New Approaches to Diagnosis and Treatment of Functional Dyspepsia

Abstract

Purpose of Review

The purpose of this article is to review the recent literature and discuss the new approaches to the diagnosis and treatment of functional dyspepsia (FD).

Recent Findings

According to the recent American College of Gastroenterology (ACG) and Canadian Association of Gastroenterology (CAG) guideline for dyspepsia, Helicobacter pylori (H. pylori) eradication is recommended as a first treatment option, and proton pump inhibitors (PPIs), tricyclic antidepressants, and prokinetics are listed as second-line therapy. On the other hand, in the Japanese guideline for FD, PPIs and prokinetics are recommended as the first-line treatment. In Japan, acotiamide, a recently launched prokinetic, showed significant efficacy in several clinical trials performed either in Japan or Europe. Regarding non-pharmacological treatment, recent topics include acupuncture, electrical stimulation, gastric peroral endoscopic myotomy, and meal and lifestyle modification. These treatments have provided significant efficacy, which provides some insights into the main pathophysiology of this disease.

Summary

Although FD is common among functional gastrointestinal disorders, it is not easy to relieve the dyspeptic symptoms of FD patients. Combinations of pharmacological and non-pharmacological treatment options are expected.

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Isolation of Fully Vancomycin-Resistant Streptococcus thoraltensis from the Nasal Cavity of a Healthy Young Adult

Microbial Drug Resistance, Ahead of Print.


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Are the Hands of Veterinary Staff a Reservoir for Antimicrobial-Resistant Bacteria? A Randomized Study to Evaluate Two Hand Hygiene Rubs in a Veterinary Hospital

Microbial Drug Resistance, Ahead of Print.


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Molecular Characterization of Salmonella enterica Serovar Enteritidis, Genetic Basis of Antimicrobial Drug Resistance and Plasmid Diversity in Ampicillin-Resistant Isolates

Microbial Drug Resistance, Ahead of Print.


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Deciphering Hybrid Larch Reaction Norms Using Random Regression

The link between phenotypic plasticity and heterosis is a broad fundamental question, with stakes in breeding. We report a case-study evaluating temporal series of wood ring traits of hybrid larch (Larix decidua x L. kaempferi and reciprocal) in relation to soil water availability. Growth rings record the tree plastic responses to past environmental conditions, and we used random regressions to estimate the reaction norms of ring width and wood density with respect to water availability. We investigated the role of phenotypic plasticity on the construction of hybrid larch heterosis and on the expression of its quantitative genetic parameters. The data came from an intra-/interspecific diallel mating design between both parental species. Progenies were grown in two environmentally contrasted sites, in France. Ring width plasticity with respect to water availability was confirmed, as all three taxa produced narrower rings under the lowest water availability. Hybrid larch appeared to be the most plastic taxon as its superiority over its parental species increased with increasing water availability. Despite the low heritabilities of the investigated traits, we found that the expression of a reliable negative correlation between them was conditional to the water availability environment. Finally, by means of a complementary simulation, we demonstrated that random regression can be applied to model the reaction norms of non-repeated records of phenotypic plasticity bound by a family structure. Random regression is a powerful tool for the modeling of reaction norms in various contexts, especially perennial species.

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Transcriptomic Plasticity in the Arthropod Generalist Tetranychus urticae Upon Long-Term Acclimation to Different Host Plants

The two-spotted spider mite Tetranychus urticae is an important pest with an exceptionally broad host plant range. This generalist rapidly acclimatizes and adapts to a new host, hereby overcoming nutritional challenges and a novel pallet of constitutive and induced plant defenses. Although recent studies reveal that a broad transcriptomic response upon host plant transfer is associated with a generalist life style in arthropod herbivores, it remains uncertain to what extent these transcriptional changes are general stress responses or host-specific. In the present study, we analyzed and compared the transcriptomic changes that occur in a single T. urticae population upon long-term transfer from Phaseolus vulgaris to a similar, but chemically defended, host (cyanogenic Phaseolus lunatus) and to multiple economically important crops (Glycine max, Gossypium hirsutum, Solanum lycopersicum and Zea mays). These long-term host plant transfers were associated with distinct transcriptomic responses with only a limited overlap in both specificity and directionality, suggestive of a fine-tuned transcriptional plasticity. Nonetheless, analysis at the gene family level uncovered overlapping functional processes, recruiting genes from both well-known and newly discovered detoxification families. Of note, our analyses highlighted a possible detoxification role for Tetranychus-specific short-chain dehydrogenases and single PLAT domain proteins, and manual genome annotation showed that both families are expanded in T. urticae. Our results shed new light on the molecular mechanisms underlying the remarkable adaptive potential for host plant use of generalist arthropods and set the stage for functional validation of important players in T. urticae detoxification of plant secondary metabolites.

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How to manage ambulance safety on the microscopic level

It's important to clean and decontaminate the ambulance interior regularly to prevent the spread of germs

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How cardiovascular check-ups save firefighter lives

Decrease your risk of cardiovascular disease and line-of-duty death with these steps to stay firefighter ready to protect your community

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Increasing sensitivity to EMS PTSD

Educating friends about EMS PTSD can prevent innocent questions that can undo years of mental health work and progress

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High Prevalence of Antibiotic Resistance and Integrons in Escherichia coli Isolated from Urban River Water, India

Microbial Drug Resistance, Ahead of Print.


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Force–Length Relationship Modeling of Wrist and Finger Flexor Muscles

Introduction Because the hand joints possess a broad range of motion, the muscle length can vary importantly which might result in significant variations of the muscle force-generating capacities. However, facing the complexity of this musculoskeletal system, no study has examined the effect of hand muscle length change on muscle force. This study aimed to characterize the force–length relationship of muscles involved in wrist and metacarpophalangeal flexion. Methods Eleven participants performed two sessions: (i) one for the wrist flexor muscles and (ii) one for the finger flexor muscles. For each session, the participants performed two maximal voluntary contractions and then two progressive isometric ramps from 0% to 100% of their maximal force capacity at five different wrist/metacarpophalangeal angles. Torque, kinematic, and electromyographic data were recorded. An ultrasound scanner was used to measure the myotendinous junction displacement of flexor carpi radialis (FCR) and flexor digitorum superficialis (FDS) during isometric contractions. A three-dimensional relationship between muscle length, force, and activation level was modeled using optimization procedure. Results Globally, the FCR was stronger and shorter compared with FDS. The results showed that the three-dimensional relationships fitted well the experimental data (mean R2 = 0.92 ± 0.07 and 0.87 ± 0.11 for FCR and FDS, respectively). Using joint angle and EMG data, this approach allows to estimate the muscle force with low estimation errors (

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An Investigation of Dynamic Cerebral Autoregulation in Adolescent Concussion

Purpose Although cerebrovascular impairments are believed to contribute to concussion symptoms, little information exists regarding brain vasomotor control in adolescent concussion, particularly autoregulatory control that forms a fundamental response mechanism during changes in blood pressure. This research tested the hypothesis that adolescent concussion is marked by impaired dynamic cerebral autoregulation. Methods Nineteen concussed adolescents (15 ± 2 yr, 13 females) and 18 healthy controls (15 ± 2 yr, 9 females) completed two sit-to-stand trials. Brachial artery blood pressure and cerebral blood flow velocity in the right middle cerebral artery were measured continuously. Dynamic rate of regulation was calculated as the rate of change in cerebrovascular resistance relative to the change in arterial blood pressure. The concussed adolescents were followed through their rehabilitation for up to 12 wk. Results At the first visit, the concussed adolescents demonstrated reduced rate of regulation compared with the healthy controls (0.12 ± 0.04 vs 0.19 ± 0.06 s−1, P ≤ 0.001). At the concussed adolescents final visit, after symptom resolution, the rate of regulation improved to levels that were not different from the healthy controls (n = 9; 0.15 ± 0.08 vs 0.19 ± 0.06 s−1, P= 0.06). Two distinct groups were observed at the final visit with some individuals experiencing recovery of dynamic cerebral autoregulation and others showing no marked change from the initial visit. Conclusion Adolescents demonstrate an impairment in dynamic cerebral autoregulation after concussion that improves along with clinical symptoms in some individuals and remains impaired in others despite symptom resolution.

