Τετάρτη, 24 Οκτωβρίου 2018

Retrieval of 28 Rare Earth Magnets From the Small Bowel With Antegrade Single Balloon Enteroscopy

imageNo abstract available

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Anti-Cytomegalovirus Activity in Human Milk and Colostrum From Mothers of Preterm Infants

imageObjectives: This study aimed to investigate the anti-human cytomegalovirus (CMV) activity of milk from seropositive and seronegative mothers of preterm infants and to analyze its changes throughout the different stages of lactation and after Holder pasteurization, a procedure adopted by donor human milk banks. Methods: Eighteen mothers of preterm infants were enrolled in the study. Colostrum, transitional milk, and mature milk samples were collected and tested for anti-CMV activity. Depletion of immunoglobulins A from milk samples was carried out by jacalin resin. Pools of milk samples were pasteurized according to Holder technique. Results: All samples were endowed with anti-CMV activity, although to a different extent. In CMV IgG-positive mothers, colostra were significantly more active than the transitional milk and mature milk samples. Moreover, they were more potent than colostra from seronegative mothers. Immunoglobulins A depletion in colostra from IgG-positive mothers resulted in a partial loss of anti-CMV activity. Holder pasteurization significantly reduced the antiviral activity. Conclusions: Human milk is endowed with anti-CMV activity and its potency may vary depending on the stage of lactation and the serological status of the mother. This biological property could partially neutralize CMV particles excreted in the milk of CMV IgG-positive mothers thus reducing the risk of transmitting infectious viruses to the infant.

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Early Life Factors and Eosinophilic Esophagitis: Building the Evidence

No abstract available

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Serum Immunoglobulin A Levels Do Not Correlate With Liver Disease Severity in Pediatric Nonalcoholic Fatty Liver Disease

imageSerum immunoglobulin A (IgA) is a biomarker of liver disease severity in adult nonalcoholic fatty liver disease (NAFLD). The objective of this study was to assess whether this is true in pediatric NAFLD. This was a retrospective study of children followed in the Steatohepatitis Center of a tertiary care center (2010–2017). Serum IgA levels, histology and biochemical markers of hepatocellular injury and metabolic dysregulation were collected. Of the 600 children with available serum IgA levels (mean age 14 ± 3 years, 62% boys, 80% non-Hispanic), IgA was elevated in 4%. The group with elevated IgA levels was younger and had a greater representation of Hispanic ethnicity compared with those with normal or low IgA. Body mass index and aminotransferases were not different between the groups. Histology was available for 170 children and was not different in those with elevated, normal and low IgA. In contrast to adults, serum IgA is not a biomarker of liver disease severity in pediatric NAFLD.

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Considerations in Donor Human Milk Use in Premature Infants

No abstract available

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Growth, Body Composition, and Micronutrient Abnormalities During and After Weaning Off Home Parenteral Nutrition

imageObjectives: The aim of the study is to assess growth, body composition, and micronutrient abnormalities in children with intestinal failure (IF) over time, both during and after weaning off parenteral nutrition (PN). Methods: Retrospective study in children on home PN between 2001 and 2015. Weight-for-age (WFA) and height-for-age (HFA) SD scores (SDS) were calculated, as well as fat mass (FM) and fat-free mass (FFM) SDS obtained by dual energy x-ray absorptiometry. The course of growth parameters and body composition was analyzed with linear-mixed models. All micronutrient measurements during the study period were obtained. Results: Fifty-two patients were included with a median follow-up of 3.4 years. Seventy-one percent weaned off after a median PN duration of 0.9 years. One year after the start of PN, 28 patients were still PN-dependent with median WFA-SDS of −0.66 and median HFA-SDS of −0.96, both significantly lower than zero. Catch-up growth was achieved during PN, but HFA-SDS decreased after weaning (P = 0.0001). At a median age of 6.2 years, median %FM SDS was 0.30 and FFM SDS was −1.21, the latter significantly lower than zero. Frequent micronutrient abnormalities during PN were vitamin A (90%), zinc (87%), and iron (76%) and after weaning vitamin A (94%), E (61%), and 25-OH vitamin D (59%). Conclusions: Children with IF demonstrate abnormal growth and body composition and frequent micronutrient abnormalities. Longitudinal evaluation showed that catch-up growth occurs during PN, but height SDS decreases after weaning. This underlines the need for close monitoring, also after reaching enteral autonomy.

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Bladder Symptoms in Children With Functional Constipation: A Systematic Review

imageObjective: The aim of the review is to perform a systematic review of the literature examining the prevalence of bladder symptoms in children with functional constipation (FC) and to compare the prevalence of those symptoms between children with and without FC. Methods: In this systematic review 4 databases were searched to July 2018. Studies investigating the prevalence of bladder symptoms in children aged 4 to 17 years with FC were included. There was no language restriction. Two reviewers independently extracted data and assessed study quality. Clinical heterogeneity between studies was investigated. Prevalence rates of bladder symptoms in children with FC were calculated. Relative risks were calculated to compare the prevalence of bladder symptoms between children with and without FC. Results: Among 23 studies of children with FC, 22 reported the prevalence bladder symptoms (12,281 children) and 7 reported the prevalence of urinary tract infections (UTIs) (687 children). The prevalence rates of single bladder symptoms, lower urinary tract symptoms (LUTS), and UTI varied between 2% to 47%, 37% to 64%, and 6% to 53%. The relative risks were 1.24 to 6.73 for 20 single bladder symptoms (12 studies) and 2.18 to 6.55 for UTI (2 studies). The 95% confidence intervals indicated significance in 14 of 20 single bladder symptoms. Conclusions: Bladder symptoms seem common in children with FC, but the reported prevalence varies greatly. Children with FC are more likely to have bladder symptoms than children without FC. We recommend that clinicians be aware of concomitant bladder symptoms in children presenting with FC.

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Obesity Does Not Affect Early Outcomes in Children With Newly Diagnosed Crohn Disease

imageThe impact of obesity on pediatric Crohn disease (CD) remains poorly characterized. We aimed to evaluate disease-related outcomes in overweight and obese children with CD, compared to normal-weight children. We conducted a retrospective cohort study of children with newly diagnosed CD enrolled in the ImproveCareNow Network. Patients were stratified into normal weight, overweight, and obese groups using standardized weight percentiles. A total of 898 children were included, with 87 children (10%) being overweight and 43 children (5%) being obese; baseline characteristics were similar between groups. There was no significant difference in number of visits in remission during 1 year between normal weight, overweight, and obese children. At 1-year follow-up, nutritional status, growth status, or medication use also did not differ between groups. Hence, obesity does not appear to adversely affect CD outcomes in children with newly diagnosed CD in the first year after diagnosis.

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Pureed Fruit Pouches for Babies: Child Health Under Squeeze

imageNo abstract available

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Quality of Life in Patients With Progressive Familial Intrahepatic Cholestasis: No Difference Between Post-liver Transplantation and Post-partial External Biliary Diversion

imageObjectives: In patients with progressive familial intrahepatic cholestasis (PFIC), partial external biliary diversion (PEBD), which is associated with a permanent stoma, is recommended as first-line therapy, whereas primary liver transplantation (LTx) is restricted to those with cirrhosis. Our aim was to quantify the health-related quality of life (HRQOL) in patients with PFIC and to evaluate whether there is a difference in their HRQOL depending on the surgical approach. Methods: A prospective HRQOL study on a consecutive series of PFIC was conducted using Pediatric Quality of Life Inventory 4.0 child-self and parent-proxy reports. Patients with PFIC after PEBD who still lived with their native livers were compared to those after LTx. Both groups were compared to healthy children. Results: A total of 32 patients (53% girls) patients with a mean age of 17.7 ± 7.3 years were studied. Twenty-two had undergone LTx at a mean age of 7.8 ± 3.8 years and 10 had undergone PEBD at a mean age of 4.1 ± 3.9 years. At the time of HRQOL assessment, the mean age was 18.9 ± 7.5 years in the LTx group and 15.3 ± 6.5 years in the PEBD group. Child-self and parent-proxy reports showed no significant difference in HRQOL between patients with PFIC after LTx and those after PEBD except for marginal difference in physical functioning/health (P = 0.07). Except for a lower score in patient school functioning of patients after LTx (P = 0.01), HRQOL-results showed no difference from healthy children in any group. Conclusions: The HRQOL of patients with PFIC after PEBD was similar to those after LTx. The HRQOL in both groups was also similar to that of healthy children. Thus, our data support the current policy of PEBD as primary surgical treatment for patients with PFIC without cirrhosis.

