Παρασκευή, 2 Νοεμβρίου 2018

Burnout and Mental Health Stigma Among Juvenile Probation Officers: The Moderating Effect of Participatory Atmosphere

Abstract

Despite high rates of mental health problems among juvenile justice-involved youth, mental health stigma among juvenile probation officers (JPOs) is under-studied. This cross-sectional study examined effects of job burnout and workplace participatory atmosphere on mental health stigma among JPOs across Indiana (n = 226). Participatory atmosphere moderated the relationship between JPO burnout-related cynicism and mental health stigma (interaction β = − 0.14, p = .04); burnout was related to greater mental health stigma at low levels of participatory atmosphere. Findings suggest participatory atmosphere mitigates effects of burnout on mental health stigma among JPOs. Organizational-level interventions might help to reduce mental health stigma and combat negative effects from burnout among JPOs.



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Endoscopic Enucleation Is Effective and Relatively Safe in Small Gastric Subepithelial Tumors Originating from Muscularis Propria

Abstract

Background

Gastric subepithelial tumors originating from muscularis propria (MP) are usually benign, but some have malignant potential.

Aims

The aim of this study was to evaluate the utility of endoscopic enucleation for the diagnosis and treatment of MP tumors.

Patients and Methods

From January 2010 to February 2018, eighty patients with gastric MP tumors underwent endoscopic enucleation at our hospital. Band ligation and resection (BLR) or endoscopic muscularis resection (EMD) was performed based on considerations of tumor size (≤ 12 mm or > 12 mm). Tumor characteristics, procedure times, complete resection rates, adverse events and recurrence were analyzed.

Results

Eighty patients with 82 lesions were eligible for inclusion in this study. BLR was used to treat 41 lesions. For these lesions, mean tumor size was 9.5 mm, median procedural time was 17.6 min (range 4–52), and the endoscopic complete resection rate was 100% (41/41). Perforation was developed in four patients, and was closed by endoscopic clipping. EMD was used to treat 41 lesions. Median procedure time was 66.1 min (range 12–260) and the endoscopic complete resection rate was 85.4% (35/41). Perforation occurred in eight patients, four patients received endoscopic treatment and four underwent surgery. Tumor recurrence was not observed in any patient over follow-up (mean 26.3 months).

Conclusion

Endoscopic enucleation appears to offer an effective, relatively safe means for diagnosing and treating gastric subepithelial tumors originating from the MP, and BLR provides a straightforward, effective, and relatively safe treatment for small MP tumors (≤ 12 mm).



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Temporal Trends in the Cardiorespiratory Fitness of 2,525,827 Adults Between 1967 and 2016: A Systematic Review

Abstract

Objective

To estimate international and national temporal trends in the cardiorespiratory fitness (CRF) of adults, and to examine relationships between trends in CRF and trends in health-related, socioeconomic, and environmental indicators.

Methods

Data were obtained from a systematic search of studies that explicitly reported temporal trends in the CRF of apparently healthy adults aged 18–59 years. Sample-weighted temporal trends were estimated using best-fitting regression models relating the year of testing to mean CRF. Post-stratified population-weighted mean changes in percent and standardized CRF were estimated. Pearson's correlations were used to describe associations between linear trends in CRF and linear trends in health-related, socioeconomic, and environmental indicators.

Results

2,525,827 adults representing eight high- and upper-middle-income countries between 1967 and 2016 collectively showed a moderate decline of 7.7% (95% CI − 8.4 to − 7.0) or 1.6% per decade (95% CI − 1.7 to − 1.5). Internationally, CRF improved in the 1960s and 1970s, and progressively declined at an increasing rate thereafter. Declines were larger for men than for women, and for young adults (< 40 years) than for middle-aged adults (≥ 40 years). All countries experienced declines in CRF with a very strong negative correlation between CRF trends and obesity trends.

Conclusions

There has been a meaningful decline in the CRF of adults since 1980, which has progressively increased in magnitude over time, suggestive of a corresponding decline in population health. Continuous national and international surveillance systems are needed in order to monitor health and fitness trends, especially among low- and middle-income countries for which data do not currently exist. PROSPERO registration number: CRD42013003678.



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QTL Mapping on a Background of Variance Heterogeneity

Standard QTL mapping procedures seek to identify genetic loci affecting the phenotypic mean while assuming that all individuals have the same residual variance. But when the residual variance differs systematically between groups, perhaps due to a genetic or environmental factor, such standard procedures can falter: in testing for QTL associations, they attribute too much weight to observations that are noisy and too little to those that are precise, resulting in reduced power and and increased susceptibility to false positives. The negative effects of such "background variance heterogeneity" (BVH) on standard QTL mapping have received little attention until now, although the subject is closely related to work on the detection of variance-controlling genes. Here we use simulation to examine how BVH affects power and false positive rate for detecting QTL affecting the mean (mQTL), the variance (vQTL), or both (mvQTL). We compare linear regression for mQTL and Levene's test for vQTL, with tests more recently developed, including tests based on the double generalized linear model (DGLM), which can model BVH explicitly. We show that, when used in conjunction with a suitable permutation procedure, the DGLM-based tests accurately control false positive rate and are more powerful than the other tests. We also find that some adverse effects of BVH can be mitigated by applying a rank inverse normal transform. We apply our novel approach, which we term "mean-variance QTL mapping", to publicly available data on a mouse backcross and, after accommodating BVH driven by sire, detect a new mQTL for bodyweight.



