Acknowledgement to Referees

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Genetics of anophthalmia and microphthalmia. Part 2: Syndromes associated with anophthalmia–microphthalmia

Abstract

As new genes for A/M are identified in the genomic era, the number of syndromes associated with A/M has greatly expanded. In this review, we provide a brief synopsis of the clinical presentation and molecular genetic etiology of previously characterized pathways involved in A/M, including the Sex-determining region Y-box 2 (SOX2), Orthodenticle Homeobox 2 (OTX2) and Paired box protein-6 (PAX6) genes, and the Stimulated by retinoic acid gene 6 homolog (STRA6), Aldehyde Dehydrogenase 1 Family Member A3 (ALDH1A3), and RA Receptor Beta (RARβ) genes that are involved in retinoic acid synthesis. Less common genetic causes of A/M, including genes involved in BMP signaling [Bone Morphogenetic Protein 4 (BMP4), Bone Morphogenetic Protein 7 (BMP7) and SPARC-related modular calcium-binding protein 1 (SMOC1)], genes involved in the mitochondrial respiratory chain complex [Holocytochrome c-type synthase (HCCS), Cytochrome C Oxidase Subunit 7B (COX7B), and NADH:Ubiquinone Oxidoreductase subunit B11 (NDUFB11)], the BCL-6 corepressor gene (BCOR), Yes-Associated Protein 1 (YAP1) and Transcription Factor AP-2 Alpha (TFAP2α), are more briefly discussed. We also review several recently described genes and pathways associated with A/M, including Smoothened (SMO) that is involved in Sonic hedgehog (SHH) signaling, Structural maintenance of chromosomes flexible hinge domain containing 1 (SMCHD1) and Solute carrier family 25 member 24 (SLC25A24), emphasizing phenotype–genotype correlations and shared pathways where relevant.

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Complex Neurobehavioral Testing of a Rat Model of the Irritable Bowel Syndrome

In albino Wistar rats, the irritable bowel syndrome (IBS) was induced by chronic restraint stress (restriction of the animals in plastic containers, 6 h per day during 7 days). In the Y-like maze, IBS rats demonstrated smaller numbers of spontaneous alternations (indices of immediate spatial memory; P < 0.05) than control animals. In the elevated plus maze, IBS rats showed a significantly reduced time spent in the open arms (P < 0.03) compared to the controls, suggesting anxiety-like effects. Moreover, episodes of stretching in this maze were more numerous in the IBS group (P < 0.05), also suggesting anxiogenic effects. Some depression-like behavior of IBS rats was observed in the forced swimming test, as was demonstrated by a significantly shorter mobility time, as compared to the control group (P < 0.05). In the radial 8-arm maze, however, chronic stress-induced IBS did not significantly affect the number of reference memory errors and time necessary for completing the task. Still, some working memory deficit was observed in the IBS group in this test, as the number of the respective errors was significantly greater (P < 0.05) in such rats vs. controls within some time intervals. In the open field test, suppression of locomotor activity (reduced number of square crossings), significantly increased number of rearings (suggesting higher anxiety), and altered fecal elimination in the IBS group were obvious (P < 0.05). Also, an increased time of grooming was observed in IBS rats in the above test (characterizing a higher anxiety level in the stress-exposed IBS group). When zoosocial behavior was tested in a three-chambered apparatus (10-min-long period of testing), rats of the IBS group spent significantly more time in the empty compartment (without a stranger rat) and less time in the compartment with a conspecific of the same age and weight (P < 0.01), which indicates decreased social motivation in the IBS group. Our results suggest that the aforementioned chronic stress-induced IBS model results in increased anxiety, depression, and suppressed social behavior. The IBS affects immediate and working memory (with nearly no effect, however, on reference memory).

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Correction to: Event-Related EEG Synchronization/Desynchronization under Conditions of Cessation and Switching over of the Programs of Manual Movements in Men

There was an error in transliteration of the name of one of the co-authors; the correct name is O. V. Korzhyk.

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Correction to: Parameters of Components N2 and P3 of the Auditory Cognitive Evoked Potentials in Musicians and Non-musicians

There was an error in the initials of one of the co-authors; the correct version is T. V. Kutsenko.

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Effects of Crocins in the Management of Neurodegenerative Pathologies: A Review

Flavonoids, in particular crocins (active compounds of Crocus and Gardenia), have been extensively used in traditional medicine and been proposed to be effective in the management of various diseases, including neurodegenerative problems. Antiepileptic and anti-Alzheimer effects of crocins have been demonstrated. The efficacy of crocins in the treatment of cerebral ischemia and traumatic brain injury was also confirmed in experimental animal studies. Treatment with crocins increased dopamine levels in the brain of an experimental model of Parkinson's disease. In addition, crocins modulate the opioid system and decrease the withdrawal syndrome. The review of the respective publications indicates that crocins can be considered effective auxiliary agents in the management of neurobiological diseases, mostly due to their antioxidant and anti-inflammatory effects.

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Identification of forearm skin zones with similar muscle activation patterns during activities of daily living

A deeper knowledge of the activity of the forearm muscles during activities of daily living (ADL) could help to better understand the role of those muscles and allow clinicians to treat motor dysfunctions more...

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Exploiting the heightened phase synchrony in patients with neuromuscular disease for the establishment of efficient motor imagery BCIs

Phase synchrony has extensively been studied for understanding neural coordination in health and disease. There are a few studies concerning the implications in the context of BCIs, but its potential for estab...

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Phenomic Selection Is a Low-Cost and High-Throughput Method Based on Indirect Predictions: Proof of Concept on Wheat and Poplar

Genomic selection - the prediction of breeding values using DNA polymorphisms - is a disruptive method that has widely been adopted by animal and plant breeders to increase productivity. It was recently shown that other sources of molecular variations such as those resulting from transcripts or metabolites could be used to accurately predict complex traits. These endophenotypes have the advantage of capturing the expressed genotypes and consequently the complex regulatory networks that occur in the different layers between the genome and the phenotype. However, obtaining such omics data at very large scales, such as those typically experienced in breeding, remains challenging. As an alternative, we proposed using near-infrared spectroscopy (NIRS) as a high-throughput, low cost and non-destructive tool to indirectly capture endophenotypic variants and compute relationship matrices for predicting complex traits, and coined this new approach "phenomic selection" (PS). We tested PS on two species of economic interest (Triticum aestivum L. and Populus nigra L.) using NIRS on various tissues (grains, leaves, wood). We showed that one could reach predictions as accurate as with molecular markers, for developmental, tolerance and productivity traits, even in environments radically different from the one in which NIRS were collected. Our work constitutes a proof of concept and provides new perspectives for the breeding community, as PS is theoretically applicable to any organism at low cost and does not require any molecular information.