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A Bibliometric Analysis of Clinical and Translational Research in Pediatric Gastroenterology From 1970 to 2017

imageObjectives: Pediatric gastroenterology is a clinical and research discipline principally developed over the past 50 years. Bibliometric methods provide quantitative analysis and identify research trends. Study aims were to characterize the growth and trends in pediatric gastroenterology clinical and translational research using citation analysis. Methods: Using citations analysis software, a search strategy specific for pediatric gastroenterology was implemented for the years 1970 to 2017. The 50 most-cited research articles per decade were identified. These 250 articles were coded for topic and study attribute. Analysis included authors, affiliations, journals, countries, and funding sources. Results: Overall average annual growth rate for pediatric gastroenterology publications was significantly higher than that for general pediatrics (51.7% vs 6.2%; P 

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Physical Activity and Skipping Breakfast Have Independent Effects on Body Fatness Among Adolescents

imageObjective: We analyzed the longitudinal relationship between breakfast intake and adiposity among adolescents, and the possible mediation role of physical activity on this phenomenon. Methods: We conducted the longitudinal study composed of 86 adolescents (11–14 years old), absence of any known chronic diseases and no regular medicine use that returned the formal consent and assent both signed. Breakfast intake was reported through face-to-face interviews. Adiposity was assessed using a densitometry scanner. Physical activity was estimated through step counts performed using pedometers. Biological maturation was estimated through the maturity level. Student t test for independent samples was used to compare adolescents who were "nonskipping breakfast" and "skipping breakfast," whereas the relationship between adiposity, physical activity, and skipping breakfast was assessed using Pearson correlation. Structural equation model was created to identify the mediation role of physical activity on the relationship between nonskipping breakfast and adiposity. Results: After 12 months, adolescents who had consumed breakfast regularly presented decreased trunk fatness (−3.5% [95% confidence interval (CI): −6.9 to −0.2]) and body fatness (−2.3% [95% CI: −3.9 to −0.7]) compared with their counterparts. Physical activity had an inverse relationship with trunk fatness (r = −0.270 [95% CI: −0.457 to −0.060]). Nonskipping breakfast was, however, not significantly related to trunk fatness; however, physical activity seems to reduce trunk fatness in our sample (r  = −0.281; 95% CI: −0.479 to −0.083). Conclusions: Adolescents who ate breakfast regularly presented lower body fatness independent of physical activity, whereas trunk fatness decreased in adolescents who improved physical activity.

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Yield and Examiner Dependence of Digital Rectal Examination in Detecting Impaction in Pediatric Functional Constipation

imageObjectives: Guidelines on functional constipation recommend digital rectal examination (DRE) when constipation is doubtful or with a suspicion of organic etiology. The guidelines do not clarify if DRE is mandatory to diagnose impaction. This study aims to determine the frequency of impaction detectable only on DRE among children satisfying Rome III criteria without requiring DRE and also the inter-observer influences on impaction detection by DRE. Methods: Children between 6 months to 13 years of age, presenting with history suggestive of constipation were assessed. After excluding those with suspicion of organic etiology, those who needed DRE for diagnosis of constipation and those who do not satisfy Rome III criteria without DRE, the rest who satisfied Rome III criteria were assessed for impaction by palpable fecoliths or constipation-associated fecal incontinence. Those without such impaction were randomized to 2 examiners for DRE to diagnose impaction, in the absence of contraindications. Results: Two hundred and thirty-three children were assessed. One hundred and sixty-nine satisfied Rome III without needing DRE. Forty-eight (28.4%) had impaction detectable without DRE. Among the rest, 28 (30.1%) had impaction by DRE. There was no difference between the frequency of impaction detected by the 2 examiners. Clinical characteristics were similar (P > 0.05) between those with impaction detectable by DRE and those without. Conclusions: DRE does detect cases of impaction not discernible by other means. Such a finding may be comparable between examiners. These children may be identified by other clinical characteristics. The clinical significance of such a finding needs more understanding from the standpoint of therapeutic choices.

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Monozygotic Twin Cases of XIAP Deficiency Syndrome

imageNo abstract available

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Is the Scout Out? The Utility of Scout Radiographs in the Pediatric Upper Gastrointestinal Examination

imageObjective: The aim of the study is to demonstrate the scout radiograph does not change patient management, alter planning, or contribute to interpretation of the outpatient pediatric upper gastrointestinal fluoroscopic examination (UGI). Methods: We retrospectively reviewed 197 outpatient pediatric UGIs performed over a 2-year period. We performed a chart review on all patients to evaluate for potentially clinically significant findings on the scout radiograph. Scout findings were categorized into 4 groups: no new clinically significant findings (group 1), potentially clinically significant findings that were not directly addressed in the electronic medical record (group 2), incidental non-gastrointestinal (GI) findings that necessitated further workup, however, were later deemed insignificant (group 3), and clinically significant findings that changed patient GI management, altered the planning of the procedure, or contributed to the interpretation of the fluoroscopic study (group 4). Results: A total of 197 UGIs were analyzed. A significant majority of cases (97.0%) were classified into group 1. Three cases (1.5%) were classified into group 2 with findings not addressed in the medical record. Two cases (1.0%) were classified into group 3, which, after further workup, were deemed not clinically significant. One case (0.5%) was classified into group 4, which resulted in a change in patient GI management. Conclusions: In our review, there was only 1 case in which the scout radiograph changed patient GI management, with moderate stool burden leading to a miralax cleanout, although there were no cases, which altered the planning of the procedure or contributed to the interpretation of the study. The scout radiograph can be omitted and/or substituted with the last image hold function to decrease radiation exposure.

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Determining Significance in the New Era for P Values

imageNo abstract available

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Evolving Trends of Gastrostomy Insertion Within a Pediatric Population

imageObjective: Gastrostomy insertion in pediatrics is usually used in children with complex needs and severe disability. The accessibility and acceptance of the procedure is increasing but population-based occurrence data are lacking and there is limited understanding of its use in clinical subgroups. Methods: This birth cohort study investigated the trends in first gastrostomy insertion among a pediatric population born between 1983 and 2009 in Western Australia using linked administrative and health data collected over a 32-year period (1983–2014). Indications were identified using diagnosis codes from linked hospitalization data and grouped according to a refined classification system. Age and birth cohort patterns of first gastrostomy use, over calendar year and age respectively, were described. Results: Of the 690,688 children born between 1983 and 2009, 466 underwent a gastrostomy insertion. Overall, the prevalence was approximately 7 cases per 10,000 births. New gastrostomy insertions were increasingly performed in children during the preschool years over calendar years and in successive birth cohorts. Children with a neurological disorder constituted the largest group receiving gastrostomy (n = 372; 79.8) including 325 (87.4%) with comorbid intellectual disability. Conclusions: New gastrostomy insertion among children who require long-term enteral feeding support increased over the study period. The procedure is most often performed in the context of severe neurological disability, including intellectual disability, and offers families potential for long-term home-based management of feeding difficulties.

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Sustained Viral Response in Genotype 4 Chronic Hepatitis C Virus–infected Children and Adolescents Treated With Sofosbuvir/Ledipasvir

imageObjectives: Recently, direct acting antivirals (DAAs), sofosbuvir (SOF) combined with ledipasvir (LED), were approved for treatment of hepatitis C virus (HCV)–infected children 12 years of age and older or weighting at least 35 kg for all HCV genotypes. The aim of this study was to assess the safety and efficacy of SOF/LED in genotype 4 HCV-infected Egyptian children and adolescents. Methods: This observational study included 40 consecutive HCV-infected children of age 12 to 35 kg, both treatment-naive and treatment-experienced. All of the children were hepatitis B virus–negative and had normal renal functions and heart rate. Patients received oral, fixed-dose combination tablet of SOF/LED (400 mg SOF, 90 mg LED [Harvoni]) once daily for 12 weeks. Potential side effects were recorded at weeks 4, 8, and 12 weeks of treatment. The study primary outcome was sustained virological response 12 weeks (SVR12) after end-of-treatment. Results: The study included 40 children and adolescents, 24 were boys (60%); their age ranged between 11.5 and 17.5 years (mean 13.9 ± 1.5). Baseline viral load ranged between 9630 and 24,600,000 IU/mL. HCV RNA became negative in 39 patients (97.5%) at 4 weeks and in all patients (100%) at weeks 8, 12, and SVR12. Asthenia was the commonest side effect, reported in 52.5% followed by headache in 47.5%. Conclusions: Treatment with all-oral DAAs (SOF/LED) for 12 weeks was well tolerated in Egyptian children and adolescents infected with genotype 4 HCV, with 100% SVR12 and negligible side effects.

