Reply to the letter regarding NADPH oxidase inhibitor

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Practical guide for the management of systemic toxicity caused by local anesthetics

Abstract

Systemic toxicity from local anesthetics can occur in any of the wide range of situations in which these agents are used. This practical guide is created to generate a shared awareness of the prevention, diagnosis, and treatment of local anesthetic systemic toxicity among all medical professionals who perform nerve blocks. Systemic toxicity of local anesthetic is induced by an increase of its protein-unbound plasma concentration. Initial symptoms are characterized by central nervous system signs such as excitation, convulsions, followed by loss of consciousness and respiratory arrest. These symptoms are often accompanied with cardiovascular signs such as hypertension, tachycardia and premature ventricular contractions. Further increase of plasma concentration of local anesthetic induces bradycardia, conduction disturbances, circulatory collapse and asystole. The incidence of local anesthetic systemic toxicity is 1–11 cases per 10,000. Infants, patients with decreased liver function and low cardiac output are vulnerable to systemic toxicity. When performing regional anesthesia, the guideline-directed monitoring, securing a venous line, preparation of medication to treat convulsions and lipid emulsions are required. For prevention of local anesthetic systemic toxicity, small-dose, divided administration, using agents with low toxicity such as ropivacaine and levobupivacaine, performing an aspiration test are recommended. If systemic toxicity is suspected, halt administration of local anesthetic, request assistance, secure venous line, airway, administration of 100% oxygen and if necessary tracheal intubation and artificial respiration should be immediately performed. Benzodiazepines are recommended to treat convulsions. Administration of 20% lipid emulsion according to the protocol is recommended to treat severe hypotension and arrhythmia.

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New Alert Criteria for Intraoperative Somatosensory Evoked Potential Monitoring

Forty years ago, anesthesiologist Betty Grundy and engineer Richard Brown, working with spine surgeon Clyde Nash, began recording somatosensory evoked potentials (SEPs) from the scalp during spine surgery. Their goal was to identify SEP changes in time to avert post-operative neurologic impairment. Their early methods were crude by today's standards. They measured 512 msec long-latency SEPs with filters 1-100 Hz. They followed scalp signals' presence or absence without identifying particular peaks of interest.

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Down‐regulation of lncRNA XIST ameliorates podocytes apoptosis in membranous nephropathy via miR‐217/TLR4 pathway

New Findings

What is the central question of this study?

Up‐regulation of lncRNA XIST in injured podocytes and membranous nephropathy has been noted, but its implication in membranous nephropathy pathogenesis has not been elucidated in detail.

What is the main finding and its importance?

We demonstrated that XIST was up‐regulated in kidney tissue of membranous nephropathy and in injured podocytes. Down‐regulation of XIST inhibited podocytes apoptosis. XIST negatively regulated miR‐217, and miR‐217 controlled TLR4. XIST modulated TLR4 through miR‐217 and inhibition of XIST suppressed podocytes apoptosis induced by Angiotensin II via miR‐217.

Abstract

Background

Membranous nephropathy is often characterized by glomerular podocyte injury. Up‐regulation of lncRNA XIST has been verified in membranous nephropathy and in injured podocytes; hence the role of XIST in podocyte injury and membranous nephropathy was explored.

Methods

QRT‐PCR and western blot were performed to detect the expression XIST, miR‐217, and TLR4 protein respectively. Podocyte apoptosis was evaluated with flow cytometry. Interaction between XIST and miR‐217 was analyzed by RIP and RNA pull‐down assay, respectively. Dual luciferase reporter assay was used to exam the interplay between miR‐217 and TLR4.

Results

LncRNA XIST and Ang II up‐regulation, kidney and podocyte injury were indicated in kidney tissue of patients with membranous nephropathy. Increase of XIST and apoptosis were induced by Ang II in podocytes. Down‐regulation of XIST inverted podocytes apoptosis induced by Ang II. MiR‐217 was negatively regulated by XIST. MiR‐217 controlled TLR4 by targeting its 3′‐UTR. XIST modulated TLR4 through miR‐217 and inhibition of XIST inverted podocytes apoptosis induced by Ang II via regulating miR‐217.

Conclusion

Down‐regulation of XIST ameliorates podocytes apoptosis via the miR‐217/TLR4 pathway, which may improve membranous nephropathy.

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Pancreatic metastasis of papillary thyroid carcinoma preoperatively diagnosed by endoscopic ultrasound-guided fine-needle aspiration biopsy: a case report with review of literatures

Abstract

Pancreatic metastatic tumors from thyroid carcinoma are extremely rare. We report a case of an 80-year-old female with a pancreatic metastatic tumor derived from papillary thyroid carcinoma which was initially resected 158 months prior to detection of the metastatic pancreatic tumor. The patient has encountered cervical lymph-node metastasis on three occasions following the initial operation. Metastatic pancreatic lesions and cervical lymph nodes were first detected using 18-fluorodeoxyglucose positron-emission tomography/computed tomography, and she was preoperatively diagnosed using endoscopic ultrasound-guided fine-needle aspiration biopsy. A coin lesion, 10 mm in size, was detected in the left lung by chest computed tomography with no abnormal uptake in 18-fluorodeoxyglucose positron-emission tomography/computed tomography. Distal pancreatectomy and cervical lymph-node dissection were performed. Adjuvant chemotherapy with weekly paclitaxel was administered because anaplastic transformation had been detected in one of the cervical lymph nodes. The patient eventually died from multiple lung metastases 11 months after removing the metastatic pancreatic lesion. We reported a rare case of a pancreatic metastatic tumor from thyroid carcinoma, and found that 18-fluorodeoxyglucose positron-emission tomography/computed tomography and endoscopic ultrasound-guided fine-needle aspiration biopsy are useful for preoperatively diagnosing tumors.

