting, and the overall group consensus from these discussions was then drafted by a smaller writing group (the 6 primary authors of this article) into this manuscript. Of course, further studies have appeared since the workshop, which the writing group has incorporated where appropriate. All participants from this in-person meeting then had the opportunity to review, edit, and approve this final manuscript; 1 participant did not approve the final manuscript and asked for his/her name to be removed. Accepted for publication August 27, 2018. Funding: This workshop was sponsored by the American Society of Anesthesiology Brain Health Initiative, the Society for Neuroscience in Anesthesiology and Critical Care, Baxter, and Pfizer. M.B. acknowledges receiving private consulting income from a legal case regarding postoperative cognitive function in an older adult and material support (ie, monitors) from Masimo for a research study. C.H.B. has consulted for and has a data share agreement with Medtronic. M.B. acknowledges support from National Institute on Aging (NIA) K76 AG057020 (and additional support from R03-AG050918 and P30AG028716), K.J.S. from National Institutes of Health (NIH) K12 HD043488 and an Alzheimer's Association Clinician Scientist Fellowship, C.H.B. from NIA K76 AG057020, S.G.D. from NIA K23 AG048332 and the American Foundation for Aging Research, R.A.W. from NIH 2R01GM101698, and R.G.E. from National Institute of General Medical Sciences P01 55876. All collaborators participated in the Best Practices Discussion at the 2016 International Perioperative Neurotoxicity Working Group meeting and helped edit the manuscript. The 2016 Perioperative Neurotoxicity Working group are also listed in Appendix. The authors declare no conflicts of interest. Address correspondence to Miles Berger, MD, PhD, Anesthesiology Department, Duke University Medical Center, 4317 Duke S Orange Zone, Durham, NC 27710. Address e-mail to Miles.berger@duke.edu. © 2018 International Anesthesia Research Society

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Effect of Apneic Oxygenation on Tracheal Oxygen Levels, Tracheal Pressure, and Carbon Dioxide Accumulation: A Randomized, Controlled Trial of Buccal Oxygen Administration

BACKGROUND: Apneic oxygenation via the oral route using a buccal device extends the safe apnea time in most but not all obese patients. Apneic oxygenation techniques are most effective when tracheal oxygen concentrations are maintained >90%. It remains unclear whether buccal oxygen administration consistently achieves this goal and whether significant risks of hypercarbia or barotrauma exist. METHODS: We conducted a randomized trial of buccal or sham oxygenation in healthy, nonobese patients (n = 20), using prolonged laryngoscopy to maintain apnea with a patent airway until arterial oxygen saturation (SpO2) dropped 90% during apnea. RESULTS: Buccal patients were more likely to achieve the primary outcome (P 94%; 750 seconds (750–750 seconds) vs 447 seconds (405–525 seconds); P

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Preclinical Evaluation of Ropivacaine in 2 Liposomal Modified Systems

BACKGROUND: Our research group has recently developed liposomes with ionic gradient and in a combined manner as donor and acceptor vesicles containing ropivacaine (RVC; at 2% or 0.75%). Looking for applications of such novel formulations for postoperative pain control, we evaluated the duration of anesthesia, pharmacokinetics, and tissue reaction evoked by these new RVC formulations. METHODS: The formulations used in this study were large multivesicular vesicle (LMVV) containing sodium acetate buffer at pH 5.5 or in a combined manner with LMVV as donor and large unilamellar vesicles (LUVs) as acceptor vesicles with an external pH of 7.4. Wistar rats were divided into 6 groups (n = 6) and received sciatic nerve block (0.4 mL) with 6 formulations of RVC (LMVVRVC0.75%, LMVV/LUVRVC0.75%, LMVVRVC2%, LMVV/LUVRVC2%, RVC 0.75%, and RVC 2%). To verify the anesthetic effect, the animals were submitted to the pain pressure test and the motor block was also monitored. Histopathology of the tissues surrounding the sciatic nerve region was also assessed 2 and 7 days after treatment. Rats (n = 6) were submitted to a hind paw incision, and mechanical hypersensitivity was measured via the withdrawal response using von Frey filaments after injection of the 6 formulations. Finally, New Zealand white rabbits (n = 6) received sciatic nerve block (3 mL) with 1 of the 6 formulations of RVC. Blood samples were collected predose (0 minutes) and at 15, 30, 45, 60, 90, 120, 180, 240, 300, 360, 420, 480, and 540 minutes after injection. RVC plasma levels were determined using a triple-stage quadrupole mass spectrometer. RESULTS: Duration and intensity of the sensory block were longer with all liposomal formulations, when compared to the plain RVC solution (P

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Two-Year Agility Maintenance Training Slows the Progression of Parkinsonian Symptoms

Introduction Parkinson's disease (PD) is a progressive neurodegenerative condition and it is unclear if long-term non-pharmaceutical interventions can slow the progression of motor and non-motor symptoms and lower drug dose. Methods In a randomized trial, after an initial 3-week-long, 15-session supervised high-intensity sensorimotor agility exercise (E) program designed to improve postural instability, the Exercise+Maintenance (E+M, n=19) group continued to exercise three times per week for 2 years, while E (n=16) and the no exercise and no maintenance control (C, n=20) continued habitual living. Eight outcomes were measured before and after the 3-week initial exercise program and then at 3, 6, 9, 12, 18, and 24 months in all patients. Results The Group by Time interactions (all p

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Accelerometer Data Processing and Energy Expenditure Estimation in Preschoolers

Purpose To assess the capacity of different acceleration metrics from wrist accelerations to estimate total and activity energy expenditure (TEE, AEE) using doubly labelled water (DLW) in preschool children. Methods Thirty-nine preschoolers (5.5±0.1 years) were included. TEE was measured using DLW during 14 days and AEE was then calculated using a predicted basal metabolic rate. Participants wore a wGT3X-BT accelerometer on their non-dominant wrist for ≥5 days. We derived the following metrics from raw accelerations: raw ActiGraph activity counts using the normal filter (NFCounts) and the low-frequency extension (LFECounts); and alternate summary metrics such as the Euclidian norm minus 1 g (ENMO), Euclidian norm of the high-pass filtered accelerations (HFEN), the band-pass filtered accelerations (BFEN), the HFEN plus Euclidean norm of low-pass filtered accelerations minus 1 g (HFEN+) and the mean amplitude deviation (MAD). Results Alternate summary metrics explained a larger proportion of the variance in TEE and AEE than ActiGraph's activity counts (counts: 7-8 and 25% of TEE and AEE; alternate summary metrics: 13-16% and 35-39% of TEE and AEE). Adjustments for body weight and height resulted in an explanation of 51% of AEE by ENMO. All of the metrics adjusted for fat mass (FM) and fat-free mass (FFM) explained up to 84% and 67% of TEE and AEE, respectively. Conclusions ENMO and the other alternate summary metrics explained more of the variance in TEE and AEE than the ActiGraph's activity counts in five-year-old children, suggesting further exploration of these variables in studies on physical activity and energy expenditure in preschoolers. Our results need confirmation in other populations with wider age groups and varying body compositions. Corresponding author: Jairo Hidalgo Migueles, Carretera de Alfacar, S/N. 18071 Granada. (+34) 958 24 43 53. jairohm@ugr.es This study was conducted under the umbrella of the MINISTOP project (Principal investigator ML). The MINISTOP study was funded by the Swedish Research Council (project no. 2012–2883), the Swedish Research Council for Health, Working Life and Welfare (2012-0906), Bo and Vera Axson Johnsons Foundation and Karolinska Institutet (all ML). JHM was supported by a Grant from the Spanish Ministry of Education, Culture and Sport (FPU15/02645); CDN by the Henning and Johan Throne-Holst Foundation; PH by a grant from the Strategic Research Area Health Care Science, Karolinska Institutet/Umeå University; CC-S by the Spanish Ministry of Economy and Competitiveness (BES-2014-068829). Francisco B. Ortega by the Spanish Ministry of Science and Innovation (RYC-2011-09011). Additional funding was obtained from the University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES). This is part of a PhD Thesis conducted in the Biomedicine Doctoral Studies at the University of Granada, Spain. Conflict of interest: The results of the present study do not constitute endorsement by ACSM. We declare that the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 28 September 2018 © 2018 American College of Sports Medicine

