Παρασκευή, 19 Οκτωβρίου 2018

Does Aerobic Training Promote the Same Skeletal Muscle Hypertrophy as Resistance Training? A Systematic Review and Meta-Analysis

Abstract

Background

Currently, there are inconsistencies in the body of evidence for the effects of resistance and aerobic training on skeletal muscle hypertrophy.

Objective

We aimed to systematically review and meta-analyze current evidence on the differences in hypertrophic adaptation to aerobic and resistance training, and to discuss potential reasons for the disparities noted in the literature.

Methods

The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed for this review. The Downs and Black checklist was used for the assessment of methodological quality of the included studies. A random-effects meta-analysis was employed. In total, three analyses were performed: (1) for whole-muscle knee extensor data; (2) for type I fiber cross-sectional area; and (3) for type II fiber cross-sectional area.

Results

The final number of included studies in the present review is 21. All studies were of good or moderate methodological quality. The meta-analysis for whole-muscle hypertrophy resulted in a significant pooled difference (p < 0.001) in responses between the aerobic training and resistance training interventions. The pooled Hedge's g, favoring resistance over aerobic training, was 0.66 (95% confidence interval 0.41–90; I2 = 0%). The meta-analysis for type I fiber cross-sectional area data resulted in a significant pooled difference (p < 0.001) between the aerobic training and resistance training groups. The pooled Hedge's g, favoring resistance training over aerobic training, was 0.99 (95% confidence interval 0.44–1.54; I2 = 24%). The meta-analysis of type II fiber cross-sectional area data resulted in a significant pooled difference (p < 0.001) between the aerobic training and resistance training groups. The pooled Hedge's g, favoring resistance training over aerobic training, was 1.44 (95% confidence interval 0.93–1.95; I2 = 8%).

Conclusions

The results of this systematic review and meta-analysis suggest that single-mode aerobic training does not promote the same skeletal muscle hypertrophy as resistance training. This finding was consistent with measurements of muscle hypertrophy both at the whole-muscle and myofiber levels. While these results are specific to the knee extensor musculature, it can be hypothesized that similar results would be seen for other muscle groups as well.



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Effects of Jumping Exercise on Muscular Power in Older Adults: A Meta-Analysis

Abstract

Background

Jump training (JT) can be used to enhance the ability of skeletal muscle to exert maximal force in as short a time as possible. Despite its usefulness as a method of performance enhancement in athletes, only a small number of studies have investigated its effects on muscle power in older adults.

Objectives

The aims of this meta-analysis were to measure the effect of JT on muscular power in older adults (≥ 50 years), and to establish appropriate programming guidelines for this population.

Data Sources

The data sources utilised were Google Scholar, PubMed, and Microsoft Academic.

Study Eligibility Criteria

Studies were eligible for inclusion if they comprised JT interventions in healthy adults (≥ 50 years) who were free of any medical condition that could impair movement.

Study Appraisal and Synthesis Methods

The inverse variance random-effects model for meta-analyses was used because it allocates a proportionate weight to trials based on the size of their individual standard errors and facilitates analysis while accounting for heterogeneity across studies. Effect sizes (ESs), calculated from a measure of muscular power, were represented by the standardised mean difference and were presented alongside 95% confidence intervals (CIs).

Results

Thirteen training groups across nine studies were included in this meta-analysis. The magnitude of the main effect was 'moderate' (0.66, 95% CI 0.33, 0.98). ESs were larger in non-obese participants (body mass index [BMI] < 30 vs. ≥ 30 kg/m2; 1.03 [95% CI 0.34, 1.73] vs. 0.53 [95% CI − 0.03, 1.09]). Among the studies included in this review, just one reported an acute injury, which did not result in the participant ceasing their involvement. JT was more effective in programmes with more than one exercise (range 1–4 exercises; ES = 0.74 [95% CI − 0.49, 1.96] vs. 0.53 [95% CI 0.29, 0.78]), more than two sets per exercise (range 1–4 sets; ES = 0.91 [95% CI 0.04, 1.77] vs. 0.68 [95% CI 0.15, 1.21]), more than three jumps per set (range 1–14 jumps; ES = 1.02 [95% CI 0.16, 1.87] vs. 0.53 [95% CI − 0.03, 1.09]) and more than 25 jumps per session (range 6–200 jumps; ES = 0.88 [95% CI 0.05, 1.70] vs. 0.49 [95% CI 0.14, 0.83]).