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Training Population Optimization for Prediction of Cassava Brown Streak Disease Resistance in West African Clones

Cassava production in the central, southern and eastern parts of Africa is under threat by cassava brown streak virus (CBSV). Yield losses of up to 100% occur in cases of severe infections of edible roots. Easy illegal movement of planting materials across African countries, and long-range movement of the virus vector (Bemisia tabaci) may facilitate spread of CBSV to West Africa. Thus, effort to pre-emptively breed for CBSD resistance in W. Africa is critical. Genomic selection (GS) has become the main approach for cassava breeding, as costs of genotyping per sample have declined. Using phenotypic and genotypic data (genotyping-by-sequencing), followed by imputation to whole genome sequence (WGS) for 922 clones from National Crops Resources Research Institute, Namulonge, Uganda as a training population (TP), we predicted CBSD symptoms for 35 genotyped W. African clones, evaluated in Uganda. The highest prediction accuracy (r = 0.44) was observed for cassava brown streak disease severity scored at three months (CBSD3s) in the W. African clones using WGS-imputed markers. Optimized TPs gave higher prediction accuracies for CBSD3s and CBSD6s than random TPs of the same size. Inclusion of CBSD QTL chromosome markers as kernels, increased prediction accuracies for CBSD3s and CBSD6s. Similarly, WGS imputation of markers increased prediction accuracies for CBSD3s and for cassava brown streak disease root severity (CBSDRs), but not for CBSD6s. Based on these results we recommend TP optimization, inclusion of CBSD QTL markers in genomic prediction models, and the use of high-density (WGS-imputed) markers for CBSD predictions across population.

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Coronary flow reserve in patients with Primary Biliary Cholangitis

It is still not clear whether primary biliary cholangitis (PBC) is associated with abnormalities of the cardiovascular system. We aimed to assess the relationship between PBC and coronary flow reserve (CFR).

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ERECTILE DYSFUNCTION IN COMPENSATED LIVER CIRRHOSIS

Data on erectile dysfunction (ED) in cirrhotic patients are limited as yet. Aim of this study was to investigate the prevalence of ED and the factors potentially involved in its development in compensated cirrhosis.

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Simulation-based mastery learning significantly reduces gender differences on the Fundamentals of Endoscopic Surgery performance exam

Abstract

Background

Analysis of the Fundamentals of Endoscopic Surgery (FES) performance exam showed higher scores for men than women. Gender differences have been reduced with task-specific practice. We assessed the effect of simulation-based mastery learning (SBML) on FES performance exam differences by gender.

Methods

Forty-seven surgical trainees [29 men (m), 18 women (w)] completed a SBML curriculum and were assessed by FES. Fourteen trained on the GI Mentor 2, 18 on the Endoscopy Training System, and 15 using the Surgical Training for Endoscopic Proficiency curriculum. Performance of male and female trainees was compared.

Results

On the pre-training assessment, there were large differences between genders in FES pass rates (m 77%, w 15%, p < 0.001), total scores (m 69 ± 11, w 50 ± 12; p < 0.001), and in four of five FES sub-task scores (Navigation, m 73 ± 19, w 55 ± 22, p = 0.02; Loop reduction, m 34 ± 29, w 14 ± 22, p = 0.02; Retroflexion, m 81 ± 17, w 47 ± 27, p < 0.001; Targeting, m 89 ± 10, w 66 ± 23, p = 0.002). No differences were discernible post training (Pass rate, m 100%, w 94%, p = 0.4; Total score, m 77 ± 8, w 72 ± 12, p = 0.2; Navigation, m 91 ± 13, w 80 ± 13, p = 0.009; Loop reduction, m 49 ± 26, w 46 ± 36, p = 0.7; Retroflexion, m 82 ± 18, w 81 ± 15, p = 0.9; Targeting, m 92 ± 15, w 86 ± 12, p = 0.12). Time needed to complete curricula was not discernably different by gender (m 3.8 ± 1.7 h, w 5.0 ± 2.6 h, p = 0.17).

Conclusions

Gender-based differences are nearly eliminated through task-specific SBML training. This lends further evidence to the validity argument for the FES performance exam as a measure of basic endoscopic skills.

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The American Association for the Surgery of Trauma Emergency General Surgery Anatomic Severity Scoring System as a predictor of cost in appendicitis

Abstract

Background

The World Society for Emergency Surgery determined that for appendicitis managed with appendectomy, there is a paucity of evidence evaluating costs with respect to disease severity. The American Association for the Surgery of Trauma (AAST) disease severity grading system is valid and generalizable for appendicitis. We aimed to evaluate hospitalization costs incurred by patients with increasing disease severity as defined by the AAST. We hypothesized that increasing disease severity would be associated with greater cost.

Methods

Single-institution review of adults (≥ 18 years old) undergoing appendectomy for acute appendicitis during 2010–2016. Demographics, comorbidities, operative details, hospital stay, complications, and institutional cost data were collected. AAST grades were assigned by two independent reviewers based on operative findings. Total cost was ascertained from billing data and normalized to median grade I cost. Non-parametric linear regression was utilized to assess the association of several covariates and cost.

Results

Evaluated patients (n = 1187) had a median [interquartile range] age of 37 [26–55] and 45% (n = 542) were female. There were 747 (63%) patients with Grade I disease, 219 (19%) with Grade II, 126 (11%) with Grade III, 50 (4%) with Grade IV, and 45 (4%) with Grade V. The median normalized cost of hospitalization was 1 [0.9–1.2]. Increasing AAST grade was associated with increasing cost (ρ = 0.39; p < 0.0001). Length of stay exhibited the strongest association with cost (ρ = 0.5; p < 0.0001), followed by AAST grade (ρ = 0.39), Clavien–Dindo Index (ρ = 0.37; p < 0.0001), age-adjusted Charlson score (ρ = 0.31; p < 0.0001), and surgical wound classification (ρ = 0.3; p < 0.0001).

Conclusions

Increasing anatomic severity, as defined by AAST grade, is associated with increasing cost of hospitalization and clinical outcomes. The AAST grade compares favorably to other predictors of cost. Future analyses evaluating appendicitis reimbursement stand to benefit from utilization of the AAST grade.

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Laparoscopic versus open emergent ventral hernia repair: utilization and outcomes analysis using the ACSNSQIP database

Abstract

Introduction

Laparoscopic ventral hernia repair (VHR) is associated with decreased morbidity and shorter length of stay (LOS) when compared to open VHR. Despite evidence of the benefits of laparoscopy, its utilization in VHR has lagged behind that of other complex surgical procedures. We hypothesized that utilization is further reduced in emergency cases. The aim of this study was to evaluate the utilization of laparoscopy in emergent VHR and to assess 30-day outcomes for patients undergoing laparoscopic emergent ventral hernia repair (LEVHR) versus open emergent ventral hernia repair (OEVHR).