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Twenty-Year Trajectories of Physical Activity Types from Midlife to Old Age

Purpose Correlates of physical activity (PA) vary according to type. However, predictors of long-term patterns of PA types into old age are unknown. This study aimed to identify 20-year trajectories of PA types into old age and their predictors. Methods 7735 men (aged 40-59 years) recruited from UK towns in 1978–80 were followed up after 12, 16 and 20 years. Men reported participation in sport/exercise, recreational activity and walking, health status, lifestyle behaviours and socio-demographic characteristics. Group-based trajectory modelling (GBTM) identified the trajectories of PA types and associations with time-stable and time-varying covariates. Results Men with ≥3 measures of sport/exercise (n=5116), recreational activity (n=5085) and walking (n=5106) respectively were included in analyses. Three trajectory groups were identified for sport/exercise, four for recreational activity and three for walking. Poor health, obesity and smoking were associated with reduced odds of following a more favourable trajectory for all PA types. A range of socioeconomic, regional and lifestyle factors were also associated with PA trajectories but the magnitude and direction were specific to PA type. For example, men with manual occupations were less likely to follow a favourable sport/exercise trajectory but more likely to follow an increasing walking trajectory compared to men with non-manual occupations. Retirement was associated with increased PA but this was largely due to increased sport/exercise participation. Conclusion PA trajectories from middle to old age vary by activity type. The predictors of these trajectories and effects of major life events, such as retirement, are also specific to the type of PA. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Corresponding author: Daniel Aggio, d.aggio@ucl.ac.uk, +44 (0)207 830 2335, Department of Primary Care & Population Health, Institute of Epidemiology and Health Care, UCL Medical School, Royal Free Campus, Rowland Hill Street, London NW3 2PF UK The results of this study do not constitute endorsement by the American College of Sports Medicine, and the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. DA is funded by a British Heart Foundation PhD studentship (FS/15/70/32044). This research was also supported by an NIHR Post-Doctoral Fellowship awarded to BJJ (2010–03–023) and by a British Heart Foundation project grant (PG/13/86/30546) to BJJ. The British Regional Heart study is supported by a British Heart Foundation grant (RG/13/16/30528). Conflicts of interest: None to declare Accepted for Publication: 13 September 2018 © 2018 American College of Sports Medicine

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Walking Pace Is Associated with Lower Risk of All-Cause and Cause-Specific Mortality

Purpose Walking pace is associated with all-cause and cardiovascular disease (CVD) mortality. Whether this association extends to other health outcomes and whether it is independent of total amount of time walked are currently unknown. Therefore, the aim of this study was to investigate whether usual walking pace is associated with a range of health outcomes. Methods 318,185 UK Biobank participants (54% women) aged 40-69 years were included. Walking pace and total walking time were self-reported. The outcomes comprised: all-cause mortality as well as incidence and mortality from cardiovascular disease (CVD), respiratory disease and cancer. The associations were investigated using Cox proportional hazard models. Results Over a mean of 5.0 years [ranging from 3.3 to 7.8], 5,890 participants died, 18,568 developed CVD, 5,430 respiratory disease and 19,234 cancer. In a fully adjusted model, compared to slow pace walkers, men and women, respectively, with a brisk pace having lower risk of mortality from all-causes (HR0.79 [95% CI: 0.69; 0.90] and 0.73 [95% CI: 0.62; 0.85]), CVD (HR 0.62 [0.50; 0.76] and 0.80 [0.73; 0.88]), respiratory disease (HR 0.58 [95% CI 0.43; 0.78] and 0.66 [0.57; 0.77]), COPD (HR 0.26 [95% 0.12; 0.56] and 0.28 [0.16; 0.49]). No associations were found for all-cause cancer, colorectal, breast cancer. However, brisk walking was associated with a higher risk of prostate cancer. Conclusions Walking pace is associated with lower risk of a wide range of important health conditions, independently of overall time spent walking. ‡CCM, SG and FP contributed equally to this work and are joint first authors * JPP, NS, JMRG contributed equally to this work and are joint senior authors. CORRESPONDING AUTHOR: Professor Jason Gill, BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life, Sciences, University of Glasgow, Glasgow G12 8TA, UK. Tel: 044 (0) 141 3304201; Fax: 044 (0) 141 3305481; E-mail address: jason.gill@glasgow.ac.uk This research has been conducted using the UK Biobank Resource under Application Number 7155. The UK Biobank was supported by the Wellcome Trust, Medical Research Council, Department of Health, Scottish Government and the Northwest Regional Development Agency. It has also had funding from the Welsh Assembly Government and the British Heart Foundation. The research was designed, conducted, analysed and interpreted by the authors entirely independently of the funding sources. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation, and statement that results of the present study do not constitute endorsement by ACSM. CONFLICT OF INTEREST: The authors declare that they have no conflict of interest. Accepted for Publication: 12 September 2018. © 2018 American College of Sports Medicine

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The Clinicopathological Correlations of hTERC Amplification with Esophageal Squamous Cell Precursor Lesions

Abstract

Background

Esophageal squamous cell precursor lesions remain one of the most controversial topics in pathology and clinical management.

Aims

To analyze the dysregulation of human telomerase RNA component (hTERC) in esophageal squamous cell precursor lesions and the clinicopathological correlations with the characteristics of esophageal squamous cell precursor lesions.

Methods

Florescence in situ hybridization was performed to detect hTERC amplification in different gradings of esophageal squamous cell precursor lesions. With retrospective follow-up data, clinicopathological correlations between hTERC and esophageal squamous cell precursor lesions were subjected to logistic regression analysis.

Results

hTERC amplification gradually increased with upgrading of dysplasia, reaching the highest level in high-grade intraepithelial neoplasia, and there was a significant difference between the low-grade intraepithelial neoplasia group and the high-grade intraepithelial neoplasia group (P = 0.00). Logistic regression analysis showed that hTERC amplification was correlated with both dysplasia grading and ulcer characteristics of esophageal squamous cell precursor lesions (P < 0.05).

Conclusions

hTERC amplification with increasing grading of esophageal squamous cell precursor lesions and the presence of ulcer characteristics might provide an important molecular and pathological marker for the diagnosis and clinical prognosis of esophageal squamous cell precursor lesions, especially for those ambiguous cases with more divergence in classification.

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Endoscopic Indication of Endoscopic Submucosal Dissection for Early Gastric Cancer Is Not Compatible with Pathologic Criteria in Clinical Practice

Abstract

Background

The inappropriate selection of patients with early gastric cancer (EGC) for endoscopic submucosal dissection (ESD) may lead to additional surgery because of a non-curative resection. This study was performed to assess the accuracy of clinical decisions in ESD for EGC.

Methods

A total of 607 cases of EGC treated by ESD were prospectively enrolled from January 2011 to June 2014 at a single academic hospital. The 607 EGCs were divided into three groups (overestimated, same-estimated, and underestimated) based on pre-procedure endoscopic findings (indication) and pathological diagnosis after ESD (criteria). We evaluated the discrepancy rates between pre-procedure indication and pathological criteria, and then analyzed the pre-procedure factors that could influence the occurrence of the discrepancies.

Results

The absolute, expanded, and beyond the expanded indication has its accuracy on curability criteria in 87%, 77.6%, and 55.6% of cases, respectively. The ratio of overall indication-criteria discrepancies was 250/607 (41.2%). The curability was significantly lower in the underestimated group compared to the overestimated and same-estimated groups (41.6% vs. 94.6%, 94.4%, p < 0.001). In multivariate analysis examining the predictive factors for discrepancies in the 598 EGCs with absolute/expanded indications, the endoscopic size ≥ 20 mm [odds ratio (OR) 2.493, confidence interval (CI) 1.546–4.022, p < 0.001], presence of ulcers (OR 1.712, CI 1.070–2.738, p = 0.025), patient age < 60 years (OR 1.689, CI 1.044–2.733, p = 0.033), and undifferentiated type EGC on forceps biopsy (OR 5.397, CI 2.027–14.369, p = 0.001) were all associated with discrepancies.