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vqtl: An R Package for Mean-Variance QTL Mapping

We present vqtl, an R package for mean-variance QTL mapping. This QTL mapping approach tests for genetic loci that influence the mean of the phenotype, termed mean QTL, the variance of the phenotype, termed variance QTL, or some combination of the two, termed mean-variance QTL. It is unique in its ability to correct for variance heterogeneity arising not only from the QTL itself but also from nuisance factors, such as sex, batch, or housing. This package provides functions to conduct genome scans, run permutations to assess the statistical significance, and make informative plots to communicate results. Because it is inter-operable with the popular qtl package and uses many of the same data structures and input patterns, it will be straightforward for geneticists to analyze future experiments with vqtl as well as re-analyze past experiments, possibly discovering new QTL.



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Mean-Variance QTL Mapping Identifies Novel QTL for Circadian Activity and Exploratory Behavior in Mice

We illustrate, through two case studies, that "mean-variance QTL mapping"-QTL mapping that models effects on the mean and the variance simultaneously-can discover QTL that traditional interval mapping cannot. Mean-variance QTL mapping is based on the double generalized linear model, which extends the standard linear model used in interval mapping by incorporating not only a set of genetic and covariate effects for mean but also set of such effects for the residual variance. Its potential for use in QTL mapping has been described previously, but it remains underutilized, with certain key advantages undemonstrated until now. In the first case study, a reduced complexity intercross of C57BL/6J and C57BL/6N mice examining circadian behavior, our reanalysis detected a mean-controlling QTL for circadian wheel running activity that interval mapping did not; mean-variance QTL mapping was more powerful than interval mapping at the QTL because it accounted for the fact that mice homozygous for the C57BL/6N allele had less residual variance than other mice. In the second case study, an intercross between C57BL/6J and C58/J mice examining anxiety-like behaviors, our reanalysis detected a variance-controlling QTL for rearing behavior; interval mapping did not identify this QTL because it does not target variance QTL. We believe that the results of these reanalyses, which in other respects largely replicated the original findings, support the use of mean-variance QTL mapping as standard practice.



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Fitness and Genomic Consequences of Chronic Exposure to Low Levels of Copper and Nickel in Daphnia pulex Mutation Accumulation Lines

In at least some unicellular organisms, mutation rates are temporarily raised upon exposure to environmental stress, potentially contributing to the evolutionary response to stress. Whether this is true for multicellular organisms, however, has received little attention. This study investigated the effects of chronic mild stress, in the form of low-level copper and nickel exposure, on mutational processes in Daphnia pulex using a combination of mutation accumulation, whole genome sequencing and life-history assays. After over 100 generations of mutation accumulation, we found no effects of metal exposure on the rates of single nucleotide mutations and of loss of heterozygosity events, the two mutation classes that occurred in sufficient numbers to allow statistical analysis. Similarly, rates of decline in fitness, as measured by intrinsic rate of population increase and of body size at first reproduction, were negligibly affected by metal exposure. We can reject the possibility that Daphnia were insufficiently stressed to invoke genetic responses as we have previously shown rates of large-scale deletions and duplications are elevated under metal exposure in this experiment. Overall, the mutation accumulation lines did not significantly depart from initial values for phenotypic traits measured, indicating the lineage used was broadly mutationally robust. Taken together, these results indicate that the mutagenic effects of chronic low-level exposure to these metals are restricted to certain mutation classes and that fitness consequences are likely minor and therefore unlikely to be relevant in determining the evolutionary responses of populations exposed to these stressors.



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The Impact of Health Literacy on Health Status and Resource Utilization in Lumbar Degenerative Disease

Health literacy, defined as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions," has been demonstrated to affect access to care and appropriate healthcare utilization.

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Prolonged pain reducing effect of Sodium Hyaluronate-CarboxyMethyl Cellulose solution in the Selective Nerve Root Block(SNRB) of lumbar radiculopathy: A Prospective, Double-Blind, Randomized Controlled Clinical Trial

The pattern of linear graph schematized by visual analogue scale (VAS) score displaying pain worsening between 2 days and 2 weeks after selective nerve root block is called rebound pain.

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4 alerts you should set up on your ePCR

ePCR alerts, milestones and triggers can prompt meaningful analysis, immediate action or additional training

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4 alerts you should set up on your ePCR

ePCR alerts, milestones and triggers can prompt meaningful analysis, immediate action or additional training

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Probiotics Can Break the Toxic Relationship Between the Intestinal Microbiome and the Kidney



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Tree of Life synagogue shooting shows need for TEMS teams

Tactical emergency medical support medics were able to get to victims of the Pittsburgh shooting quickly and render aid

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Minority Report: ENUMERATing Treatment of Chronic HBV Infection Among Asian-American Communities



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Dual Delayed-Release Dexlansoprazole for Healing and Maintenance of Healed Erosive Esophagitis: A Safety Study in Adolescents

Abstract

Background

In gastroesophageal reflux disease (GERD), the frequency of heartburn symptoms and erosive esophagitis (EE) increases with age in children and adolescents. Proton pump inhibitor, dexlansoprazole, is approved for healing EE of all grades, maintenance of healed EE, relief of heartburn, and treatment of symptomatic non-erosive GERD in patients ≥ 12 years.

Aim

To assess safety and efficacy of dexlansoprazole dual delayed-release capsule in healing of EE and maintenance of healed EE in adolescents.