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The Respiratory Compensation Point and the Deoxygenation Break Point Are Not Valid Surrogates for Critical Power and Maximum Lactate Steady State

No abstract available

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Hypoxic Training Improves Normoxic Glucose Tolerance in Adolescents with Obesity

Purpose This study aimed to test whether environmental hypoxia could potentiate the effects of exercise training on glucose metabolism and insulin sensitivity. Methods Fourteen adolescents with obesity were assigned to 6 wk of exercise training either in normoxic or in hypoxic conditions (FiO2 15%). Adolescents trained three times per week for 50–60 min, including endurance and resistance exercises. Oral glucose tolerance test, blood and morphological analyses, and physical performance tests were performed before and after the training period. Results After training, hypoxia, but not normoxia, decreased the area under the curve of plasma insulin (−49%; P = 0.001) and glucose levels (−14%; P = 0.005) during oral glucose tolerance test. Decreased plasma triglycerides levels (P = 0.03) and increased maximal aerobic power (P = 0.002), work capacity at 160 bpm (P = 0.002), and carbohydrate consumption during exercise (P = 0.03) were measured only in the hypoxic group. Conclusions Hypoxic exercise training was particularly efficient at improving glucose tolerance and insulin response to a glucose challenge in adolescents with obesity. These results suggest that exercise training in hypoxia could be an interesting strategy against insulin resistance and type 2 diabetes development in adolescents with obesity.

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Small-Sided Soccer in School Reduces Postprandial Lipemia in Adolescent Boys

Purpose Although laboratory-based moderate- to high-intensity exercise reduces postprandial lipemia in adolescents, this exercise differs to the free-living physical activities in which young people typically engage. This study compared the effect of free-living afterschool soccer activity and treadmill exercise on in-school postprandial lipemia in adolescent boys. Methods Fifteen boys (12.6 ± 0.5 yr) completed three, 2-d experimental trials. On day 1, participants rested (CON), exercised for 48 min on a treadmill at 60% V˙O2peak (TM), or played 48 min of 5-a-side soccer (SOC). On day 2, participants attended school where a capillary blood sample determined fasting triacylglycerol ([TAG]) and glucose ([glucose]) concentrations. Participants then consumed a standardized breakfast (0 h) and lunch (4.5 h), and blood samples were collected postprandially at 2.5, 5.0, and 7.0 h. Results Reductions in fasting [TAG] were small-moderate after TM (−16%, 95% confidence interval [CI] = −27% to −2%, effect size [ES] = 0.46), but large after SOC (−30%, 95% CI = −40% to −20%, ES = 1.00) compared with CON; the concentration was also lower in SOC compared with TM (−18%, 95% CI = −29% to −5%, ES = 0.53). On the basis of ratios of geometric means, the area under the TAG versus time curve was 18% lower after TM (95% CI = −29% to −5%, ES = 0.51) and 25% lower after SOC (95% CI = −35% to −13%, ES = 0.76) compared with CON. By contrast, SOC and TM were not significantly different (−9%, 95% CI = −21% to 5%, ES = 0.25). Conclusion Compared with duration-matched inactivity (CON), after-school small-sided soccer (SOC) and treadmill exercise (TM) resulted in a similar, moderate reduction of postprandial lipemia in adolescent boys.

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Gait Biomechanics in Anterior Cruciate Ligament–reconstructed Knees at Different Time Frames Postsurgery

Purpose To examine knee and hip biomechanics during walking and jogging in groups of ACLR patients at early, mid, and late time frames postsurgery and healthy controls. Methods Participants included individuals with a history of primary, unilateral ACLR, stratified into early (1.4 ± 0.4 yr post, n = 18), mid (3.3 ± 0.6 yr post, n = 20), and late (8.5 ± 2.8 yr post, n = 20) ACLR groups based on time postsurgery, and a healthy control group (n = 20). Walking and jogging motion capture analysis of knee and hip kinetics and kinematics were measured in the sagittal and frontal planes. Interlimb (within groups) and between-group comparisons were performed for all gait variables. Statistical comparisons were made across the gait cycle by plotting graphs of means and 90% confidence intervals and identifying regions of the gait cycle in which the 90% confidence intervals did not overlap. Results Early ACLR group demonstrated reduced knee flexion, knee extension, knee adduction, and hip adduction moments on the ACLR limb. Mid ACLR group demonstrated no gait differences between limbs or other groups. Late ACLR group demonstrated reduced knee flexion moments, and greater knee and hip adduction moments in their ACLR limb. Control group demonstrated no interlimb differences. Conclusions Walking and jogging gait biomechanics presented differently in patients at different stages in time after ACLR surgery. The early ACLR group demonstrated lower sagittal and frontal plane joint loading on the ACLR limb compared with contralateral and control limbs. The mid ACLR group did not demonstrate any gait differences compared with the contralateral or control limb. The late ACLR group demonstrated lower sagittal plane joint loading compared with control limbs and greater frontal plane joint loading compared to contralateral and control limbs.

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Impact of a Graded Exercise Program on V˙O2peak and Survival in Heart Failure Patients

Introduction Although exercise therapy has the potential to improve health outcomes of patients with chronic heart failure (CHF), less than 50% of patients adhere to prescribed physical activity guidelines 1 yr after cardiac rehabilitation. We aimed to assess the effects of an extended cardiac rehabilitation program with 12 months of graded exercise therapy (GET) and resistance exercise training (RT) on exercise capacity and long-term survival in patients with CHF. Methods This prospective cohort study included 60 CHF patients between 2009 and 2010. The GET-RT program consisted of exercise sessions at 6 d·wk−1. Total training time of aerobic exercises increased incrementally every other week without changing exercise intensity. Resistance exercise training consisted of 8 exercises with a durable resistance band. Guidance consisted of a step-down approach from in-hospital to home-based training. Cardiopulmonary exercise tests were performed at baseline, 3, 6, and 12 months. Subsequently, patients were propensity score matched on a 1:2 ratio with controls (n = 117) from a CHF registry of patients from the same clinic receiving usual out-patient care and the incidence of all-cause mortality was compared between both groups. Results Baseline V˙O2 peak was 15.0 mL·min−1·kg−1 and significantly elevated at 3 months (+1.1 mL·min−1·kg−1 (95% CI, 0.4–1.8), 6 months (+2.9 mL·min−1·kg−1 (95% CI, 1.1–2.9) and 12 months (+2.6 mL·min−1·kg−1 (95% CI, 1.4–3.8). During 8 yr of follow-up 23 (38.3%) patients of the GET-RT program died versus 63 (53.8%) patients of the control group (P = 0.063). Conclusions The 12-month GET-RT program was associated with an improved fitness during 1-yr follow-up, whereas a tendency toward better survival rates was observed during long-term follow-up.

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Psychodiagnostics: Classification of the Yips Phenomenon based on Musician’s Dystonia

Purpose Similar to musician's focal dystonia, a task-specific phenomenon known as yips, has also been reported in professional athletes. Yips is usually described as focal dystonia, or choking under pressure, or as lying on a continuum between both. Based on the common occupational conditions across musicians and athletes, the present exploratory study aimed to investigate whether musicians diagnosed with focal dystonia and golfers affected with yips, can be similarly subclassified based on their psychological profiles. Methods Twenty healthy musicians, 20 musicians with focal dystonia, 20 healthy golfers, and 20 yips-affected golfers went through a test battery including three psycho-diagnostic standardized questionnaires (the Competitive Trait Anxiety Inventory, the Frost's Multidimensional Perfectionism Scale, and the Stress Coping Questionnaire), measuring trait cognitive and somatic anxiety, perfectionistic tendencies and different stress coping strategies. Results Findings based on a clustering procedure suggest that similar to musician's dystonia, yips-affected golfers can be classified into those with and those without specific elevated perfectionistic, stress and anxiety traits. The roles of these different psychological profiles as possible triggering factors of the yips are discussed and compared with those of musician's dystonia. Conclusions The current study suggests that the yips phenomenon might cover a broader range of different subtypes of movement disturbances than those already suggested in the literature. Finally, a theoretical model, which explains the role of the different triggering factors in the discrimination of the different subtypes, is suggested. A better classification and understanding of the different subtypes of yips could lead to a more accurate diagnosis and to the design of more individualized treatment intervention.