Conclusions

Indication judged by pre-procedural endoscopy is not sufficiently accurate to be used as a good measurement for post-procedural criteria.

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Ultra-short Celiac Disease Is a Distinct and Milder Phenotype of the Disease in Children

Abstract

Background and Aims

Approximately 10% of children with celiac disease (CD) have ultra-short celiac disease (USCD), where histological abnormalities are limited to the duodenal bulb. The aim of our retrospective study was to identify clinical and serological characteristics at baseline and at follow-up of children with USCD.

Methods

All children that were diagnosed with CD in our unit during 7/2010–12/2017, in whom biopsies were taken from duodenal bulb and second part, were included. We compared disease characteristics and course between children with USCD and children with involvement in the second part of the duodenum.

Results

Out of 3740 children who underwent upper gastrointestinal endoscopies, 648 were diagnosed with CD. Seventy-one (11%) of those children had limited involvement in the duodenal bulb. The USCD group included more females (P = 0.021), were older (P = 0.005), had a lower prevalence of diarrhea (P = 0.003), anemia (P = 0.007), anti-tissue transglutaminase (TTG) antibodies count (P < 0.001) at presentation, lower frequency of endoscopic abnormality, lower Marsh score, and a trend toward shorter time to the normalization of anti-TTG antibodies under a gluten-free diet compared to the extensive CD. There were no differences in body mass index or duration of symptoms before diagnosis.

Conclusion

Children with USCD presented with a distinct phenotype of milder symptoms, lower celiac serology, and milder endoscopic and histological findings, with a trend toward faster normalization under a gluten-free diet compared to those with extensive CD. Further studies are needed to determine the long-term course and prognosis of USCD.

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Underserved Does Not Mean Undeserved: Unfurling the HCV Care in the Safety Net

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Incidence and Management of Infusion Reactions to Infliximab in an Alternate Care Setting

Abstract

Background

Infliximab is a chimeric anti-tumor necrosis factor alpha (TNF-α) monoclonal antibody that ameliorates inflammation when it binds to and neutralizes TNF-α. It is often used in patients with Crohn's disease and ulcerative colitis to reduce the severity of disease symptoms and induce disease remission. Infusions are generally administered in the hospital setting due to concerns over patient safety, and limited data exist regarding the incidence and management of infusion reactions (IRs) in an alternate care setting without direct physician oversight.

Aims

The aim of this study was to evaluate the incidence of IRs following administration of infliximab and associated management approaches in an alternate care setting.

Methods

A retrospective chart review of 796 patients with Crohn's disease or ulcerative colitis that received a combined 5581 infusions with one home infusion provider between January 2014 and November 2016 was conducted. Timing, severity, management approach, and outcomes of IRs were abstracted and analyzed.

Results

A total of 109 infusion reactions (2.0% of all infusions) were recorded in 62 patients (7.8% of all patients). The majority of these reactions were acute and mild or moderate in severity and resolved with rate adjustments and/or medication. Emergency room visits were required in 0.1% of all infusions, and 0.3% of all infusions were not completed due to a reaction.

Conclusions

IRs to infliximab were uncommon and mostly mild or moderate in severity. Resolution of the IR and continuation of therapy was achieved in most patients through a management approach that included prompt recognition and initial treatment via rate adjustments and medications according to physician's orders.

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Reduced Imaging Radiation Exposure and Costs Associated with Anti-Tumor Necrosis Factor Therapy in Crohn’s Disease

Abstract

Background

Radiation exposure from diagnostic imaging may increase cancer risk of Crohn's disease (CD) patients, who are already at increased risk of certain cancers.

Aim

To compare imaging radiation exposure and associated costs in CD patients during the year pre- and post-initiation of anti-tumor necrosis factor (anti-TNF) agents or corticosteroids.

Methods

Adults were identified from a large US claims database between 1/1/2005 and 12/31/2009 with ≥ 1 abdominal imaging scan and 12 months of enrollment before and after initiating therapy with anti-TNF or corticosteroids. Imaging utilization, radiation exposure, and healthcare costs pre- and post-initiation were examined.

Results

Anti-TNF-treated patients had significantly fewer imaging examinations the year prior to initiation than corticosteroid-treated patients. Cumulative radiation doses before initiation were significantly higher for corticosteroid patients compared to anti-TNF patients (22.3 vs. 17.7 millisieverts, P = 0.0083). After therapy initiation, anti-TNF-treated patients had significantly fewer imaging examinations (2.9 vs. 5.2, P < 0.0001) and less radiation exposure (7.4 vs. 15.4 millisieverts, P <0.0001) than corticosteroid-treated patients in the follow-up period. Reductions in imaging costs adjusted for 1000 patient-years after initiation of therapy were − $275,090 and − $121,960 (P = 0.0359) for anti-TNF versus corticosteroid patients, respectively.

Conclusions

This analysis demonstrated that patients treated with anti-TNF agents have fewer imaging examinations, less radiation exposure, and lower healthcare costs associated with imaging than patients treated with corticosteroids. These benefits do not account for additional long-term benefits that may be gained from reduced radiation exposure.

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Body Mass Index and the Risk of Deep Surgical Site Infection Following Posterior Cervical Instrumented Fusion

Surgical site infection (SSI) following spine surgery is associated with increased morbidity, reoperation rates, hospital readmissions and cost. The incidence of SSI following posterior cervical spine surgery is higher than anterior cervical spine surgery, with rates from 4.5-18%. It is well documented that higher body mass index (BMI) is associated with increased risk of SSI after spine surgery. There are only a few studies that examine the correlation of BMI and SSI after posterior cervical instrumented fusion (PCIF) using national databases, however, none that compare trauma and non-traumatic patients.

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Negligible impact of birth on renal function and drug metabolism

Pediatric Anesthesia, EarlyView.


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Caudal and intravenous dexmedetomidine similarly prolong the duration of caudal analgesia in children: A randomized controlled trial

Pediatric Anesthesia, Volume 28, Issue 10, Page 888-896, October 2018.


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A cluster of high psychological and somatic symptoms in children with idiopathic scoliosis predicts persistent pain and analgesic use 1 year after spine fusion

Pediatric Anesthesia, Volume 28, Issue 10, Page 873-880, October 2018.


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Cover Image

Pediatric Anesthesia, Volume 28, Issue 10, Page i-i, October 2018.


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Issue Information

Pediatric Anesthesia, Volume 28, Issue 10, Page iii-v, 827‐828, October 2018.


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Autonomic cardiac regulation after general anesthesia in children

Pediatric Anesthesia, Volume 28, Issue 10, Page 881-887, October 2018.


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Reply to Galante, Dario, regarding their comment ‘Tracheobronchial angles in children: Can it change during anesthesia?’

Pediatric Anesthesia, Volume 28, Issue 10, Page 930-930, October 2018.


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Inside Cover

Pediatric Anesthesia, Volume 28, Issue 10, Page ii-ii, October 2018.


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Incidence of hypoglycemia in fasted young children referred for elective surgery

Pediatric Anesthesia, Volume 28, Issue 10, Page 933-934, October 2018.


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In this issue October 2018

Pediatric Anesthesia, Volume 28, Issue 10, Page 829-829, October 2018.


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Ultrasound‐guided serratus anterior plane block for effective pain control after resection of large chest wall vascular malformation in a child with Phosphatase and Tensin (PTEN) hamartoma tumor syndrome

Pediatric Anesthesia, Volume 28, Issue 10, Page 931-933, October 2018.


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A simple care bundle to reduce unplanned admission rate for day case pediatric circumcision

Pediatric Anesthesia, Volume 28, Issue 10, Page 924-929, October 2018.


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In‐hospital usability and feasibility evaluation of Panda, an app for the management of pain in children at home

Pediatric Anesthesia, Volume 28, Issue 10, Page 897-905, October 2018.