Methods

A multicenter, phase 2, 36-week study was conducted in 62 adolescents (12–17 years) with endoscopically confirmed EE. Patients received dexlansoprazole 60 mg once daily (QD) during open-label healing phase. Those with confirmed healing at week 8 were randomized to dexlansoprazole 30 mg QD or placebo during 16-week, double-blind maintenance phase, with subsequent treatment-free follow-up of ≥ 12 weeks. Primary endpoints were treatment-emergent adverse events (TEAEs) in ≥ 5% of patients during treatment. Secondary endpoints included percentages of patients with healing of EE and with maintenance of healed EE.

Results

88% of patients achieved EE healing, and 61.3% reported a TEAE [headache (12.9%), oropharyngeal pain (8.1%), diarrhea (6.5%), and nasopharyngitis (6.5%)]. During maintenance phase, healing was maintained in 82% and 58% of dexlansoprazole and placebo groups, respectively. 72.0% of dexlansoprazole-treated patients reported TEAEs, which included headache (24.0%), abdominal pain (12.0%), nasopharyngitis (12.0%), pharyngitis (12.0%), sinusitis (12.0%), bronchitis (8.0%), upper respiratory tract infection (8.0%), and insomnia (8.0%); 61.5% experienced a TEAE with placebo.

Conclusions

Dexlansoprazole is safe and efficacious for healing EE and maintenance of healed EE in adolescents.



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When should EMS professionals report abuse?

Our cohosts discuss a recent event involving a paramedic allegedly choking a patient, and how and when to speak up in that situation

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Pulsara unveils 3 new patient-type modules for communication platform

The additional modules include Trauma, Sepsis and Cardiac Arrest, allowing care team members to communicate about patients more efficiently

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The many lives of KATs — detectors, integrators and modulators of the cellular environment

The many lives of KATs — detectors, integrators and modulators of the cellular environment

The many lives of KATs — detectors, integrators and modulators of the cellular environment, Published online: 02 November 2018; doi:10.1038/s41576-018-0072-4

Lysine acetyltransferases (KATs) act at the interface of the cellular environment and transcription to modify levels of acetylation on target proteins. This Review highlights the roles of KATs beyond chromatin regulation, as detectors of metabolic intermediates and as integrators of signalling pathways, which enable cells to respond to and directly meet their homeostatic needs.

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Autism spectrum disorder: insights into convergent mechanisms from transcriptomics

Autism spectrum disorder: insights into convergent mechanisms from transcriptomics

Autism spectrum disorder: insights into convergent mechanisms from transcriptomics, Published online: 02 November 2018; doi:10.1038/s41576-018-0066-2

Transcriptome profiling in different brain regions has revealed distinct patterns of gene and non-coding RNA expression, as well as alternative splicing, in autism spectrum disorder (ASD). The authors review these ASD-associated signatures and the resulting mechanistic insights into ASD.

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The 3′UTR of human MAVS mRNA contains multiple regulatory elements for the control of protein expression and subcellular localization

Publication date: Available online 1 November 2018

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

Author(s): Ling Xu, Li Peng, Tianle Gu, Dandan Yu, Yong-Gang Yao

Abstract

Post-transcriptional regulation controls the mRNA stability, translation efficiency, and subcellular localization of a protein. The mitochondrial antiviral signaling protein (MAVS) plays a vital role in innate antiviral immunity. The MAVS mRNA has a long 3′ untranslated region (UTR, >9 kb) and an understanding of this region may help to explain the post-transcriptional regulation in a key protein. In this study, we aimed to characterize the role of the MAVS 3′UTR during MAVS expression by truncating the 3′UTR into different fragments so as to identify the regulatory elements. We found that the different fragments (H1–H5) of the MAVS 3′UTR play different roles in regulating the subcellular localization and function of MAVS. Three AU-rich elements (AREs) in the MAVS 3′UTR H1 fragment (region 1-3445 in the 3′UTR) repressed MAVS expression by interacting with HuR to destabilize its mRNA. The MAVS 3′UTR H5 fragment (region 5955-7687 in the 3′UTR) affected the cellular localization of MAVS in mitochondria and influenced the subsequent antiviral function. Four miR-27a binding sites were recognized in the MAVS 3′UTR, and treatment of miR-27a inhibited MAVS expression and promoted the replication of the vesicular stomatitis virus (VSV). The identification of multiple regulatory elements in the MAVS 3′UTR offers new insights into the precise control of MAVS expression in innate immunity.



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Preoperative Evaluation of the Pediatric Patient

Publication date: December 2018

Source: Anesthesiology Clinics, Volume 36, Issue 4

Author(s): Allison Basel, Dusica Bajic



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Preoperative Management of Medications

Publication date: December 2018

Source: Anesthesiology Clinics, Volume 36, Issue 4

Author(s): Zdravka Zafirova, Karina G. Vázquez-Narváez, Delia Borunda



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Creating a Pathway for Multidisciplinary Shared Decision-Making to Improve Communication During Preoperative Assessment

Publication date: December 2018

Source: Anesthesiology Clinics, Volume 36, Issue 4

Author(s): Timothy D. Quinn, Piotr Wolczynski, Raymond Sroka, Richard D. Urman



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Diabetes Mellitus: Preoperative Concerns and Evaluation

Publication date: December 2018

Source: Anesthesiology Clinics, Volume 36, Issue 4

Author(s): Roshni Sreedharan, Basem Abdelmalak



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Surgical Prehabilitation: Nutrition and Exercise