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Intermittent Running and Cognitive Performance after Ketone Ester Ingestion

Purpose Ingestion of exogenous ketones alters the metabolic response to exercise and may improve exercise performance, but it has not been explored in variable-intensity team sport activity, or for effects on cognitive function. Methods On two occasions in a double-blind, randomized crossover design, 11 male team sport athletes performed the Loughborough Intermittent Shuttle Test (part A, 5 × 15-min intermittent running; part B, shuttle run to exhaustion), with a cognitive test battery before and after. A 6.4% carbohydrate–electrolyte solution was consumed before and during exercise either alone (PLA) or with 750 mg·kg−1 of a ketone ester (KE) supplement. Heart rate, RPE, and 15-m sprint times were recorded throughout, and serial venous blood samples were assayed for plasma glucose, lactate, and β-hydroxybutyrate. Results KE resulted in plasma β-hydroxybutyrate concentrations of ~1.5 to 2.6 mM during exercise (P

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The Yips: Methods to Identify Golfers with a Dystonic Etiology/Golfer’s Cramp

Purpose To determine whether quantitative methods could separate golfers with a possible dystonic cause of the "yips" from those that appear to be nondystonic. Methods Twenty-seven golfers completed 10 two-handed and 10 right hand–only putts. Surface EMG assessed forearm muscle co-contraction and motion detectors monitored wrist and putter movements. Based on a videotape review, golfers were grouped into those with yips of dystonic etiology, those with the yips nondystonic, and those with no yips. Results On video review of two-handed putting, five golfers had yips that appeared to be dystonic, nine had yips that did not appear to be dystonic, and 13 had no yips. During two-handed putting co-occurrence of a yipped putt and wrist flexor/extensor and/or pronator/supinator co-contraction was significantly more frequent in those with dystonic yips. The dystonic group had no increase in the number of yipped putts or yips with co-contraction when putting right hand only, whereas the nondystonic group had significantly more yipped putts and more yipped putts with co-contraction with right hand only. Conclusions Quantitative methods were identified that appear to identify golfers with a dystonic etiology for the yips. It is not just the frequency of yips nor just specific motion patterns alone, rather it is also a combination of yips with co-occurring co-contraction when putting with two hands, and then right hand only, that distinguished this possible etiology. Despite being a small study, identifying a dystonic pattern, even in a nonpressure indoor setting, may aid in assessment and possible monitoring of treatment.

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Predicting Ground Reaction Force from a Hip-Borne Accelerometer during Load Carriage

Introduction Ground reaction forces (GRF) during load carriage differ from unloaded walking. Methods to quantify peak vertical GRF (pGRFvert) of Soldiers walking with loads outside of a laboratory are needed to study GRF during operationally relevant tasks. Purpose Develop a statistically based model to predict pGRFvert during loaded walking from ActiGraph GT3X+ activity monitor (AM) vertical acceleration. Methods Fifteen male Soldiers (25.4 ± 5.3 yr, 85.8 ± 9.2 kg, 1.79 ± 9.3 m) wore an ActiGraph GT3X+ AM over their right hip. Six walking trials (0.67–1.58 m·s−1) with four loads (no load, 15, 27, 46 kg) and two types of footwear (athletic shoes and combat boots) were completed on an instrumented force plate treadmill. Average peak vertical AM acceleration (pACCvert) and pGRFvert were used to develop a regression equation to predict pGRFvert. The model was validated using a leave-one-subject-out approach. Root mean square error (RMSE) and average absolute percent difference (AAPD) between actual and predicted pGRFvert were determined. pGRFvert was also predicted for two novel data sets and AAPD and RMSE calculated. Results The final equation to predict pGRFvert included pACCvert, body mass, carried load mass, and pACCvert-carried load mass interaction. Cross-validation resulted in an AAPD of 4.0% ± 2.7% and an RMSE of 69.5 N for leave-one-subject-out and an AAPD of 5.5% ± 3.9% and an RMSE of 78.7 N for the two novel data sets. Conclusion A statistically based equation developed to predict pGRFvert from ActiGraph GT3X+ AM acceleration proved to be accurate to within 4% for Soldiers carrying loads while walking. This equation provides a means to predict GRF without a force plate.

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Resistance Exercise Selectively Mobilizes Monocyte Subsets: Role of Polyphenols

Purpose To examine the impact of polyphenol supplementation on the recruitment, mobilization, and activation of monocyte subsets after resistance exercise. Methods Thirty-eight recreationally active males (22.1 ± 3.1 yr; 173.9 ± 7.9 cm; 77.8 ± 14.5 kg) were assigned to 28 d of polyphenol blend (PPB) supplementation, placebo (PL), or control (CON). Blood samples were obtained before (PRE) postresistance exercise, immediately (IP) postresistance exercise, 1 h (1H) postresistance exercise, 5 h (5H) postresistance exercise, 24 h (24H) postresistance exercise, and 48 h (48H) postresistance exercise (PPB/PL) or rest (CON). Fine-needle biopsies were obtained from the vastus lateralis at PRE, 1H, 5H, and 48H. Circulating concentrations of macrophage chemoattractant protein-1 (MCP-1) and fractalkine, as well as intramuscular MCP-1 were analyzed via multiplex assay. Changes in the proportions and expression of CD11b on monocyte subsets were assessed via flow cytometry. Results Circulating MCP-1 increased in PPB and PL at IP with further increases at 5H. Intramuscular MCP-1 was increased at 1H, 5H, and 48H in all groups. Classical monocyte proportions were reduced in PPB and PL at IP, and increased at 1H. Nonclassical monocytes were increased in PPB and PL at IP, whereas intermediate monocytes were increased at IP, and reduced at 1H. Intermediate monocytes were increased in PPB at 24H and 48H. CD11b expression was reduced on PPB compared with PL and CON at PRE on intermediate and nonclassical monocytes. Conclusions Resistance exercise may elicit selective mobilization of intermediate monocytes at 24H and 48H, which may be mediated by tissue damage. Additionally, polyphenol supplementation may suppress CD11b expression on monocyte subsets at rest.

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Documentation for Athletic Training, 3rd Edition

No abstract available

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High-Intensity Interval Training Augments Muscle Carnosine in the Absence of Dietary Beta-alanine Intake

Purpose Cross-sectional studies suggest that training can increase muscle carnosine (MCarn), although longitudinal studies have failed to confirm this. A lack of control for dietary β-alanine intake or muscle fiber type shifting may have hampered their conclusions. The purpose of the present study was to investigate the effects of high-intensity interval training (HIIT) on MCarn. Methods Twenty vegetarian men were randomly assigned to a control (CON) (n = 10) or HIIT (n = 10) group. High-intensity interval training was performed on a cycle ergometer for 12 wk, with progressive volume (6–12 series) and intensity (140%–170% lactate threshold [LT]). Muscle carnosine was quantified in whole-muscle and individual fibers; expression of selected genes (CARNS, CNDP2, ABAT, TauT, and PAT1) and muscle buffering capacity in vitro (βmin vitro) were also determined. Exercise tests were performed to evaluate total work done, V˙O2max, ventilatory thresholds (VT) and LT. Results Total work done, VT, LT, V˙O2max, and βmin vitro were improved in the HIIT group (all P 0.05). MCarn (in mmol·kg−1 dry muscle) increased in the HIIT (15.8 ± 5.7 to 20.6 ± 5.3; P = 0.012) but not the CON group (14.3 ± 5.3 to 15.0 ± 4.9; P = 0.99). In type I fibers, MCarn increased in the HIIT (from 14.4 ± 5.9 to 16.8 ± 7.6; P = 0.047) but not the CON group (from 14.0 ± 5.5 to 14.9 ± 5.4; P = 0.99). In type IIa fibers, MCarn increased in the HIIT group (from 18.8 ± 6.1 to 20.5 ± 6.4; P = 0.067) but not the CON group (from 19.7 ± 4.5 to 18.8 ± 4.4; P = 0.37). No changes in gene expression were shown. Conclusions In the absence of any dietary intake of β-alanine, HIIT increased MCarn content. The contribution of increased MCarn to the total increase in βmin vitro appears to be small.