Conclusions

JT is safe and effective in older adults. Practitioners should construct varied JT programmes that include more than one exercise and comprise more than two sets per exercise, more than three jumps per set, and 60 s of recovery between sets. An upper limit of three sets per exercise and ten jumps per set is recommended. Up to three training sessions per week can be performed.



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Acknowledgment to reviewers



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Surgical technique and chylothorax following coronary artery bypass grafting

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Achilleas Lazopoulos, Dimitrios Paliouras, Nikolaos Barbetakis

Annals of Cardiac Anaesthesia 2018 21(4):468-468



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Predictors of acute kidney injury in patients undergoing adult cardiac surgery

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Sreja Gangadharan, KR Sundaram, Senthilvelan Vasudevan, B Ananthakrishnan, Rakhi Balachandran, Abraham Cherian, Praveen Kerala Varma, Luis Bakero Gracia, K Murukan, Ashish Madaiker, Rajesh Jose, Rakesh Seetharaman, Kirun Gopal, Sujatha Menon, M Thushara, Reshmi Liza Jose, G Deepak, Sudheer Babu Vanga, Aveek Jayant

Annals of Cardiac Anaesthesia 2018 21(4):448-454

Background: Acute kidney injury (AKI) after cardiac surgery (CS) is not uncommon and has serious effects on mortality and morbidity. A majority of patients suffer mild forms of AKI. There is a paucity of Indian data regarding this important complication after CS. Aims and Objectives: The primary objective was to study the incidence of AKI associated with CS in an Indian study population. Secondary objectives were to describe the risk factors associated with AKI-CS in our population and to generate outcome data in patients who suffer this complication. Methods: Serial patients (n = 400) presenting for adult CS (emergency/elective) at a tertiary referral care hospital in South India from August 2016 to November 2017 were included as the study individuals. The incidence of AKI-CS AKI network (AKIN criteria), risk factors associated with this condition and the outcomes following AKI-CS are described. Results: Out of 400, 37 (9.25%) patients developed AKI after CS. AKI associated with CS was associated with a mortality of 13.5% (no AKI group mortality 2.8%, P = 0.001 [P < 0.05]). When AKI was severe enough to need renal replacement therapy, the mortality increased to 75%. Patients with AKI had a mean hospital stay 16.92 ± 12.75 days which was comparatively longer than patients without AKI (14 ± 7.98 days). Recent acute coronary syndrome, postoperative atrial fibrillation, and systemic hypertension significantly predicted the onset of AKI-CS in our population. Conclusions: The overall incidence of AKI-CS was 9.25%. The incidence of AKI-CS requiring dialysis (Stage 3 AKIN) AKI-CS was lower (2%). However, mortality risks were disproportionately high in patients with AKIN Stage 3 AKI-CS (75%). There is a need for quality improvement in the care of patients with AKI-CS in its most severe forms since mortality risks posed by the development of Stage 3 AKIN AKI is higher than reported in other index populations from high resource settings.

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Facilitating noncardiac surgery for the patient with left ventricular assist device: A guide for the anesthesiologist

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Kai-Yin Hwang, Nian-Chih Hwang

Annals of Cardiac Anaesthesia 2018 21(4):351-362

The introduction of left ventricular assist device (LVAD) has improved survival rates for patients with end-stage heart failure. Two categories of VADs exist: one generates pulsatile flow and the other produces nonpulsatile continuous flow. Survival is better for patients with continuous-flow LVADs. With improved survival, more of such patients now present for noncardiac surgery (NCS). This review, written for the general anesthesiologists, addresses the perioperative considerations when the patient undergoes NCS. For best outcomes, a multidisciplinary approach is essential in perioperative management of the patient.

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Preoperative predictors of poor laryngoscope views in pediatric population undergoing cardiac catheterization

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Madan Mohan Maddali, Haifa Mohammed Ali Al-Zaabi, Is'haq Said Salim Al-Aamri, Nishant Ram Arora, Sathiya Murthi Panchatcharam