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Cholangitis complicated by infection of a simple hepatic cyst

Abstract

An 87-year-old man was admitted to our hospital due to fever and elevated liver enzymes. Computed tomography (CT) scan revealed bile duct stones with a dilated biliary system, which confirmed the diagnosis of cholangitis. A 12-cm simple hepatic cyst was also seen in the right liver, which had been detected on CT scan 5 years before, and did not change in size. Fever did not subside even after endoscopic biliary drainage and a repeated CT scan showed an enlarged cyst up to 14 cm, suggesting cyst infection. An enlarged hepatic cyst collapsed after percutaneous transhepatic drainage, along with resolution of fever. Simple hepatic cysts are common and most of them are asymptomatic. Infection of simple hepatic cysts is a rare condition and the major entry route is considered as the biliary tract as communication between the biliary tract and cysts is reportedly observed in those cases. However, in our case, no communication was seen on cholangiogram or cystogram on fluoroscopy and bilirubin level of the cyst aspirate was low. Given the fact that patients with cholangitis are rarely complicated by hepatic cyst infection, other routes of bacterial entry to simple hepatic cysts should also be considered.

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Rapid reversal of colonic pneumatosis with restoration of mesenteric arterial supply

Abstract

Pneumatosis cystoides intestinalis (PCI) is characterized by gas-filled cystic lesions within the wall of the large intestine and presents along a spectrum of clinical severity ranging from benign to life threatening. Etiopathogenesis is multifactorial and postulated to result from either mechanical or bacterial causes. In this report, we present a patient with chronic abdominal pain evaluated with colonoscopy revealing segmental PCI isolated to the distal colon. Further investigation revealed an abdominal aortic aneurysm (AAA) compromising the inferior mesenteric artery takeoff. Endovascular repair of the AAA resulted in clinical resolution of abdominal pain and endoscopic resolution of PCI. To our knowledge, this is the first report to document endoscopic resolution of PCI with restoration of mesenteric arterial supply, highlighting vascular insufficiency as a predisposing and reversible pathogenic mechanism.

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Electrical pulse stimulation induces differential responses in insulin action in myotubes from severely obese individuals

Key Points

Exercise/exercise training can enhance insulin sensitivity through adaptations in skeletal muscle, the primary site of insulin‐mediated glucose disposal; however, in humans the range of improvement can vary substantially. The purpose of this study was to determine if obesity influences the magnitude of the exercise response in relation to improving insulin sensitivity in human skeletal muscle. Electrical pulse stimulation (EPS) (24 h) of primary human skeletal muscle myotubes improved insulin action in tissue from both lean and severely obese individuals. However, responses to EPS were blunted with obesity. EPS improved insulin signal transduction in myotubes from lean but not severely obese subjects and increased AMP accumulation and AMPK Thr¹⁷² phosphorylation, but to a lesser degree in myotubes from the severely obese. These data reveal that myotubes of severely obese individuals enhance insulin action and stimulate exercise‐responsive molecules with contraction, but in a manner and magnitude that differs from lean subjects.

Abstract

Exercise/muscle contraction can enhance whole‐body insulin sensitivity; however, in humans the range of improvements can vary substantially. In order, to determine if obesity influences the magnitude of the exercise response, this study compared the effects of electrical pulse stimulation (EPS) ‐induced contractile activity upon primary myotubes derived from lean and severely obese (BMI ≥ 40 kg/m²) women. Prior to muscle contraction, insulin action was compromised in myotubes from the severely obese as evident by reduced insulin‐stimulated glycogen synthesis, glucose oxidation, glucose uptake, insulin signal transduction (IRS1, Akt, TBC1D4), and insulin‐stimulated GLUT4 translocation. EPS (24 h) increased AMP, IMP, AMPK Thr¹⁷² phosphorylation, PGC1α content, and insulin action in myotubes of both the lean and severely obese subjects. However, despite normalizing indices of insulin action to levels seen in the lean control (non‐EPS) condition, responses to EPS were blunted with obesity. EPS improved insulin signal transduction in myotubes from lean but not severely obese subjects and EPS increased AMP accumulation and AMPK Thr¹⁷² phosphorylation, but to a lesser degree in myotubes from the severely obese. These data reveal that myotubes of severely obese individuals enhance insulin action and stimulate exercise‐responsive molecules with contraction, but in a manner and magnitude that differs from lean subjects.

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Physical inactivity induced insulin resistance: Could alterations to the vasculature be to blame?

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Part-Time Paramedic - Upper Kittitas County Medic One

PLEASE VISIT https://ift.tt/2z253IP for a full application! Medic One is the sole ALS provider and the primary transport agency for the northwestern part of Kittitas County, Washington, serving the communities of Snoqualmie Pass, Lake Kachess, Easton, Roslyn, Ronald, Cle Elum, and South Cle Elum, and the surrounding rural and wilderness areas, including a forty-one mile section of Interstate ...

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Paramedic Inpatient, (NICU/PICU - Flex) FT; 36 hours per week 5p-5a with weekend rotation - Children's Hospital & Medical Center

The inpaitent paramedic serves a clinical resource on inpateint units (critical care or med surg). Working to the full scope of their license, the paramedic will complete assessments, perform procedures, administer meds, and respond to emergencies in the assigned unit or division. The paramedic will interact with patients and famillies and be part of the pediatric and neonatal care team.

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Instructor, EMS - Gateway Technical College

The Instructor, EMS, will teach EMS courses at all levels and teach Paramedic classes using the Department of Health Services (DHS) curricula - assist in the delivery of all pre-hospital EMS didactic and lab skills at the Paramedic level. This position reports to the Dean, School of Protective & Human Services. Responsibilities: - Plan and teach courses which fulfill the current curriculum goals and ...

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Allergy alerts ‐ the incidence of parentally reported allergies in children presenting for general anaesthesia

Abstract

Background and aim

Pediatric patients increasingly report allergies, including allergies to food and medications. We sought to determine the incidence and, nature of parent‐reported allergies in children presenting for surgery and its significance for anaesthetists.

Method

We prospectively collected data on admissions through our surgical admission unit over a two‐month period at a pediatric tertiary care teaching hospital. Data collected included patient demographics, history of atopy, with more comprehensive information collected if an allergy was reported. A clinical immunologist and an anaesthetist reviewed the documentation of all patients reporting an allergy.