Methods

We used the ACS-NSQIP database for years 2006–2015 to compare LEVHR versus OEVHR. Inclusion required two factors: (1) classification as an emergency case and (2) primary procedure documented as laparoscopic or open repair of incarcerated umbilical, ventral, or incisional hernia. LOS and 30-day morbidity and mortality were assessed.

Results

A total of 13,126 patients underwent emergent repair of initial or recurrent umbilical, ventral, or incisional hernia. 1130 (8.6%) underwent LEVHR repair and 11,996 (91.4%) underwent OEVHR. Patient demographic data display a trend toward decreased utilization of laparoscopy in patients with more significant comorbidities. LEVHR was associated with decreased operative time and postoperative LOS. LEVHR was associated with decreased superficial surgical site infection (SSI), deep SSI, and 30-day mortality. Subgroup analysis displays decreased incidence of superficial SSI, deep SSI, wound disruption, pneumonia, and postoperative sepsis for patients ASA1-3 undergoing LEVHR versus OEVHR.

Conclusion

Utilization of laparoscopy in VHR is low in emergency cases. Patients who did undergo LEVHR had decreased postoperative LOS and decreased infectious and wound-related morbidity. Increased utilization in emergency VHR could significantly improve patient outcomes. Further study is warranted.

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Laparoscopic right hemicolectomy with CME: standardization using the “critical view” concept

Abstract

Background

Complete mesocolic excision is gradually becoming an established oncologic surgical principle for right hemicolectomy. However, the procedure is technically demanding and carries the risk of serious complications, especially when performed laparoscopically. A standardized procedure that minimizes technical hazards and facilitates teaching is, therefore, highly desirable.

Methods

An expert group of surgeons and one anatomist met three times. The initial aim was to achieve consensus about the surgical anatomy before agreeing on a sequence for dissection in laparoscopic CME. This proposal was evaluated and discussed in an anatomy workshop using post-mortem body donors along with videos of process-informed procedures, leading to a definite consensus.

Results

In order to provide a clear picture of the surgical anatomy, the "open book" model was developed, consisting of symbolic pages representing the corresponding dissection planes (retroperitoneal, ileocolic, transverse mesocolic, and mesogastric), vascular relations, and radicality criteria. The description of the procedure is based on eight preparative milestones, which all serve as critical views of safety. The chosen sequence of the milestones was designed to maximize control during central vascular dissection. Failure to reach any of the critical views should alert the surgeon to a possible incorrect dissection and to consider converting to an open procedure.

Conclusion

Combining the open-book anatomical model with a clearly structured dissection sequence, using critical views as safety checkpoints, may provide a safe and efficient platform for teaching laparoscopic right hemicolectomy with CME.

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Canadian general surgery residents’ need formal curricula and objective performance assessments in gastrointestinal endoscopy training: a program director census

Abstract

Introduction

Methods of developing and determining General Surgery (GS) residents' competency in gastrointestinal endoscopy in Canada are not currently standardized. This study aimed to assess the status of gastrointestinal endoscopy training in Royal College of Physicians and Surgeons of Canada (RCPSC) GS residency programs.

Methods

A 35-question survey was developed using GS gastrointestinal endoscopy curricula guidelines. All 17 RCPSC GS program directors were contacted to complete the questionnaire via the web-based SurveyMonkey.ca® platform.

Results

All 17 program directors completed the survey (100% response rate). Program demographics Sixteen programs reported having dedicated endoscopy rotations with a mean duration of 2.8 months (range 0–4, SD 1.1). Upon completion of dedicated endoscopy rotations, four programs (25%) reported having formal skills assessments and three (18.8%) reported formal knowledge examinations. All programs required endoscopy procedures be logged throughout residency, but only three (21.4%) included quality indicators. Only one program required residents to obtain Fundamentals of Endoscopic Surgery certification. Program outcomes The reported estimated mean number of procedures during residents' endoscopy rotations was 82 (range 10–150, standard deviation 33.6) gastroscopies and 156 (40–350, 76.3) colonoscopies. The mean number of procedures during residents' entire residencies was 150 (20–400, 98.6) gastroscopies and 241 (50–500, 76.3) colonoscopies. The number of months of dedicated endoscopy training significantly correlated with the total estimated number of endoscopic procedures performed (ρ = 0.67, p = 0.02). Eleven program directors (73.3%) believed residents were prepared for independent endoscopy practice, while four disagreed (26.7%). Program directors' perceptions of residents' preparedness were significantly correlated with the number of endoscopic procedures performed by residents (p < 0.01) but not the robustness of the endoscopy curriculum (p = 0.72).

Conclusion

Endoscopy training in RCPSC GS residency programs is highly variable. Program directors' perceptions of residents' competency appear to be significantly correlated with procedure numbers and few have adopted formal curricula and performance assessments.

Visual abstract

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Laparoscopic extended liver resection: are postoperative outcomes different?

Abstract

Background

Although laparoscopic major hepatectomy (LMH) is becoming increasingly common in specialized centers, data regarding laparoscopic extended major hepatectomies (LEMH) and their outcomes are limited. The aim of this study was to compare the perioperative characteristics and postoperative outcomes of LEMH to standard LMH.

Methods

All patients who underwent purely laparoscopic anatomical right or left hepatectomy and right or left trisectionectomy between February 1998 and January 2016 are enrolled. Demographic, clinicopathological, and perioperative factors were collected prospectively and analyzed retrospectively. Perioperative characteristics and postoperative outcomes in LEMH were compared to those of standard LMH.

Results

Among 195 patients with LMH, 47 (24.1%) underwent LEMH, colorectal liver metastases representing 66.7% of all indications. Preoperative portal vein embolization was undertaken in 31 (15.9%) patients. Despite more frequent vascular clamping, blood loss was higher in LEMH group (400 vs. 214 ml; p = 0.006). However, there was no difference in intraoperative transfusion requirements. Thirty-one patients experienced liver failure with no differences between LMH and LEMH groups. Postoperative mortality was comparable in the two groups [3 (2.5%) LMH patients vs. 2 (5%) LEMH patients (p = 0.388)]. Overall morbidity was higher in the LEMH group [49 LMH patients (41.5%) vs. 24 LEMH patients (60%) (p = 0.052)]. Patients treated with left LEMH experienced more biliary leakage (p = 0.011) and more major pulmonary complications (p = 0.015) than left LMH.

Conclusion

LEMH is feasible at the price of important morbidity, with manageable and acceptable outcomes. These exigent procedures require high-volume centers with experienced surgeons.

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Minimally invasive surgery techniques in pelvic exenteration: a systematic and meta-analysis review

Abstract

Background

Pelvic exenteration is potentially curative for locally advanced and recurrent pelvic cancers. Evolving technology has facilitated the use of minimally invasive surgical (MIS) techniques in selected cases. We aimed to compare outcomes between open and MIS pelvic exenteration.