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Early Life Incidence of Gastrointestinal and Respiratory Infections in Children With Gastroschisis: A Cohort Study

imageObjectives: Survival in infants with gastroschisis is increasing although little is known about early childhood morbidity. In the context of a hypothesized link between the gastrointestinal (GI) tract and immune function, this study explores rates of GI and respiratory infections in children with gastroschisis. Methods: We conducted a population-based retrospective cohort study using data from the Health Improvement Network, a large database of UK primary care medical records. We identified children born from 1990 to 2013, and extracted follow-up data to their fifth birthday. We calculate incidence rates (IR) of GI and respiratory tract infections, overall and stratified by age, sex, socioeconomic status, and gestational age at birth, and compared these between children with and without gastroschisis by calculating adjusted incidence rate ratios (aIRR). Results: Children with gastroschisis had a 65% higher IR of GI infection compared to children without (aIRR 1.65, 95% confidence interval [CI] 1.37–1.99, P 

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Macrophage Markers Are Poorly Associated With Liver Histology in Children With Nonalcoholic Fatty Liver Disease

imageObjectives: We have previously demonstrated associations between the macrophage activation marker soluble (s)CD163 and histology of nonalcoholic fatty liver disease (NAFLD) in adults, and elevated sCD163 levels in children with obesity with NAFLD. Macrophage activation has, however, not been investigated in children with biopsy-proven NAFLD, which was the objective of the present study. Methods: We used in-house enzyme-linked immunosorbent assays to measure sCD163 and the novel macrophage marker soluble mannose receptor (sMR) in a cross-sectional (n = 155) pediatric NAFLD cohort, and a cohort of NAFLD children (n = 36) undergoing a randomized trial by the probiotic VSL#3. We included 56 healthy nonobese children for comparison. Results: Levels of sCD163 and sMR were higher in both of the NAFLD cohorts compared with controls (P 

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Editorial Board



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Early pancreatic cancer — The role of endoscopic ultrasound with or without tissue acquisition in diagnosis and staging

Pancreatic cancer (PC) is one of the deadliest cancers with a 5-year overall survival of less than 6%. Due to its insidious clinical course and unspecific symptoms, the diagnosis is usually late, with only 15–20% patients presenting with potentially curable disease. It is, therefore, extremely important to identify patients with PC at early stages of the disease when tumors may be amenable to surgical resection. For unresectable and borderline resectable PC it is consensual to perform a biopsy to have a cyto/histological confirmation of malignancy before treatment.

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Translation and initial validation of the Medication Adherence Report Scale (MARS) in Italian patients with Crohn’s Disease

The MARS-5 (Medication Adherence Report Scale) was developed in English. The aim of this project was to analyse the MARS-5I (© Prof Rob Horne) psychometric properties and to identify whether its Italian translation is suitable for assessing medication adherence in Crohn Disease (CD) Italian patients. The MARS was translated and linguistically validated in Italian. The MARS-5I was used for evaluating medication adherence in the SOLE study, conducted in Italy on 552 subjects with CD. In order to un-bias the questionnaire results from the effects of treatment change and/or effectiveness, the analyses were performed on the 277 patients whose disease activity remained stable, selected among the 371 patients who maintained the same treatment between two consecutive visits.

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Intraductal ultrasonographic diagnosis of hydatid membranes in the common bile duct

A 76-year-old Tibetan woman was admitted to us with a one-month history of intermittent abdominal pain, fever and jaundice. There was a history of excision of hepatic hydatid cyst 40 years ago. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a cystic mass in the right lobe of the liver and abnormal material in a dilated common bile duct (CBD), which was demonstrated as a multiple cord-like structure by magnetic resonance cholangiopancreatography (MRCP) (Fig. 1a). Endoscopic retrograde cholangiopancreatography (ERCP) revealed a hugely dilated CBD with irregular filling defects (Fig.

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AISF position paper on HCV in immunocompromised patients

This report summarizes the clinical features and the indications for treating HCV infection in immunocompromised and transplanted patients in the Direct Acting Antiviral drugs era.

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Harmonising proton pump inhibitors treatment in the specialist setting following the SIGE recommendations

we read with great interest the position paper of the Italian Society of Gastroenterology (SIGE) on the appropriateness of prescription for proton pump inhibitor (PPI) drugs that was recently published in Digestive and Liver Disease, as we feel that the statements reported in the manuscript should actually represent a "Dos and don'ts" companion handbook in everyday clinical practice of both primary care physicians and specialists in gastroenterology [1].

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Large abdominopelvic mammary-type myofibroblastoma with incomplete resection and recurrence

A 48-year-old man consulted for vague abdominal discomfort and increased urinary frequency. CT showed a large abdominopelvic mass compressing the urinary bladder, prostate, and rectum (Fig. 1). This lesion was well-demarcated with no involvement of adjacent anatomic structures. Surgery and pathology showed a mammary-type myofibroblastoma (MTM), which was incompletely resected due to its large size. Follow-up CT, a year later, showed a recurring lesion in the pelvis with very slow growth during subsequent 4-year imaging monitoring (Fig.

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Cost–Benefit Analysis of Providing Fluoride Varnish in a Pediatric Primary Care Office

The American Academy of Pediatrics and the U.S. Preventive Services Task Force, among others, call for the provision of fluoride varnish in the pediatric primary care setting, but many barriers exist to the implementation of such a service in this setting. Knowledge of costs and benefits is one such barrier.

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Impact of Parental Military Service on the Health of Military-Connected Children: A Case Study

More than 2.1 million children have had at least one parent deploy in support of Operation Enduring Freedom and/or Operation Iraqi Freedom. A total of 58% of enlisted personnel (active duty, reserve, or National Guard) have families, and 40% have two or more children (Brendel, Maynard, Albright, & Bellomo, 2014). Seventeen years of sustained military involvement in Iraq and Afghanistan has placed an increased physical and emotional burden on military-connected children. Many dependent children are living with a service member parent who suffers from the physical and or psychological wounds of war (e.g., polytrauma, amputations, traumatic brain injury, posttraumatic stress disorder).

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NAPNAP Position Statement on Immunizations

The National Association of Pediatric Nurse Practitioners (NAPNAP) supports the timely and complete immunization of all infants, children, adolescents, and adults in an attempt to maximize the health and wellbeing of all people. Routine childhood immunizations prevent as many as 3 million deaths per year. In addition, 1.5 million deaths per year could be avoided if global vaccination efforts continue to improve (World Health Organization, 2017).

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Access to Maternal Mental Health Services: Trends in State Legislation

Postpartum depression is the most common but underrecognized medical complication of childbearing, and 10% to 15% of pregnant and postpartum women will experience depression. Currently, only 30.8% of women with postpartum depression are identified, and only 6.3% receive adequate treatment (Cox, Sowa, Meltzer-Brody, & Gaynes, 2016). Given this disparity in detection and treatment, women who suffer maternal mental health disorders need effective health policies to increase access to mental health services.

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Celiac Disease in the Pediatric Population

Celiac disease is an autoimmune disorder in which the lining of the gastrointestinal tract is damaged by an immune-mediated response to gluten proteins (Allen, 2015). It is a polygenetic disease that only appears in genetically susceptible individuals (Newton & Singer, 2012). It is a worldwide concern, with North America having a high prevalence rate (Liu et al., 2017). Celiac disease can present in a spectrum of manifestations, making it difficult to identify and diagnosis (Reilly & Green, 2012).

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Society Page



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Information for Readers



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On Elections, Imposter Syndrome, and Burnout

I am going to let you in on a little secret: I am writing this in the midst of a July heat wave and trying to imagine what will be important and salient in November. I see the beginning of the chaos of the holiday season and the onset of flu, rotavirus, and the dreaded respiratory syntactical virus. Elective surgery schedules are exploding as people try to get care scheduled before their deductibles reset on January 1st. And, of course, the midterm elections loom large. By November, many middle childhood and adolescent kids present with new concerns about inattention and school performance, and many in fall sports have signs of overuse injuries.

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Table of Contents



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Celiac Disease in the Pediatric Population



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The Power of Positive Psychology

One of the most popular courses at Yale University is PSCY 157, Psychology and the Good Life, taught by Professor Laurie Santos. Similar to those on other college campuses, the course focuses on self-care and mental health. Students learn about the definitions and evidence-based predictors of happiness along with the attendant myths, and also practice strategies to attain greater optimism and satisfaction in life.

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Cystic Fibrosis: Advancing Along the Continuum

Cystic fibrosis (CF) is an autosomal recessive genetic disorder resulting from a mutation in the gene which encodes a cellular transmembrane protein channel known as the CF transmembrane conductance regulator. Located systemically on the surface of numerous cells, these altered channels yield multisystem dysfunction. Typical manifestations seen are chronic, progressive, obstructive lung disease, pancreatic insufficiency, CF-related diabetes mellitus, malabsorption and malnutrition, liver disease, and infertility.