Annals of Cardiac Anaesthesia 2018 21(4):376-381

Background: The primary objective of this study was to identify pre-anesthetic airway assessment parameters that would predict Cormack and Lehane grade III and IV laryngoscopy views in pediatric patients undergoing cardiac catheterization procedures. The secondary end points were to identify factors that would contribute to difficult laryngoscope views in this subset of patients. Settings and Design: Prospective observational study performed at a single tertiary cardiac care center. Materials and Methods: 199 children below 5 years of age undergoing elective cardiac catheterization were included. Pre-anesthetic airway assessment was done by modified Mallampati grading, lower lip to chin distance [LCD], tragus to mouth angle [TMA], thyromental distance [TMD], neck circumference [NC], and the ratio of height to thyromental distance [RHTMD]. Demographic data including American Society of Anesthesiologists physical status [ASA PS] were recorded for each child. Receiver Operating Characteristic curves were plotted and Areas Under the Curve were measured to identify the best cut off values for each of the airway evaluation method that would predict poor laryngoscopy views as well as assess their accuracy in doing so. Results: LCD, TMD and low body mass index were found to have good sensitivity, specificity and accuracy in predicting Grade III and IV laryngoscope views. ASA PS grade III and above patients had a significantly higher incidence of poor laryngoscope visualization. Conclusions: LCD, TMA, TMD, NC, RHTMD and BMI could all be used combinedly as screening tools during pre-anesthetic airway evaluation for predicting difficult laryngoscope views in children. Among these, LCD, TMD along with low body mass index might have better accuracy.

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Unrecognized hyperlucent lesion on lateral film of chest X-Ray

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Ankita Singh, Navneet Kumar Srivastva, Prabhat Tewari, Gauranga Majumdar

Annals of Cardiac Anaesthesia 2018 21(4):440-441

We report an interesting case of bulla right lung, incidently found during CABG surgery.

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The efficacy of different modes of analgesia in postoperative pain management and early mobilization in postoperative cardiac surgical patients: A systematic review

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Brenda Nachiyunde, Louisa Lam

Annals of Cardiac Anaesthesia 2018 21(4):363-370

Cardiac surgery induces severe postoperative pain and impairment of pulmonary function, increases the length of stay (LOS) in hospital, and increases mortality and morbidity; therefore, evaluation of the evidence is needed to assess the comparative benefits of different techniques of pain management, to guide clinical practice, and to identify areas of further research. A systematic search of the Cochrane Central Register of Controlled Trials, DARE database, Joanna Briggs Institute, Google scholar, PUBMED, MEDLINE, EMBASE, Academic OneFile, SCOPUS, and Academic search premier was conducted retrieving 1875 articles. This was for pain management postcardiac surgery in intensive care. Four hundred and seventy-one article titles and 266 abstracts screened, 52 full text articles retrieved for critical appraisal, and ten studies were included including 511 patients. Postoperative pain (patient reported), complications, and LOS in intensive care and the hospital were evaluated. Anesthetic infiltrations and intercostal or parasternal blocks are recommended the immediate postoperative period (4–6 h), and patient-controlled analgesia (PCA) and local subcutaneous anesthetic infusions are recommended immediate postoperative and 24–72 h postcardiac surgery. However, the use of mixed techniques, that is, PCA with opioids and local anesthetic subcutaneous infusions might be the way to go in pain management postcardiac surgery to avoid oversedation and severe nausea and vomiting from the narcotics. Adequate studies in the use of ketamine for pain management postcardiac surgery need to be done and it should be used cautiously.

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Missing swan ganz catheter

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Monish S Raut, Arun Maheshwari

Annals of Cardiac Anaesthesia 2018 21(4):462-463



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Tissue oximetry during cardiac surgery and in the cardiac intensive care unit: A prospective observational trial

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Benjamin J Heller, Pranav Deshpande, Joshua A Heller, Patrick McCormick, Hung-Mo Lin, Ruiqi Huang, Gregory Fischer, Menachem M Weiner

Annals of Cardiac Anaesthesia 2018 21(4):371-375

Background: Cerebral oximetry using near-infrared spectroscopy (NIRS) has well-documented benefits during cardiac surgery. The authors tested the hypothesis that NIRS technology can be used at other sites as a tissue oximeter during cardiac surgery and in the Intensive Care Unit (ICU). Aims: To establish feasibility of monitoring tissue oximetry during and after cardiac surgery, to examine the correlations between tissue oximetry values and cerebral oximetry values, and to examine correlations between oximetry values and mean arterial pressure (MAP) in order to test whether cerebral oximetry can be used as an index organ. Settings and Designs: A large, single-center tertiary care university hospital prospective observational trial of 31 patients undergoing cardiac surgery with cardiopulmonary bypass was conducted. Materials and Methods: Oximetry stickers were applied to both sides of the forehead, the nonarterial line forearm, and the skin above one paraspinal muscle. Data were collected from before anesthesia induction until extubation or for at least 24 h in patients who remained intubated. Statistical Analysis: Categorical variables were evaluated with Chi-square or Fisher's exact tests, while Wilcoxon rank-sum tests or student's t-tests were used for continuous variables. Results: The correlation between cerebral oximetry values and back oximetry values ranged from r = 0.37 to 0.40. The correlation between cerebral oximetry values and forearm oximetry values ranged from r = 0.11 to 0.13. None of the sites correlated with MAP. Conclusions: Tissue oximetry at the paraspinal muscle correlates with cerebral oximetry values while at the arm does not. Further research is needed to evaluate the role of tissue oximetry on outcomes such as acute renal failure, prolonged need for mechanical ventilation, stroke, vascular ischemic complications, prolonged ICU and hospital length of stay, and mortality in cardiac surgery.