Results

We reviewed 1001 pediatric patients, 158 (15.8%) patients with parent‐reported allergies; to medications/drugs (n=73), food (n=66), environmental allergens (dust/grasses, n=35), tapes/dressings (n=27), latex (n=4) and venom (e.g. bee, wasp, n=9). 41 patients reported antibiotic allergies, with Beta–lactam antibiotics being the most common, with the majority presenting with rash alone (57%). 10 patients reported allergies to non‐steroidal anti‐inflammatory drugs (NSAID) and 8 to opioids. 24 patients reported egg and/or peanut allergy. Only 3/1001 (0.3%) patients were deemed to have evidence of likely IgE mediated drug allergy. Of the reported allergies, only 60 (38.2%) had been investigated prior, most likely to be followed up were food (53%) and environmental allergies (44.4%). Only 4/73 (5.5%) reported medication allergies had further follow up. Just 4 patients (0.4% of the entire cohort) had drug sensitivities/allergies that were likely to majorly alter anaesthesia practice.

Conclusion

Only the minority of parent‐reported allergies in paediatric surgical patients were specialist confirmed and likely to be clinically relevant. Self‐reported food allergy is commonly specialist verified, reactions to medications were generally not. Over‐reporting of allergies is increasingly common and limits clinician choice of medications. Better education of patients and their families and more timely verification or dismissal of parent‐reported reactions is urgently needed.

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Current understanding and perioperative management of pediatric pulmonary hypertension

Summary

Pediatric pulmonary hypertension (PH) is a complex disease with multiple, diverse etiologies affecting the premature neonate to the young adult. Pediatric pulmonary arterial hypertension (PAH), whether idiopathic or associated with congenital heart disease, is the most commonly discussed form of pediatric PH, as it is progressive and lethal. However, neonatal forms of PH are vastly more frequent, and while most cases are transient, the risk of morbidity and mortality in this group deserves recognition. PH due to left heart disease is another subset increasingly recognized as an important cause of pediatric PH. One aspect of pediatric PH is very clear: anesthetizing the child with PH is associated with a significantly heightened risk of morbidity and mortality. It is therefore imperative that anesthesiologists who care for children with PH have a firm understanding of the pathophysiology of the various forms of pediatric PH, the impact of anesthesia and sedation in the setting of PH, and anesthesiologists' role as perioperative experts from preoperative planning to postoperative disposition. This review summarizes the current understanding of pediatric PH physiology, preoperative risk stratification, anesthetic risk, and intraoperative considerations relevant to the underlying pathophysiology of various forms of pediatric PH.

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The Advancement of Pediatric Anesthesia Pharmacology: David Ryan Cook (Scions, Serendipity, and Six Degrees of Separation)

Summary

Dr. David Ryan Cook, Professor Emeritus of Anesthesiology and Pharmacology at the University of Pittsburgh and Chief of Anesthesiology at Children's Hospital of Pittsburgh (1977‐1999), is a pioneer in the field of pediatric anesthesiology and pharmacology. Dr. Cook contributed significantly to the understanding of pharmacologic differences among infants, children, and adults. His work as a clinician‐scientist, educator, and mentor defined the pharmacology of many of the anesthetic agents we continue to use today. He brought science to the art of anesthesia and enhanced the safety of pediatric perioperative care. Based on a 2017 interview with Dr. Cook, this article outlines the development of his career and his contributions to the field of anesthesiology and pharmacology.

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FRAGILE X SYNDROME AND CONNECTIVE TISSUE CONNECTIVE TISSUE DEFICITS IN FRAGILE X SYNDROME

Fragile X Syndrome is the most common cause of inherited intellectual disabilities and autism spectrum disorders and it is an X‐linked disorder in which there is a deficiency of the Fragile X Mental Retardation 1 protein. This protein is crucial in regulating translation of mRNAs related to dendritic maturation and cognitive development. The phenotype of FXS is characterized by neurobehavioral alterations, social deficits, communication difficulties, and findings which suggest an alteration of connective tissue, especially in the ligaments and muscles, cardiovascular system and genitourinary system. Connective tissue connects and supports all other tissues of the body, and is composed of cells and extracellular matrix. Severalproteins have been involved in the connective tissue abnormalities associated with the FXS, such as matrix metalloproteinase 9, which plays an important role in the homeostasis of the extracellular matrix, being a potential therapeutic target for certain tetracycline antibiotics that have shown beneficial effects in FXS.Here we review connective tissue problems described in Fragile X Syndrome.

This article is protected by copyright. All rights reserved.

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Dark Neurons of the Brain

The structure and functional characteristics of dark hyperchromic and hyperchromic shrunken neurons in the brain have been studied at the light and electron microscopic levels in health and various pathologies. Hyperchromic dark neurons are cells with active protein synthesis which, however, die by apoptosis as a result of prolonged and intense exposure to unfavorable factors or because of genetic abnormalities.

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Results of a Randomized, Double-Blind, Multicenter, Placebo-Controlled, Parallel-Group Study of the Efficacy and Safety of Mexidol in Prolonged Sequential Therapy of Patients in the Acute and Early Recovery Stages of Hemispheric Stroke (the EPICA study)

Objectives. To assess the efficacy and safety of prolonged sequential therapy with Mexidol in patients with hemispheric ischemic stroke (IS) in the acute and early recovery phases. Materials and methods. A randomized, double-blind, multicenter, placebo-controlled, parallel-group study included 151 patients (62 men and 89 women) was performed in which 150 patients (62 men and 88 women) aged 40–79 years were randomized. Simple randomization was used to define two groups: patients of group 1 received Mexidol therapy at a dose of 500 mg/day by intravenous infusion for 10 days followed by oral doses of 1 tablet (125 mg) three times a day for eight weeks. Patients of group 2 received placebo by the same protocol. The duration of involvement in the trial was 67–71 days. Results. At the end of treatment, mean scores on the modified Rankin scale (mRS) were lower in group 1 than group 2 (p = 0.04). Decreases in mean mRS scores (at visits 1–5) were more marked in group 1 (p = 0.023). The proportion of patients achieving recovery corresponding to 0–2 points on the mRS (at visit 5) was significantly greater in group 1 (p = 0.039). Testing on the National Institutes of Health Stroke Scale at visit 5 gave a significantly lower score in group 1 (p = 0.035). Decreases in scores on the National Institutes of Health Stroke Scale at the end of treatment relative to the baseline level in patients with diabetes mellitus were more marked in group 1 (p = 0.038). In group 1, the total population and the subpopulation of patients with diabetes mellitus showed more marked improvements in quality of life, which was apparent by visit 2. The proportion of patients without difficulty mobilizing was significantly greater in group 1 (p = 0.022). There were no significant differences in the frequencies of adverse events in patients of the two groups. Conclusions. Use of Mexidol in the acute and early recovery phases of IS is recommended.