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Is Running Better than Walking for Reducing Hip Joint Loads?

Purpose Knowledge of hip biomechanics during locomotion is necessary for designing optimal rehabilitation programs for hip-related conditions. The purpose of this study was to: 1) determine how lower-limb muscle contributions to the hip contact force (HCF) differed between walking and running; and 2) compare both absolute and per-unit-distance (PUD) loads at the hip during walking and running. Methods Kinematic and ground reaction force data were captured from eight healthy participants during overground walking and running at various steady-state speeds (walking: 1.50 ± 0.11 m·s−1 and 1.98 ± 0.03 m·s−1; running: 2.15 ± 0.18 m·s−1 and 3.47 ± 0.11 m·s−1). A three-dimensional musculoskeletal model was used to calculate the HCF as well as lower-limb muscular contributions to the HCF in each direction (posterior–anterior; inferior–superior; lateral–medial). The impulse of the resultant HCF was calculated as well as the PUD impulse (BW·s·m−1) and PUD force (BW·m−1). Results For both walking and running, HCF magnitude was greater during stance than swing and was largest in the inferior–superior direction and smallest in the posterior–anterior direction. Gluteus medius, iliopsoas, and gluteus maximus generated the largest contributions to the HCF during stance, whereas iliopsoas and hamstrings generated the largest contributions during swing. When comparing all locomotion conditions, the impulse of the resultant HCF was smallest for running at 2.15 m·s−1 with an average magnitude of 2.14 ± 0.31 BW·s, whereas the PUD impulse and force were smallest for running at 3.47 m·s−1 with average magnitudes of 0.95 ± 0.18 BW·s·m−1 and 1.25 ± 0.24 BW·m−1, respectively. Conclusions Hip PUD loads were lower for running at 3.47 m·s−1 compared with all other locomotion conditions because of a greater distance travelled per stride (PUD impulse) or a shorter stride duration combined with a greater distance travelled per stride (PUD force).

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Physical Activity, Cardiorespiratory Fitness, and Incident Glaucoma

Purpose This study aimed to examine the associations of physical activity and cardiorespiratory fitness (hereafter fitness) with incident glaucoma in a prospective observational study. Methods Physical activity was measured by self-reported leisure-time activities, and fitness was measured by maximal treadmill test. Incident glaucoma was defined based on physician diagnosis. Participants were 9519 men and women between the ages of 40 and 81 yr old (mean age 50 yr) who were enrolled in the Aerobics Center Longitudinal Study. Hazard ratios (HR) were estimated using Cox proportional hazard regression after adjusting for age, sex, race, examination year, smoking status, heavy alcohol drinking, hypertension, hypercholesterolemia, abnormal ECG, diabetes, cardiovascular disease, and cancer. Results A total of 128 cases of incident glaucoma were reported during a mean follow-up of 5.7 yr. A significantly lower risk of incident glaucoma (HR = 0.53, 95% confidence interval [95% CI] = 0.35–0.79) was found in individuals who met the physical activity guidelines of ≥500 MET·min·wk−1 compared with inactive individuals (0 MET·min·wk−1). Compared with low fitness (lower third), individuals with high fitness (upper third) also had a significantly lower risk of incident glaucoma (HR = 0.60, 95% CI = 0.38–0.95). A joint analysis of physical activity and fitness showed that meeting physical activity guidelines and being in the high fitness category was associated with the lowest risk for developing glaucoma (HR = 0.49, 95% CI = 0.31–0.79). Conclusion These data provide epidemiological evidence that meeting physical activity guidelines or being fit reduces the risk of developing glaucoma.

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Numerical Reconstruction of Traumatic Brain Injury in Skiing and Snowboarding

Purpose Proper evaluation of ski helmet designs and safety standards should rely on head impact conditions involved in skiing and snowboarding head injuries. To study these impacts, main crash scenarios involving head injuries are numerically replicated. Methods Multibody models of skiers and snowboarders were developed to investigate five common crash scenarios involved in traumatic brain injury: forward and sideways skiing falls, snowboarding backward falls, collisions between users and collisions with obstacles. For each scenario, the influence of crash conditions on head impact (location, speed, linear and rotational accelerations) and risk of injury are evaluated. Crash conditions were initial velocity, user height, position and approach angle, slope steepness, obstacles, and snow stiffness. Results One thousand one hundred forty-nine crashes were simulated and three significant levels of impact conditions were discriminated over the investigated crash scenarios: 1) the smallest normal-to-slope impact velocities (6 km·h−1; 22 km·h−1) and peak linear accelerations (42g; 75g) were obtained during forward and sideways skiing falls; 2) snowboarding backward falls and collisions between users were associated with high normal-to-surface impact velocities (26 km·h−1; 32 km·h−1) and head accelerations (80g; 149g) above one published threshold for mild traumatic brain injury but below the pass/fail criteria of helmet standard tests; 3) collisions with obstacles were associated with high normal-to-surface impact velocities (19 km·h−1; 35 km·h−1) and the highest head accelerations (626g; 1885g). Conclusions Current impact conditions of helmet standard evaluations consistently replicate collisions with obstacles, but need to be revised to better reflect other significant crash scenarios leading to traumatic brain injury.

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Handgrip Strength, Function, and Mortality in Older Adults: A Time-varying Approach

Purpose To determine the time-varying associations between 1) decreased handgrip strength and disabilities in each activity of daily living (ADL) function, and 2) disaggregated ADL limitations and time to mortality in older adults. Methods A United States nationally representative sample of 17,747 older adults from the Health and Retirement Study were followed up for 8 yr. Maximal handgrip strength was measured with a hand-held dynamometer. Ability to perform ADL was self-reported. Date of death was identified by the National Death Index and exit interviews. Separate covariate-adjusted hierarchical logit models were used to examine the time-varying associations between decreased handgrip strength and each ADL outcome. Distinct covariate-adjusted Cox models were used to analyze the time-varying associations between disaggregated ADL limitations and time to mortality. Results Every 5-kg decrease in handgrip strength was associated with increased odds for the following ADL limitations: 20% for eating, 14% for walking, 14% for bathing, 9% for dressing, 8% for transferring, and 6% for toileting. The presence of a bathing, walking, toileting, eating, and dressing ADL disability was associated with a 47%, 43%, 32%, 30%, and 19% higher hazard for mortality, respectively. A transferring ADL disability was not significantly associated with mortality. Conclusions Decreased handgrip strength was associated with increased odds for each ADL limitation, and in turn, most individual ADL impairments were associated with a higher hazard for mortality in older adults. These findings provide insights into the disabling process by identifying which ADL limitations are most impacted by decreased handgrip strength and the subsequent time to mortality for each ADL disability.