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The value of institutional protocols and focused cardiac ultrasound during a case of ultramassive transfusion

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Muhammad Salman Tahir Janjua, Shvetank Agarwal, Manuel R Castresana

Annals of Cardiac Anaesthesia 2018 21(4):433-436

A 53-year-old female was admitted to the emergency department with an exsanguinating bleed from the rectum which was of unclear origin. In what could be considered an ultramassive transfusion, 60 units packed red blood cells, 23 units fresh frozen plasma, 20 units platelets, 6 units cryoprecipitate, 30 L of crystalloids, 2 L of colloids, and 4 g of tranexamic acid were transfused over the course of 7 h. An arterio-enteric fistula was diagnosed and treated by an interventional radiologist. The patient recovered rapidly thereafter without any major neurologic, pulmonary, cardiac, or hematologic complications.

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Abdominal compartment syndrome after surgical repair of Type A aortic dissection

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Fotini Ampatzidou, Athanasios Madesis, George Kechagioglou, George Drossos

Annals of Cardiac Anaesthesia 2018 21(4):444-445

Abdominal compartment syndrome is associated with severe dysfunction of intra-abdominal and intrathoracic organs. Medical therapy, with the goal of reducing intra-abdominal pressure, leads to improvement in organ perfusion.

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Usefulness of ultrasound-guided measurement of minimal transverse diameter of subglottic airway in determining the endotracheal tube size in children with congenital heart disease: A prospective observational study

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Rahul Pillai, Suresh Kumaran, L Jeyaseelan, Sajan P George, Raj Sahajanandan

Annals of Cardiac Anaesthesia 2018 21(4):382-387

Introduction: The search for an accurate and predictable method to estimate the endotracheal tube (ETT) size in pediatric population had led to derivation of many formulae. Of this, age-based formulae are the most commonly used. Studies have shown that minimal transverse diameter of subglottic airway (MTDSA) measurements using a high-frequency probe improves the success rate of predicting the airway diameter to about 90%. We did a prospective observational study using MTDSA as the criteria to select the size of ETT in children with congenital heart disease. Methods: In this prospective observational study, 51 children aged from 1 day to 5 years, scheduled for cardiac surgery, were enrolled for this study. The ETT size was guided solely based on the MTDSA. Leak test was used to determine the best-fit ETT size. Results: Data from 49 patients were analyzed. Agreement between the ETT determined by MTDSA and that predicted by Cole's age-based formulas with the best-fit ETT size was analyzed using a Bland–Altman plot. Conclusion: Age-based formula showed poor correlation (27.5%) compared to MTDSA (87.8%) in predicting the best-fit ETT. We observed that pediatric patients with congenital heart disease need a larger sized ETT as compared to what was predicted by age-based formula. Using ultrasound MTDSA measurements to guide selection of ETT size is a safe and accurate method in pediatric cardiac population.

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Is routine preoperative chest X-ray: An underutilized tool in asymptomatic patients!

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Swati Jindal, Satinder Gombar, Kompal Jain

Annals of Cardiac Anaesthesia 2018 21(4):460-461



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Dreams content and emotional load in cardiac rehabilitation patients and their relation to anxiety and depression

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Saeid Komasi, Ali Soroush, Habibolah Khazaie, Ali Zakiei, Mozhgan Saeidi

Annals of Cardiac Anaesthesia 2018 21(4):388-392

Background: The assessment of a dream and its mechanisms and functions may help us to percept cognitions, emotions, and complex behaviors of patients. Hence, the present study aimed to assess (i) the rate of perceived dream and its emotional load and content and (ii) the relationship between functions of dream with anxiety and depression. Methods: In this cross-sectional study, 167 cardiac patients who had undergone rehabilitation in the western part of Iran were assessed during May–October 2016. Research instrument included Beck depression inventory, Beck anxiety inventory, Schredl's dream emotions manual, and content analysis of dreams manual. The findings were analyzed through Pearson's correlative coefficient and multiple regression analysis. Results: The mean age of participants (66.5% men) was 59.1 ± 9 years. The results indicated that the emotional content of patients' dreams included happiness (49.1%), distress (43.1%), sad (13.8%), fear (13.2%), and anger (3%). Although women report more sad dreams than men (P = 0.026), there was no difference between them in terms of other components of dreams, anxiety, and depression. Regression models showed that anxiety and depression were significantly able to predict perceived dream rates (P = 0.030) and emotionally negative dreams (P = 0.019). Conclusion: The increased rates of depression, especially anxiety, are related to increasing perceived dreams with negative and harmful emotional load. Regarding severity and negative content of dreams are reflexes of stressful emotional daily experiences, the management of experienced psychological symptoms such as depression and anxiety is concerned as an undeniable necessity.