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Correcting for repeated outcome measures

Pediatric Anesthesia, Volume 28, Issue 10, Page 935-935, October 2018.


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Can population cohort studies assess the long‐term impact of anesthesia in children?

Pediatric Anesthesia, Volume 28, Issue 10, Page 930-931, October 2018.


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The phylogenomics of evolving virus virulence

The phylogenomics of evolving virus virulence

The phylogenomics of evolving virus virulence, Published online: 10 October 2018; doi:10.1038/s41576-018-0055-5

The virulence of viruses is a major determinant of the health burden of viral infections in humans and other species. In this article, Geoghegan and Holmes discuss how largely disparate research fields — theoretical modelling of virulence evolution and experimental dissection of genetic virulence determinants in laboratory model systems — can be bridged by considering real genomic data of viral evolution in a phylogenetic context. They describe the underlying principles of virulence evolution and how they apply to real-world viral infections and outbreaks of global importance.

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The phylogenomics of evolving virus virulence

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Genome-wide association studies for corneal and refractive astigmatism in UK Biobank demonstrate a shared role for myopia susceptibility loci

Abstract

Previous studies have suggested that naturally occurring genetic variation contributes to the risk of astigmatism. The purpose of this investigation was to identify genetic markers associated with corneal and refractive astigmatism in a large-scale European ancestry cohort (UK Biobank) who underwent keratometry and autorefraction at an assessment centre. Genome-wide association studies for corneal and refractive astigmatism were performed in individuals of European ancestry (N = 86,335 and 88,005 respectively), with the mean corneal astigmatism or refractive astigmatism in fellow eyes analysed as a quantitative trait (dependent variable). Genetic correlation between the two traits was calculated using LD Score regression. Gene-based and gene-set tests were carried out using MAGMA. Single marker-based association tests for corneal astigmatism identified four genome-wide significant loci (P < 5 × 10⁻⁸) near the genes ZC3H11B (1q41), LINC00340 (6p22.3), HERC2/OCA2 (15q13.1) and NPLOC4/TSPAN10 (17q25.3). Three of these loci also demonstrated genome-wide significant association with refractive astigmatism: LINC00340, HERC2/OCA2 and NPLOC4/TSPAN10. The genetic correlation between corneal and refractive astigmatism was 0.85 (standard error = 0.068, P = 1.37 × 10⁻³⁵). Here, we have undertaken the largest genome-wide association studies for corneal and refractive astigmatism to date and identified four novel loci for corneal astigmatism, two of which were also novel loci for refractive astigmatism. These loci have previously demonstrated association with axial length (ZC3H11B), myopia (NPLOC4), spherical equivalent refractive error (LINC00340) and eye colour (HERC2). The shared role of these novel candidate genes for astigmatism lends further support to the shared genetic susceptibility of myopia and astigmatism.

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Transcriptome profiling suggests roles of innate immunity and digestion metabolism in purplish Washington clam

Abstract

The purplish Washington clam (Saxidomus purpuratus) in the family Veneridae is distributed widely along the intertidal zones of northeast Asia and is increasingly being utilized as a commercially important food resource. Bivalves maintain homeostasis by regulating their food intake and digestion, innate immunity, and biotransformation in a mollusk-specific organ, the digestive gland. To understand digestive gland-specific pathways, we generated a high-quality de novo assembly of the digestive gland transcriptome of this clam using the Illumina Miseq platform. A total of 9.9 million raw reads were obtained and assembled using the Oases assembly platform, resulting in 27,358 contigs with an N50 of 433 bp. Functional gene annotations were performed using Gene Ontology, Eukaryotic Orthologous Groups, and Kyoto Encyclopedia of Genes and Genomes pathway analyses. In the transcriptome, many crucial genes involved in innate immunity and digestion metabolism were detected. A number of enzymes associated with drug metabolism were annotated, as much as that identified from the whole transcriptome of the Pacific oyster Crassostrea gigas. We provide valuable sequence information of S. purpuratus to predict functional understandings of the bivalve-specific digestive gland. This resource will be valuable for researchers comparing gene compositions and their expression levels in the digestive glands of bivalves.

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Heart rate variability of typically developing and autistic children and adults before, during and after sleep

Publication date: Available online 9 October 2018

Source: International Journal of Psychophysiology

Author(s): Marie-Pierre Tessier, Marie-Hélène Pennestri, Roger Godbout

Abstract

Introduction

Studies suggest a sympathetic-parasympathetic disequilibrium in children with autism spectrum disorder (ASD), compared to typically developing (TD) children. The autonomic nervous system (ANS) shows profound modification with age but studies in ASD adults are lacking. The ANS is also influenced by vigilance states such as wakefulness and sleep. The aim of this study is to explore differences in ANS activity in typically developing (TD) and ASD individuals during sleep and wakefulness, as a function of age.

Methods

Four groups of participants (17 adults with ASD, 16 TD adults, 13 children with ASD and 13 TD children) were recorded for two consecutive nights in a sleep laboratory. Electrocardiogram (ECG) was sampled during wakefulness (before and after sleep) and during stage N2 and REM sleep. Groups were compared on their heart rate variability parameters (LFnu, HFnu, LF/HF ratio) in each vigilance state.

Results

Results show that ASD adults had lower HFnu in the morning than TD adults (p < 0.05). During REM sleep, adults had higher LF/HF ratio than children, regardless of their clinical status (p < 0.05).

Conclusions

Results of this study show autonomic distinctiveness during wakefulness specifically in ASD adults, suggesting a lower parasympathetic activity in the morning. Whether this characteristic represents a developmental feature or is related to lower sleep quality remains to be clarified.

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Measurement Characteristics and Clinical Utility of the Motor Evaluation Scale for Upper Extremity in Stroke Patients

Publication date: Available online 9 October 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Ann Van de Winckel, Linda Ehrlich-Jones

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Instability of microsatellites linked to targeted genes in CRISPR/Cas9-edited and traditional gene knockout mouse strains

Publication date: Available online 10 October 2018

Source: Journal of Genetics and Genomics

Author(s): Xueyun Huo, Xiulin Zhang, Yihan Liu, Yizhu Sun, Yu Ren, Changlong Li, Xiaoyan Du, Zhenwen Chen

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Heterogeneous ribonucleoprotein F regulates YAP expression via a G-tract in 3′UTR

Publication date: Available online 10 October 2018

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

Author(s): Wing-Keung Chu, Li-Man Hung, Chun-Wei Hou, Jan-Kan Chen

Abstract

The Yes-associated protein (YAP) is a transcription coactivator that plays crucial roles in organ size control and tumorigenesis, and was demonstrated to be inhibited by the Hippo signaling pathway. To date, the molecular mechanisms regulating the expression of YAP in human cells remain unknown. In the present study, we found that hnRNP F and hnRNP U negatively regulate YAP expression. We also showed that downregulation of YAP expression by hnRNP F and hnRNP U was not at the transcriptional level. Knockdown of hnRNP F or hnRNP U increased YAP mRNA stability, suggesting the downregulation of YAP expression was by a post-transcriptional mechanism. A putative hnRNP F binding site was identified in the YAP 3′UTR at 685 to 698, and deletion of this putative hnRNP F element abolished the down-regulation effect of YAP mRNA stability by hnRNP F. Binding of the hnRNP F to the YAP 3′UTR was demonstrated by Cross-linked RNA Immunoprecipitation. mRNA stability is a possible secondary effect of alternative splicing or other nuclear process. Understanding the regulation of YAP expression would provide insights into the mechanisms underlying the maintenance of tissue size homeostasis and tumorigenesis.