Publication date: December 2018

Source: Anesthesiology Clinics, Volume 36, Issue 4

Author(s): John Whittle, Paul E. Wischmeyer, Michael P.W. Grocott, Timothy E. Miller



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Preoperative Cardiac Evaluation for Noncardiac Surgery

Publication date: December 2018

Source: Anesthesiology Clinics, Volume 36, Issue 4

Author(s): Vahé S. Tateosian, Deborah C. Richman



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Designing and Running a Preoperative Clinic

Publication date: December 2018

Source: Anesthesiology Clinics, Volume 36, Issue 4

Author(s): Jeanna D. Blitz, Christian Mabry



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Forthcoming Issues

Publication date: December 2018

Source: Anesthesiology Clinics, Volume 36, Issue 4

Author(s):



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Contents

Publication date: December 2018

Source: Anesthesiology Clinics, Volume 36, Issue 4

Author(s):



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Contributors

Publication date: December 2018

Source: Anesthesiology Clinics, Volume 36, Issue 4

Author(s):



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Copyright

Publication date: December 2018

Source: Anesthesiology Clinics, Volume 36, Issue 4

Author(s):



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Preoperative Patient Evaluation

Publication date: December 2018

Source: Anesthesiology Clinics, Volume 36, Issue 4

Author(s): Zdravka Zafirova, Richard D. Urman



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Modulation of behavioral and brain responses to visual perspective taking by social rejection: Evidence from electrophysiology

Publication date: Available online 1 November 2018

Source: International Journal of Psychophysiology

Author(s): Suhao Peng, Yue Leng, Sheng Ge, Dan Tao, Mengyuan Ding, Wenming Zheng, Huihua Deng

Abstract

Visual perspective taking (VPT) is crucial for reasoning about other people's mental states. To explore the modulation of behavioral and neural responses to visual perspective taking by social rejection, we firstly manipulated rejection using get-acquainted oral communication and a two-person visual perspective task, then explored how the experience of social rejection affected the behavioral and neural responses during the follow-up classical one-person visual perspective task. The subjective rating and behavior results showed that social rejection increased individuals' negative affect level and feelings of need-threat, decreased self-regulation and impulsive control. The event-related potentials (ERP) and standardized low resolution brain electromagnetic tomography (sLORETA) results mainly showed that the increased parietal late slow wave (LSW) showed greater activities in SPL and rTPJ after social rejection. Moreover, compared with making judgments from self-perspective, making judgments from other-perspective yielded later TP450 and greater late frontal wave (LFW). In addition, the left LFW of socially rejected group showed more positive amplitude for other-inconsistent condition than that for other-consistent condition. These results suggested that social rejection might decrease impulsive control behaviorally, as well as increase neural processing of perspective taking, including visual-spatial perspective taking (indexed by the LSW), calculating of the self and other perspectives (indexed by the TP450), and processing of others' visual perspectives (indexed by the LFW). Our findings provide powerful evidence on neural mechanism underlying how social rejection modulates visual perspective taking, and support the model of social monitoring system, in that socially rejected individuals motivate to attend more carefully to social cues, such as other people's perspective.



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Autism spectrum disorder: insights into convergent mechanisms from transcriptomics



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The many lives of KATs — detectors, integrators and modulators of the cellular environment



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Ways of improving precise knock-in by genome-editing technologies

Abstract

Despite the recent discover of genome-editing methods, today we can say these approaches have firmly entered our life. Two approaches—knocking out malfunctioning gene allele or correcting the mutation with precise knock-in—can be used in hereditary monogenic diseases treatment. The latter approach is relatively ineffective. Modern data about the ways of repair of double-strand DNA breaks formed by nucleases are presented in this review. The main part of the review is devoted to the ways of increasing precise and effective knock-in: inhibition of non-homologous end joining and stimulation of homology-directed repair key factors, use of small molecules with unknown mechanism of action, cell-cycle synchronization and cell-cycle-dependent activity of Cas9, donor molecule design, selection, alternative methods for insertion and other approaches.



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Neonatal anesthesia in low birth weight babies at Hospital Nacional Guido Valadares, Dili, Timor‐Leste

Pediatric Anesthesia, EarlyView.


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Editorial Board

Experimental Physiology, Volume 103, Issue 11, Page 1572-1574, 1 November 2018.


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Corrigendum

Experimental Physiology, Volume 103, Issue 11, Page 1571-1571, 1 November 2018.


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The impact of 2‐years of high intensity exercise training on a model of integrated cardiovascular regulation

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


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If serotonin does not exhaust you, it makes you stronger

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


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ORAI1 channel gating and selectivity is differentially altered by natural mutations in the first or third transmembrane domain

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


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Interneuronal NMDA receptors regulate long‐term depression and motor learning in the cerebellum

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


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PKCδ constrains the S‐pathway to phrenic motor facilitation elicited by spinal 5‐HT7 receptors or severe acute intermittent hypoxia​

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


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Issue Information

The Journal of Physiology, Volume 596, Issue 21, Page 5065-5066, 1 November 2018.