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Anesthesia considerations in neonate with tetralogy of fallot posted for laparotomy

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Sushama Raghunath Tandale, Kalpana V Kelkar, Amey A Ghude, Priyanka V Kambale

Annals of Cardiac Anaesthesia 2018 21(4):465-466



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Is elevated blood glucose a marker of occult tissue hypoperfusion in off-pump coronary artery bypass grafting?

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Soumi Das, Kakali Ghosh, Avijit Hazra, Chaitali Sen, Anupam Goswami

Annals of Cardiac Anaesthesia 2018 21(4):393-401

Context: Hyperglycemia has been found to occur during myocardial infarction and cardiac surgery even in nondiabetic patients. These being essentially stressful processes associated with hypoperfusion, we decided to find a possible relationship between the occurrence of global tissue hypoperfusion (GTH) and elevated blood glucose level in adult nondiabetic patients undergoing elective off-pump coronary artery bypass grafting (CABG). Aims: This study aims to observe for the occurrence of global tissue hypoperfusion and its effect on blood glucose level and whether raised blood glucose level can be used as a marker for GTH. Design: Prospective, observational study. Settings: Cardiothoracic operation theater and intensive care unit of a tertiary care teaching hospital. Materials and Methods: The occurrence of global tissue hypoperfusion were detected with the help of combined markers of mixed venous oxygen saturation and arterial lactate level at various perioperative study points together with arterial blood glucose level. Blood glucose level compared between the patients with and without GTH. Statistical Analysis Used: Numerical variables were compared between groups by Student's t-test and categorical variables by Fisher's exact test. Two-tailed P ≤ 0.05 was considered for statistically significant. Results: The incidence of GTH was 67%. Blood glucose level was raised in patients with GTH at some study time points but with poor sensitivity and specificity values. Conclusions: Global tissue hypoperfusion is a common occurrence in even nondiabetic patients undergoing elective off-pump CABG. A relationship exists between rise in blood glucose level and global tissue hypoperfusion in such patients, although it cannot be viewed as marker of the same.

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Statistical literacy for healthcare professionals: Why is it important?

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Rakesh Aggarwal

Annals of Cardiac Anaesthesia 2018 21(4):349-350



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Predictors and outcome of early extubation in infants postcardiac surgery: A single-center observational study

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Shahzad Alam, Akunuri Shalini, Rajesh G Hegde, Rufaida Mazahir, Akanksha Jain

Annals of Cardiac Anaesthesia 2018 21(4):402-406

Objective: The objective of the current study was to evaluate the timing of first extubation and compare the outcome of patient extubated early with others; we also evaluated the predictors of early extubation in our cohort. Materials and Methods: This prospective cohort study included children <1 year of age undergoing surgery for congenital heart disease. Timing of first extubation was noted, and patients were dichotomized in the group taking 6 h after completion of surgery as cutoff for early extubation. The outcome of the patients extubated early was compared with those who required prolonged ventilation. Variables were compared between the groups, and predictors of early extubation were evaluated using multivariate logistic regression analysis. Results: One hundred and ninety-four (33.8%) patients were extubated early including 2 extubation in operating room and 406 (70.7%) were extubated within 24 h. Four (0.7%) patients died without extubation. No significant difference in mortality and reintubation was observed between groups. Patient extubated early had a significant lower incidence of sepsis (P = 0.003) and duration of Intensive Care Unit (ICU) stay (P = 0.000). Age <6 months, risk adjustment for congenital heart surgery category ≥3, cardiopulmonary bypass time ≥80 min, aortic cross-clamp time ≥ 60 min, and vasoactive-inotropic score >10 were independently associated with prolonged ventilation. Conclusion: Early extubation in infants postcardiac surgery lowers pediatric ICU stay and sepsis without increasing the risk of mortality or reintubation. Age more than 6 months, less complex of procedure, shorter surgery time, and lower inotropic requirement are independent predictors of early extubation.