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Myt1 and Myt1l transcription factors limit proliferation in GBM cells by repressing YAP1 expression

Publication date: Available online 10 October 2018

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

Author(s): Tiffany A. Melhuish, Izabela Kowalczyk, Arkadi Manukyan, Ying Zhang, Anant Shah, Roger Abounader, David Wotton

Abstract

Myelin transcription factor 1 (Myt1) and Myt1l (Myt1-like) are zinc finger transcription factors that regulate neuronal differentiation. Reduced Myt1l expression has been implicated in glioblastoma (GBM), and the related St18 was originally identified as a potential tumor suppressor for breast cancer. We previously analyzed changes in gene expression in a human GBM cell line with re-expression of either Myt1 or Myt1l. This revealed largely overlapping gene expression changes, suggesting similar function in these cells. Here we show that re-expression of Myt1 or Myt1l reduces proliferation in two different GBM cell lines, activates gene expression programs associated with neuronal differentiation, and limits expression of proliferative and epithelial to mesenchymal transition gene-sets. Consistent with this, expression of both MYT1 and MYT1L is lower in more aggressive glioma sub-types. Examination of the gene expression changes in cells expressing Myt1 or Myt1l suggests that both repress expression of the YAP1 transcriptional coactivator, which functions primarily in the Hippo signaling pathway. Expression of YAP1 and its target genes is reduced in Myt-expressing cells, and there is an inverse correlation between YAP1 and MYT1/MYT1L expression in human brain cancer datasets. Proliferation of GBM cell lines is reduced by lowering YAP1 expression and increased with YAP1 over-expression, which overcomes the anti-proliferative effect of Myt1/Myt1l expression. Finally we show that reducing YAP1 expression in a GBM cell line slows the growth of orthotopic tumor xenografts. Together, our data suggest that Myt1 and Myt1l directly repress expression of YAP1, a protein which promotes proliferation and GBM growth.

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mRNA cap regulation in mammalian cell function and fate

Publication date: Available online 9 October 2018

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

Author(s): Alison Galloway, Victoria H. Cowling

Abstract

In this review we explore the regulation of mRNA cap formation and its impact on mammalian cells. The mRNA cap is a highly methylated modification of the 5′ end of RNA pol II-transcribed RNA. It protects RNA from degradation, recruits complexes involved in RNA processing, export and translation initiation, and marks cellular mRNA as "self" to avoid recognition by the innate immune system. The mRNA cap can be viewed as a unique mark which selects RNA pol II transcripts for specific processing and translation. Over recent years, examples of regulation of mRNA cap formation have emerged, induced by oncogenes, developmental pathways and during the cell cycle. These signalling pathways regulate the rate and extent of mRNA cap formation, resulting in changes in gene expression, cell physiology and cell function. This article is part of a Special Issue entitled: mRNA modifications in gene expression control edited by Dr. Soller Matthias and Dr. Fray Rupert.

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Effects of Blood Flow Restriction Training on Muscular Strength and Hypertrophy in Older Individuals: A Systematic Review and Meta-Analysis

Abstract

Background

The combination of low-load resistance training with blood flow restriction (BFR) has recently been shown to promote muscular adaptations in various populations. To date, however, evidence is sparse on how this training regimen influences muscle mass and strength in older adults.

Purpose

The purpose of this systematic review and meta-analysis was to quantitatively identify the effects of low-load BFR (LL-BFR) training on muscle mass and strength in older individuals in comparison with conventional resistance training programmes. Additionally, the effectiveness of walking with and without BFR was assessed.

Methods

A PRISMA-compliant systematic review and meta-analysis was conducted. The systematic literature research was performed in the following electronic databases from inception to 1 June 2018: PubMed, Web of Science, Scopus, CINAHL, SPORTDiscus and CENTRAL. Subsequently, a random-effects meta-analysis with inverse variance weighting was conducted.

Results

A total of 2658 articles were screened, and 11 studies with a total population of N = 238 were included in the meta-analysis. Our results revealed that during both low-load training and walking, the addition of BFR elicits significantly greater improvements in muscular strength with pooled effect sizes (ES) of 2.16 (95% CI 1.61 to 2.70) and 3.09 (95% CI 2.04 to 4.14), respectively. Muscle mass was also increased when comparing walking with and without BFR [ES 1.82 (95% CI 1.32 to 2.32)]. In comparison with high-load training, LL-BFR promotes similar muscle hypertrophy [ES 0.21 (95% CI − 0.14 to 0.56)] but lower strength gains [ES − 0.42 (95% CI − 0.70 to − 0.14)].

Conclusion

This systematic review and meta-analysis reveals that LL-BFR and walking with BFR is an effective interventional approach to stimulate muscle hypertrophy and strength gains in older populations. As BFR literature is still scarce with regard to potential moderator variables (e.g. sex, cuff pressure or training volume/frequency), further research is needed for strengthening the evidence for an effective application of LL-BFR training in older people.

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Relationship between physical activity and intramyocellular lipid content is different between young and older adults

Abstract

Purpose

Intramyocellular lipid (IMCL) is influenced by physical exercise; however, whether the habitual level of physical activity affects resting IMCL content remains unclear. The purpose of this study was to determine the relationship between physical activity levels and resting IMCL content in young and older adults.

Methods

In total, 15 nonobese young adults (21.0 ± 0.0 years) and 15 older adults (70.7 ± 3.8 years) were recruited. Time spent performing physical activities for 10 days was assessed using a three-dimensional ambulatory accelerometer, and intensity was categorized as light [< 3.0 metabolic equivalents (METs)], moderate (3.0–6.0 METs), or vigorous (> 6.0 METs). Physical activity level was calculated as the product of METs and time spent performing physical activities (MET h) at each intensity level. The IMCL content in the vastus lateralis was determined using ¹H-magnetic resonance spectroscopy after overnight fasting.

Results

No significant differences in IMCL content were observed between young and older adults. Vigorous intensity physical activity (time and MET h) was significantly lower in older than young adults (p < 0.01); this difference was not observed for light and moderate intensity physical activity. Light intensity physical activity (time and MET h) was significantly and inversely correlated with IMCL content in young adults (r = − 0.59 and r = − 0.58; both p < 0.05), but not in older adults.

Conclusions

These results suggest that daily light intensity physical activity reduces resting IMCL content in young adults, whereas no significant relationship was seen between daily physical activity and resting IMCL content in older adults.

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Benefit of early vs deferred antiretroviral therapy on progression of liver fibrosis among people with HIV in the START randomized trial

Hepatology

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Efficacy and safety of peginterferon alfa-2a (40KD) in children with chronic hepatitis B: The PEG-B-ACTIVEStudy

Hepatology

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Diploid/triploid mixoploidy: A consequence of asymmetric zygotic segregation of parental genomes

American Journal of Medical Genetics Part A, EarlyView.


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Imaging phenotype of multiple mitochondrial dysfunction syndrome 2, a rare BOLA3‐associated leukodystrophy

American Journal of Medical Genetics Part A, EarlyView.


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Proceedings of the fifth international RASopathies symposium: When development and cancer intersect

American Journal of Medical Genetics Part A, EarlyView.


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Contemporary Academic Contributions From Anesthesiologists in Adult Critical Care Medicine

BACKGROUND: Anesthesiology has a long relationship with critical care medicine (CCM). However, US anesthesiologists are less likely to practice CCM than non-US anesthesiologists. To date, no studies have compared academic contributions in CCM between US anesthesiologists and non-US anesthesiologists. The objective of our study was to use recent trends in critical care publications as a surrogate for academic contribution among US and non-US anesthesiologists. METHODS: Research articles published between 2010 and 2015 in 3 anesthesiology journals (Anesthesiology, Anesthesia & Analgesia, and British Journal of Anaesthesia) and 3 multidisciplinary CCM journals (Critical Care Medicine, Intensive Care Medicine, and Journal of Critical Care) were reviewed. Author information, including the primary department appointment and geographic location for the first and senior author(s), and article details, including topic and publication type, were collected. Odds ratios for having a first or senior author from the United States were calculated. Anesthesiologists' contributions in individual journals were summarized, as were trends in anesthesiology CCM publications during the 6-year study period. RESULTS: A total of 3831 articles were reviewed, with 1050 (27.4%) having US authors. Eighty-two and one-half percent of CCM articles in anesthesiology journals had a US anesthesiologist as first author, and 81% had a US anesthesiologist as senior author, while fewer CCM articles in multidisciplinary journals had a US anesthesiologist as first (12.1%) or senior (12.3%) author. When considering all publications, 16.3% and 16.4% of articles had a US anesthesiologist as the first or senior author compared with articles for which non-US anesthesiologists were first (23.8%) or senior (20.9%) authors. The odds of having a US anesthesiologist as first or senior author compared to a non-US anesthesiologist for all publications were 0.6 (0.5–0.7) and 0.7 (0.6–0.9). The number of publications trended downward for both US anesthesiologists and non-US anesthesiologists during the study period. CONCLUSIONS: When compared to non-US anesthesiologists, US anesthesiologists had more CCM publications in anesthesiology journals and fewer publications in multidisciplinary CCM journals. The number of anesthesiology CCM publications decreased for both US and non-US anesthesiologists throughout the study period. Accepted for publication September 5, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Jesse J. Kiefer, MD, Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, 3400 Spruce St, Silverstein #5036, Philadelphia, PA 19104. Address e-mail to jesse.kiefer@uphs.upenn.edu. © 2018 International Anesthesia Research Society