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PEG 3350 Versus Lactulose for Treatment of Functional Constipation in Children: Randomized Study

Objectives: The aim of this study was to compare the clinical efficacy and tolerance of polyethylene glycol 3350 (PEG) and lactulose for the treatment of functional constipation in infants and children. Methods: This randomized, multicenter study covered 12 weeks of treatment and 4 weeks of follow-up of patients with functional constipation. Patients were randomized (central randomization) to receive either PEG or lactulose. The primary end points were the number of defecations per week after 12 weeks of treatment and improvement in stool consistency of at least 2 points in the Bristol scale. The secondary end point was the presence of adverse events. Bowel movements ≥ 3 per week and stool consistency ≥ 2 (Bristol scale) were considered as successful treatment. Results: We enrolled 102 patients (M 57, F 45) aged 3.62 ± 1.42 years and 88 completed the study. At week 12, good clinical outcome was achieved in 98% (PEG) and 90% (lactulose). The PEG group had more defecations per week compared with the lactulose group [7.9 ± 0.6 vs. 5.7 ± 0.5, p = 0.008] and both groups had similar frequency of defecation with pain (5% vs. 5%; p = 0.9), stool retention (7% vs. 10%; p = 057), large volume of stools (30% vs. 31%; p = 0.9) and hard stools (7% vs. 13%; p = 0.58). There were more patients with side effects in the lactulose group (15 vs. 23, p = 0.02), mostly bloating and abdominal pain. Conclusions: PEG 3350 is more effective and causes fewer side effects than lactulose in the treatment of constipation in infants and children. Clinical Trial Registration: clinicaltrials.gov, NCT03177434 Address correspondence and reprint requests to Dorota Jarzębicka, MD, ul. Aleja Dzieci Polskich 20, 04-730 Warsaw (e-mail: dorota.jarzebicka@wp.pl). Received 22 May, 2018 Accepted 11 October, 2018 Funding Source: No funding was secured for this study. Financial Disclosure: The authors have no financial relationships relevant to this article to disclose. Conflicts of Interest: PEG 3350 for patients was delivered by Vitis Pharma, Poland. The authors have no conflicts of interest relevant to this article to disclose. Table of Contents Summary This study compared the clinical efficacy and tolerance of PEG 3350 and lactulose for the treatment of functional constipation in infants and children. Contributors' Statement Page Dorota Jarzeębicka: collected data, conceptualized and designed the study, designed the data collection instruments, drafted the initial manuscript, reviewed, revised and final approved the manuscript. Joanna Sieczkowska-Gołub: collected data, drafted the initial manuscript, reviewed and revised the manuscript. Jarosław Kierkusś: conceptualized and designed the study, designed the data collection instruments, coordinated and supervised data collection, and critically reviewed the manuscript Piotr Czubkowski: designed the data collection instruments, carried out the analyses, drafted the initial manuscript, reviewed and revised the manuscript. Monika Kowalczuk-Krystoń: collected data, drafted the initial manuscript, reviewed and revised the manuscript. Maciej Pelc: collected data, drafted the initial manuscript, reviewed and revised the manuscript. Dariusz Lebensztejn: conceptualized and designed the study, coordinated and supervised data collection, and critically reviewed and revised the manuscript. Bartosz Korczowski: conceptualized and designed the study, coordinated and supervised data collection, and critically reviewed the manuscript. Piotr Socha: conceptualized and designed the study, carried out the analyses, drafted the initial manuscript, reviewed and revised the manuscript. Grzegorz Oracz: conceptualized and designed the study, designed the data collection instruments, coordinated and supervised data collection, and critically reviewed the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Reporting of time to rescue analgesia: Would it have made a difference in results?

No abstract available

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Near-infrared spectroscopy in vegetables and humans: An observational study

imageBACKGROUND Cerebral near-infrared spectroscopy (NIRS) of tissue oxygen saturation is claimed to be a surrogate marker for global cerebral perfusion. Increasingly, NIRS target-based therapy has been used during cardiac surgery in the hope of decreasing the incidence of adverse neurological outcome. OBJECTIVES We report NIRS values for some common vegetables and faculty at a world-class medical institution. DESIGN Observational nonblinded study. SETTING Single tertiary care institution and local urban vegetable market. PARTICIPANTS Five yams (Dioscorea cayenensis), five courgettes (Cucurbita pepo) and five butternut squashes (Cucurbita moschata) were studied. Five cardiothoracic surgeons and anaesthesiologists were the control group. INTERVENTIONS None. MAIN OUTCOME MEASURES NIRS value of each species. RESULTS Mean NIRS value for the control group was 71% [95% confidence interval (CI) 68 to 74] and was similar to that of the yellow squashes [75% (95% CI 74 to 76)]. These values were significantly greater than the NIRS measurements of both the butternut squash and yam [63% (95% CI 62 to 64) and 64% (95% CI 63 to 65), respectively, P 

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Anaesthesia and orphan disease: a child with Koolen-de Vries syndrome