Methods

A review of comparative studies was performed. Firstly, we evaluated the differences in surgical techniques with respect to operative time, blood loss, and margin status. Secondly, we assessed differences in 30-day morbidity and mortality rates, and length of hospital stay.

Results

Four studies that directly compared open and MIS exenteration were included. Analysis was performed on 170 patients; 78.1% (n = 133) had open pelvic exenteration, while 21.8% (n = 37) had a MIS exenteration. The median age for open exenteration was 57.7 years versus 63 years for MIS exenteration. Even though the operative time for MIS exenteration was 83 min longer (p < 0.001), it was associated with a median of 1,750mls less blood loss. The morbidity rate for MIS exenterative group was 56.7% (n = 21/37) versus 88.5% (n = 85/96) in the open exenteration group, with pooled analysis observing a 1.17 relative risk increase in 30-day morbidity (p = 0.172) in the open exenteration group. In addition, the MIS cohort had a 6-day shorter length of hospital stay (p = 0.04).

Conclusion

MIS exenteration can be performed in highly selective cases, where there is favourable patient anatomy and tumour characteristics. When feasible, it is associated with reduced intra-operative blood loss, shorter length of hospital stay, and reduced morbidity.

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A predictive model for patients with median arcuate ligament syndrome

Abstract

Background

Due to the rarity of median arcuate ligament (MAL) syndrome, patient selection for surgery remains difficult. This study provides a predictive model to optimize patient selection and predict outcomes following a MAL release.

Methods

Prospective data from patients undergoing a MAL release included demographics, radiologic studies, and SF-36 questionnaires. Successful postoperative changes in SF-36 was defined as an improvement > 10% in the total SF-36 score. A logistic regression model was used to develop a clinically applicable table to predict surgical outcomes. Celiac artery (CA) blood flow velocities were compared pre- and postoperatively and Pearson correlations were examined between velocities and SF-36 score changes.

Results

42 patients underwent a laparoscopic MAL release with a mean follow-up of 28.5 ± 18.8 months. Postoperatively, all eight SF-36 scales improved significantly. The logistic regression model for predicting surgical benefit was significant (p = 0.0244) with a strong association between predictors and outcome (R² = 0.36). Age and baseline CA expiratory velocity were significant predictors of improvement and predicted clinical improvement. There were significant differences between pre- and postoperative CA velocities. Postoperatively, the bodily pain scale showed the most significant increase (64%, p < 0.0001). A table was developed using age and preoperative CA expiratory velocities to predict clinical outcomes.

Conclusions

Laparoscopic MAL produces significant symptom improvement, particularly in bodily pain. This is one of the first studies that uses preoperative data to predict symptom improvement following a MAL release. Age and baseline CA expiratory velocity can be used to guide postoperative expectations in patients with MAL syndrome.

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Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: an up-to-date meta-analysis of randomized controlled trials

Abstract

Background

This study was performed to compare the safety and effectiveness of early laparoscopic cholecystectomy (ELC) with delayed laparoscopic cholecystectomy (DLC) for acute cholecystitis (AC).

Methods

A systematic search was performed of PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from 1 August 1990 to 1 April 2018. Randomized controlled trials comparing ELC versus DLC were included. The primary outcome was bile duct injury (BDI) and bile leakage. The secondary outcomes were wound infection, total complications, conversion to open surgery, operation time, and total hospital stay. The statistical analysis was performed using Review Manager (RevMan) version 5.3 software (Cochrane Informatics and Knowledge Management Department).

Results

Fifteen RCTs were included. A meta-analysis showed no significant differences between ELC and DLC in terms of BDI (risk ratio [RR] 0.79; 95% confidence interval [CI] 0.23–2.79; p = 0.72) (in all subgroups of surgery: within 7, 4, and 3 days) (p = 0.22, 0.49, 0.49, respectively) or bile leakage (RR 2.05; 95% CI 0.98–4.31; p = 0.06). No significant differences were found in the rate of wound infection (RR 0.75; 95% CI 0.51–1.11; p = 0.15), total complications (RR 0.90; 95% CI 0.58–1.39; p = 0.63), or conversion to open surgery (RR 0.94; 95% CI 0.74–1.21; p = 0.64). There were no significant differences in the operation time between ELC and DLC (mean difference [MD] = 9.29 min; 95% CI − 0.41 to 18.98; p = 0.06), but ELC was associated with a longer surgery time within 7 days (MD = 16.49 min; 95% CI 2.10–30.88; p = 0.02). The pooled results showed that ELC was associated with a significantly shorter duration of hospital stay (MD = − 3.07 days; 95% CI − 3.98 to − 2.16; p < 0.00001), but with no significantly difference with postoperative hospital stay (MD = 0.45 days; 95% CI − 0.38 to 1.29; p = 0.29).

Conclusion

ELC appears as safe and effective as DLC for acute cholecystitis within 7 days from presentation and may shorten the total hospital stay.

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Surgical outcomes for diverticulitis in young patients: results from the NSQIP database

Abstract

Background

The incidence of diverticulitis is increasing among young patients (≤ 50 years), as are rates of recurrent disease. There is ongoing controversy regarding the best management strategy for this patient group. Guidelines have changed from elective colectomy after a single episode to a more individualized approach no longer based on patient age. This study investigated the clinical presentation and surgical outcomes of young patients undergoing surgery for diverticulitis over two time periods.

Methods

The American College of Surgeons National Surgical Quality Improvement Program database was searched from 2005 to 2014 to identify all patients ≤ 50 with a diagnosis of diverticulitis. Data were obtained on patient demographics, comorbidity, perioperative details, and 30-day post-operative outcomes. Data were compared between two time periods, being 2005–2010 (Group 1) and 2011–2014 (Group 2).

Results

10,844 patients were included in the analysis. The mean patient age was 43 years (range 18–50), and 35% were female. Significantly more patients were obese (BMI > 30) in Group 2 (52%) versus Group 1 (47%). Laparoscopic surgery and emergency surgery and perforation rates were significantly higher in Group 2. Wound infection was significantly less in Group 2. Post-operative organ/space infection and medical morbidity were significantly higher in Group 2.

Conclusions

In recent years, there has been a change to a more conservative approach for elective colonic resection in young patients with a history of diverticulitis. Increasingly young patients presenting for surgery for diverticulitis are male and obese, and increased rates of post-operative medical morbidity have been observed. The laparoscopic approach is more common, with resultant increased operative times, and decreased wound infection rates. The observed increased in emergency surgery and perforation rates may be explained by the change in management approach with less elective resections.

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Coronary flow reserve in patients with Primary Biliary Cholangitis

It is still not clear whether primary biliary cholangitis (PBC) is associated with abnormalities of the cardiovascular system. We aimed to assess the relationship between PBC and coronary flow reserve (CFR).