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Habituation of Somatosensory Event-Related Potentials in Subthreshold Rhythmic (1 Hz) Electrocutaneous Stimulation of the Arm during the Slow-Wave Stage of Daytime Sleep

Previous studies have shown that low-frequency subthreshold electrocutaneous stimulation of the arm during deep slow-wave sleep in humans improves sleep quality. The main cognitive processes are known to operate during sleep, and use of event-related potentials is the main method for analysis of these processes. The aims of the present work were to study the characteristics of somatosensory event-related potentials (sERP) on rhythmic (1 Hz) subthreshold electrocutaneous volley stimulation of the arm during the slow-wave stage of daytime sleep and to evaluate the potential for habituation of sERP to rhythmic stimulation during sleep. Subthreshold stimulation during sleep produced somatosensory event-related potentials (ERP) (group mean, n = 16) in which three long-latency components could be identifi ed, which were more marked in the frontal lead of the contralateral hemisphere. Comparison of sERP averaged from the beginning and end of the volley of stimuli (30 stimuli) demonstrated signifi cant decreases in the amplitudes of all sERP components by the end of the volley. It is suggested that the decrease in sERP amplitude in slow-wave sleep is due to the simplest form of stimulus-dependent nonassociative learning - habituation.

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The Dorsal and Ventral Hippocampus Have Different Reactivities to Proinflammatory Stress: Corticosterone Levels, Cytokine Expression, and Synaptic Plasticity

The dorsal and ventral parts of the hippocampus are functionally and morphologically nonidentical, and differences include stress reactivity. The present report describes the first study of the influence of proinflammatory stress induced by administration of lipopolysaccharide on the functional state and levels of the stress hormone corticosterone and proinflammatory cytokines in the dorsal (DH) and ventral (VH) hippocampus as compared with the neocortex, as well as changes in blood levels. The DH and VH responded specifically to proinflammatory stress: neurological inflammation developed more quickly in the DH, while corticosterone accumulation occurred more quickly in the neocortex and VH; functionally (in terms of the state of synaptic plasticity and the phenomenon of in vivo long-term potentiation), the DH suffered first, impairments then spreading to the VH.

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Association between Genes for Inflammatory Factors and Neuroticism, Anxiety, and Depression in Men with Ischemic Heart Disease

Objectives. To study the relationship between the immune system and depression, as well as its endophenotypes (neuroticism and trait anxiety), in patients with ischemic heart disease (IHD). Materials and methods. Studies were performed in a group of men with IHD and depression (78 patients) and without depression (91 patients), as well as in healthy male volunteers (127 subjects). Polymorphisms of the interleukin-4 (IL-4 –589C/T), interleukin-6 (IL-6 –174G/C), tumor necrosis factor α (TNF-α –308G/A), and C-reactive protein (CRP –717A/G) genes were studied. Results. An association between the IL-6 –174G/C polymorphism with depression comorbid with IHD was found (p = 0.01, OR = 2.3, 95% CI = 1.2–4.3), which was apparent as an increase in the frequency of the highly expressed G allele in the group of patients with depression. The IL-4 –589C/T polymorphism was associated with IHD: the frequency of the CC IL-4 –589C/T genotype was greater in this group of patients than in the control group regardless of the presence of depression (p = 0.007, OR = 2.1, 95% CI = 1.2–3.4). The TNF-α –308G/A and CRP –717A/G polymorphisms were not associated with depression in IHD. There were no signifi cant differences in the expression of neuroticism or trait anxiety in carriers of different genotypes at the IL-4 –589C/T, IL-6 –174G/C, TNF-α –308G/A, or CRP –717A/G loci. Conclusions. The association between the IL-6 –174G/C polymorphism with depression comorbid with IHD is consistent with published data on the role of IL-6 in the depression of depression in cardiology patients.

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Incidence of VO2max Responders to Personalized vs Standardized Exercise Prescription

Introduction Despite knowledge of cardiorespiratory fitness (CRF) training responders and non-responders, it is not well understood how the exercise intensity prescription impacts the incidence of response. The purpose of this study was to determine CRF training responsiveness based on cohort specific technical error (TE) following 12 weeks of standardized or individually prescribed exercise and the use of a verification protocol to confirm maximal oxygen uptake (VO2max). Methods Sedentary adult participants (9 men; 30 women; 48.2±12.2 yr) completed exercise training on 3 days a week for 12 weeks with exercise intensity prescribed based on standardized methods using heart rate reserve (HRR) or an individualized approach using ventilatory thresholds. A verification protocol was used at baseline and 12 weeks to confirm the identification of a true VO2max and subsequent relative percent changes to quantify CRF training responsiveness. A cohort-specific TE (4.7%) was used as a threshold to identify incidence of response. Results Relative VO2max significantly increased (p

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The Energy Cost of Sitting versus Standing Naturally in Man