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Shortened Lifespan and Other Age-Related Defects in Bang Sensitive Mutants of Drosophila melanogaster

Mitochondrial diseases are complex disorders that exhibit their primary effects in energetically active tissues. Damage generated by mitochondria is also thought to be a key component of aging and age-related disease. An important model for mitochondrial dysfunction is the bang sensitive (bs) mutants in Drosophila melanogaster. Although these mutants all show a striking seizure phenotype, several bs mutants have gene products that are involved with mitochondrial function, while others affect excitability another way. All of the bs mutants (parabss, eas, jus, ses B, tko are examined here) paralyze and seize upon challenge with a sensory stimulus, most notably mechanical stimulation. These and other excitability mutants have been linked to neurodegeneration with age. In addition to these phenotypes, we have found age-related defects for several of the bs strains. The mutants eas, ses B, and tkodisplay shortened lifespan, an increased mean recovery time from seizure with age, and decreased climbing ability over lifespan as compared to isogenic CS or w1118lines. Other mutants show a subset of these defects. The age-related phenotypes can be rescued by feeding melatonin, an antioxidant, in all the mutants except ses B. The age-related defects do not appear to be correlated with the seizure phenotype. Inducing seizures on a daily basis did not exacerbate the phenotypes and treatment with antiepileptic drugs did not increase lifespan. The results suggest that the excitability phenotypes and the age-related phenotypes may be somewhat independent and that these phenotypes mutants may arise from impacts on different pathways.



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Highly Continuous Genome Assembly of Eurasian Perch (Perca fluviatilis) Using Linked-Read Sequencing

The Eurasian perch (Perca fluviatilis) is the most common fish of the Percidae family and is widely distributed across Eurasia. Perch is a popular target for professional and recreational fisheries, and a promising freshwater aquaculture species in Europe. However, despite its high ecological, economical and societal importance, the available genomic resources for P. fluviatilis are rather limited. In this work, we report de novo assembly and annotation of the whole genome sequence of perch. The linked-read based technology with 10X Genomics Chromium chemistry and Supernova assembler produced a draft perch genome ~1.0 Gbp assembly (scaffold N50 = 6.3 Mb; the longest individual scaffold of 29.3 Mb; BUSCO completeness of 88.0%), which included 281.6 Mb of putative repeated sequences. The perch genome assembly presented here, generated from small amount of starting material (0.75 ng) and a single linked-read library, is highly continuous and considerably more complete than the currently available draft of P. fluviatilis genome. A total of 23,397 protein-coding genes were predicted, 23,171 (99%) of which were annotated functionally from either sequence homology or protein signature searches. Linked-read technology enables fast, accurate and cost-effective de novo assembly of large non-model eukaryote genomes. The highly continuous assembly of the Eurasian perch genome presented in this study will be an invaluable resource for a range of genetic, ecological, physiological, ecotoxicological, functional and comparative genomic studies in perch and other fish species of the Percidae family.



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Whole-Genome Analysis of Introgression Between the Spotted Owl and Barred Owl (Strix occidentalis and Strix varia, Respectively; Aves: Strigidae) in Western North America

As the barred owl (Strix varia; Aves: Strigiformes: Strigidae) expands throughout western North America, hybridization between barred and spotted owls (Strix varia and S. occidentalis, respectively), if abundant, may lead to genetic swamping of the endangered spotted owl. We analyzed low-coverage, whole-genome sequence data from fifty-one barred and spotted owls to investigate recent introgression between these two species. Although we obtained genomic confirmation that these species can and do hybridize and backcross, we found no evidence of widespread introgression. Plumage characteristics of western S. varia that suggested admixture with S. occidentalis appear unrelated to S. occidentalis ancestry and may instead reflect local selection.



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RNA-Seq-Based Analysis Reveals Heterogeneity in Mature 16S rRNA 3' Termini and Extended Anti-Shine-Dalgarno Motifs in Bacterial Species

We present an RNA-Seq based approach to map 3' end sequences of mature 16S rRNA (3' TAIL) in bacteria with single-base specificity. Our results show that 3' TAILs are heterogeneous among species; they contain the core CCUCC anti-Shine-Dalgarno motif, but vary in downstream lengths. Importantly, our findings rectify the mis-annotated 16S rRNAs in 11 out of 13 bacterial species studied herein (covering Cyanobacteria, Deinococcus-Thermus, Firmicutes, Proteobacteria, Tenericutes, and Spirochaetes). Furthermore, our results show that species-specific 3' TAIL boundaries are retained due to their high complementarity with preferred Shine-Dalgarno sequences, suggesting that 3' TAIL bases downstream of the canonical CCUCC motif play a more important role in translation initiation than previously reported.



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Editorial Board



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Early pancreatic cancer — The role of endoscopic ultrasound with or without tissue acquisition in diagnosis and staging

Pancreatic cancer (PC) is one of the deadliest cancers with a 5-year overall survival of less than 6%. Due to its insidious clinical course and unspecific symptoms, the diagnosis is usually late, with only 15–20% patients presenting with potentially curable disease. It is, therefore, extremely important to identify patients with PC at early stages of the disease when tumors may be amenable to surgical resection. For unresectable and borderline resectable PC it is consensual to perform a biopsy to have a cyto/histological confirmation of malignancy before treatment.

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Translation and initial validation of the Medication Adherence Report Scale (MARS) in Italian patients with Crohn’s Disease

The MARS-5 (Medication Adherence Report Scale) was developed in English. The aim of this project was to analyse the MARS-5I (© Prof Rob Horne) psychometric properties and to identify whether its Italian translation is suitable for assessing medication adherence in Crohn Disease (CD) Italian patients. The MARS was translated and linguistically validated in Italian. The MARS-5I was used for evaluating medication adherence in the SOLE study, conducted in Italy on 552 subjects with CD. In order to un-bias the questionnaire results from the effects of treatment change and/or effectiveness, the analyses were performed on the 277 patients whose disease activity remained stable, selected among the 371 patients who maintained the same treatment between two consecutive visits.

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Intraductal ultrasonographic diagnosis of hydatid membranes in the common bile duct

A 76-year-old Tibetan woman was admitted to us with a one-month history of intermittent abdominal pain, fever and jaundice. There was a history of excision of hepatic hydatid cyst 40 years ago. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a cystic mass in the right lobe of the liver and abnormal material in a dilated common bile duct (CBD), which was demonstrated as a multiple cord-like structure by magnetic resonance cholangiopancreatography (MRCP) (Fig. 1a). Endoscopic retrograde cholangiopancreatography (ERCP) revealed a hugely dilated CBD with irregular filling defects (Fig.

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AISF position paper on HCV in immunocompromised patients

This report summarizes the clinical features and the indications for treating HCV infection in immunocompromised and transplanted patients in the Direct Acting Antiviral drugs era.

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Harmonising proton pump inhibitors treatment in the specialist setting following the SIGE recommendations

we read with great interest the position paper of the Italian Society of Gastroenterology (SIGE) on the appropriateness of prescription for proton pump inhibitor (PPI) drugs that was recently published in Digestive and Liver Disease, as we feel that the statements reported in the manuscript should actually represent a "Dos and don'ts" companion handbook in everyday clinical practice of both primary care physicians and specialists in gastroenterology [1].

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Large abdominopelvic mammary-type myofibroblastoma with incomplete resection and recurrence

A 48-year-old man consulted for vague abdominal discomfort and increased urinary frequency. CT showed a large abdominopelvic mass compressing the urinary bladder, prostate, and rectum (Fig. 1). This lesion was well-demarcated with no involvement of adjacent anatomic structures. Surgery and pathology showed a mammary-type myofibroblastoma (MTM), which was incompletely resected due to its large size. Follow-up CT, a year later, showed a recurring lesion in the pelvis with very slow growth during subsequent 4-year imaging monitoring (Fig.

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Crestline’s Specialty Vehicle Division introduces new Patient Transport Unit

SASKATOON, SK, Canada — Crestline Coach, a global leader in ambulance and specialty vehicle manufacturing and a Canadian distributor of small to mid-sized buses, announced the recent addition of the Crestline manufactured Patient Transport Unit to its portfolio of specialty vehicle solutions. Crestline designed the Patient Transport Unit to bridge the gap between health care and long-term...

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Braun Ambulances to Display Four Units at EMS World Expo 2018

The ambulance manufacturer will showcase what it means to be Built for Life with two new ambulances showcased next to a five-year-old unit and a remounted unit VAN WERT, Ohio — Braun Ambulances will be attending EMS World Expo October 29-November 2, 2018. The ambulance manufacturer will display four ambulances, including two Nashville ambulances, a Jacksonville unit, and a remounted New...

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Coaching from the sidelines: the nuclear periphery in genome regulation

Coaching from the sidelines: the nuclear periphery in genome regulation

Coaching from the sidelines: the nuclear periphery in genome regulation, Published online: 24 October 2018; doi:10.1038/s41576-018-0063-5

Recent technological advances are enabling new views of the 3D genome within the space of the nucleus. These studies are beginning to reveal the ways cells co-opt the structures and components of the nuclear periphery for genome organization and gene regulation.

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Penfield’s stimulation for direct cortical motor mapping: An outdated technique?