No abstract available

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Peri-operative oral caffeine does not prevent postoperative atrial fibrillation after heart valve surgery with cardiopulmonary bypass: A randomised controlled clinical trial

imageBACKGROUND Raised plasma levels of endogenous adenosine after cardiac surgery using cardiopulmonary bypass (CPB) have been related to the incidence of postoperative atrial fibrillation (POAF). OBJECTIVE We wished to assess if caffeine, an adenosine receptor antagonist could have a beneficial effect on the incidence of POAF. DESIGN A randomised controlled study. SETTING Single University Hospital. PATIENTS One hundred and ten patients scheduled for heart valve surgery with CPB. INTERVENTIONS We randomly assigned patients to receive peri-operative oral caffeine (400 mg every 8 h for 2 days) or placebo. Adenosine plasma concentrations and caffeine pharmacokinetic profile were evaluated in a subgroup of 50 patients. MAIN OUTCOME MEASURES The primary endpoint was the rate of atrial fibrillation during postoperative hospital stay. RESULTS The current study was stopped for futility by the data monitoring board after an interim analysis. The incidence of atrial fibrillation was similar in the caffeine and in the placebo group during hospital stay (33 vs. 29%, P = 0.67) and the first 3 postoperative days (18 vs. 15%; P = 0.60). Basal and postoperative adenosine plasma levels were significantly associated with the primary outcome. Adenosine plasma levels were similar in the two treatment groups. Caffeine administration was associated with a higher incidence of postoperative nausea and vomiting (27 vs. 7%, P = 0.005). CONCLUSION Oral caffeine does not prevent POAF after heart valve surgery with CPB but increased the incidence of postoperative nausea and vomiting. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, no.: NCT01999829.

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Incidence of akathisia after postoperative nausea and vomiting prophylaxis with droperidol and ondansetron in outpatient surgery: A multicentre controlled randomised trial

imageBACKGROUND Akathisia, a distressing movement disorder induced by butyrophenones, has been described with low doses of droperidol used for postoperative nausea and vomiting (PONV) prophylaxis, but the incidence remains unclear. OBJECTIVES To determine the incidence of akathisia after PONV prophylaxis with two doses of droperidol in comparison with ondansetron, in patients undergoing ambulatory surgery. We hypothesised that the incidence of akathisia is higher with droperidol than that with ondansetron. DESIGN Randomised controlled double blind trial. SETTING Two University Hospital Centres and two private Clinics from January to September 2014. PATIENTS Patients (n=297) undergoing general anaesthesia for ambulatory surgery were randomly allocated to receive PONV prophylaxis with droperidol (0.625 or 1.25 mg) or ondansetron 4 mg; patients of the three groups also received 4 mg of dexamethasone. Exclusion criteria were contraindication to droperidol and ondansetron, use of psychotropic medications or benzodiazepines or history of psychotic illness. INTERVENTIONS Participants received droperidol (0.625 or 1.25 mg) or ondansetron 4 mg during general anaesthesia. After discharge from the postanaesthesia care unit presence and severity of akathisia were assessed using the Barnes Akathisia Rating Scale at 4 h postoperatively. MAIN OUTCOME MEASURES Score of the Global Clinical Assessment of Akathisia of Barnes Akathisia Rating Scale. RESULTS The number of akathisia observed was 1/118 (0.8%) in the ondansetron group, 1/84 (1.2%) in droperidol 0.625 mg group, and 3/87 (3.4%) in droperidol 1.25 mg group. The akathisia rate difference among the three groups was not significant (P = 0.52). We could not demonstrate significant differences in the incidence of akathisia between the two doses of droperidol. The only case of marked akathisia treated with benzodiazepines was observed after droperidol 1.25 mg. CONCLUSION The use of droperidol or ondansetron for PONV prophylaxis is associated to a low incidence of akathisia (0.8 to 3.4%) after general anaesthesia for ambulatory surgery. TRIAL REGISTRATION Clinicaltrials.gov: NCT01942343.

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Peri-operative respiratory adverse events in children with upper respiratory tract infections allowed to proceed with anaesthesia: A French national cohort study

imageBACKGROUND Peri-operative respiratory adverse events (PRAEs) in paediatric patients with upper respiratory tract infections (URTIs) remain inadequately explored in patients allowed to proceed to anaesthesia and surgery. OBJECTIVE To determine the incidence and risk factors of PRAE in children with URTI allowed to proceed to anaesthesia. DESIGN Multicentre cohort study performed over 6 months in France. SETTING Sixteen centres with dedicated paediatric anaesthetists. PATIENTS Eligible patients were aged from 0 to 18 years with URTI symptoms on admission or a history of such over the preceding 4 weeks. MAIN OUTCOMES The primary outcome of the study was to determine predictors of PRAE. Secondary outcomes were: predictors of peri-operative arterial desaturation and of the decision to proceed with anaesthesia and surgery in children with URTI. RESULTS Overall, 621 children were included and 489 (78.7%) anaesthetised. Of those anaesthetised, 165 (33.5%) and 97 (19.8%) experienced PRAE and arterial desaturation, respectively. Factors predictive of PRAE included patient age, tracheal intubation and the absence of midazolam premedication. Factors predictive of peri-operative arterial desaturation included patient age, anaesthetist experience, endoscopic procedures and the presence of other PRAE. Factors predicting proceeding to anaesthesia in the context of URTI included anaesthetist experience, emergency procedures and the absence of severe URTI symptoms. CONCLUSION The risk of PRAE in patients anaesthetised in the presence of URTI was similar to previous publications – close to 30%. In the light of our findings, first, current rescheduling indications should be questioned, and second, further medical and organisational strategies should be investigated to reduce PRAE in children with URTI. TRIAL REGISTRATION The study was registered in the European Networks of Centers for Pharmacoepidemiology and Pharmacovigilance (EUPAS16436).