PURPOSE Prolonged sitting is a major health concern, targeted via government policy and the proliferation of height-adjustable workstations and wearable technologies to encourage standing. Such interventions have the potential to influence energy balance and thus facilitate effective management of body/fat mass. It is therefore remarkable that the energy cost of sitting versus standing naturally remains unknown. METHODS Metabolic requirements were quantified via indirect calorimetry from expired gases in 46 healthy men and women (age 27±12 y, mass 79.3±14.7 kg, body mass index 24.7±3.1 kg·m-2, waist:hip 0.81±0.06) under basal conditions (i.e. resting metabolic rate; RMR) and then, in a randomized and counterbalanced sequence, during lying, sitting and standing. Critically, no restrictions were placed on natural/spontaneous bodily movements (i.e. fidgeting) to reveal the fundamental contrast between sitting and standing in situ whilst maintaining a comfortable posture. RESULTS The mean [95% CI] increment in energy expenditure was 0.18 [0.06 to 0.31] kJ⋅min-1 from RMR to lying, 0.15 [0.03 to 0.27] kJ⋅min-1 from lying to sitting and 0.65 [0.53 to 0.77] kJ⋅min-1 from sitting to standing. An ancillary observation was that the energy cost of each posture above basal metabolic requirements exhibited marked inter-individual variance, which was inversely correlated with resting heart rate for all postures (r=-0.5 [-0.7 to -0.1]) and positively correlated with self-reported physical activity levels for lying (r=0.4 [0.1 to 0.7]) and standing (r=0.6 [0.3 to 0.8]). CONCLUSION Interventions designed to reduce sitting typically encourage 30-120 min⋅d-1 more standing in situ (rather than perambulation), so the 12 % difference from sitting to standing reported here does not represent an effective strategy for the treatment of obesity (i.e. weight-loss) but could potentially attenuate any continued escalation of the on-going obesity epidemic at a population level. Corresponding author: Dr James A. Betts PhD FACSM, Department for Health, University of Bath, Bath, BA2 7AY, United Kingdom. E-mail: J.Betts@bath.ac.uk The authors declare that they have no conflict of interest in relation to this work – no external funding or support was provided for this work. The results of the present study do not constitute endorsement by ACSM. The results presented are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for publication October 2018. © 2018 American College of Sports Medicine

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24-Hour Movement and Nonmovement Behaviors in Older Adults. The IMPACT65+ Study

Introduction The aims of this study were: (i) to provide a detailed description of movement and non-movement behaviors objectively-assessed over the complete 24-hour period in a sample of older adults, and (ii) to analyze differences in these behaviors by sex, age, educational level, body mass index, self-rated health, and chronic conditions. Methods The sample comprised 607 high-functioning community-dwelling older adults (383 women), aged 65 to 92 years, who participated in the IMPACT65+ study. Movement and non-movement behaviors were assessed by the Intelligent Device for Energy Expenditure and Activity, which provide estimates on both temporal and spatial gait parameters, and identify specific functional activities on the basis of acceleration and position information. Results The final sample with valid data was 432 older adults (284 women). Around 30.7% of daily time was engaged in sedentary behavior (SB), while 33.5% and 35.8% was represented by physical activity (PA) and sleep, respectively. Sitting passive was the most prevalent SB (vs. lying and reclining), while most of light PA was by standing (vs. active sitting and walking at

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Life Events and Longitudinal Effects on Physical Activity: Adolescence to Adulthood

Introduction Common life events such as getting married or gaining employment may be opportunities to intervene on health behaviors like physical activity. The purpose of this study was to determine the changes in moderate-to-vigorous physical activity (MVPA) associated with several common life events from adolescence to young adulthood. Methods Participants in Project EAT (ages 11 to 18 at baseline and 25 to 36 at wave 4) were surveyed at four time points from 1998 to 2016. Questions included marital status, employment status, post-secondary education completion and enrollment, and living situation between each wave. Linear regression was used to model the effect of each life event on change in self-reported MVPA. Post-hoc mediation analysis was conducted to examine whether having a child mediated the effect of getting married on the change in MVPA. Results Average MVPA declined from 6.5 hours per week at baseline to 4.3 hours per week at wave 4. Having a child was associated with a significant decrease in MVPA between waves 2 and 3 and between waves 3 and 4. Getting married and leaving parents' home were associated with significant decreases in MVPA between waves 3 and 4. Having a child both mediated and moderated the effect of getting married on MVPA. Conclusion This study provides evidence that MVPA declines both after getting married and after having a child and that these effects are not independent. Interventions to maintain or increase MVPA could profitably target couples planning to get married or have a child. Corresponding Author: Jonathan Miller, Mail: 717 Delaware Street Suite 166, Minneapolis, Minnesota 55414, Email: mill5687@umn.edu, Phone: 651-247-5096, Fax: 612-624-0315 This study was supported by grant R01HL116892 to investigator Dianne Neumark-Sztainer from the National Heart, Lung, and Blood Institute. Jonathan Miller is supported by grant T32CA163184 from the National Cancer Institute (PI: Michele Allen). Mary J. Christoph is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) under National Research Service Award (NRSA) in Primary Medical Care, grant number T32HP22239 (PI: Iris Borowsky). Dr Winkler is supported by grant T32DK083250 from the National Institute of Diabetes and Digestive and Kidney Diseases (PI: Dr Jeffery). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute, the National Cancer Institute, US Department of Health and Human Services, National Institute of Diabetes and Digestive and Kidney Diseases or the National Institutes of Health. The results of this study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute endorsement by ACSM. Accepted for Publication: 31 October 2018 © 2018 American College of Sports Medicine

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Comparison of Exclusive Double Poling to Classical Techniques of Cross-country Skiing

Introduction This study aimed to 1) determine basic physiological demands during a simulated on-snow cross-country skiing (XCS) race when using grip-waxed skis (all classical XCS techniques=CLASSIC), versus glide-waxed skis for exclusive double poling (DP) and 2) analyze in which track sections DP is different from CLASSIC under controlled gliding conditions in elite junior and senior skiers. Methods 19 male and female elite XC skiers performed 1) two randomized simulated XCS races over 5.3 km using DP or CLASSIC measuring section times, VO2, heart rate, blood lactate and RPE, and 2) VO2peak-tests using diagonal stride and DP on treadmill. Results The total group showed no differences in performance or physiological responses between DP and CLASSIC. Elite male skiers achieved improved (~23s, P0.05) and females worse (~43s, P

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Bacteriophage Therapy Testing against Shigella flexneri in a Novel Human Intestinal Organoid-Derived Infection Model