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Right atrial myxoma: Unusual location; uncommon association

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Om Prakash Sanjeev, Soumya Sankar Nath, Deepak Malviya, Subhas Singh Rajput

Annals of Cardiac Anaesthesia 2018 21(4):437-439

We are presenting a case of the right atrial myxoma found in a case of rheumatic heart disease. During transthoracic echocardiography for the evaluation of a suspected rheumatic valvular heart disease, a diagnosis of severe mitral stenosis with severe mitral regurgitation with the right atrial thrombus was made. On transesophageal echocardiography, a pedunculated mass in the right atrium was confirmed. In the course of surgery, it was found that there is a tumor originating from the right atrial appendage (RAA) which was confused with clot on echocardiography. Rheumatic heart disease and myxomas have different etiopathogenesis, and this coexistence has not been reported. Further, right atrial myxoma arising out of RAA is also being reported for the first time.

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Predictors and outcome of early extubation in infants postcardiac surgery: A single-center observational study

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Bhupesh Kumar, Ganesh Kumar Munirathinam

Annals of Cardiac Anaesthesia 2018 21(4):407-408



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Aortic regurgitation after chemoport catheter insertion: Diagnostic dilemma

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Vijay Mohan Hanjoora, Gaurav Gupta, Monish S Raut

Annals of Cardiac Anaesthesia 2018 21(4):442-443

Catheter insertion in central vein can potentially cause accidental arterial injury. However it is very unusual to see such catheter in aorta causing aortic regurgitation. Pressure monitoring and Ultrasound guidance can reliably prevent accidental arterial puncture.

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Posterior Vertebral Endplate Fractures: A Retrospective Study on a Rare Etiology of Back Pain in Youth and Young Adults

Posterior lumbar vertebral endplate fracture occurs with avulsion of the ring apophysis from the posterior vertebral body. Although this has been described in adolescents and young adults, proper diagnosis is often delayed or missed entirely. Surgery may be curative.

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71st World Health Assembly, Geneva, Switzerland 2018

No abstract available

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In Response

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Protecting the Beans: Perioperative Acute Kidney injury

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In Response

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“Randomization at the Expense of Relevance.” L. J. Cronbach and Intravenous Acetaminophen as an Opioid-Sparing Adjuvant

No abstract available

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American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Gastrointestinal Dysfunction Within an Enhanced Recovery Pathway for Elective Colorectal Surgery: Erratum

No abstract available

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Preoperative Intravenous Iron to Enhance a Blood Management Program: Is It All in “Vein”?

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Perioperative Two-Dimensional Transesophageal Echocardiography: A Practical Handbook, 2nd ed

No abstract available

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Multimodal General Anesthesia: A Principled Approach to Producing the Drug-Induced, Reversible Coma of Anesthesia

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In Response

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Why Cost-Effectiveness?

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Nitrous Oxide Supply Systems

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Intraoperative Oliguria: Physiological or Beginning Acute Kidney Injury?

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Balancing Act: Multimodal General Anesthesia

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Surveying the Literature: Synopsis of Recent Key Publications

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Anesthesia: The Gift of Oblivion and the Mystery of Consciousness

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Implication of Major Adverse Postoperative Events and Myocardial Injury on Disability and Survival: A Planned Subanalysis of the ENIGMA-II Trial

imageBACKGROUND: Globally, >300 million patients have surgery annually, and ≤20% experience adverse postoperative events. We studied the impact of both cardiac and noncardiac adverse events on 1-year disability-free survival after noncardiac surgery. METHODS: We used the study cohort from the Evaluation of Nitrous oxide in Gas Mixture of Anesthesia (ENIGMA-II) trial, an international randomized trial of 6992 noncardiac surgical patients. All were ≥45 years of age and had moderate to high cardiac risk. The primary outcome was mortality within 1 postoperative year. We defined 4 separate types of postoperative adverse events. Major adverse cardiac events (MACEs) included myocardial infarction (MI), cardiac arrest, and myocardial revascularization with or without troponin elevation. MI was defined using the third Universal Definition and was blindly adjudicated. A second cohort consisted of patients with isolated troponin increases who did not meet the definition for MI. We also considered a cohort of patients who experienced major adverse postoperative events (MAPEs), including unplanned admission to intensive care, prolonged mechanical ventilation, wound infection, pulmonary embolism, and stroke. From this cohort, we identified a group without troponin elevation and another with troponin elevation that was not judged to be an MI. Multivariable Cox proportional hazard models for death at 1 year and assessments of proportionality of hazard functions were performed and expressed as an adjusted hazard ratio (aHR) and 95% confidence intervals (CIs). RESULTS: MACEs were observed in 469 patients, and another 754 patients had isolated troponin increases. MAPEs were observed in 631 patients. Compared with control patients, patients with a MACE were at increased risk of mortality (aHR, 3.36 [95% CI, 2.55–4.46]), similar to patients who suffered a MAPE without troponin elevation (n = 501) (aHR, 2.98 [95% CI, 2.26–3.92]). Patients who suffered a MAPE with troponin elevation but without MI had the highest risk of death (n = 116) (aHR, 4.29 [95% CI, 2.89–6.36]). These 4 types of adverse events similarly affected 1-year disability-free survival. CONCLUSIONS: MACEs and MAPEs occur at similar frequencies and affect survival to a similar degree. All 3 types of postoperative troponin elevation in this analysis were associated, to varying degrees, with increased risk of death and disability.