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ERECTILE DYSFUNCTION IN COMPENSATED LIVER CIRRHOSIS

Data on erectile dysfunction (ED) in cirrhotic patients are limited as yet. Aim of this study was to investigate the prevalence of ED and the factors potentially involved in its development in compensated cirrhosis.

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Paramedic Chief Digital: How to improve patient and provider safety on the road

This issue features articles highlighting the importance of patient and provider safety during ambulance transport and the need for an EMS overhaul

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Rapid Response: Is EMS response different when the active shooter survives?

Despite the shooter's despicable intent and multiple murders, he becomes another patient to triage, treat and transport

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A multicenter observational study on the clinicopathological features of gastric cancer in young patients

Abstract

Background

The details of gastric cancer in young patients remain unclear because of the low prevalence of the disease. This study aimed to clarify the clinicopathological features and prognosis of gastric cancer in young patients.

Methods

From January 2007 to January 2016, patients in their 20s and 30s who were diagnosed with primary gastric cancer at 4 hospitals were enrolled. Their clinical characteristics and prognosis were evaluated.

Results

The total number of patients was 72. The median age was 36 years, and the ratio of males to females was 1:1. The dominant histological type was undifferentiated type (66/72, 92%). Helicobacter pylori (H. pylori) was positive in 81% (54/67). Although there were some asymptomatic patients in stages I–III, all stage IV patients had some clinical symptoms at the diagnosis. The percentage of stage IV was significantly higher in patients in their 20s than in those in their 30s (75% vs. 25%, P < 0.001). The Kaplan–Meier method showed that the overall survival of patients in their 20s was significantly lower than that of patients in their 30s (P = 0.037).

Conclusions

A high rate of H. pylori infection was revealed in young gastric cancer patients. The patients in their 20s had a worse prognosis than those in their 30s. We should consider examining the H. pylori infection status for young patients as well as older patients to identify high-risk populations.

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The Impact of Provision of Professional Language Interpretation on Length of Stay and Readmission Rates in an Acute Care Hospital Setting

Abstract

The provision of professional interpreting services (PIS) in the hospital setting can decrease clinically significant communication errors and improve clinical outcomes. The aim of this study was to investigate the differences in length of stay (LOS) and 30 day readmission rates associated with provision of PIS in the Emergency Department (ED) and inpatient wards. A retrospective audit at a tertiary referral adult hospital in Brisbane, Australia, identified all admissions of patients requiring an interpreter. Patients provided an interpreter in the Emergency Department had a mean (age-adjusted) LOS 22.4 h less than patients not provided an interpreter in ED (95% CI 10.9–33.9). For patients provided with an interpreter on the ward the mean LOS was longer, (IRR 2.2, 1.8–2.3, p < 0.0001). There was no association between interpreter provision in either ED or the inpatient ward and readmission rate. Provision of PIS in the Emergency Department to those patients who require it can significantly reduce hospital LOS.

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High-dose intraoperative remifentanil infusion increases early postoperative analgesic consumption: a prospective, randomized, double-blind controlled study

Abstract

Purpose

The purpose of this study was to determine whether intraoperative infusion of remifentanil induces acute tolerance to opioids, and compare the postoperative pain and opioid consumption by the effect site concentrations of remifentanil.

Methods

One hundred and ninety-eight patients undergoing gastrectomy were randomly assigned to maintain target effect site concentrations of remifentanil at 0 (Group 1, n = 39), 2 (Group 2, n = 40), 4 (Group 3, n = 39), 8 (Group 4, n = 40), or 12 ng/ml (Group 5, n = 40) during operation. Postoperative pain intensities and fentanyl requirement were recorded at postoperative 2, 6, 24, and 48 h.

Results

Fentanyl requirement for postoperative 2 h was significantly greater in Group 5 compared to Group 1 (376 ± 116 vs. 283 ± 129 µg, P = 0.03). However, there were no differences in fentanyl requirements among the groups after postoperative 2 h. Also, total fentanyl consumption for 48 h was similar in all groups (Group 1; 3106 ± 629, Group 2; 2970 ± 705, Group 3; 3017 ± 555, Group 4; 3151 ± 606, and Group 5; 2984 ± 443 µg, P = 0.717). Pain scores at rest and during deep breathing were comparable in all groups at the time of each examination.

Conclusion

Intraoperative infusion of remifentanil with 12 ng/ml of effect site concentration in patients undergoing gastrectomy increases early postoperative fentanyl requirement. Acute opioid tolerance would be developed by higher concentration of remifentanil than dosage of common anesthetic practice.

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Six-year monitoring of the vertical distribution of radiocesium in three forest soils after the Fukushima Dai-ichi Nuclear Power Plant accident

Publication date: Available online 28 October 2018

Source: Journal of Environmental Radioactivity

Author(s): Junko Takahashi, Yuichi Onda, Daichi Hihara, Kenji Tamura

Abstract

After the Fukushima Dai-ichi Nuclear Power Plant accident on March 2011, several studies showed that the downward migration of ¹³⁷Cs from litter to mineral soil is more rapid in forests in Fukushima than in forests affected by the Chernobyl accident. Therefore, the downward migration within mineral soil layers is more important for predicting long-term dynamics of ¹³⁷Cs in forest ecosystems in Fukushima. In the present study, we monitored the detailed vertical distribution of ¹³⁷Cs in litter and soil layers for 6 y (2011–2017) following the previous study (2011–2012), and found that temporal changes in those distributions were different among mixed forest (MF), mature cedar (MC) and young cedar (YC) forests. The ¹³⁷Cs concentrations and inventories in the litter layer exponentially decreased with time for all sites, with more than 80–95% of the deposited ¹³⁷Cs on the forest floor distributed in mineral soil layers by 2017. The percentage of ¹³⁷Cs inventory in the litter layer to the total ¹³⁷Cs inventory in litter and mineral soil layers was well fitted by a single exponential equation with decreasing rate of 0.22–0.44 y⁻¹. The slower migration was observed in the YC site, probably because of higher initial interception of ¹³⁷Cs fallout by dense canopy. As the downward migration from litter to mineral soil progressed, the ¹³⁷Cs concentration in the first few cm of mineral soil surface gradually increased and became higher than the ¹³⁷Cs concentration in the litter within 2–3 y of the accident. The ¹³⁷Cs concentration in mineral soil layers exponentially decreased with depth throughout survey period, and an exponential equation fitted well. The relaxation depth of ¹³⁷Cs concentration in mineral soil layers estimated by the exponential equation were constantly increasing in the MC and YC sites with 0.08 cm y⁻¹. In contrast, there was no temporal increase in the relaxation depth in the MF site, indicating little migration to subsurface soil layer from not only litter layer but also surface soil layer. Further studies are necessary to identify the forests prone to the downward migration of ¹³⁷Cs and its factors regarding both forest and soil characteristics.