Objective: Enteric bacterial pathogens cause diarrheal disease and mortality at significant rates throughout the world, particularly in children under the age of 5 years. Our ability to combat bacterial pathogens has been hindered antibiotic resistance, a lack of effective vaccines, and accurate models of infection. With the renewed interest in bacteriophage therapy, we sought to use a novel human intestinal model to investigate the efficacy of a newly isolated bacteriophage against Shigella flexneri. Methods: A S. flexneri 2457T-specific bacteriophage was isolated and assessed through kill curve experiments and infection assays with colorectal adenocarcinoma HT-29 cells and a novel human intestinal-derived organoid monolayer model. In our treatment protocol, organoids were generated from intestinal crypt stem cells, expanded in culture, and seeded onto transwells to establish two-dimensional monolayers that differentiate into intestinal cells. Results: The isolated bacteriophage efficiently killed S. flexneri 2457T, other S. flexneri strains, and a strain of 2457T harboring an antibiotic resistance cassette. Analyses with laboratory and commensal Escherichia coli strains demonstrated that the bacteriophage was specific to S. flexneri, as observed under co-culture conditions. Importantly, the bacteriophage prevented both S. flexneri 2457T epithelial cell adherence and invasion in both infection models. Conclusions: Bacteriophages offer feasible alternatives to antibiotics for eliminating enteric pathogens, confirmed here by the bacteriophage-targeted killing of S. flexneri. Furthermore, application of the organoid model has provided important insight into Shigella pathogenesis and bacteriophage-dependent intervention strategies. The screening platform described herein provides proof-of-concept analysis for the development of novel bacteriophage therapies to target antibiotic-resistant pathogens. Address correspondence and reprint requests to Christina S. Faherty, PhD, Address: 114 16th Street (114-3503), Charlestown, MA 02129-4404 (E-mail: csfaherty@mgh.harvard.edu). Received 27 June, 2018 Accepted 15 October, 2018 Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). Funding Sources: Funding was provided through the Bill and Melinda Gates Foundation grant OPP1139856. Additional financial support was provided by the National Institute of Allergy and Infectious Diseases grants U19-AI082655 (Cooperative Center on Human Immunology to AF) and K22AI104755 (to CSF). The Lu lab acknowledges additional financial support by the National Science Foundation (MCB-1350625, #1521925), the National Institutes of Health (5-P50-GM098792-05 and 4-R33-AI121669-03), the Office of Naval Research (N00014-13-l-0424), the Army Research Office (W911NF-ll-1-0281), the Broad Institute, the Koch Institute, the Defense Threat Reduction Agency (HDTRAl-14-1-0007), the Kenneth Rainin Foundation (2016-3066), the Ellison Foundation (AG-NS-0948-12), the Wertheimer Fund, the Institute for Soldier Nanotechnologies (W9111NF-13-D-0001), J-WAFS, Novartis (14081955), the Desphande Center at MIT, the Singapore-MIT Alliance for Research and Technology, the Center for Microbiome Informatics and Technology (15127713), and Excet, Inc. (17033835). The TEM core at MGH is supported by National Institute of Neurological Disorders and Stroke P30NS045776. Support for the Philly Dake Electron Microscope Facility was provided by the National Institutes of Health grant 1S10RR023594S10 and by funds from the Dake Family Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. The funders had no role in the study decision, data collection and analysis, decision to publish, or preparation of the manuscript. Conflicts of Interest and Source of Funding: Alejandro Llanos-Chea: None Robert J. Citorik: None Kourtney P. Nickerson: None Laura Ingano: None Gloria Serena: None Stefania Senger: None Timothy K. Lu: Stock/equity holder in Ampliphi and Eligo Biosciences Alessio Fasano: None Christina S. Faherty: None Author's Roles: Alejandro Llanos-Chea: Designed and performed experiments, analyzed data, and contributed to writing the manuscript Robert J. Citorik: Designed and performed experiments, analyzed data, and contributed to writing the manuscript; Kourtney P. Nickerson: Performed experiments and analyzed data Laura Ingano: Performed experiments and analyzed data Gloria Serena: Performed experiments and analyzed data Stefania Senger: Performed experiments, analyzed data, and contributed reagents, materials, and analysis tools Timothy K. Lu: Designed experiments, contributed reagents, materials, and analysis tools; contributed to writing the manuscript Alessio Fasano: Contributed reagents, materials, analysis tools; and contributed to writing the manuscript Christina S. Faherty: Designed experiments, analyzed data, contributed reagents, materials, and analysis tools, and contributed to writing the manuscript Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.jpgn.org). © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Eculizumab Is Safe and Effective as a Long-term Treatment for Protein-losing Enteropathy Due to CD55 Deficiency

Objectives: Loss of the complement inhibitor CD55 leads to a syndrome of early-onset protein-losing enteropathy (PLE), associated with intestinal lymphangiectasia and susceptibility to large-vein thrombosis. The in vitro and short-term treatment benefits of eculizumab (C5-inhibitor) therapy for CD55-deficiency have been previously demonstrated. Here we present the 18-months treatment outcomes for 3 CD55-deficiency patients with sustained therapeutic response. Methods: Three CD55-deficiency patients received off-label eculizumab treatment. Clinical and laboratory treatment outcomes included frequency and consistency of bowl movements, weight, patient/parent reports of overall well-being, and serum albumin and total protein levels. Membrane attack complex deposition on leukocytes was tested by flow cytometry, before and during eculizumab treatment. Results: Marked clinical improvement was noted in all 3 patients with resolution of PLE manifestations, that is, diarrhea, edema, malabsorption, overall well-being, growth, and quality of life. In correlation with the clinical observations, we observed progress in all laboratory outcome parameters, including increase in albumin and total protein levels, and up to 80% reduction in membrane attack complex deposition on leukocytes (P

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Prevalence of Celiac Disease in a Long-Term Study of a Spanish At-Genetic-Risk Cohort from the General Population