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Mild Perioperative Hypothermia and Myocardial Injury: A Retrospective Cohort Analysis

BACKGROUND: We tested the primary hypothesis that final intraoperative esophageal temperature is associated with increased odds of a composite of in-hospital all-cause mortality and myocardial injury within 7 days after noncardiac surgery. Secondary exposures were time-weighted average intraoperative temperature and area

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Intensive Care Unit Readmission After Left Ventricular Assist Device Implantation: Causes, Associated Factors, and Association With Patient Mortality

BACKGROUND: Previous studies on readmissions after left ventricular assist device (LVAD) implantation have focused on hospital readmissions after dismissal from the index hospitalization. Because few data exist, the purpose of this study was to examine intensive care unit (ICU) readmissions in patients during their initial hospitalization for LVAD implantation to determine reasons for, factors associated with, and incidence of mortality after ICU readmission. METHODS: A retrospective analysis was performed from February 2007 to March 2015 of patients at our institution receiving first-time LVAD implantation. After LVAD implantation, patients dismissed from the ICU who then required ICU readmission before hospital dismissal were compared to those not requiring ICU readmission before hospital dismissal with respect to preoperative, intraoperative, and postoperative factors. RESULTS: Among 287 LVAD patients, 266 survived their initial ICU admission, of which 49 (18.4%) required ICU readmission. The most common reasons for readmission were bleeding and respiratory failure. Factors found to be univariably associated with ICU readmission were preoperative hemoglobin, preoperative aspartate aminotransferase, preoperative atrial fibrillation, preoperative dialysis, longer cardiopulmonary bypass times, and higher intraoperative allogeneic blood transfusion requirements. Multivariable analysis revealed ICU readmission to be independently associated with preoperative dialysis (odds ratio, 12.86; 95% confidence interval, 3.16–52.28; P

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Recognizing the Chinese Pioneer of Neuraxial Labor Analgesia: Dr Guang-Bo Zhang and Her Unpublished Manuscript From More Than a Half-Century Ago

Dr Guang-Bo Zhang was the first anesthesiologist to administer and study the effects of labor epidural analgesia in China. Between September 1963 and March 1964, she conducted an observational study evaluating the effects of neuraxial analgesia for laboring women. She presented her research and prepared an article; however, due to the Great Proletarian Cultural Revolution (Cultural Revolution), which began in 1966, her work went unpublished. She successfully preserved her unpublished article, notes, and slides throughout the Cultural Revolution by hiding them in a countryside location near Beijing. These 54-year-old, previously unpublished documents represent the first known clinical trial of neuraxial labor analgesia conducted in China. Accepted for publication Septermber 5, 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). LMA is a registered trademark of Teleflex Incorporated or its affiliates. Reprints will not be available from the authors. Address correspondence to Ling-Qun Hu, MD, Department of Anesthesiology, Northwestern University Feinberg School of Medicine, 251 E Huron St F4-701, Chicago, IL 60611. Address e-mail to l-hu2@northwestern.edu. © 2018 International Anesthesia Research Society

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Emergency Department Airway Management Responsibilities in the United States

BACKGROUND: In the 1990s, emergency medicine (EM) physicians were responsible for intubating about half of the patients requiring airway management in emergency rooms. Since then, no studies have characterized the airway management responsibilities in the emergency room. METHODS: A survey was sent via the Eastern Association for Surgery and Trauma and the Trauma Anesthesiology Society listservs, as well as by direct solicitation. Information was collected on trauma center level, geographical location, department responsible for intubation in the emergency room, department responsible for intubation in the trauma bay, whether these roles differed for pediatrics, whether an anesthesiologist was available "in-house" 24 hours a day, and whether there was a protocol for anesthesiologists to assist as backup during intubations. Responses were collected, reviewed, linked by city, and mapped using Python. RESULTS: The majority of the responses came from the Eastern Association for Surgery of Trauma (84.6%). Of the respondents, 72.6% were from level-1 trauma centers, and most were located in the eastern half of the United States. In the emergency room, EM physicians were primarily responsible for intubations at 81% of the surveyed institutions. In trauma bays, EM physicians were primarily responsible for 61.4% of intubations. There did not appear to be a geographical pattern for personnel responsible for managing the airway at the institutions surveyed. CONCLUSIONS: The majority of institutions have EM physicians managing their airways in both emergency rooms and trauma bays. This may support the observations of an increased percentage of airway management in the emergency room and trauma bay setting by EM physicians compared to 20 years ago. Accepted for publication September 5, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Joshua W. Sappenfield, MD, Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Rd, PO Box 100254, Gainesville, FL 32610. Address e-mail to jsappenfield@anest.ufl.edu. © 2018 International Anesthesia Research Society

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Fluid Challenge During Anesthesia: A Systematic Review and Meta-analysis

BACKGROUND: Assessing the volemic status of patients undergoing surgery is part of the routine management for the anesthesiologist. This assessment is commonly performed by means of dynamic indexes based on the cardiopulmonary interaction during mechanical ventilation (if available) or by administering a fluid challenge (FC). The FC is used during surgery to optimize predefined hemodynamic targets, the so-called Goal-Directed Therapy (GDT), or to correct hemodynamic instability (non-GDT). METHODS: In this systematic review, we considered the FC components in studies adopting either GDT or non-GDT, to assess whether differences exist between the 2 approaches. In addition, we performed a meta-analysis to ascertain the effectiveness of dynamic indexes pulse pressure variation (PPV) and stroke volume (SV) variation (SVV), in predicting fluid responsiveness. RESULTS: Thirty-five non-GDT and 33 GDT studies met inclusion criteria, including 5017 patients. In the vast majority of non-GDT and GDT studies, the FC consisted in the administration of colloids (85.7% and 90.9%, respectively). In 29 non-GDT studies, the colloid infused was the 6% hydroxyethyl starch (6% HES; 96.6% of this subgroup). In 20 GDT studies, the colloid infused was the 6% HES (66.7% of this subgroup), while in 5 studies was a gelatin (16.7% of this subgroup), in 3 studies an unspecified colloid (10.0% of this subgroup), and in 1 study albumin (3.3%) or, in another study, both HES 6% and gelatin (3.3%). In non-GDT studies, the median volume infused was 500 mL; the time of infusion and hemodynamic target to assess fluid responsiveness lacked standardization. In GDT studies, FC usually consisted in the administration of 250 mL of colloids (48.8%) in 10 minutes (45.4%) targeting an SV increase >10% (57.5%). Only in 60.6% of GDT studies, a safety limit was adopted. PPV pooled area under the curve (95% confidence interval [CI]) was 0.86 (0.80–0.92). The mean (standard deviation) PPV threshold predicting fluid responsiveness was 10.5% (3.2) (range, 8%–15%), while the pooled (95% CI) sensitivity and specificity were 0.80 (0.74–0.85) and 0.83 (0.73–0.91), respectively. SVV pooled area under the curve (95% CI) was 0.87 (0.81–0.93). The mean (standard deviation) SVV threshold predicting fluid responsiveness was 11.3% (3.1) (range, 7.5%–15.5%), while the pooled (95% CI) sensitivity and specificity were 0.82 (0.75–0.89) and 0.77 (0.71–0.82), respectively. CONCLUSIONS: The key components of FC including type of fluid (colloids, often 6% HES), volume (500 and 250 mL in non-GDT studies and GDT studies, respectively), and time of infusion (10 minutes) are quite standardized in operating room. However, pooled sensitivity and specificity of both PPV and SVV are limited. Accepted for publication August 27, 2018. Funding: None. Conflicts of Interest: See Disclosures at the end of the article. 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 Antonio Messina, PhD, Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas, Humanitas University, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy. Address e-mail to mess81rc@gmail.com. © 2018 International Anesthesia Research Society