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In Response

No abstract available

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Postoperative Hypotension and Surgical Site Infections After Colorectal Surgery: A Retrospective Cohort Study

imageBACKGROUND: Hypotension compromises local tissue perfusion, thereby reducing tissue oxygenation. Hypotension might thus be expected to promote infection. Hypotension on surgical wards, while usually less severe than intraoperative hypotension, is common and often prolonged. In this retrospective cohort study, we tested the hypotheses that there is an association between surgical site infections and low postoperative time-weighted average mean arterial pressure and/or postoperative minimum mean arterial pressure. METHODS: We considered patients who had colorectal surgery lasting ≥1 hour at the Cleveland Clinic between 2009 and 2013. We defined blood pressure exposures as time-weighted average (primary) and minimum mean arterial pressure (secondary) within 72 hours after surgery. We assessed associations between continuous blood pressure exposures with a composite of deep and superficial surgical site infection using separate severity-weighted average relative effect generalized estimating equations models, each using an unstructured correlation structure and adjusting for potentially confounding variables. RESULTS: A total of 5896 patients were eligible for analysis. Time-weighted mean arterial pressure and surgical site infection were not significantly associated, with an estimated odds ratio (95% CI) of 1.03 (0.99–1.08) for a 5-mm Hg decrease (P = .16). However, there was a significant inverse association between minimum postoperative mean arterial pressure and infection, with an estimated odds ratio of 1.08 (1.03–1.12) per 5-mm Hg decrease (P = .001). CONCLUSIONS: Postoperative time-weighted mean arterial pressure was not associated with surgical site infection, but lowest postoperative mean arterial pressure was. Whether the relationship is causal remains to be determined.

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In Response

No abstract available

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Evaluation of the Inter- and Intrahospital Spread of Multidrug Resistant Gram-Negative Bacteria in Lithuanian Hospitals

Microbial Drug Resistance, Ahead of Print.


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From Dehydration to Fractures: Medical Issues Faced by People Crossing the United States: Mexico Border

Abstract

To quantify the number of Border Crossers seen at our hospitals, broken down by diagnoses and age. We used our electronic medical record to identify the number of patients in custody of the United States Border Patrol who were seen at Banner-University: South and University Campuses during the calendar year 2016. 734 patients were identified, and the electronic medical record was used to identify the primary diagnosis and age for each one. We then manually categorized them into groups of common diagnoses. We also compared the number of border crosser emergency department (ED) visits to overall ED visits. Of 734 patients, 77% were male, 60% were between 16 and 40 years of age, and 18% were under age 18 years. They made up 1.3% of ED visits to South Campus, but less than 0.1% to University Campus. The top categories were musculoskeletal trauma (n = 235, 32%), and dehydration and rhabdomyolysis (n = 95, 13%). The age range of border crossers brought to our EDs varies widely, as do their primary diagnoses, although trends can be seen. They make up a 1.3% of overall emergency department visits at South Campus hospital.



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Altered splicing in Alzheimer transcriptomes

Altered splicing in Alzheimer transcriptomes

Altered splicing in Alzheimer transcriptomes, Published online: 19 October 2018; doi:10.1038/s41576-018-0064-4

A study in Nature Genetics reports the analysis of transcriptomes of the ageing brain and highlights the impact of genetic variation underlying altered mRNA splicing in Alzheimer disease.

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Navigating mouse cell types

Navigating mouse cell types

Navigating mouse cell types, Published online: 19 October 2018; doi:10.1038/s41576-018-0067-1

A new study reports the 'Tabula Muris', an atlas of single-cell RNA sequencing data from >100,000 cells across 20 mouse tissues.