Neurosurgeons worldwide are indebted to Dr. Wilder Penfield for his seminal work on intraoperative cortical mapping. Although Penfield was not the first to apply electrical current to the human brain in Neurosurgery - Robert Bartholow's case dates back to 1874 (Bartholow, 1874) -, he certainly pioneered the development of cortical stimulation into a routine neurosurgical procedure (Ladino et al., 2018). The original work by Penfield and Boldrey in 1937 reads: "Stimulation is carried out by either unipolar or bipolar platinum electrodes which emerge from a glass handle and are attached to insulated wires […] In recent years we have found a thyratron stimulator […] and have usually employed a wave frequency of from 55 to 65 per second […] The current is thus constant and may be altered accurately in rate and intensity" (Penfield and Boldrey, 1937).

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Approaches to Sleep in Severely Brain Damaged Patients – Further comments and replies to Kotchoubey & Pavlov

We would like to further contribute to the discussion regarding circadian rhythms in patients with disorders of consciousness (DOC; Kotchoubey and Pavlov, 2018a,b; Rossi Sebastiano et al., 2018; Rossi Sebastiano and Franceschetti, 2018; Schabus et al., 2018). Specifically, we would like to respond to Kotchoubey and Pavlov (2018b) and clarify remaining issues and misunderstandings that seem to have arisen from our previous comment (Schabus et al., 2018).

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Machine learning versus human expertise: the case of sleep stage classification in Disorders of Consciousness. Response to Wislowska et al

The discussion published in several Letters in Clinical Neurophysiology appears to be productive because consensus has been attained regarding most questions except one. This is the question of whether automatic methods of the analysis of sleep stages can, or actually do, outperform scoring by human experts. As regards the former part of the question (i.e., whether they can), we agree that the answer should be positive. As regards the latter part (i.e., whether they already do), some hesitations remain.

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Non-invasive brain stimulation in the modulation of cerebral blood flow after stroke: a systematic review of Transcranial Doppler studies

NIBS has been successfully explored as a biomarker and therapeutic adjunct for functional recovery after stroke. rTMS and tDCS are two such promising neuromodulatory techniques that have been widely investigated to prime the motor areas of the brain in combination with task-specific practice (Bastani et al., 2012, Hsu et al., 2012, Jodie et al., 2015, Le et al., 2014). Although these techniques have demonstrated modest efficacy, clinical translation is still limited as the underlying physiological mechanisms are not completely understood, nor is the inter-individual variability associated with these techniques resolved (López-Alonso et al., 2014, Maeda et al., 2000, Wiethoff et al., 2014).

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Heart rate variability in neonatal patients with seizures

Seizures are the most common alterations observed in neurological conditions affecting newborns (Evans and Levene, 1998). Due to its larger excitability, the developing brain is more prone to seizures than the mature brain (Holmes and Ben-Ari, 1998; Lawrence and Inder, 2010; Levene, 2002; Nardou et al., 2013). The incidence of neonatal seizures (NS) is about 1 to 3 per 1000 live births, but this estimate increases when preterm infants are included (Vasudevan and Levene, 2013). NS are generally related to serious brain conditions (e.g.

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Delirium is not associated with altered hub flexibility of the posterior cingulate cortex

Delirium is an acute disturbance of attention, awareness and cognition that tends to fluctuate over time. It is an acute and serious condition, affecting more than 15% of all hospitalized patients, and is related to poor outcomes such as prolonged length of hospital stay and long-term cognitive impairment. Although previous studies suggest multiple hypotheses towards underlying mechanisms, e.g. neurotransmitter imbalances, abnormal stress response and neuroinflammation, the exact pathogenesis of delirium remains poorly understood.

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Cervical Medial Branch Block Volume Dependent Dispersion Patterns as a Predictor for Ablation Success: A Cadaveric Study

Neck pain is one of the most common causes of chronic pain and the fourth leading cause of disability worldwide; it is estimated that between 36% to 67% of this pain is due to facet arthropathy. For patients who have pain refractory to conservative treatments literature supports management with diagnostic cervical medial branch blocks (cMBBs) to identify the associated facet innervation as the source of pain followed by therapeutic radiofrequency ablation (RFA) of the identified nerves. Cervical RFA has good published outcomes, but the procedure is dependent upon the specificity of the diagnostic block to achieve maximal success.

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Natural Course of Asymptomatic Walled Off Pancreatic Necrosis

There is paucity of data on natural course of asymptomatic walled off necrosis (WON).

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Natural Course of Asymptomatic Walled Off Pancreatic Necrosis

There is paucity of data on natural course of asymptomatic walled off necrosis (WON).

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Coaching from the sidelines: the nuclear periphery in genome regulation



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Effect of Exercise Intervention on Cardiac Function in Type 2 Diabetes Mellitus: A Systematic Review

Abstract

Background

The effect of exercise on cardiac function/structure in type 2 diabetes mellitus (T2DM) with or without diabetic cardiomyopathy (DCM) is not yet completely understood. To date, results of studies have been controversial with variable outcomes due to the variety of exercise modalities.

Objectives

The aim of the present review was to examine the impact of exercise intervention, and different types of exercise, on cardiac function and structure in T2DM through a systematic literature review, combining both pre-clinical and clinical studies.

Methods

A systematic literature search was performed on PubMed, Web of Science, and PEDro to identify studies up to 2 April 2018. Articles were included when well-defined exercise protocols were provided, and cardiac function in T2DM patients or validated animal models was examined.

Results

In diabetic animals, improvements in both diastolic and systolic function through exercise therapy were mainly attributed to reduced collagen deposition. In T2DM patients, improvements were observed in diastolic function, but not consistently in systolic function, after endurance (and combined resistance) exercise training. Different exercise intervention modalities and exercise types seemed equally effective in improving cardiac structure and function.

Conclusion

Exercise training elicits significant improvements in diastolic function and beneficial remodeling in T2DM and DCM animal models, but not necessarily improvements in systolic function and left ventricular structure, regardless of exercise type. Therefore, exercise intervention should be a cornerstone in the treatment of T2DM patients not only to improve glycemic control but also to specifically enhance cardiac function.



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Sociocultural Factors Influencing Caregiver Appraisals Following Traumatic Brain Injury

Publication date: Available online 23 October 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Angelle M. Sander, Robin A. Hanks, Phillip A. Ianni, Nicholas R. Boileau, Anna L. Kratz, Elizabeth A. Hahn, David S. Tulsky, Noelle E. Carlozzi

Abstract
Objective

To investigate the association of the sociocultural variables race/ethnicity, education, and poverty level to caregivers' positive and negative appraisals following traumatic brain injury.

Design

Survey.

Setting

Community.

Participants

344 caregivers (216 White; 69 Black; 39 Hispanic) of persons with complicated mild to severe TBI at least one-year post-injury.

Intervention

Not applicable.

Main Outcome Measures

Modified Caregiver Appraisal Scale (M-CAS); Zarit Burden Interview (ZBI).

Results

Black caregivers reported lower levels of perceived burden on both the M-CAS and the ZBI. Black and Hispanic caregivers reported more traditional caregiver ideology (caregiving as a responsibility) than did Whites. Greater poverty was associated with higher burden on the M-CAS, lower caregiver satisfaction, and less mastery. Higher education was associated with higher burden on the ZBI and with lower caregiver mastery.

Conclusions and Implications

Treatment professionals should be culturally sensitive to the different perspectives that caregivers may have based on sociocultural factors. Sociocultural factors should be considered in research investigating caregiver outcomes, including appraisals.



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Interventions to Improve Micronutrient Status of Women of Reproductive Age in Southeast Asia: A Narrative Review on What Works, What Might Work, and What Doesn’t Work

Abstract

Objectives To provide an overview of nutrition-specific and nutrition-sensitive interventions that could improve micronutrient status of women of reproductive age. Methods This narrative review has a special focus on Southeast Asia, as the work was undertaken within the framework of the SMILING (Sustainable Micronutrient Interventions to controL deficiencies and Improve Nutrition status and General health in Southeast Asia) project. Results In order for new interventions to become accepted, comprehension and interpretation of potential impact of different strategies by policymakers and non-nutritionists is needed. By presenting a wide overview of strategies, and discussing the context and current consensus on these strategies, the review aims to help with the formulation of new recommendations for national programs in Southeast Asia. Conclusions Current policies in Southeast Asia to improve micronutrient status of women of reproductive age are focused too much on single micronutrient supplementation for pregnant women (iron and folic acid supplements). A more holistic approach, including both nutrition-specific and nutrition-sensitive interventions, is needed.