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Clinical significance of hepatic steatosis according to coronary plaque morphology: Assessment using controlled attenuation parameter

Journal of Gastroenterology

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Association between physician burnout and patient safety, professionalism, and patient satisfaction: A systematic review and meta-analysis

JAMA

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The electrodiagnosis of Guillain-Barré syndrome subtypes: where do we stand?

Publication date: Available online 28 October 2018

Source: Clinical Neurophysiology

Author(s): Antonino Uncini, Satoshi Kuwabara

Abstract

It is controversial as to whether the electrophysiological Guillain-Barré syndrome (GBS) subtypes can be diagnosed on the basis of a single study and which criteria sets and cut-offs should be used. Serial electrophysiologic studies have shown that a significant number of patients changed electrodiagnostic subtype largely because of the recognition of reversible conduction failure as a possible evidence of axonal pathology. However, other reports concluded that electrodiagnosis can be made by a single study, the subtypes depending on the characteristic of the criteria set applied. Such divergent views, although explicable by the different methodology employed, can be confusing in the everyday practice. We argue that the pathophysiology of GBS is dynamic and that serial studies allow a more accurate diagnosis of subtypes. A second study, although not always practicable, is recommended in patients showing no clear demyelinating features, low amplitude distal compound muscle action potentials or conduction block without temporal dispersion. For practical purposes, we propose that at a first study Uncini's or Rajabally's criteria sets can can be employed for an indicative subtype diagnosis. Finally, although the GBS subtype diagnosis has currently no impact on treatment, we believe that is important for understanding the underlying pathophysiology and prognostication.

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The class II phosphoinositide 3-kinases PI3K-C2α and PI3K-C2β differentially regulate clathrin-dependent pinocytosis in human vascular endothelial cells

Abstract

Pinocytosis is an important fundamental cellular process that is used by the cell to transport fluid and solutes. Phosphoinositide 3-kinases (PI3Ks) regulate a diverse array of dynamic membrane events. However, it is not well-understood which PI3K isoforms are involved in specific mechanisms of pinocytosis. We performed knockdown studies of endogenous PI3K isoforms and clathrin heavy chain (CHC) mediated by small interfering RNA (siRNA). The results demonstrated that the class II PI3K PI3K-C2α and PI3K-C2β, but not the class I or III PI3K, were required for pinocytosis, based on an evaluation of fluorescein-5-isothiocyanate (FITC)–dextran uptake in endothelial cells. Pinocytosis was partially dependent on both clathrin and dynamin, and both PI3K-C2α and PI3K-C2β were required for clathrin-mediated—but not clathrin-non-mediated—FITC-dextran uptake at the step leading up to its delivery to early endosomes. Both PI3K-C2α and PI3K-C2β were co-localized with clathrin-coated pits and vesicles. However, PI3K-C2β, but not PI3K-C2α, was highly co-localized with actin filament-associated clathrin-coated structures and required for actin filament formation at the clathrin-coated structures. These results indicate that PI3K-C2α and PI3K-C2β play differential, indispensable roles in clathrin-mediated pinocytosis.

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Respiratory‐related cortical activity in patients with COPD and aged normal individuals: toward a different vision of dyspnoea?

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


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Prolonged exercise training improves the acute type II muscle fibre satellite cell response in healthy older men

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


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Combined hepatocellular-cholangiocarcinoma successfully treated with sorafenib: case report and review of the literature

Abstract

Sorafenib, a multiple kinase inhibitor, has been established as first-line standard systemic chemotherapy for patients with advanced hepatocellular carcinoma (HCC). We encountered a patient with combined hepatocellular and cholangiocarcinoma (CHC) who achieved complete remission in response to sorafenib treatment. A 58-year old man with hepatitis C virus (HCV)-induced liver cirrhosis was diagnosed with CHC in segments 6th and 7th of the liver and underwent partial surgical resection. Three months later, CHC recurred as metastases at multiple intrahepatic sites, lymph nodes, and bones, making surgery impossible. Treatment with sorafenib was initiated at 400 mg b.i.d., later reduced to 400 mg/day. After 6 months of sorafenib administration, he no longer showed abnormal uptake on fluorodeoxyglucose positron emission tomography. He was continued on sorafenib for 2.5 years, but later discontinued due to adverse events. He has shown no evidence of tumor recurrence more than 1 year after sorafenib discontinuation. His HCV was eradicated by direct-acting antivirals, and he remains in good health.

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Rhythmic robotic training enhances motor skills of both rhythmic and discrete upper-limb movements after stroke: a longitudinal pilot study

Discrete and rhythmic movements are two fundamental motor primitives being, at least partially, controlled by separate neural circuitries. After a stroke, both primitives may be impaired in the upper limb. Currently, intensive functional movement therapy is recommended after stroke, but it is mainly composed of discrete movements. No recommendation is made for the specific training of rhythmic movements. However, if they form two different primitives, both should receive a specific training to recover the complete motor repertoire, as many daily live movements integrate both of them. This paper reports the effects of a pure unilateral rhythmic movement therapy on motor performance, after stroke. Thirteen patients with chronic stroke participated in this longitudinal pilot study. They were assessed twice before the therapy to validate their chronic state, and twice after the last session to establish the short-term and long-term effects of the therapy. The therapy itself was composed of 12 sessions spread over 1 month. The exercises consisted in performing straight or circular rhythmic movements, while receiving assistance as need through a robotic device. Short-term and long-term improvements were observed in rhythmic movements regarding smoothness, velocity, and harmonicity. More surprisingly, some transfer occurred to the untrained discrete movements. This finding disputes previous studies that reported no transfer from rhythmic to discrete movements with healthy participants. Correspondence to Renaud Ronsse, PhD, Institute of Mechanics, Materials, and Civil Engineering, Université Catholique de Louvain, Place du Levant 2 – bte L5.04.02, 1348 Louvain-la-Neuve, Belgium Tel: +32 1047 4796; fax: +32 1047 2501; e-mail: renaud.ronsse@uclouvain.be Received July 17, 2018 Accepted October 9, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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A Randomized Crossover Study Investigating the Running Economy of Highly-Trained Male and Female Distance Runners in Marathon Racing Shoes versus Track Spikes

Abstract

Background

Running economy represents a complex interplay of physiological and biomechanical factors that are able to adapt chronically through training, or acutely through other interventions such as changes in footwear. The Nike Vaporfly (NVF) shoe was designed for marathon running on the roads and has been shown to improve running economy by ~ 4% compared with other marathon shoes, however, during track racing, distance runners traditionally wear a much lighter shoe with an embedded spike plate around the forefoot.

Objective

The aim of this study was to determine if, and to what extent, the NVF shoes improve running economy compared with established track spikes (Nike Zoom Matumbo 3 [NZM]) and marathon racing shoes (Adidas Adizero Adios 3 [ADI]).