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Early Motor Unit Conduction Velocity Changes to High-Intensity Interval Training versus Continuous Training

Purpose Moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT) are associated with different adjustments in motor output. Changes in motor unit (MU) peripheral properties may contribute to these adjustments, but this is yet to be elucidated. This study evaluated early changes in MU conduction velocity (MUCV) and MU action potential amplitude after 2 wk of either HIIT or MICT. Methods Sixteen men were assigned to either an MICT group or HIIT group (n = 8 each), and participated in six training sessions over 14 d. HIIT: 8 to 12 × 60-s intervals at 100% peak power output. Moderate-intensity continuous training: 90 to 120 min continuous cycling at ~65% V˙O2peak. Preintervention and postintervention, participants performed maximal voluntary contractions (MVC) and submaximal (10%, 30%, 50%, and 70% of MVC) isometric knee extensions while high-density EMG was recorded from the vastus medialis (VM) and vastus lateralis (VL) muscles. The high-density EMG was decomposed into individual MU by convolutive blind-source separation and tracked preintervention and postintervention. Results Both training interventions induced changes in MUCV, but these changes depended on the type of training (P

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Modeling Training Loads and Injuries: The Dangers of Discretization

Purpose To evaluate common modeling strategies in training load and injury risk research when modeling continuous variables and interpreting continuous risk estimates; and present improved modeling strategies. Method Workload data were pooled from Australian football (n = 2550) and soccer (n = 23,742) populations to create a representative sample of acute:chronic workload ratio observations for team sports. Injuries were simulated in the data using three predefined risk profiles (U-shaped, flat and S-shaped). One-hundred data sets were simulated with sample sizes of 1000 and 5000 observations. Discrete modeling methods were compared with continuous methods (spline regression and fractional polynomials) for their ability to fit the defined risk profiles. Models were evaluated using measures of discrimination (area under receiver operator characteristic [ROC] curve) and calibration (Brier score, logarithmic scoring). Results Discrete models were inferior to continuous methods for fitting the true injury risk profiles in the data. Discrete methods had higher false discovery rates (16%–21%) than continuous methods (3%–7%). Evaluating models using the area under the ROC curve incorrectly identified discrete models as superior in over 30% of simulations. Brier and logarithmic scoring was more suited to assessing model performance with less than 6% discrete model selection rate. Conclusions Many studies on the relationship between training loads and injury that have used regression modeling have significant limitations due to improper discretization of continuous variables and risk estimates. Continuous methods are more suited to modeling the relationship between training load and injury. Comparing injury risk models using ROC curves can lead to inferior model selection. Measures of calibration are more informative judging the utility of injury risk models.

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Paramedic 12 HOUR SHIFT - Cabarrus County EMS

Hiring range for this position is $38,043.20 - 43,368.00. Initial placement for new employees is customarily at entry level through 25% percentile. Pay grade for this position is 14. Performs advanced technical work responding, rescuing, and transporting the sick and injured and administering emergency medical care at the paramedic level. Work is performed under the regular supervision of a Shift Supervisor ...

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State EMS Training Administrator - Vermont Department of Health

The Vermont Department of Health is looking for a creative and energetic person to lead EMS education in our state. This unique opportunity combines a diverse yet nimble EMS system with an administration enthusiastic in the pursuit of excellence. Job Description: Training and coordinating work at a professional level involving the development, implementation and evaluation of a system of training for ...

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Resting Energy Expenditure in Patients with Familial Dysautonomia: A Preliminary Study

Objectives: Familial dysautonomia (FD) is a rare hereditary sensory and autonomic neuropathy characterized by chronic lung disease and cyclic vomiting due to hyper-adrenergic crises. Most FD patients are in a depleted nutritional state; however the phenotype of the disease is quite different between patients, as for the severity of lung disease and the intensity and frequency of these pathognomonic crises. In this study we wanted to investigate whether resting energy expenditure (REE) levels are increased in this population, and if correlations exist between REE levels and phenotype severity. Methods: Data was collected from 12 FD patients (6/6 m/f). REE measurements were conducted by indirect calorimeter. Measured REE % predicted were correlated with pulmonary function, severity of the scoliosis, serum C- reactive protein, yearly frequency of hyper-adrenergic crisis, hospital admissions and the use of nocturnal noninvasive positive pressure ventilation. Results: Mean REE was 112 ±13% predicted with 50% being in a hypermetabolic state (REE/HB > 110%). Body Mass Index (BMI) was below normal range in 75% of patients, and reduced energy intake was also decreased in 75%. No significant correlations to disease severity factors were found. When dividing the subjects to REE levels above or below 125% predicted, Patients with REE above 125% predicted presented with significantly lower Inspiratory Capacity (IC) (42.7% predicted vs 62.8% predicted; p=0.04). Conclusions: Hypermetabolic state was described in 50% of FD patients. The Low BMI is explained by combination of relative anorexia and increased REE. The REE levels are related to the underling respiratory disease. Address correspondence and reprint requests to Bat-El Bar Aluma, MD, Pulmonary Unit and the National Center for Cystic Fibrosis, Edmond and Lily Safra Children's Pediatric Hospital, Sheba Medical Center, Tel Hashomer, Israel (e-mail: BatEl.BarAluma@sheba.health.gov.il). Received 20 May, 2018 Accepted 7 October, 2018 Conflicts of Interest and Source of Funding: None declared © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Clinical and Genetic Study of children With Peutz-Jeghers Syndrome Identifies a High Frequency of STK11 De Novo Mutation

Objectives: The present study aims to identify the genotype-phenotype correlation in children with Peutz-Jeghers Syndrome (PJS) through the analysis of STK11 gene mutations in the context of clinical and pathological characteristics. Method: In this observational cohort study, the clinical characteristics of 18 families diagnosed with pediatric PJS were collected. Genomic DNA from the peripheral blood of affected children and their family members was collected. The coding region of STK11 was amplified by PCR and screened for mutation by Sanger sequencing. The families that were negative for STK11 mutation were further assessed by multiplex ligation-dependent probe amplification (MLPA). Result: Initial presentation in affected children was at 1.6 to 14.2 years and included anemia in 8 patients whereas 6 presented for screening by virtue of family history. All patients underwent endoscopy, colonoscopy, and polypectomy. Polyps were distributed throughout the gastrointestinal (GI) tract, including the small intestine, stomach, colon, and rectum. In the 18 pediatric PJS families, STK11 mutations were detected in 8 families by Sanger sequencing, and large deletions were detected in 3 by MLPA, respectively. Nine of the 11 STK11 mutations were de novo, 3 were novel (c.419T>C:p.L140P, c.314T>G:p.L105X), and (c.488_489insACGG p.L164fs). Conclusions: Although the main clinical features of pediatric PJS were similar to those of PJS cases in adults, a high frequency of STK11 de novo mutations were encountered in our population of patients with PJS. Address correspondence and reprint requests to Hong-Mei Zhao, MD, Jie-Yu You, MD, Department of Gastroenterology, Hunan Children's Hospital, 86 Ziyuan Road, Changsha 410007, China (e-mails: 364875977@foxmail.com, yjy660111@sina.com). Received 27 May, 2018 Accepted 14 September, 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). This work was supported by Health and Family Planning Commission Fund of Hunan Province (B2016040 to H.M.Z.), the national natural Science Foundation of china (31501017 to Y.J.Y.) and the Key laboratory fund of Hunan Province (2018tP1028 to Z.H.X.). 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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Sustainable Positive Response to Sirolimus in Juvenile Polyposis of Infancy

No abstract available

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Should Paediatricians Be Aware of Cystic Echinococcosis? A Literature Review

Among parasitic hepatic cystic lesions, the most common disease is represented by cystic echinococcosis, especially in high endemic countries. European epidemiology of cystic echinococcosis in children is very difficult to assess because of under-reporting but is increasing, because of high immigration flows from endemic countries and an increased awareness. Hydatidosis can be localized in every part of the body. The liver and lungs are the most common localizations in both children and adults. Multi-organ involvement is rarely reported in children. Different tests are available. Usually the sensitivity of serological screening tests is variable, ranging between 60 and 90%. The immunoblot assay is used as a confirmatory test because of its higher sensitivity and specificity. Radiological tests are the gold standard for diagnosis of cystic echinococcosis, with an ultrasound accuracy of about 90%. In case of inactive and uncomplicated cysts the watch-and-wait approach is recommended. Albendazole, currently used for three to six months consecutively represents the most commonly used drug in children even if there is limited experience in treating children under six years of age. Percutaneous treatment with the puncture, aspiration, injection and re-aspiration technique is a minimally invasive procedure. Surgery is indicated based on cyst characteristics in case of big cysts with multiple daughter cysts, single superficial cysts at risk of spontaneous or traumatic rupture, cysts related with the biliary tract in which the percutaneous treatment is contraindicated and cysts compressing related structures. Address correspondence and reprint requests to Luisa Galli, MD, Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Viale Pieraccini 24, I-50139, Florence, Italy (e-mail: luisa.galli@unifi.it). Received 7 August, 2018 Accepted 8 October, 2018 Funding: none. Conflict of interest: none. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Oral Pyridostigmine-Responsive Visceral Myopathy with ACTG2 Mutations: A Case Series