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Conservative Management and Rehabilitation in the Older Runner with Knee Osteoarthritis: An Evidence-Based Review

Osteoarthritis (OA) is an age-related condition that commonly affects the middle-aged and elderly population including individuals who continue to pursue an active and athletic lifestyle. Running is an easily accessible activity with many health benefits; thus, it is becoming a popular form of exercise, even in older individuals. Studies evaluating the correlation between running and OA show conflicting results; however, most studies show an increased risk of OA in runners with a combination of modifiable and non-modifiable risk factors. This study reviews the current literature to provide an overview of conservative (non-pharmacological and pharmacological) management strategies including patient education, therapeutic modalities and exercises, mechanical measures, dietary factors, oral and injectable pharmacotherapies, and orthobiologics. Rehabilitation considerations and return-to-sport guidelines are discussed, emphasizing the notion that a return to running activity requires reduction in mileage and formulation of a structured exercise program that includes strengthening, flexibility, and stability exercises, as well as modifications in the running technique. *Corresponding Author: William Micheo, MD, Professor and Chair, Sports Medicine Fellowship Director, Physical Medicine, Rehabilitation and Sports Medicine Department, University of Puerto Rico, School of Medicine, PO Box 365067, San Juan, PR 00936-5067. E-mail: william.micheo@upr.edu, wmicheo@usa.net. Telephone: 787-751-9625. Fax: 787-754-1478 ** The authors received no specific funding for this work ***Authors have no conflicts of interest to disclose for this work Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Impaired Thermoregulatory Function during Dynamic Exercise in Multiple Sclerosis

Introduction Impairments in sudomotor function during passive whole-body heating have been reported in multiple sclerosis (MS), a demyelinating disease of the CNS that disrupts autonomic function. However, the capability of the thermoregulatory system to control body temperature during exercise has never been assessed in MS. Thus, the aim of the present study was to test the hypothesis that thermoregulatory function is impaired in MS patients compared to healthy controls (CON) exercising at similar rates of metabolic heat production. Methods Sweating and skin blood flow responses were compared between 12 individuals diagnosed with relapsing-remitting MS (9 females, 3 males) and 12 sex-, age-, mass- and BSA-matched healthy controls during a single bout of cycling exercise (rate of metabolic heat production: ~4.5 W/kg) for 60 min in a climate-controlled room (25 °C, 30% RH). Results Individuals with MS exhibited an attenuated increase in cumulative whole-body sweat loss after 30 min (MS: 72 ± 51; CON: 104 ± 37 g, p=0.04) and 60 min (MS: 209 ± 94; CON: 285 ± 62 g, p=0.02), as well as lower sweating thermosensitivity (MS: 0.49 ± 0.26; CON: 0.86 ± 0.30 mg/cm2/min/°C, p=0.049). Despite evidence for thermoregulatory dysfunction, there were no differences between MS and CON in esophageal or rectal temperatures at 30 or 60 min time points (p>0.05). Cutaneous vasculature responses were also not different in MS compared to CON (p>0.05). Conclusion Taken together, MS blunts sweating responses during exercise while cutaneous vasculature responses are preserved. Altered mechanisms of body temperature regulation in persons with MS may lead to temporary worsening of disease symptoms and limit exercise tolerance under more thermally challenging conditions. Corresponding Author: Scott L. Davis, PhD, Associate Professor, Department of Applied Physiology & Wellness, Southern Methodist University, 3101 University Blvd., Suite 163, Dallas, TX 75205. Phone: (214) 768-1028. Fax: (214) 768-4990. Email: sldavis@smu.edu This study was supported by National Heart, Lung, and Blood Institute grant R15-HL-117224 (S. L. Davis); National Multiple Sclerosis Society grants RG4043A1/1 and RG4696A3/2 (S. L. Davis); MS Research Australia Incubator grant 14-009 (O. Jay and S. L. Davis); MS Research Australia Postgraduate Fellowship 15-087 (G. K. Chaseling); and the Kuzell Institute (S. L. Davis and O. Jay). Conflicts of Interest: No conflicts of interest, financial or otherwise, are declared by the authors. The results of this study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results and conclusions of the study do not constitute endorsement by the American College of Sports Medicine. Accepted for publication September 2018. © 2018 American College of Sports Medicine

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Evidence for an Upper Threshold for Resistance Training Volume in Trained Women

Introduction The purpose of the present study was to compare the effects of different volumes of resistance training (RT) on muscle performance and hypertrophy in trained women. Methods The study included 40 volunteers that performed RT for 24 weeks divided in to groups that performed five (G5), 10 (G10), 15 (G15) and 20 (G20) sets per muscle group per session. Ten repetition maximum (10RM) tests were performed for the bench press, lat pull down, 45° leg press, and stiff legged deadlift. Muscle thickness (MT) was measured using ultrasound at biceps brachii, triceps brachii, pectoralis major, quadriceps femoris, and gluteus maximus. Results All groups significantly increased all MT measures and 10RM tests after 24 weeks of RT (p0.05). G5 and G10 showed significantly greater 10RM increases than G15 for lat pulldown, leg press and stiff legged deadlift. 10RM changes for G20 were lower than all other groups for all exercises (p

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Effects of Resistance Training on Arterial Stiffness in Persons at Risk for Cardiovascular Disease: A Meta-analysis

Abstract

Background

Arterial stiffness (AS) is a key measure in predicting risk for cardiovascular disease (CVD) and related events, independent of other risk factors. Resistance training (RT) has been shown to increase AS in young healthy subjects. However, the effects of RT on AS in persons with or at risk for CVD remain unclear; this uncertainty is a barrier to RT prescription in this population. Considering RT may be as effective as or superior to aerobic exercise prescription in treating some co-morbidities associated with CVD, it would be helpful to clarify whether RT does lead to clinically meaningful increases (detrimental) in AS in those with CVD or CVD risk factors.

Objectives

The aim of this study was to (1) assess the effects of RT on measures of AS in at-risk populations, and (2) discuss the implications of the findings for clinical exercise physiologists.

Data Sources

The electronic databases PubMed, Web of Science, SPORTDiscus, and Google Scholar were searched from inception to February 2018. The reference lists of eligible articles and reviews were also checked.

Study Selection

Inclusion criteria were: (1) the trial was a randomized controlled trial; (2) exercise prescription of RT or a combination of resistance and aerobic exercise for at least 8 weeks; (3) control group characteristics allowed for comparison of the main effects of the exercise prescription; (4) subjects had known CVD or a risk factor associated with CVD according to the American College of Sports Medicine (ACSM) guidelines; (5) article measured at least carotid to femoral pulse wave velocity (PWV) or augmentation index (AIx).

Appraisal and Synthesis Methods

Initially, 1427 articles were identified. After evaluation of study characteristics, quality and validity data from 12 articles and 13 cohorts involving 651 participants (223 women, 338 men, 90 unknown) were extracted for the meta-analysis. To enable comparisons between assessments, and to infer clinical significance, standardized mean differences (SMD) were calculated. When data were not available, values were estimated according to Cochrane guidelines.

Results

According to the JADAD scale, the mean quality of studies was 3 out of 5. The duration of the included studies ranged from 8 weeks to 24 months. RT trended towards decreasing (improving) PWV (SMD = − 0.168, 95% CI − 0.854 to 0.152, p = 0.057). There were no significant differences in AIx (SMD = − 0.286), diastolic blood pressure (SMD = − 0.147), systolic blood pressure (SMD = − 0.126), or central systolic blood pressure (SMD = − 0.405).

Conclusion

The available evidence suggests that RT does not increase (worsen) AS in patients who have or are at risk for CVD. Considering RT may be as effective as or superior to aerobic exercise prescription in treating some co-morbidities associated with CVD, these findings suggest that RT is a suitable exercise prescription in primary and secondary prevention settings.



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Assessment of radon concentrations and exposure doses in dwellings surrounding a high capacity gas turbine power station using passive measurements and dispersion modeling

Publication date: January 2019

Source: Journal of Environmental Radioactivity, Volume 196

Author(s): Abdullah E. Alali, Khaled F. Al-Shboul, Qusai Bani Yaseen, Ayah Alaroud

Abstract

A continuous passive measurement of indoor and outdoor radon R222n, concentration is carried out in the nearby residential areas surrounding a high capacity gas-fired power station. The mean value for indoor measurements was 26.5 ± 1.75 Bq/m3 that is below the worldwide indoor mean of 40 Bq/m3 and for outdoor was 39.4 ± 4.04 Bq/m3 which is higher than the worldwide average outdoor radon concentration of 10 Bq/m3. The annual estimated effective doses were found to vary from 0.54 to 1.05 mSv/y with an average value of 0.67 ± 0.04 mSv/y for indoor dose and from 0.23 to 0.57 mSv/y with an average value of 0.37 ± 0.03 mSv/y for outdoor dose with an overall mean annual effective dose of 1.03 mSv/y. Furthermore, the measured and modeled radon excess levels due to plant operation, both, show that the effect of power plant emission on atmospheric radon levels in the surrounding region is not significant.