Methods

Twenty-four highly-trained runners (12 male, 12 female) ran 4 × 5 min trials on a treadmill while wearing each of the four shoe conditions: NVF, NZM, ADI, and the NVF matched in weight to the ADI shoe (NVF +), during three separate visits—visit 1: familiarization; visit 2: 14 and 18 km·h⁻¹ for men, 14 and 16 km·h⁻¹ for women; visit 3: 16 km·h⁻¹ for men, 15 km·h⁻¹ for women, plus a maximal rate of oxygen uptake (VO₂max) test for both sexes. We measured the rates of oxygen uptake (VO₂), carbon dioxide production and biomechanical measures while running at each velocity and shoe condition.

Results

The NVF shoe improved running economy by 2.6 ± 1.3% compared with the NZM, 4.2 ± 1.2% compared with ADI, and 2.9 ± 1.3% when matched in weight of the ADI shoe. Among the 24 subjects, the difference in running economy over the four velocities between the NVF and NZM shoes ranged from + 0.50 to − 5.34%, and − 1.72 to − 7.15% for NVF versus ADI. Correlations between changes in running economy and changes in biomechanical variables were either trivial or small, but unclear.

Conclusion

The NVF enhanced running economy compared with track spikes and marathon shoes, and should be considered a viable shoe option for track and road racing.

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Aerobic Training Protects Cardiac Function During Advancing Age: A Meta-Analysis of Four Decades of Controlled Studies

Abstract

Background

In contrast to younger athletes, there is comparatively less literature examining cardiac structure and function in older athletes. However, a progressive accumulation of studies during the past four decades offers a body of literature worthy of systematic scrutiny.

Objectives

We conducted a systematic review, meta-analysis and meta-regression of controlled echocardiography studies comparing left ventricular (LV) structure and function in aerobically trained older athletes (> 45 years) with age-matched untrained controls, in addition to investigating the influence of chronological age.

Methods

Electronic databases were searched from inception to January 2018 before conducting a random-effects meta-analysis to calculate pooled differences in means, effect size and 95% confidence intervals (CIs). Study heterogeneity was reported using Cochran's Q and I² statistic.

Results

Overall, 32 studies (644 athletes; 582 controls) were included. Athletes had greater LV end-diastolic diameter (3.65 mm, 95% CI 2.66–4.64), interventricular septal thickness (1.23 mm, 95% CI 0.85–1.60), posterior wall thickness (1.20 mm, 95% CI 0.83–1.56), LV mass (72 g, 95% CI 46–98), LV mass index (28.17 g·m², 95% CI 19.84–36.49) and stroke volume (13.59 mL, 95% CI 7.20–19.98) (all p < 0.01). Athletes had superior global diastolic function [ratio of early (E) to late (A) mitral inflow velocity (E/A) 0.18, 95% CI 0.13–0.24, p < 0.01; ratio of early (e′) to late (a′) diastolic annular tissue velocity (e′/a′) 0.23, 95% CI 0.06–0.40, p = 0.01], lower A (−8.20 cm·s⁻¹, 95% CI −11.90 to −4.51, p < 0.01) and a′ (−0.72 cm·s⁻¹, 95% CI −1.31 to −0.12, p = 0.02), and more rapid e′ (0.96 cm·s⁻¹, 95% CI 0.05–1.86, p = 0.04). Meta-regression for chronological age identified that athlete–control differences, in the main, are maintained during advancing age.

Conclusions

Athletic older men have larger cardiac dimensions and enjoy more favourable cardiac function than healthy, non-athletic counterparts. Notably, the athlete groups maintain these effects during chronological ageing.

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Maximal Sprint Speed and the Anaerobic Speed Reserve Domain: The Untapped Tools that Differentiate the World’s Best Male 800 m Runners

Abstract

Recent evidence indicates that the modern-day men's 800 m runner requires a speed capability beyond that of previous eras. In addition, the appreciation of different athlete subgroups (400–800, 800, 800–1500 m) implies a complex interplay between the mechanical (aerial or terrestrial) and physiological characteristics that enable success in any individual runner. Historically, coach education for middle-distance running often emphasises aerobic metabolic conditioning, while it relatively lacks consideration for an important neuromuscular and mechanical component. Consequently, many 800 m runners today may lack the mechanical competence needed to achieve the relaxed race pace speed required for success, resulting in limited ability to cope with surges, run faster first laps or close fast. Mechanical competence may refer to the skilled coordination of neuromuscular/mechanical (stride length/frequency/impulse) and metabolic components needed to sustain middle-distance race pace and adjust to surges efficiently. The anaerobic speed reserve (ASR) construct (difference between an athlete's velocity at maximal oxygen uptake [v \(\dot{V}\) O₂max]—the first speed at which maximal oxygen uptake [ \(\dot{V}\) O_2max] is attained) and their maximal sprint speed (MSS) offers a framework to assess a runner's speed range relative to modern-day race demands. While the smooth and relaxed technique observed in middle-distance runners is often considered causal to running economy measured during submaximal running, little empirical evidence supports such an assumption. Thus, a multidisciplinary approach is needed to examine the underpinning factors enabling elite 800 m running race pace efficiency. Here, we argue for the importance of utilising the ASR and MSS measurement to ensure middle-distance runners have the skills to compete in the race-defining surges of modern-day 800 m running.

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Prevalence of Risk for Exercise Dependence: A Systematic Review

Abstract

Background

Exercise dependence (EXD) can be considered an addictive behaviour because it presents signs typical of other addictive behaviours. Despite possible health problems related to EXD, the prevalence of risk for EXD has never been systematically reviewed.

Objective

This article aimed to systematically review the prevalence of risk for EXD.

Methods

Studies were identified from searches in the ERIC, PsycINFO, PubMed, Scopus, SPORTDiscus, and Web of Science electronic databases up to June 2018. Empirical studies were selected if (1) they included the outcomes of the prevalence of EXD; (2) participants were regular exercisers; and (3) they were published in either the English, French, Portuguese, or Spanish languages. A total of 34 articles met the inclusion criteria.

Results

The prevalence of risk for EXD was estimated to be between 3 and 7% of regular exercisers and the university student population, and between 6 and 9% of the athlete population.

Conclusion

The results of this review indicated that the prevalence of risk for EXD varies with the characteristics of the exerciser, but an overall prevalence of 3–9% is estimated. Risk for EXD is a cause for concern and, from a public health point of view, is a problem that has to be addressed.

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Effects of Evening Exercise on Sleep in Healthy Participants: A Systematic Review and Meta-Analysis

Abstract

Background

Current recommendations advise against exercising in the evening because of potential adverse effects on sleep.

Objectives

The aim of this systematic review was to investigate the extent to which evening exercise affects sleep and whether variables such as exercise intensity or duration modify the response.