No abstract available

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Updates in Pediatric Pancreatitis: Proceedings of the NASPGHAN Frontiers in Pediatric Pancreatology Symposium

Introduction: The Pancreas Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) aims to promote awareness of pediatric pancreatic diseases, support clinical and basic science research in the field, educate pediatric gastroenterologists, and advocate on behalf of pediatric patients with pancreatic disorders. Methods: At the 2017 Annual NASPGHAN meeting, the Pancreas Committee held a full day symposium on pediatric pancreatic diseases, entitled, "Frontiers in Pediatric Pancreatology." The symposium served as a timely and novel academic meeting that brought together individuals with a vested interest in the care of children with pancreatic disorders. The objective of this day-long course was to update practicing gastroenterologists on the latest advances in research, management algorithms, endoscopic therapies, radiographic resources, surgical approaches, and novel drug therapies targeted to pediatric pancreatitis. Results: Presentations were divided into 4 modules: 1. Diagnosis, risk factors, and natural history of pancreatitis, 2. Pancreatic imaging and exocrine function, 3. Management of pancreatitis, and 4. New frontiers in pediatric pancreatitis research. The course fostered a unique ecosystem for interdisciplinary collaboration, in addition to promoting discussion and stimulating new research hypotheses regarding pediatric pancreatic disorders. Oral presentations by experts in various fields of pancreatology led to thought-provoking discussion; in addition, a meet-the-professor luncheon stimulated critical evaluation of current research in pediatric pancreatic diseases, highlighting knowledge gaps as well as future research endeavors. Discussion: The current report summarizes the major learning points from this novel symposium focusing on the growing demographic of pediatric pancreatic diseases. Address correspondence and reprint requests to Veronique D. Morinville, MDCM, FRCPC, Division of Pediatric Gastroenterology and Nutrition, Montreal Children's Hospital, McGill University Health Centre, B04.2443, 1001 Blvd Decarie, Montreal, QC, Canada, H4A 3J1 (e-mail: Veronique.morinville@mcgill.ca),SohailZ.Husain,MD,DivisionofPediatricGastroenterology,HepatologyandNutrition,Children'sHospitalofPittsburghofUPMCandtheUniversityofPittsburgh,4401PennAvenue,Pittsburgh,PA15224USA(e-mail:sohail.husain@chp.edu). Received 28 April, 2018 Accepted 27 September, 2018 Sohail Z. Husain and Veronique D. Morinville Co-Senior Authors. Funding Source: The Symposium that was the basis to this work was supported in part by the NIH grant 1R13DK115222-01 Conflicts of Interest reported: Nil reported by all authors Author Roles: Amit Grover: conceptualization and drafting of initial manuscript, editing; approval of final manuscript as submitted. AJF, MAEH, JFE, TBG, QYL, MEL, JDN, TMP, VKS, ATT, AU: Writing up of initial individual summaries pertinent to their respective presentations given during the symposium; editing of manuscript; approval of final manuscript Sohail Husain: Conceptualization, drafting and critically reviewing the manuscript; writing up of summary of presentation; editing and approval of final manuscript. Drs. Husain and Morinville equally served as Senior Co-Authors. Veronique Morinville: Conceptualization, drafting and critically reviewing the manuscript; writing up of summary of presentation; editing and approval of the final manuscript. Drs. Husain and Morinville equally served as Senior Co-Authors. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Hepatotoxicity of Statins as determined by Serum Alanine Aminotransferase in a Pediatric Cohort with Dyslipidemia

Objective: To evaluate the hepatotoxicity of statins, as determined by serum alanine aminotransferase (ALT), in children and adolescents with dyslipidemia in real world clinical practice. Study design: Clinical and laboratory data were prospectively collected between September 2010 and March 2014. We compared ALT levels between patients prescribed versus not prescribed 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitors (statins), and then compared ALT before and after initiation of statins. Results: Over the 3.5-year observation period, there were 2704 ALT measurements among 943 patients. The mean age was 14 years; 54% were male, 47% obese, and 208 patients were treated with statins. Median follow-up after first ALT was 18 months. The mean (SD) ALT in statin and non-statin users was 23 (20) U/L and 28 (28) U/L, respectively. In models adjusted for age, sex and race, ALT was 2.1 U/L (95% CI 0.1, 4.4; p = 0.04) lower among statin users, which was attenuated after adjustment for weight category. Patients started on statins during the observation period did not demonstrate an increase in ALT over time (ALT 0.9 U/L [95% CI −5.2, 3.4] increase per year; p = 0.7). Conclusion: In our study population, we did not observe a higher burden of ALT elevations among pediatric patients on statins as compared to those with dyslipidemia who are not on statins, supporting the hepatic safety of statin use in childhood. Address correspondence and reprint requests to Nirav K. Desai, Boston Children's Hospital, Division of Gastroenterology, Hepatology, and Nutrition, 300 Longwood Ave, Boston, MA 02225 (e-mail: Nirav.desai@childrens.harvard.edu). Received 23 March, 2018 Accepted 9 September, 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). Nirav K. Desai and Michael M. Mendelson These authors contributed equally as co-first authors. Maureen M. Jonas and Sarah D. de Ferranti These authors contributed equally as co-senior authors. Funding: MMM was supported by the NHLBI K99 HL136875 and The Tommy Kaplan Fund, Department of Cardiology, Boston Children's Hospital, Boston, MA. JPZ was funded by NHLBI K23 HL111335 The funding sources had no role in the design of this study and did not have any role during its execution, analyses, interpretation of the data, or decision to submit results. Disclosures: No author has any relevant disclosures. NKD is currently an employee of Shire Plc; however, the study, analysis, and preparation of the final manuscript occurred prior to beginning this employment. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Human ALKBH3-induced m1A demethylation increases the CSF-1 mRNA stability in breast and ovarian cancer cells

Publication date: Available online 17 October 2018

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

Author(s): Ho-Hyung Woo, Setsuko K. Chambers

Abstract

In ovarian and breast cancers, the actions of the cytokine CSF-1 lead to poor prognosis. CSF-1 expression can be regulated post-transcriptionally. RNA methylation is another layer of posttranscriptional regulation. The methylation of N¹ atom of adenine (m¹A) results in a conformational change of RNA which regulates translational efficiency. Our study indicates that the m¹A is also involved in the CSF-1 mRNA decay. The alteration of ALKBH3 expression, an m¹A demethylase, regulates the CSF-1 mRNA stability. Demethylation of m¹A by ALKBH3 increases the half-life of CSF-1 mRNA without affecting the translation efficiency. The m¹A in CSF-1 mRNA is mapped in the 5′UTR near the translation initiation site. YTHDF2, a known m⁶A reader which interacts with the CCR4-NOT deadenylation complex, is not the reader of m¹A-containing CSF-1 mRNA. Overexpression of ALKBH3 increases CSF-1 expression and the degree of cancer cell invasiveness without affecting cell proliferation or migration. Collectively, we showed that CSF-1 mRNA decay can be regulated at an epigenetic level, and that alteration of the N¹‑methylation status leads to phenotypic changes in cancer cell behavior.

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Great ape thorax and shoulder configuration—An adaptation for arboreality or knuckle-walking?

Publication date: December 2018

Source: Journal of Human Evolution, Volume 125

Author(s): Nathan E. Thompson, Danielle Rubinstein, Susan G. Larson

Abstract

Great apes exhibit a suite of morphological traits of the shoulder and upper thorax that have traditionally been linked to orthograde arborealism. Recently it has been proposed that these traits are instead adaptations for knuckle-walking, and more broadly, that knuckle-walking itself is an adaptation for shock absorption during terrestriality. Here we test several tenets of these hypotheses using kinematic and kinetic data from chimpanzees and macaques, and electromyographic data of shoulder muscle activity in chimpanzees. We collected 3D kinematic data to quantify motion of the acromion and trunk during quadrupedalism and vertical climbing in chimpanzees as well as ground reaction forces to investigate the presence and magnitude of impact transient forces during terrestrial locomotion in chimpanzees and macaques. We also investigated patterns of recruitment of select forelimb musculature (triceps brachii and serratus anterior) using previously collected data in chimpanzees to determine whether these muscles may function to absorb impact transient forces. We found that the acromion is significantly more elevated in vertical climbing than during knuckle-walking, while dorsoventral ranges and magnitudes of motion were similar between gaits. Ground reaction forces indicate that only a minority of strides in either chimpanzees or macaques have transient forces and, when present, these transient forces as well as loading rates are small. Electromyographic results show that activity of the triceps brachii may facilitate energy absorption while serratus anterior likely functions to support the trunk, as in other primates. Our data suggest there is little to no evidence supporting recent hypotheses that the African ape upper thorax and shoulder configuration is an adaptation for knuckle-walking, or more broadly, that knuckle-walking exists as an adaptation to absorb impact shock during terrestriality. We do however find some evidence that shoulder configuration allows greater scapular elevation in chimpanzees during arboreal behaviors (e.g., vertical climbing).