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Relative doses instead of relative concentrations for the determination of the consequences of the radiological atmospheric releases

Publication date: January 2019

Source: Journal of Environmental Radioactivity, Volume 196

Author(s): Primož Mlakar, Marija Zlata Božnar, Boštjan Grašič

Abstract

Radiological atmospheric releases require population dose calculation for proper determination of preventive measures. The old concept of relative concentrations requires long lasting constant emission which is not realistic.

The proposed concept of the "relative doses" is the generalization and expansion of the known concept of relative concentrations. Relative doses allow an evaluation of the general non-stationary pollutants emission under the real weather conditions over complex terrain. Relative doses can be calculated even before the actual source term – quantified emission - is known.

The relative impact is also very useful for considering the possible impact of an accident scenario on the surroundings for various meteorological situations. This is applied for environmental impact assessments which require long term statistical evaluation. The method has a practical possible application for realistic dose assessment of effectiveness of additional protection achieved by installation of Passive Containment Filtered Venting Systems (PCFVS). PCFVS is considered an obligatory safety upgrade after the Fukushima accident.

Graphical abstract

Image 1



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Editorial Board

Publication date: December 2018

Source: Journal of Environmental Radioactivity, Volume 195

Author(s):



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Comparative Effects of Sodium Bicarbonate and Intravenous Lipid Emulsions on Reversing Bupivacaine-Induced Electrophysiological Toxicity in a Porcine Experimental Model

BACKGROUND: Bupivacaine cardiotoxicity mainly manifests as inhibition of the cardiac sodium channel, which slows conduction, particularly at the ventricular level. Experimental studies have demonstrated that intravenous lipid emulsions (ILEs) can reduce the cardiotoxic effects of bupivacaine, but the extent of these effects is controversial. Sodium bicarbonate (B) represents the standard treatment of toxicity related to sodium channel–blocking drugs. The aim of this study was to compare the effects of ILEs and B on the speed of recovery from bupivacaine-induced effects on the electrocardiographic parameters. METHODS: Bupivacaine 4 mg/kg was administered to 24 anesthetized pigs. Three minutes after delivering the bupivacaine bolus, the animals were given the following: ILE 1.5 mL/kg followed by 0.25 mL/kg/min (ILE group) and B 2 mEq/kg followed by 1 mEq/kg/h (B group). Controls (C group) were given saline solution, 50 mL followed by 1 mL/kg/h. Electrophysiological parameters were evaluated in sinus rhythm and during right ventricular pacing at several time intervals up to 30 minutes. Data were analyzed as the area under the curve (AUC) for the first 10 minutes (AUC10) or 30 minutes (AUC30). RESULTS: Bupivacaine increased the sinus cycle length, PR interval, and QRS duration. AUC30 of the sinus rhythm QRS duration after antidote administration was significantly different among the 3 groups (P = .003). B group experienced faster recovery from intoxication than the C group (AUC10, P = .003; AUC30, P = .003) or the ILE group (AUC10, P = .018). During the first minute, 50% of the B group (versus 0% of the ILE and C groups) had recovered >30% of QRS duration (P = .011). The trend toward faster recovery in the ILE group than in the C group did not reach significance (AUC10, P = .23; AUC30, P = .06). Effects on the paced QRS duration at a rate of 150 bpm were more intense but with similar results (B versus C group: AUC10, P = .009; AUC30, P = .009; B versus ILE: AUC10, P = .015; AUC30, P = .024). The recovery process of the paced QRS tended to be slower for all antidotes. CONCLUSIONS: In a closed-chest swine model, B was an effective treatment for electrophysiological alterations caused by established bupivacaine toxicity. At clinical doses, B ameliorated bupivacaine electrocardiographic toxicity faster than ILE. Use-dependent effects of bupivacaine are prominent and delay the effects of both antidotes, but B produces faster recovery than ILE. Accepted for publication September 19, 2018. Funding: Supported by a research grant from the Ministry of Economy, Industry, and Competitiveness of Spain, and Fondos Fondo Europeo de Desarrollo Regional. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Matilde Zaballos, MD, PhD, Department of Anesthesiology, Hospital General Universitario Gregorio Marañón, C/Tellez, No. 52, 3º D, Madrid 28007, Spain. Address e-mail to mati@plagaro.net. © 2018 International Anesthesia Research Society

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Objective Epidural Space Identification Using Continuous Real-Time Pressure Sensing Technology: A Randomized Controlled Comparison With Fluoroscopy and Traditional Loss of Resistance

BACKGROUND: Performance of epidural anesthesia and analgesia depends on successful identification of the epidural space (ES). While multiple investigations have described objective and alternative methodologies to identify the ES, traditional loss of resistance (LOR) and fluoroscopy (FC) are currently standard of care in labor and delivery (L&D) and chronic pain (CP) management, respectively. While FC is associated with high success, it exposes patients to radiation and requires appropriate radiological equipment. LOR is simple but subjective and consequently associated with higher failure rates. The purpose of this investigation was to compare continuous, quantitative, real-time, needle-tip pressure sensing using a novel computer-controlled ES identification technology to FC and LOR for lumbar ES identification. METHODS: A total of 400 patients were enrolled in this prospective randomized controlled noninferiority trial. In the CP management arm, 240 patients scheduled to receive a lumbar epidural steroid injection had their ES identified either with FC or with needle-tip pressure measurement. In the L&D arm, 160 female patients undergoing lumbar epidural catheter placements were randomized to either LOR or needle-tip pressure measurement. Blinded observers determined successful ES identification in both arms. A modified intention-to-treat protocol was implemented, with patients not having the procedure for reasons preceding the intervention excluded. Noninferiority of needle-tip pressure measurement regarding the incidence of successful ES identification was claimed when the lower limit of the 97.27% confidence interval (CI) for the odds ratio (OR) was above 0.50 (50% less likely to identify the ES) and P value for noninferioirty <.023. results: demographics were similar between procedure groups with a mild imbalance in relation to gender when evaluated through standardized difference. noninferiority of needle-tip pressure measurement was demonstrated fc where pain management patients presented success rate es identification both methodologies ci p=".021" for and l experienced noninferior the novel technology vs or using priori delta conclusions: objective lumbar continuous quantitative real-time compuflo epidural computer controlled anesthesia system resulted rates compared lor cp respectively. benefits this may include nonexposure radiation contrast medium consequently reduced health care costs. accepted publication september funding: clinical trial funded by milestone scientific livingston nj. conflicts interest: see disclosures at end article. number: nct02378727 clinicaltrials.gov. reprints will not be available from authors. address correspondence ralf e. gebhard md department anesthesiology university miami miller school medicine nw ave c-300 fl e-mail rgebhard international research society>

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Distraction-Free Induction Zone: A Quality Improvement Initiative at a Large Academic Children’s Hospital to Improve the Quality and Safety of Anesthetic Care for Our Patients

BACKGROUND: Noise in the operating room may cause distractions during critical periods and impair reliable communication between staff. Even momentary inefficiency while administering anesthesia can lead to errors and serious consequences for the patient. Distractions to an anesthesia provider during critical periods such as induction and emergence are a patient safety issue. Because of concerns regarding unacceptable noise levels and distractions during induction of general anesthesia, our institution developed a quality improvement initiative, the "Distraction-Free Induction Zone." The specific aim of this project was to decrease the percentage of cases with a distraction, described as music, unnecessary conversations, or loud noises, occurring during induction of general anesthesia in pediatric otolaryngology operating rooms from 61% to 15%. METHODS: To complete this quality improvement initiative, a multidisciplinary team used improvement science methods, including The Model for Improvement with interventions tested via Plan-Do-Study-Act cycles. We used tools such as the Key Driver Diagram, Pareto Charts, Process Flow Chart, and Plan-Do-Study-Act worksheets. Data were manually collected and entered weekly in an Excel spreadsheet. Statistical process control methods, including a run chart and a P-control chart, were used for data analysis. Our measure was a composite measure in which observation of 1 of the 3 distractions during induction of general anesthesia categorized the case as a case with a distraction. RESULTS: We tested and implemented several interventions via Plan-Do-Study-Act cycles in which 3 main interventions collectively were associated with an observed decrease in distractions during induction of general anesthesia. These included educating the perioperative staff present in the operating room to help them understand that distractions to anesthesia providers represent a patient safety issue, the operating room circulating nurse taking responsibility to pause any music on arrival to the operating room, and the anesthesiologist reminding the staff in the operating room of induction time and/or asking for quiet during induction if a distraction occurs. The percentage of cases with a distraction during induction of general anesthesia in our pediatric otolaryngology operating rooms decreased from 61% to 15% by April 15, 2017 and to 10% by June 5, 2017. CONCLUSIONS: Using improvement science methods, we observed a decrease in distractions during induction of general anesthesia, improved a process, and encouraged change in culture at a large academic children's hospital to enhance the quality and safety of the anesthetic care we provide our patients. Accepted for publication September 19, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Christy J. Crockett, MD, Department of Anesthesiology, Vanderbilt University Medical Center, 2200 Children's Way, Suite 3116, Nashville, TN 37232. Address e-mail to christy.crockett@vumc.org. © 2018 International Anesthesia Research Society