Methods

A systematic search was performed in PubMed, Cochrane, EMBASE, PsycINFO, and CINAHL databases. Studies evaluating sleep after a single session of evening physical exercise compared to a no-exercise control in healthy adults were included. All analyses are based on random effect models.

Results

The search yielded 11,717 references, of which 23 were included. Compared to control, evening exercise significantly increased rapid eye movement latency (+ 7.7 min; p = 0.032) and slow-wave sleep (+ 1.3 percentage points [pp]; p = 0.041), while it decreased stage 1 sleep (− 0.9 pp; p = 0.001). Moderator analyses revealed that a higher temperature at bedtime was associated with lower sleep efficiency (SE) (b = − 11.6 pp; p = 0.020) and more wake after sleep onset (WASO; b = + 37.6 min; p = 0.0495). A higher level of physical stress (exercise intensity relative to baseline physical activity) was associated with lower SE (− 3.2 pp; p = 0.036) and more WASO (+ 21.9 min; p = 0.044). Compared to cycling, running was associated with less WASO (− 12.7 min; p = 0.037). All significant moderating effects disappeared after removal of one study.

Conclusion

Overall, the studies reviewed here do not support the hypothesis that evening exercise negatively affects sleep, in fact rather the opposite. However, sleep-onset latency, total sleep time, and SE might be impaired after vigorous exercise ending ≤ 1 h before bedtime.

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Does silvering or 11-ketotestosterone affect osmoregulatory ability in the New Zealand short-finned eel ( Anguilla australis )?

Abstract

Silvering has been associated with advancing osmoregulatory ability. Given the demonstrated role of 11-ketotestosterone (11KT) in mediating many of the silvering-related changes, we investigated the role of 11KT in driving this advanced osmoregulatory ability in the New Zealand short-finned eel (Anguilla australis). Yellow (non-migratory) eels with or without 11KT implants and blank-implanted silver (migratory) eels, either held in freshwater or subjected to seawater challenge, were sampled to determine serum [Na⁺] and [Cl⁻], pituitary prolactin mRNA levels, gill Na⁺/K⁺-ATPase activity and gill mRNA levels for Na⁺/K⁺-ATPase-α1 subunit and for Na⁺/K⁺/2Cl⁻ co-transporter-1α-subunit. Developmental stage and 11KT treatment advanced the eels' osmoregulatory ability. Thus, serum [Na⁺] and [Cl⁻] were affected by developmental stage and 11KT treatment upon seawater challenge. However, seawater challenge, not 11KT treatment or developmental stage, produced the strongest and the most consistent effects on A. australis osmoregulatory processes, inducing significant effects in all the relevant parameters we measured. In light of our results and in view of the eel's marine ancestry, we contend that A. australis, or freshwater eels in general, are highly tolerant and able to adapt quickly to changing salinities even at the yellow stage, which may preclude a critical need for an advanced osmoregulatory ability at silvering.

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Dexmedetomidine preserves the endothelial glycocalyx and improves survival in a rat heatstroke model

Abstract

Purpose

Heatstroke causes systemic inflammation, followed by vascular endothelial damage. The normal vascular endothelium is coated by endothelial glycocalyx (EGCX). Dexmedetomidine (DEX) has an anti-inflammatory effect, but there has been little investigation on the influence of heatstroke on EGCX and the effect of DEX on this condition. Therefore, we examined whether EGCX was disrupted in heatstroke and if DEX improved survival and preserves EGCX.

Methods

Anesthetized Wistar rats were randomly assigned to three groups: a DEX group treated with DEX (5 µg/kg/h) and 0.9% saline infused continuously at 10 ml/kg/h during heat exposure; a NSS group given 0.9% saline during heat exposure; and a SHAM group given 0.9% saline alone without heat exposure. Heatstroke was induced by exposure to an ambient temperature of 40 °C with relative humidity of 60%. The survival rate was assessed up to 2 h after the start of heat exposure. Plasma levels of syndecan-1 and the thickness of EGCX using electron microscopy were measured when the systolic blood pressure fell to less than 80 mmHg.

Results

The survival rate after 2 h of heat exposure was significantly higher in the DEX group compared to the NSS group (89% vs. 22%, P = 0.004). Plasma levels of syndecan-1 were 0.6 ± 1.3, 9.7 ± 5.9, and 2.1 ± 3.4 ng/ml in the SHAM, NSS and DEX groups, respectively (P = 0.013). The thickness of EGCX was significantly higher in the DEX group compared with the NSS group (P = 0.001).

Conclusions

EGCX was disrupted in heatstroke, and DEX improved survival and preserved EGCX.

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Patterns of Hysteresis Between Induction and Emergence of Neuroanesthesia are Present in Spinal and Intracranial Surgeries

Background: Recovery of consciousness is usually seen as a passive process, with emergence from anesthesia depicted as the inverse process of induction resulting from the elimination of anesthetic drugs from their central nervous system sites of action. However, that need not be the case. Recently it has been argued that we might encounter hysteresis to changes in the state of consciousness, known as neural inertia. This phenomenon has been debated in neuroanesthesia, as manipulation of the brain might further influence recovery of consciousness. The present study is aimed at assessing hysteresis between induction and emergence under propofol-opioid neuroanesthesia in humans using estimated propofol concentrations in both spinal and intracranial surgeries. Methods: We identified the moments of loss (LOR) and recovery of responsiveness (ROR) in 21 craniotomies and 25 spinal surgeries. Propofol was given slowly until loss of responsiveness and stopped at the end of surgery. An opioid was present at induction and recovery. Propofol infused was recorded and plasma and effect-site concentrations were estimated using 2 pharmacokinetic models. Dose-response curves were generated. Estimated propofol plasma and effect-site concentrations were compared to assess hysteresis. Results: Estimated propofol concentrations at LOR and ROR showed hysteresis. Whether for spinal or intracranial surgeries, the EC50 of propofol at which half of the patients entered and exited the state of responsiveness was significantly different. Conclusions: Hysteresis was observed between propofol concentrations at LOR and ROR, in both patients presenting for spinal and intracranial surgeries. Manipulation of the brain does not appear to change patterns of hysteresis, suggesting that neural inertia may occur in humans, in a way similar to that found in animal species. These findings justify performing a clinical study in patients using measured propofol concentrations to assess neural inertia. Supported by the Fundação para a Ciência e Tecnologia with the reference projects SFRH/BD/98915/2013 and UID/SEM/50022/2013. The authors have no conflicts of interest to disclose. Address correspondence to: Ana Leitão Ferreira, MSc, MS, Center of Clinical Investigation in Anesthesiology, Service of Anesthesiology, Hospital Center of Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal (e-mail: ana.leitao.ferreira@gmail.com). Received April 12, 2018 Accepted September 14, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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Journal Club

No abstract available

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The independency of the Bereitschaftspotential from previous stimulus‐locked P3 in visuomotor response tasks

Psychophysiology, EarlyView.


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