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Intraoperative Hypothermia is Associated With Reduced Acute Kidney Injury After Spine Surgery Under General Anesthesia: A Retrospective Observational Study

Background: Although hypothermia is known to have protective effects against ischemic injuries, the effects of hypothermia on kidney injury have not yet been elucidated. Therefore, this study aimed to identify the association between intraoperative hypothermia and postoperative acute kidney injury (AKI) in patients who underwent spine surgery under general anesthesia. Methods: In this retrospective observational study, we analyzed the medical records of adult patients who underwent elective spine surgery between January 2010 and March 2018. Patients were classified into the normothermia group (36.5 to 37.5°C), mild hypothermia group (35 to 36.5°C), and hypothermia group (

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Cognitive Aids for the Diagnosis and Treatment of Neuroanesthetic Emergencies: Consensus Guidelines on Behalf of the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) Education Committee

Cognitive aids and evidence-based checklists are frequently utilized in complex situations across many disciplines and sectors. The purpose of such aids is not simply to provide instruction so as to fulfill a task, but rather to ensure that all contingencies related to the emergency are considered and accounted for and that the task at hand is completed fully, despite possible distractions. Furthermore, utilization of a checklist enhances communication to all team members by allowing all stakeholders to know and understand exactly what is occurring, what has been accomplished, and what remains to be done. Here we present a set of evidence-based critical event cognitive aids for neuroanesthesia emergencies developed by the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) Education Committee. The authors have no funding or conflicts of interest to disclose. Address correspondence to: Amie L. Hoefnagel, MD, Department of Anesthesiology, University of Florida College of Medicine—Jacksonville, 2nd Floor, Clinical Center, 655 West 8th Street, C72, Jacksonville, FL 32209 (e-mail: amie.hoefnagel@jax.ufl.edu). Received August 7, 2018 Accepted August 27, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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Regional Versus General Anesthesia: Effect of Anesthetic Techniques on Clinical Outcome in Lumbar Spine Surgery A Prospective Randomized Controlled Trial

Background: There are only a few prospective clinical trials investigating the effects of different anesthetic techniques on clinical outcomes after lumbar spine surgery. The purpose of this study was to evaluate clinical outcomes in patients receiving general (GA) and regional anesthesia (RA) for lumbar spine surgery. Methods: This was a single-center, 2-arm, trial in which 100 patients undergoing lumbar spine surgery were randomized to receive either RA or GA (50 per group). The primary endpoint was morphine consumption during the first postoperative 48 hours. In addition, anesthesia time, transition time (defined as time from end of surgery to admission to the postoperative anesthesia care unit), visual analogue scale (VAS) for pain, and patient satisfaction at hospital discharge were recorded. Results: There was no difference in the primary endpoint (cumulative morphine consumption at 48 h) between the 2 anesthesia types. Anesthesia and transition times were significantly shorter in the RA compared with the GA group—anesthesia time 125.4±23.6 minutes for GA versus 99.4±13.5 minutes for RA, transition time 22.5 minutes for GA versus 10.0 minutes for RA (both P

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Real-world efficacy of glecaprevir plus pibrentasvir for chronic hepatitis C patient with previous direct-acting antiviral therapy failures

Abstract

Background

Combination therapy with glecaprevir (GLE) and pibrentasvir (PIB) has high efficacy for pan-genotypic hepatitis C virus (HCV)-infected patients. However, the efficacy of the therapy for failures to prior direct-acting antiviral (DAA) regimens in real-world practice is not well known.

Methods

Thirty patients infected with HCV genotype 1b, 2a, 2b, or 3a who failed to respond during prior DAA therapies were treated with GLE/PIB for 12 weeks. HCV NS3 and NS5A drug resistance-associated variants (RAVs) were determined by direct sequencing.

Results

Twenty-eight out of 30 patients (93.3%) achieved SVR12 by GLE/PIB treatment. SVR12 rates were similar between patients with and without advanced liver fibrosis (94.7% and 91.0%, respectively). All 9 patients with genotype 2a, 2b, or 3a HCV infection achieved SVR12. However, two genotype 1b HCV-infected patients who failed previous daclatasvir plus asunaprevir treatment experienced HCV relapse after the end of GLE/PIB treatment. Direct sequence analysis showed the presence of NS3-D168E plus NS5A-L31I/P58S/Y93H RAVs in one patient and NS5A-L31F/P32del RAVs in another patient before GLE/PIB treatment. In the former patient, NS3-D168E plus NS5A-L31I/P58S/Y93H RAVs persisted, and additional NS5A-L28M/V75A variants emerged after HCV relapse.

Conclusions

GLE/PIB treatment for HCV-infected patients who did not respond to prior DAA treatments was highly effective regardless of liver fibrosis stage. However, some genotype 1b HCV-infected patients, especially those with NS5A-P32del, may have low susceptibility to the treatment.

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Review of reduction factors by buildings for gamma radiation from radiocaesium deposited on the ground due to fallout

Publication date: Available online 16 October 2018

Source: Journal of Environmental Radioactivity

Author(s): Hiroko Yoshida-Ohuchi, Norihiro Matsuda, Kimiaki Saito

Abstract

In order to estimate residents' external dose due to radionuclide exposure resulting from fallout deposit on the ground, the shielding and dose reduction effects provided by structures such as houses and workplaces are taken into account as most individuals spend a large portion of their time indoors. Many works on both calculation and measurement for European and American settlements have been reported and factors such as, shielding factors, protection factors, reduction factors, and location factors have been determined. However, measurement data for Japanese settlements are lacking. Thus, the Japanese government used reduction factors given in the International Atomic Energy Agency documents from American and European settlements when Fukushima Dai-ichi Nuclear Power Plant (FDNPP) accident occurred. The United Nations Scientific Committee on the Effects of Atomic Radiation used location factors from European settlements for the same reason. Soon after the FDNPP accident, several measurements and calculations were performed to obtain specific reduction factors for Japanese settlements due to this lack of data. This research reviews previous studies that determined factors such as, shielding factors, protection factors, reduction factors, and location factors and summarizes specific results for Japan. We discuss the issues in determining these factors and in applying them to estimate indoor dose. The contribution of surface contamination to the indoor ambient dose equivalent rate is also discussed.

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Radiocesium interaction with clay minerals: Theory and simulation advances Post–Fukushima

Publication date: Available online 16 October 2018

Source: Journal of Environmental Radioactivity

Author(s): Masahiko Okumura, Sebastien Kerisit, Ian C. Bourg, Laura N. Lammers, Takashi Ikeda, Michel Sassi, Kevin M. Rosso, Masahiko Machida

Abstract

Insights at the microscopic level of the process of radiocesium adsorption and interaction with clay mineral particles have improved substantially over the past several years, triggered by pressing social issues such as management of huge amounts of waste soil accumulated after the Fukushima Dai–ichi nuclear power plant accident. In particular, computer–based molecular modeling supported by advanced hardware and algorithms has proven to be a powerful approach. Its application can now generally encompass the full complexity of clay particle adsorption sites from basal surfaces to interlayers with inserted water molecules, to edges including fresh and weathered frayed ones. On the other hand, its methodological schemes are now varied from traditional force–field molecular dynamics on large–scale realizations composed of many thousands of atoms including water molecules to first–principles methods on smaller models in rather exacting fashion. In this article, we overview new understanding enabled by simulations across methodological variations, focusing on recent insights that connect with experimental observations, namely: 1) the energy scale for cesium adsorption on the basal surface, 2) progress in understanding the structure of clay edges, which is difficult to probe experimentally, 3) cesium adsorption properties at hydrated interlayer sites, 4) the importance of the size relationship between the ionic radius of cesium and the interlayer distance at frayed edge sites, 5) the migration of cesium into deep interlayer sites, and 6) the effects of nuclear decay of radiocesium. Key experimental observations that motivate these simulation advances are also summarized. Furthermore, some directions toward future solutions of waste soil management are discussed based on the obtained microscopic insights.