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In Reply: Encouraging a Bare Minimum While Striving for the Gold Standard A Response to the Updated WHO-WFSA Guidelines

No abstract available

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Encouraging a Bare Minimum While Striving for the Gold Standard: A Response to the Updated WHO-WFSA Guidelines

No abstract available

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Dexmedetomidine-Mediated Prevention of Renal Ischemia-Reperfusion Injury Depends in Part on Cholinergic Anti-Inflammatory Mechanisms

BACKGROUND: Organ ischemia-reperfusion injury often induces local and systemic inflammatory responses, which in turn worsen organ injury. These inflammatory responses can be regulated by the central nervous system, particularly by the vagal nerve and nicotinic acetylcholine receptors, which are the key components of cholinergic anti-inflammatory pathway. Activation of the cholinergic anti-inflammatory pathway can suppress excessive inflammatory responses and be a potential strategy for prevention of ischemia-reperfusion injury of organs including the kidney. METHODS: Vagal nerve activity, plasma acetylcholine, catecholamine and inflammatory mediators, renal tissue injury, and cell death were measured in mice with bilateral renal ischemia/reperfusion with or without treatment with dexmedetomidine (Dex), an α2-adrenergic receptor agonist. RESULTS: Dex significantly increased the discharge frequency of the cervical vagal nerve by up to 142 Hz (mean) (P

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Ophthalmologic Anesthesia: Seeing the Forest for the Trees

No abstract available

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Perioperative Management and In-Hospital Outcomes After Minimally Invasive Repair of Pectus Excavatum: A Multicenter Registry Report From the Society for Pediatric Anesthesia Improvement Network

BACKGROUND: There are few comparative data on the analgesic options used to manage patients undergoing minimally invasive repair of pectus excavatum (MIRPE). The Society for Pediatric Anesthesia Improvement Network was established to investigate outcomes for procedures where there is significant management variability. For our first study, we established a multicenter observational database to characterize the analgesic strategies used to manage pediatric patients undergoing MIRPE. Outcome data from the participating centers were used to assess the association between analgesic strategy and pain outcomes. METHODS: Fourteen institutions enrolled patients from June 2014 through August 2015. Network members agreed to an observational methodology where each institution managed patients based on their institutional standards and protocols. There was no requirement to standardize care. Patients were categorized based on analgesic strategy: epidural catheter (EC), paravertebral catheter (PVC), wound catheter (WC), no regional (NR) analgesia, and intrathecal morphine techniques. Primary outcomes, pain score and opioid consumption by postoperative day (POD), for each technique were compared while adjusting for confounders using multivariable modeling that included 5 covariates: age, sex, number of bars, Haller index, and use of preoperative pain medication. Pain scores were analyzed using repeated-measures analysis of variance with Bonferroni correction. Opioid consumption was analyzed using a multivariable quantile regression. RESULTS: Data were collected on 348 patients and categorized based on primary analgesic strategy: EC (122), PVC (57), WC (41), NR (120), and intrathecal morphine (8). Compared to EC, daily median pain scores were higher in patients managed with PVC (POD 0), WC (POD 0, 1, 2, 3), and NR (POD 0, 1, 2), respectively (P

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In Response

No abstract available

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Surveying the Literature: Synopsis of Recent Key Publications

No abstract available

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Pharmacokinetics of Cefazolin and Vancomycin in Infants Undergoing Open-Heart Surgery With Cardiopulmonary Bypass

BACKGROUND: Gram-positive bacteria account for nearly three-quarters of all surgical site infections. Antibiotic prophylaxis against these bacteria with cephalosporins or, in select circumstances, with vancomycin is considered standard of care for prevention of surgical site infections. There is little evidence to describe the optimal dosing regimen for surgical site infection prophylaxis in infants undergoing cardiac surgery, and a great deal of institutional variability exists in dosing prophylactic antibiotics. We designed this study to describe an optimal dose regimen for cephalosporin and vancomycin based on pharmacokinetic evidence for infant open-heart surgery on cardiopulmonary bypass. METHODS: Two separate cohorts of infants undergoing cardiac surgery with cardiopulmonary bypass were evaluated. Plasma concentrations of vancomycin (cohort 1, N = 10) and cefazolin (cohort 2, N = 10) were measured, and mixed-effects pharmacokinetic models were constructed for each drug. Simulations of various dosing regimens were performed to describe an appropriate dosing regimen necessary to maintain antibiotic concentrations above the susceptibility cutoff for staphylococci. RESULTS: Both cefazolin and vancomycin plasma concentration versus time profiles were characterized by a 2-compartment model. Subject weight was a significant covariate for V1 for vancomycin. Subject age was a significant covariate for V1 for cefazolin. Cardiopulmonary bypass did not influence concentration versus time profiles. Simulations demonstrated that a 1-hour vancomycin infusion (15 mg·kg−1), repeated every 12 hours and a 10-minute infusion of cefazolin (30 mg·kg−1), repeated every 4 hours maintained plasma concentrations above 4 μg·mL−1 and 16 μg·mL−1, for vancomycin and cefazolin, respectively. Both concentrations are above the minimum inhibitory concentration 90 for most susceptible staphylococci. CONCLUSIONS: Prophylactic treatment of vancomycin 15 mg·kg−1 infused >1 hour with 12-hour redosing and cefazolin 30 mg·kg−1 infused >10 minutes with 4-hour redosing will maintain serum levels of each antibiotic above the susceptibility cut-offs for susceptible staphylococci in infants undergoing cardiac surgery. Cefazolin levels may be adequate for some, but not all, Gram-negative bacteria. The effect of cardiopulmonary bypass on pharmacokinetics is negligible. Accepted for publication September 19, 2018. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Clinical Trials Registry: NCT01619982. Reprints will not be available from the authors. Address correspondence to Jerry Ingrande, MD, MS, Department of Anesthesiology, University of California, San Diego School of Medicine, 402 Dickinson St, Hillcrest, CA 92103. Address e-mail to jingrande@ucsd.edu. © 2018 International Anesthesia Research Society

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Cervical Spine Movement in a Cadaveric Model of Severe Spinal Instability: A Study Comparing Tracheal Intubation With 4 Different Laryngoscopes

Background: This study compared the Macintosh blade direct laryngoscope, Glidescope, C-Mac d-Blade, and McGrath MAC X-blade video laryngoscopes in 2 cadaveric models with severe cervical spinal instability. We hypothesized that the Glidescope video laryngoscope would allow for intubation with the least amount of cervical spine movement. Our secondary endpoints were glottic visualization and intubation success. Methods: In total, 2 fresh cadavers underwent maximal surgical destabilization from the craniocervical junction to the cervicothoracic junction by a neurosurgical spine specialist, with subsequent neutral positioning of the heads with surgical head fixation devices. On each cadaver, 8 experienced anesthesiologists performed four intubations with the 4 laryngoscopes in random order. Lateral radiographic measurements determined vertebral displacement during intubation. Results: Cervical spine displacements were not significantly different amongst video laryngoscopes. Cormack-Lehane Grade 1 views were achieved with all attempts with each of the 3 video laryngoscopes; intubation attempts with the Macintosh blade achieved only grade 3 or grade 4 views. Intubation was successful every time with a video laryngoscope but only during 1 of 16 intubation attempts with the Macintosh blade. Conclusions: In a cadaveric model with maximally destabilized cervical spines, cervical spine movement was observed during attempted laryngoscopy using each of 3 video laryngoscopes, although there was no significant difference between the laryngoscopes. Given cervical spine displacement occurred, these video laryngoscopes do not prevent cervical spine motion during laryngoscopy. However, with improved glottic visualization and intubation success, video laryngoscopes are superior to the Macintosh blade in both cervical spine safety and intubation efficacy in the model studied. Supported by Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center. The authors have no conflicts of interest to disclose. Address correspondence to: Jia W. Romito, MD, Department of Anesthesiology & Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9068 (e-mail: Jia.Romito@utsouthwestern.edu). Received March 5, 2018 Accepted September 19, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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Association between tongue muscle strength and masticatory muscle strength

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


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Sex hormone levels by presence and severity of cirrhosis in women with chronic hepatitis C virus (HCV) infection

Journal of Viral Hepatitis

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A case of airway obstruction caused by probable nasotracheal tube cuff herniation in a horse.

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A case of airway obstruction caused by probable nasotracheal tube cuff herniation in a horse.

Vet Anaesth Analg. 2017 01;44(1):191-192

Authors: Richardson E, McMillan M

PMID: 27301894 [PubMed - indexed for MEDLINE]



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Flowing from sense to action. Are neural integrators necessary?

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


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