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Green blood plasma from a patient with breast cancer after sentinel lymph node biopsy

imageNo abstract available

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Emergence delirium in children is related to epileptiform discharges during anaesthesia induction: An observational study

imageBACKGROUND Epileptiform discharges frequently occur in children during induction of anaesthesia. However, studies analysing the impact of epileptiform discharges on postoperative emergence delirium in children are still scarce. The aim of this study is to correlate the incidence of epileptiform activity during anaesthesia induction with the occurrence of emergence delirium during stay in the recovery room. OBJECTIVES Prospective, observational cohort study in children 0.5 to 8 years old undergoing planned surgery. Bifrontal electroencephalogram electrodes were placed before induction of anaesthesia. Visual electroencephalogram analysis was performed from start of anaesthetic agent administration until intubation with regard to epileptiform patterns: rhythmic polyspikes; periodic epileptiform discharges; delta with spikes; and suppression with spikes. Emergence delirium was assessed during stay in the recovery room using the Pediatric Assessment of Emergence Delirium Score. DESIGN Prospective, observational cohort study. SETTING University hospital – Germany/Berlin. Children were included between September 2015 and February 2017. PATIENTS A total of 62 Children, aged 0.5 to 8 years old undergoing planned surgery were included. MAIN OUTCOME MEASURES Primary outcome was emergence delirium. Secondary outcomes, peri-operative Electroencephalography (EEG) data analysis. The presented study analysed an association between emergence delirium and the occurrence of epileptiform discharges during anaesthesia induction. RESULTS A total of 43.5% of the children developed emergence delirium and 56.5% did not. Epileptiform discharges were observed more often in children developing emergence delirium (63%) compared with children not developing emergence delirium (43%). But only the occurrence of interictal spike events – such as rhythmic polyspikes; periodic epileptiform discharges and delta with spikes – were significantly related to emergence delirium (emergence delirium-group 48% vs. nonemergence delirium-group 14%, OR = 5.6 [95% CI: 1.7 to 18.7]; P = 0.004). CONCLUSION Emergence delirium in children is significantly related to interictal spike events occurring during induction of anaesthesia. CLINICAL TRIAL NCT02481999.

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Pitfalls of clinical practice guidelines in the era of broken science: Let's raise the standards

No abstract available

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Ultrasound assessment of gastric emptying time after a standardised light breakfast in healthy children: A prospective observational study

imageOBJECTIVES Current guidelines recommend 6 h of fasting for solids before anaesthesia. However, prolonged fasting may lead to discomfort, hunger, thirst, misbehaviour and lipolysis. To prevent this, a more liberal fasting regimen has been empirically implemented in our children's hospital, allowing a shorter fasting time of 4 h for a standardised light breakfast. AIM The aim of this study was to determine the gastric emptying time after a standardised light breakfast in healthy children. DESIGN A prospective observational noninterventional study. METHODS After fasting overnight, the children had a standardised light breakfast. Before and afterwards, ultrasound examinations of the gastric antrum were performed hourly to determine the gastric antral area (GAA), which is a surrogate parameter for gastric volume in children in the right lateral position (RLP). Demographic data and fasting times are presented as mean ± SD (range) and GAA as median (interquartile range). RESULTS Twenty-two children aged 7.8 (2.5 to 13.6) years volunteered for this study. After fasting overnight [735 ± 120 (467 to 930) min], the initial GAA was 3.06 (2.35 to 4.03) cm2 in RLP. After the light breakfast, GAA in RLP initially increased and decreased subsequently. After 4 h, GAA in RLP was lower than the initial value (median of differences −0.54, 95% confidence interval −1.00 to −0.07, P 

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How current transfusion practices in geriatric patients with hip fracture still differ from current guidelines and the effects on outcome: A retrospective observational study

imageBACKGROUND Transfusion guidelines have become increasingly restrictive. We investigated actual transfusion practices in geriatric hip fracture patients, why they differ from current guidelines and how this affects outcome. OBJECTIVES The primary aim was to examine transfusion timing, evaluate how many red blood cell (RBC) transfusions are in keeping with guidelines and how this affects morbidity (infection, cardiac events and delirium), mortality and length of stay (LOS). Our secondary aim was to test the hypothesis that guidelines were more likely to be deviated from shortly before discharge and with consecutive transfusions. DESIGN A retrospective observational study. SETTING The Luzerner Kantonsspital, a major trauma centre, over a 12-month period from 1 February 2015 to 31 January 2016. PATIENTS All patients over 70 years of age admitted to the Luzerner Kantonsspital with hip fractures over a 12-month period in 2015 to 2016 were included. RESULTS 156 patients were included, to which 141 units of RBCs were transfused. All pre and intra-operative transfusions were according to guidelines; 110 transfusions were postoperative and 37 of these were not according to guidelines. Patients who were transfused had longer LOS in hospital (P = 0.002) and an odds ratio (OR) of 2.7 of contracting an infection (P = 0.04) in comparison with patients who were not transfused. No significant differences in mortality, LOS or morbidity were found between patients transfused according to guidelines and more liberal thresholds. Guidelines were more likely to be deviated from within the last 2 days before discharge than prior to this (58 vs. 24%, P = 0.03). Furthermore, 24 stable patients received two consecutive RBC units resulting in posttransfusion haemoglobin values of between 83 and 124 g l−1. CONCLUSION Most RBC transfusions occur postoperatively, many still according to liberal transfusion thresholds, in particular shortly before discharge and as part of consecutive transfusions. Transfused patients had longer LOS and more infections than patients not transfused, but there was no difference in mortality, LOS or morbidity between patients transfused according to current guidelines and those where guidelines were deviated from.