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Regional Analgesia Added to General Anesthesia Compared With General Anesthesia Plus Systemic Analgesia for Cardiac Surgery in Children: A Systematic Review and Meta-analysis of Randomized Clinical Trials

BACKGROUND: The aim of this systematic review was to compare the effects of regional analgesic (RA) techniques with systemic analgesia on postoperative pain, nausea and vomiting, resources utilization, reoperation, death, and complications of the analgesic techniques in children undergoing cardiac surgery. METHODS: A search was done in May 2018 in PubMed, Embase, and the Cochrane Central Register of Controlled Trials for randomized controlled trials comparing RA techniques with systemic analgesia. Risks of bias of included trials were judged with the Cochrane tool. Data were analyzed with fixed- (I2

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The Importance of Differentiating Charges and Cost

No abstract available

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Use of the Bougie Endotracheal Tube Introducer in Unstable Cervical Spine Airway Management?

No abstract available

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Resting Hemodynamics and Response to Exercise Using the 6-Minute Walk Test in Late Pregnancy: An International Prospective Multicentre Study

BACKGROUND: Cardiac disease is the leading cause of maternal death. Assessment of cardiovascular fitness is important in pregnant women because it is linked to increased risk of cardiac disease but is rarely undertaken or studied. The 6-Minute Walk Test (6MWT) is a safe exercise test but is not used in pregnancy. We determined the 95% reference interval for resting heart rate (HR) and distance walked for the 6MWT, as well as hemodynamic recovery variables, and quantified expectations and actual experiences of exertion and breathlessness with exercise in late pregnancy. METHODS: After institutional research board approval (Australian and New Zealand Clinical Trials Registry Number: 12615000964516), 300 healthy term nulliparous pregnant women performed the 6MWT at 3 tertiary referral obstetric hospitals using a standardized protocol. Each woman underwent two 6MWT with maximum 15-minute recovery period after each test. Hemodynamic variables were measured at rest and after exercise. Participants were asked 4 questions, 2 regarding expectation and 2 regarding actual experience, using the Rating of Perceived Exertion scale and Modified Borg Dyspnea scale. RESULTS: Participant characteristics and resting variables were mean (standard deviation [SD]); age, 31 years (4.2 years); body mass index, 27 kg/m2 (2.9 kg/m2); gestational age, 37 weeks (1.3 weeks); HR, 85 bpm (10.8 bpm) with 95% reference interval 64–106 bpm; systolic blood pressure, 112 mm Hg (10.2 mm Hg); diastolic blood pressure, 72 mm Hg (8.6 mm Hg); oxygen saturation, 98% (0.9%); and respiratory rate, 18 breaths/min (5.7 breaths/min). The mean (SD) average distance walked was 488 m (94.9 m) with a speed of 3.0 mph (0.64 mph) with a 95% reference interval of 302–674 m. The mean (SD) HR increase with exercise was 12 bpm (11.0 bpm) with a median [quartile] recovery time of 5.0 minutes [1–8 minutes]. A lower resting HR was associated with increased distance walked (r = −0.207; 95% confidence interval, −0.313 to −0.096; P

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Implementing a Pediatric Perioperative Surgical Home Integrated Care Coordination Pathway for Laryngeal Cleft Repair

BACKGROUND: The Pediatric Perioperative Surgical Home (PPSH) model is an integrative care model designed to provide better patient care and value by shifting focus from the patient encounter level to the overarching surgical episode of care. So far, no PPSH model has targeted a complex airway disorder. It was hypothesized that the development of a PPSH for laryngeal cleft repair would reduce the high rates of postoperative resource utilization observed in this population. METHODS: Institutional review board approval was obtained for the purpose of data collection and analysis. A multidisciplinary team of anesthesiologists, surgeons, nursing staff, information technology specialists, and finance administrators was gathered during the PPSH development phase. Standardized perioperative (preoperative, intraoperative, and postoperative) protocols were developed, with a focus on preoperative risk stratification. Patients presenting before surgery with ≥1 predefined medical comorbidity were triaged to the intensive care unit (ICU) postoperatively, while patients without severe systemic disease were triaged to a lower-acuity floor for overnight observation. The success of the PPSH protocol was defined by quality outcome and value measurements. RESULTS: The PPSH initiative included 120 patients, and the pre-PPSH period included 115 patients who underwent laryngeal cleft repair before implementation of the new process. Patients in the pre-PPSH period were reviewed and classified as ICU candidates or lower acuity floor candidates had they presented in the post-PPSH period. Among the 79 patients in the pre-PPSH period who were identified as candidates for the lower-acuity floor transfer, 70 patients (89%) were transferred to the ICU (P

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In Response

No abstract available

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Predicting the Depth of the Lumbar Plexus in Pediatric Patients: A Retrospective Magnetic Resonance Imaging Study

BACKGROUND: The lumbar plexus (LP) block is commonly used for analgesia for lower extremities. If the depth of the LP (LPD) can be predicted, the performance time and procedure-related complications could be reduced. METHODS: Three hundred sixty-one magnetic resonance images of pediatric patients (

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Physiotherapy in postinfection injury to cranial nerves III, IV, and VI: a case study

The patient with bacterial infection sequelae in the form of damage to cranial nerves (CN) III, IV, and VI was followed-up. He had exhibited clinical and radiographic signs of paranasal sinusitis. Prior to his physiotherapy, the patient received standard treatment with natural and synthetic antibiotics and steroids. After acute signs of infection resolved without any functional improvement, the patient was referred to a rehabilitation unit to undergo neuromuscular re-education of the paralyzed extraocular muscles. Periorbital hydrocortisone iontophoresis and visuomotor exercises with intense ideomotor stimulation led to complete and rapid resolution of extraocular muscle paralysis and diplopia. Physiotherapy can be an effective treatment of choice after failed pharmacological treatment in patients with damage to CN III and VI. It has many theoretical advantages, including non-invasiveness and avoidance of first-pass metabolism of drugs administered systemically. Correspondence to: Agnieszka Olga Lewińska, MSc, 2nd Department of Clinical Radiology, Medical University of Warsaw, ul. Stefana Banacha 1a, 02-097 Warsaw, Poland, agnieszka.lewinska@wum.edu.pl, +48790013404 Declaration of Interest The Authors declare that there is no conflict of interest. Role of the funding source This study was not sponsored or funded. Details of any previous presentation of the research, manuscript, or abstract in any form None of our materials have been previously published or are otherwise copyrighted. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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A STIMULUS-RESPONSE FRAMEWORK TO INVESTIGATE THE INFLUENCE OF CONTINUOUS VERSUS INTERVAL WALKING EXERCISE ON SELECT SERUM BIOMARKERS IN KNEE OSTEOARTHRITIS