Objectives: To perform long-term celiac disease (CD) screening in an HLA-DQ2 (+) cohort from the general population and to assess the influence of risk genotypes on its development. Methods: In 2004, an HLA-DQ2 (+) cohort was selected. After the first CD screening at age 2–3 years, we performed a follow-up screening 8–10 years later. Anti-TG2 antibodies were determined using a rapid test kit. Results were confirmed by serum IgA anti-TG2 and IgA EMA determination. CD diagnosis was carried out by intestinal biopsies. Four HLA-DQ2 genotypic groups were used: G1: DQ2.5/DQ2.5 (G1A) or DQ2.5/ DQ2.2 (G1B); G2: DQ2.2/DQ7.5 (DQ2.5 trans); G3: DQ2.5/ X; G4: DQ2.2/X. Results: CD prevalence after 10 years of follow-up was 5.8% (95%CI 3.8–8.7). One of every three HLA-DQ2(+) children carried at least one haplotype DQ2.2 or DQ7. The homozygous genotype DQ2.5/DQ2.5 and the HLA-DQ2.5 trans genotype increased CD risk 4- and 3-fold, respectively. The homozygous genotype DQ2.5/ DQ2.2 did not increase the CD risk. Children carrying G1 or G2 genotypes were diagnosed with CD earlier and more frequently during the follow-up compare with those carrying G3 or G4 genotypes. 81% of children with spontaneous antibody negativization after the first screening maintained negative antibodies. Conclusions: A repeated screening of at-risk children during their follow-up allowed us to diagnose new CD cases. In our cohort, HLA- DQ2.5 trans genotype conferred a higher risk in the development of CD than HLA- DQ2.5/DQ2.2. The majority of children with potential CD and CD autoimmunity at 10 years of age remained healthy. Address correspondence and reprint requests to Sonia Fernández-Fernández, PhD, Pediatric Gastroenterology Unit, Department of Pediatrics, Hospital Universitario Severo Ochoa. Avenida Orellana s/n 28911 Leganés, Madrid, Spain (e-mail: soniaferfer@hotmail.com). Received 31 July, 2018 Accepted 17 October, 2018 Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). The authors report no conflicts of interest. The study was funded by the UAX-Santander Foundation through two grants obtained in 2015 and 2016. The funding source did not play any role in the study's design, data collection, analyses, nor in the interpretation of data, writing, or submission of this article. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Shared Decision Making About Starting anti-TNFs: A Pediatric Perspective

Shared decision making (SDM) is central to patient-centered medicine and has the potential to improve outcomes for pediatric patients with inflammatory bowel diseases. We surveyed specialists about their use of SDM in the decision to start a tumor necrosis factor-α inhibitor in pediatric patients. Results were compared between those who reported using SDM and those who did not. Of 209 respondents, 157 (75%) reported using SDM. Physician/practice characteristics were similar between users and non-users. There were no statistically significant differences between groups in the components deemed important to the decision-making process nor the number of barriers or facilitators to SDM. Exploratory analyses suggested that physicians using SDM were more accepting of adolescent involvement in the decision-making process. Our results question the effectiveness of using reported barriers and facilitators to guide interventions to improve use of SDM, and suggest further work is needed to understand the adolescent role in decision-making. Address correspondence and reprint requests to Hilary K. Michel, MD, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave., Pediatric Gastroenterology, 3rd Floor, Pittsburgh, PA 15220 (e-mail: hilary.michel2@upmc.edu). Received 13 August, 2018 Accepted 4 October, 2018 Sources of Funding: Data collection was funded by grant #K23HD073149 from the Eunice Kennedy Shriver National Institute of Child Health & Human Development to Dr. Lipstein. Conflicts of Interest: None declared. Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Can Pediatric Endoscopists Accurately Assess Their Clinical Competency? A Comparison Across Skill Levels

Background: Assessment is critical to support pediatric endoscopy training. Although trainee engagement in assessment is encouraged, the use of self-assessment and its accuracy among pediatric endoscopists is not well described. We aimed to determine the self-assessment accuracy of novice, intermediate and experienced pediatric endoscopists. Methods: Novice (performed 1000) pediatric endoscopists from 3 North American academic teaching hospitals each performed a clinical colonoscopy. Endoscopists were assessed in real-time by two experienced endoscopists using the Gastrointestinal Endoscopy Competency Assessment Tool for Pediatric Colonoscopy (GiECATKIDS). In addition, participants self-assessed their performance using the same instrument. Self-assessment accuracy between the externally assessed and self-assessed scores was evaluated using absolute difference scores, intraclass correlation coefficients (ICCs), and Bland-Altman analyses. Results: 47 endoscopists participated (21 novices, 16 intermediates and 10 experienced). There was moderate agreement of externally assessed and self-assessed GiECATKIDS total scores with an ICC of 0.72 (95% confidence interval [CI], 0.55–0.83). The absolute difference scores among the three groups were significantly different (P = 0.005), with experienced endoscopists demonstrating a more accurate self-assessment compared to novices (P = 0.003). Bland-Altman plots revealed that novice endoscopists' self-assessed scores tended to be higher than their externally-assessed scores, indicating they overestimated their performance. Conclusions: We found that endoscopic experience was positively associated with self-assessment accuracy among pediatric endoscopists. Novices were inaccurate in assessing their endoscopic competence and were prone to overestimation of their performances. Our findings suggest novices may benefit from targeted interventions aimed at improving their insight and self-awareness. Address correspondence and reprint requests to Catharine M. Walsh, MD, MEd, PhD, FAAP, FRCPC, Division of Gastroenterology, Hepatology and Nutrition, the Learning and Research Institutes, Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children, Division of Gastroenterology, Hepatology and Nutrition, 555 University Ave, Room 8256, Black Wing, Toronto, ON, Canada M5G 1X8 (E-mail: catharine.walsh@mail.utoronto.ca). Received 1 May, 2018 Accepted 6 October, 2018 Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). Financial Disclosure: The authors have no financial relationships relevant to this article to disclose. Sources of Funding: This project was supported by an American Society of Gastrointestinal Endoscopy Quality in Endoscopic Research Award. CMW hold a Career Development Award from the Canadian Child Health Clinician Scientist Program. Disclosures: None. Funding /Support: This project was supported by an American Society of Gastrointestinal Endoscopy Quality in Endoscopic Research Award. CMW holds a Career Development Award from the Canadian Child Health Clinician Scientist Program. Role of the sponsor: No funding organization had any role in the design and conduct of the study, collection, management, analysis and interpretation of the data; and preparation, review, or approval of the manuscript. Previous presentations: The abstract of an earlier version of this article was presented as an oral presentation at the 2015 NASPGHAN Annual Meeting, where it was awarded the "NASPGHAN Endoscopy Prize". Conflicts of Interest: No authors have any conflicts of interest to report. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Recanalization of Chronic Extrahepatic Portal Vein Obstruction in Pediatric Patients Using A Minilaparotomy Approach