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The degree of adherence to CONSORT reporting guidelines for the abstracts of randomised clinical trials published in anaesthesia journals: A cross-sectional study of reporting adherence in 2010 and 2016

imageBACKGROUND Abstracts are intended to be concise summaries of the entire randomised clinical trial (RCT). Despite their importance, few studies have examined the reporting quality of abstracts in the anaesthesiology literature. OBJECTIVES To examine the quality of RCT abstract reporting according to the CONSORT for Abstracts guidelines and determine whether recommended items omitted from the abstract were present in the body of the article. DESIGN A cross-sectional study of RCTs. SETTING This study was performed at the University of Western Ontario and University Hospital, London Health Sciences Centre. PARTICIPANTS All RCTs meeting inclusion criteria that were published in 2010 or 2016 in six general anaesthesiology journals (Anaesthesia, Anesthesia & Analgesia, Anesthesiology, British Journal of Anaesthesia, Canadian Journal of Anesthesia and European Journal of Anaesthesiology). MAIN OUTCOME MEASURES The 16 checklist items from the CONSORT for Abstracts statement were used to create a convenience score as a proxy for RCT abstract reporting quality, with each criterion measured as being reported in abstract, not reported in abstract but reported in full-text article, or not reported in abstract or full-text article. RESULTS Of the 395 RCTs identified, 219 were published in 2010 and 176 were published in 2016. Out of the maximum possible score of 16, the median abstract score increased from 4 points [interquartile range (IQR): 3 to 5] in 2010 to 6 points [IQR: 5 to 8] in 2016. Although most checklist items showed improvement from 2010 to 2016, around 75% of RCTs in 2016 met fewer than half of the 16 items with no RCTs reporting all 16 items in the abstract. A majority of the RCTs had the information present in the full-text. In 2016, only 71 out of 176 (40%) of RCTs reported outcomes conforming to the CONSORT guidelines (with an effect size and a confidence interval around the effect size) in the Abstract. CONCLUSION Abstracts for many anaesthesiology RCTs are incomplete selective summaries of the entire article.

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Intra-osseous-access-associated lower limb compartment syndrome in a critically injured paediatric patient

imageNo abstract available

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ICU mortality and variables associated with ICU survival in Poland: A nationwide database study

imageBACKGROUND Recently published international comparison data across European countries revealed high mortality rates in Polish ICUs. OBJECTIVES Estimation of the rate of ICU mortality and identification of variables associated with ICU survival in Poland. DESIGN Retrospective analyses of a database reporting ICU stays in Poland. SETTINGS AND PATIENTS The study included data from all adult patients admitted to an ICU in Poland from 1 January 2012 to 31 December 2012. MAIN OUTCOME MEASURES ICU mortality and variables associated with ICU survival. RESULTS A total of 48 282 patients were treated in 347 ICUs (mean age 63.1 ± 16.8 years, 59% men) with 20 278 deaths (42.0%). Variables associated with ICU survival were: tertiary level of hospital care [relative risk (RR) 0.86, 95% confidence interval (CI) 0.80 to 0.92, P 

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Life-threatening ketoacidosis in a lactating woman

imageNo abstract available

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Comparison of the peripheral antinociceptive effect of somatostatin with bupivacaine and morphine in the rodent postoperative pain model

imageBACKGROUND AND OBJECTIVES Infiltration of surgical wound with local anaesthetics attenuate postoperative pain. However, side effects can also occur. Somatostatin (SST) and its analogues like octreotide reportedly reduce peripheral sensitisation. The current study evaluates peripherally mediated antinociceptive effect of SST in a rat model of postoperative pain. This was compared with bupivacaine and morphine under identical experimental conditions. DESIGN Randomised vehicle-controlled blind study. SETTING Pain research laboratory, All India Institute of Medical Sciences, New Delhi from February 2014 to July 2017. EXPERIMENTAL SUBJECT Rodent hind paw incision model. INTERVENTIONS Sprague-Dawley rats were subjected to incision and one of the following drugs administered into the open wound once by a micropipette: SST (10, 30 or 100 μg), bupivacaine (3, 10, 30, 50 or 100 μg) or morphine (100 μg). Antinociceptive effect of SST was further evaluated for its reversibility, site of action, effect on spinal c-fos expression and blood glucose level. The site of action of morphine was also investigated. MAIN OUTCOME MEASURE Nociception was estimated by nonevoked (guarding behaviour) and evoked (mechanical allodynia and thermal hyperalgesia) pain behaviours between 2 h and days 4 to 7. RESULTS Nociception was maximum 2 h after incision. SST (10 to 100 μg) significantly attenuated guarding behaviour between 2 h and day 2. A delayed inhibitory effect was observed on allodynia. Bupivacaine (10 to 100 μg doses) similarly decreased guarding score up to day 2 though evoked pain behaviours were relatively unaffected. In contrast, morphine produced a potent but transient inhibitory effect on guarding score at 2 h, which was mediated by both peripheral and central opioid receptors. The antinociceptive effect of SST was peripherally mediated by type 2 receptors and was associated with decreased c-fos staining. Blood glucose level was unaltered. CONCLUSION Guarding behaviour, which likely represents pain-at-rest following surgery, was attenuated by both bupivacaine and SST to comparable extents. This novel peripherally mediated antinociceptive effect of SST needs further evaluation.

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Paucity of evidence for the effectiveness of prophylactic low-dose oxytocin protocols (<5 IU) compared with 5 IU in women undergoing elective caesarean section: A systematic review of randomised controlled trials

imageNo abstract available

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