Objective Compare changes in the concentration of serum biomarkers in response to continuous versus interval walking exercise in participants with knee osteoarthritis (OA). Design A two-phase sequential design. Twenty-seven participants with unilateral knee OA completed two separate treadmill walking sessions: 1) continuous 45-minute walking exercise and 2) three 15-minute bouts of walking exercise separated by 1-hour rest periods for a total of 45 minutes in an interval format. Participants reported their knee pain using the numeric pain rating scale and serum levels of biomarkers associated with tissue turnover [cartilage oligomeric matrix protein (COMP)], inflammation [Tumor necrosis factor-α (TNF-α)] and pain [neuropeptide-Y (NPY)] were evaluated at baseline and every 15 minutes for both conditions. Results Continuous walking resulted in a cumulative increase in COMP concentration up to 45 minutes, whereas interval walking was associated with return of COMP concentrations back to baseline at 45 minutes. There were no significant changes in TNF-α and NPY concentration during walking. There was a significant increase in pain compared to baseline in the continuous walking regimen only. Conclusion Incorporating rest breaks in walking regimens may impact the potential deleterious effects of longer continuous bouts on the knee joint as well as limit pain during exercise. The project described was supported by the University of Pittsburgh Medical Center Rehabilitation Institute, Pittsburgh Claude D. Pepper Older Americans Independence Center through (Grant number P30 AG024827), the National Institutes of Health (Grant numbers UL1 RR024153, UL1 TR000005 and K12 HD055931) and the Justus Lehman Award from the Foundation for Physical Medicine and Rehabilitation Corresponding Author: Prakash Jayabalan, MD, PhD, Attending Physician Scientist, Shirley Ryan AbilityLab and Assistant Professor, Northwestern University Feinberg School of Medicine, Chicago, IL, pjayabalan@sralab.org Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Measuring the Impact of Research Using Conventional and Alternative Metrics

Bibliometrics utilize statistical methods to measure the scholarly impact of publications. Bibliometrics are categorized as conventional metrics (CM) or alternative metrics (AM). CM have often been considered the standard to measure the impact of publication-related scholarship. With the growing popularity of social media (SoMe) and ease of instantaneous distribution of information globally, AM have become an important complementary measure of scholarly activity. Bibliometrics may provide a standard performance measurement that may be used for tenure and/or promotion among academic institutions. The alternative metric industry has shown considerable growth with increasingly improved algorithms working towards standardization. Together, CM and AM may synergistically complement each other to provide an accelerated translation from research to clinical care that may lead to tremendous benefits in patients. All physicians and other healthcare professionals should receive training in bibliometrics and understand the potential impact of professional social media use. Corresponding Author: Sasha E. Knowlton, MD, Spaulding Rehabilitation Hospital, 300 First Avenue, Charlestown, MA 02129, Phone: 617-952-5000, Fax: 617-952-5937, Email: seknowlton@partners.org Author Disclosures: None Competing interests: None Funding, grants, or equipment provided from any source: None Financial benefits to the authors: None Details of any previous presentation: None Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Electrical stimulation in the treatment of hemiplegic shoulder pain: a meta-analysis of randomized controlled trials

OBJECTIVE To determine the effect of electrical stimulation (ES) in the treatment of hemiplegic shoulder pain (HSP). DESIGN Eight databases were systematically searched for randomized controlled trials (RCTs) with a treatment duration of at least two weeks comparing ES with sham stimulation or no stimulation for patients with HSP. Shoulder pain on the hemiplegic side after stroke at baseline was required at study selection. The overall effects of ES were calculated using a meta-analytic method. RESULTS Six studies were included. The pooled data indicated that ES may have a positive effect for patients with HSP on pain reduction (n=193; SMD [standardized mean difference] = -1.89; 95% CI [-3.05, -0.74]) and pain-free external rotation (PFER) (n=164; WMD [weighted mean difference] = 18.92; 95% CI [7.00, 30.84]). Meta-analysis also showed better recovery of activities of daily living (ADL) independence in patient groups receiving ES (n=167; WMD = 8.96; 95% CI [5.26, 12.66]). CONCLUSIONS ES may be an effective pain management methodology for hemiplegic shoulders and may contribute to pain-free range of external rotation as well as ADL recovery. However, these results should be interpreted with caution, given the low number of selected studies and risk of potential bias. Contributed equally, Huaide Qiu, Jiahui Li, Ting Zhou Correspondence to two authors below: Prof. Hongxing Wang, MD, PhD, School of Rehabilitation Medicine, Nanjing Medical University, 140 Hanzhong Road, Nanjing, Jiangsu Province, China, 210029, Tel:+86-25-86862196, Email: hongxingwangphd@aol.com. Prof. Jianan Li, MD, School of Rehabilitation Medicine, Nanjing Medical University, 140 Hanzhong Road, Nanjing, Jiangsu Province, China, 210029, Tel:+86-25-83318752, E-mail:lijianan_rehab@sina.com Funding: This work was supported by Science and Technology Projects in Clinical Medicine of Jiangsu Province (BL2012029) (Jianan Li) and Priority Academic Program Development of Jiangsu Higher Education Institutions (JX10231801) (Hongxing Wang). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Is Occupational Therapy After Hip Fracture Surgery Effective in Improving Function? A Systematic Review and Meta-analysis of Randomized Controlled Studies

Objectives This study is aimed to evaluate whether occupational therapy (OT) improves activities of daily living (ADL) and overall physical functioning of patients after hip fracture surgery (HFS). Data sources PubMed-Medline, Embase, and Cochrane Library databases. Review methods We searched for randomized controlled trials comparing OT with comprehensive postoperative care (without OT) after HFS. A pairwise meta-analysis using fixed- and random-effects models was performed. The primary outcome of interest was performance of ADL assessed in any manner. The secondary outcomes were other functional parameters: 1) physical function; 2) health perception and emotion; and 3) fall occurrence. Effect sizes were computed as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Results Five randomized controlled trials including a total of 524 participants were retrieved. There was a trend towards improvement in ADL, physical function, and fall occurrence, these changes were not significant. However, health perception and patient emotions improved significantly in the OT group (SMD=0.391; 95% CI, 0.104–0.678; p=0.008). Conclusion OT after HFS seems to improve overall function. Indeed, the positive effects of OT on health perception and emotions were evident. Therefore, OT can be suggested in comprehensive rehabilitation programs after HFS. Address correspondence to Jae-Young Lim, MD, PhD, Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea; Telephone: +82 31 787 7732; Fax: +82 31 787 4056, E-mail: drlim1@snu.ac.kr Funding: This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HC15C1189). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Dorsal Scapular Neuropathy as a Rare Cause of Complex Regional Pain Syndrome: A Reappraisal on Ultrasound Imaging and Guidance for Recalcitrant Pain

No abstract available

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The Effects of Electrical Stimulation Parameters in Managing Spasticity after Spinal Cord Injury: A Systematic Review

Controversial findings about the effects of neuromuscular electrical stimulation (NMES) and functional electrical stimulation (FES) in managing spasticity have been raised after spinal cord injury (SCI). A systematic review was conducted to identify the range of the stimulation parameters that may alleviate spasticity. Three independent reviewers searched Medline (PubMed), web of knowledge, Scopus, Cochrane Central, Virtual Health Library and Physiotherapy Evidence Database until January 2018. Inclusion criteria were applications of NMES/FES on the lower extremity muscles, stimulation parameters (frequency, pulse duration and amplitude of current) and measures of spasticity after SCI. The primary outcome was spasticity as measured by the Modified Ashworth Scale and the secondary outcome was spasticity assessed by other indirect measures. Twenty-three clinical and non-clinical trials were included with 389 subjects. NMES/FES provided reductions in spasticity by 45-60% with decrease in electromyography activity and increase in range of motion after SCI. The identified stimulation parameters were frequency of 20-30Hz, pulse duration of 300-350 μs and amplitude of the current > 100 mA. NMES/FES provides an effective rehabilitation strategy in managing spasticity. However, a recommendation of the stimulation parameters cannot be accurately assumed due to high variability in the methodology, design and heterogeneity of the included studies. Funding: No funding was received for this project Correspondence: Ashraf S. Gorgey, MPT, PhD, FACSM, Department of Veterans Affairs, Hunter Holmes McGuire Medical Center, Spinal Cord Injury & Disorders Service, 1201 Broad Rock Boulevard, Richmond, VA 23249, Email: ashraf.gorgey@va.gov, Tel: + 1- (804)-675-5000 ext. 3386, Fax: + 1- 804-675-5223 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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The dynamics of cortical GABA in human motor learning

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


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Shining light on the paraventricular nucleus: The role of glutamatergic PVN neurons in blood pressure control

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


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Schaaf‐Yang syndrome overview: Report of 78 individuals

American Journal of Medical Genetics Part A, EarlyView.


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