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Publisher Correction: Base editing: precision chemistry on the genome and transcriptome of living cells

Publisher Correction: Base editing: precision chemistry on the genome and transcriptome of living cells

Publisher Correction: Base editing: precision chemistry on the genome and transcriptome of living cells, Published online: 19 October 2018; doi:10.1038/s41576-018-0068-0

Publisher Correction: Base editing: precision chemistry on the genome and transcriptome of living cells

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Adaptations to Concurrent Training in Combination with High Protein Availability: A Comparative Trial in Healthy, Recreationally Active Men

Abstract

Background

We implemented a high-protein diet (2 g·kg−1·d−1) throughout 12 weeks of concurrent exercise training to determine whether interferences to adaptation in muscle hypertrophy, strength and power could be attenuated compared to resistance training alone.

Methods

Thirty-two recreationally active males (age: 25 ± 5 years, body mass index: 24 ± 3 kg·m−2; mean ± SD) performed 12 weeks of either isolated resistance (RES; n = 10) or endurance (END; n = 10) training (three sessions·w−1), or concurrent resistance and endurance (CET; n = 12) training (six sessions·w−1). Maximal strength (1RM), body composition and power were assessed pre- and post-intervention.

Results

Leg press 1RM increased ~ 24 ± 13% and ~ 33 ± 16% in CET and RES from PRE-to-POST (P < 0.001), with no difference between groups. Total lean mass increased ~ 4% in both CET and RES from PRE-to-POST (P < 0.001). Ultrasound estimated vastus lateralis volume increased ~ 15% in CET and ~ 11% in RES from PRE-to-POST (P < 0.001), with no difference between groups. Wingate peak power relative to body mass displayed a trend (P = 0.053) to be greater in RES (12.5 ± 1.6 W·kg BM−1) than both CET (10.8 ± 1.7 W·kg BM−1) and END (10.9 ± 1.8 W·kg BM−1) at POST. Absolute VO2peak increased 6.9% in CET and 12% in END from PRE-to-POST (P < 0.05), with no difference between groups.

Conclusion

Despite high protein availability, select measures of anaerobic power-based adaptations, but not muscle strength or hypertrophy, appear susceptible to 'interference effects' with CET and should be closely monitored throughout training macro-cycles.

Trials Registry: This trial was registered with the Australian-New Zealand Clinical Trials Registry (ACTRN12617001229369).



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Hurricane deployment is not Beach Week for Ambulance Strike Teams

Operating in the public eye under conditions that may require evacuation or assisting colleagues at a moment's notice means responders must be ready 24/7

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Occurrence of hepatocellular carcinoma 24 years after successful interferon therapy in a patient with chronic hepatitis C: a case report

Abstract

An 82-year-old man presented with hepatocellular carcinomas (HCCs) 24 years after achieving a sustained virological response (SVR) to an interferon for hepatitis C. His hepatic fibrosis stage was F1 when he was treated at 58 years. He was followed-up by annual blood tests and abdominal ultrasonography or computed tomography. After the IFN treatment, he had drunk approximately 100 g of ethanol. Serum aspartate aminotransferase and gamma-glutamyl transpeptidase levels had been elevated since 2012. To investigate the possible factors that affect hepatocarcinogenesis over 10 years after achieving an SVR, we reviewed the literature. Of 39 reported patients, 26, as well as ours, had one or more lifestyle-related factors, including body mass index ≥ 25 kg/m2, diabetes mellitus, impaired glucose tolerance, hepatosteatosis, or alcohol consumption. In our patient, aging and daily alcohol consumption might have triggered the development of HCCs.



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Correction to: Cancer Biother Radiopharm 2014;29(8):303–309. DOI: 10.1089/cbr.2014.1653 and Cancer Biother Radiopharm 2014;29(10):451–456. DOI: 10.1089/cbr.2014.1698

Cancer Biotherapy and Radiopharmaceuticals, Volume 33, Issue 8, Page 363-363, October 2018.


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Correction to: Cancer Biother Radiopharm 2014;29(8):303–309. DOI: 10.1089/cbr.2014.1653 and Cancer Biother Radiopharm 2014;29(10):451–456. DOI: 10.1089/cbr.2014.1698

Cancer Biotherapy and Radiopharmaceuticals, Volume 33, Issue 8, Page 363-363, October 2018.


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Altered splicing in Alzheimer transcriptomes



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Navigating mouse cell types



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Publisher Correction: Base editing: precision chemistry on the genome and transcriptome of living cells



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Metformin use and gastric cancer risk in diabetic patients after Helicobacter pylori eradication

Journal of the National Cancer Institute

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