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Applicability of Kd for modelling dissolved 137Cs concentrations in Fukushima river water: Case study of the upstream Ota River

Publication date: Available online 16 October 2018

Source: Journal of Environmental Radioactivity

Author(s): Kazuyuki Sakuma, Hideki Tsuji, Seiji Hayashi, Hironori Funaki, Alex Malins, Kazuya Yoshimura, Hiroshi Kurikami, Akihiro Kitamura, Kazuki Iijima, Masaaki Hosomi

Abstract

A study is presented on the applicability of the distribution coefficient (K_d) absorption/desorption model to simulate dissolved ¹³⁷Cs concentrations in Fukushima river water. The upstream Ota River basin was simulated using GEneral-purpose Terrestrial Fluid-flow Simulator (GETFLOWS) for the period 1 January 2014 to 31 December 2015. Good agreement was obtained between the simulations and observations on water and suspended sediment fluxes, and on particulate bound ¹³⁷Cs concentrations under both base and high flow conditions. By contrast the measured concentrations of dissolved ¹³⁷Cs in the river water were much harder to reproduce with the simulations. By tuning the K_d values for large particles, it was possible to reproduce the mean dissolved ¹³⁷Cs concentrations during base flow periods (observation: 0.32 Bq/L, simulation: 0.36 Bq/L). However neither the seasonal variability in the base flow dissolved ¹³⁷Cs concentrations (0.14–0.53 Bq/L), nor the peaks in concentration that occurred during storms (0.18–0.88 Bq/L, mean: 0.55 Bq/L), could be reproduced with realistic simulation parameters. These discrepancies may be explained by microbial action and leaching from organic matter in forest litter providing an additional input of dissolved ¹³⁷Cs to rivers, particularly over summer, and limitations of the K_d absorption/desorption model. It is recommended that future studies investigate these issues in order to improve simulations of dissolved ¹³⁷Cs concentrations in Fukushima rivers.

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Successful Helicobacter pylori eradication therapy improves symptoms of chronic constipation

Helicobacter

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Duplicated distal phalanx of thumb or hallux in trisomy 13: A recurrent feature in a series of 42 fetuses

American Journal of Medical Genetics Part A, EarlyView.


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Personalised medicine and population health: breast and ovarian cancer

Abstract

It has been suggested that a personalised approach to cancer prevention and screening might lead to a new paradigm for cancer control. Various aspects include testing for high-penetrance cancer susceptibility genes and generating personal risks scores, based on panels of single nucleotide polymorphisms. These tests can categorize women into various groupings of risk for cancer prevention (surgery and chemoprevention) cancer screening and prevention of cancer recurrence. In this review, I investigate various claims and come to the conclusion that the approach may be beneficial for the occasional patient but is unlikely to have any impact on reducing the burden of cancer incidence and mortality as whole. Challenges include meeting a high uptake of the test in the population, developing an effective and acceptable intervention and the willingness of healthy women to follow health care provider recommendations. The review focuses on strategies to reduce mortality from breast and ovarian cancer but is potentially applicable to other cancer sites, such as colon, prostate, and endometrial.

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Enhanced availability of serotonin increases activation of unfatigued muscle but exacerbates central fatigue during prolonged sustained contractions

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


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Development Of The Cerebral Cortex And The Effect Of The Intrauterine Environment

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


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Exercise training reduces the insulin‐sensitizing effect of acute exercise in human skeletal muscle

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


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Baroreflex functionality in the eye of diffusion tensor imaging

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


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RAAS inhibitors directly reduce diabetes‐induced Renal fibrosis via PDGF and CTGF inhibition

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


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Effect of Intravenous Lidocaine, Dexamethasone, and Their Combination on Postoperative Sore Throat: A Randomized Controlled Trial

BACKGROUND: Postoperative sore throat (POST), hoarseness, and cough after tracheal intubation are not uncommon. Although both lidocaine and dexamethasone have been used independently to reduce these events, there is no study assessing the combined effects of lidocaine and dexamethasone. METHODS: This prospective, double-blind, randomized controlled study enrolled 180 patients requiring general anesthesia with endotracheal intubation for >90 minutes. They received 1 of the 4 intravenous agents just before induction of anesthesia: lidocaine (1.5 mg/kg-) in group L, dexamethasone (8 mg) in group D, lidocaine (1.5 mg/kg) with dexamethasone (8 mg) in group DL, and placebo as normal saline in group NS. Standard anesthesia protocol was followed. Incidence and severity of a sore throat, cough, and hoarseness of voice were assessed up to 24 hours postoperatively. The primary outcome was the incidence of POST, and the main effects of dexamethasone and lidocaine were the primary interest. RESULTS: Data of 45 patients in D, 44 in L, 44 in DL, and 43 in NS groups were analyzed. The incidence of a sore throat was 36%, 43%, 25%, and 56% in group D, L, DL, and NS, respectively (P = .02). Dexamethasone with or without lidocaine reduced the incidence of the POST (odds ratio, 0.44; 95% confidence interval, 0.24–0.82; P

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Ancillary factors in the treatment of orofacial pain: a topical narrative review

Journal of Oral Rehabilitation, Volume 0, Issue ja, -Not available-.


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Titanium release in peri‐implantitis

Journal of Oral Rehabilitation, Volume 0, Issue ja, -Not available-.


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Hardness of the habitual diet and its relationship with cognitive function among 70‐year‐old Japanese elderly: findings from the SONIC study

Journal of Oral Rehabilitation, Volume 0, Issue ja, -Not available-.


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Combining Russian stimulation with isometric exercise improves strength, balance, and mobility in older people with falls syndrome

One of the main causes of falls in older people is muscle strength loss associated with aging. Russian stimulation can improve muscle strength in healthy individuals, but the effect has never been tested in older individuals with falls syndrome. The aim of this study was to evaluate the usefulness of Russian stimulation plus isometric exercise to improve muscular strength, balance, and mobility in older people with falls syndrome. The recruited participants (older than 60 years, at least one fall in the past year) were evaluated by a physiatrist, who collected clinical data and performed baseline and final evaluations (muscle strength, Berg balance scale, Tinetti mobility test, get up and go test, and 6-min walk test). A physical therapist applied the 10/50/10 protocol for Russian stimulation, stimulating the quadriceps and tibialis anterior muscles separately; simultaneously, the participants performed isometric exercise at a frequency of three sessions per week for 12 weeks. Descriptive statistics, the paired-sample t-test, and the χ2-test were performed. The study included 25 participants (96% women, mean age 65.2±5.5 years). After the intervention, there was a significant improvement in the strength of the quadriceps (~30%) and tibialis anterior (~40%) muscles as well as the results of the balance (Tinetti 22%, Berg 10%) and mobility (get up and go 25%, 6-min distance 20%) tests. On the basis of the improvements in the Tinetti and Berg scores, significantly fewer participants were classified as being at increased risk for falls. The muscle strength correlated with several clinical evaluation results, but not with the Tinetti test score. Russian stimulation plus isometric exercise improves strength, balance, and mobility, which may decrease the fall risk. Correspondence to Carlos Omar Lopez López, PhD, MD, Rehabilitation Department, Hospital General de México 'Dr Eduardo Liceaga', Dr Balmis148, Col Doctores, Del. Cuauhtémoc, CP 06726 Ciudad de México, México Tel: +52 552 789 2000 x6119; e-mail: c.lopez.8108@gmail.com Received April 23, 2018 Accepted September 17, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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