Purpose: Extrahepatic portal vein obstruction (EHPVO) is the most frequent cause of portal hypertension in children. Some patients are not amenable to meso-Rex bypass and alternative surgeries don't restore physiologic flow. We aim to demonstrate the feasibility and safety of minilaparotomy for recanalization of chronic EHPVO. Methods: This 2013–2015 single-center, retrospective review included pediatric patients with chronic EHPVO who underwent minilaparotomy, mesenteric vein access, and attempted recanalization of the occluded portal vein. Outcomes included portal patency, resolution of variceal bleeding, size and number of varices, spleen size, and platelet count. Results: There were 6 EHPVO patients. The median age was 9.9 years and median duration of EHPVO was 7 years (3–16 years). EHPVO etiologies were liver transplantation (50%), idiopathic (33%), and umbilical vein catheterization (17%). Four patients (67%) had successful portal vein recanalization and stenting. At last follow-up [median 3.1 years (2.2–4.3 years)] all successfully recanalized patients had patent portal vein stents and resolution of varices and variceal bleeding. The median reduction in spleen size was 26%, with improvement in platelet counts (50 to 310/μL). The 2 patients with an idiopathic etiology may have never had a main extrahepatic portal vein based on imaging, and both were unable to be recanalized. Conclusions: Recanalization and stenting of a prolonged occlusion of the portal vein via a minilaparotomy approach is feasible, safe, and may provide an alternative to shunt surgery or endoscopic therapy in selected patients. Address correspondence and reprint requests to Sydne Muratore, MD, Department of Surgery, University of Minnesota, 420 Delaware St SE, MMC 195, Minneapolis, MN 55455 (. e-mail: clark626@umn.edu). Received 6 June, 2018 Accepted 23 October, 2018 Author contributions: Study conception and design: SM, RA, SF, DH Acquisition of data: SM, RA, SF, DH Analysis and interpretation of data: SF, RA Drafting of manuscript: SM Critical revision of manuscript: SM, RA, SF, DH Level of evidence: IV The authors report no conflicts of interests. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Steps Forward in the Management of Familial Cholestasis

No abstract available

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Inflammatory Bowel Diseases and School Absenteeism

Objectives: Inflammatory Bowel Diseases (IBD) are chronic diseases which negatively affect the schooling of children. The aim is to analyze school absenteeism and its causes in children followed for IBD. Methods: A prospective multicenter study of IBD patients aged from 5 to 18 years old, from September 2016 to June 2017. Data on absenteeism and its causes were collected via a monthly questionnaire completed by patients or their family by mail. The results were compared with existing data supplied by the school authorities (497 students without IBD divided by class). Results: 106 patients (62 boys), median age of 14 (5 to 18), were included. The global response rate was 83.1%. The IBD patients were absent an average of 4.8 +/− 5.5% of school days during the school year, against 3.2 +/− 1.6% for non IBD group (p = 0.034). Digestive disorders accounted for 34% of the causes of absenteeism. 27% of the absences were due to scheduled events (hospitalizations, endoscopy, or consultations). By excluding the absences for scheduled care, the rate of school absenteeism of IBD patients is significantly lower than that of non-IBD group. Conclusion: Children with IBD are more frequently absent from school than non IBD group. The main cause of school absenteeism appears to be associated with the disease itself. The share of scheduled absenteeism is quite large. The organization and scheduling of the patients' care path must be a priority to maximally limit the negative impact of their disease on the patients' schooling. Address correspondence and reprint requests to Alain Dabadie, MD, Department of Child and Adolescent Medicine, CHU Rennes Hôpital Sud, 16 boulevard de Bulgarie, BP 90347, 35203 Rennes Cedex 2, France (alain.dabadie@chu-rennes.fr). Received 22 August, 2018 Accepted 28 October, 2018 Funding/Conflict of interest: none for all authors. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Esophageal Compliance Quantifies Epithelial Remodeling in Pediatric Patients with Eosinophilic Esophagitis

Background: The management of eosinophilic esophagitis (EoE) relies on the severity of esophageal eosinophilia, yet there is poor evidence of its prediction of esophageal fibrotic remodeling and subsequent complications such as dysphagia, food impactions, or strictures. Functional Luminal Impedance (FLIP) has had limited use in pediatric patients to evaluate esophageal tissue mechanics. We aimed to standardize the FLIP technique and to measure esophageal compliance in children with EoE in comparison to controls. Methods: Subjects were enrolled into a prospective observational study and had FLIP performed at the time of endoscopy. We calculated esophageal distensibility and compliance for the total and segmental esophagus independently (i.e., proximal, middle and distal esophageal segments). We evaluated esophageal biopsies for eosinophilia and epithelial remodeling, calculated endoscopy scores, and documented patient symptoms. Results: We enrolled 11 EoE and 12 controls subjects, aged 5–18 years old. While EoE subjects had lower esophageal compliance (p = 0.004) than controls, the difference in distensibility did not reach significance (p = 0.151). Epithelial remodeling severity was more strongly correlated with compliance than with distensibility. Epithelial remodeling scores ≥2 had a significant association with lower compliance both segmentally and in the entire esophagus (p = 0.029), but not with distensibility. Compliance measures were more sensitive in detecting subjects with remodeling score ≥2 than distensibility (79% versus 64%). Conclusion: Compliance is a more sensitive measure of esophageal epithelial remodeling in children compared to distensibility, and a more appropriate measure of esophageal tissue mechanics. Standardized placement of the FLIP catheter is important to accurately assess esophageal compliance. Address correspondence and reprint requests to Hayat Mousa, MD, AGAF, 3020 Children's Way MC5030, San Diego, CA 92123 (E-mail: hmousa@ucsd.edu); Maheen Hassan, MD, University of California San Diego, San Diego, CA United States (E-mail: m1hassan@ucsd.edu). Received 31 January, 2018 Accepted 15 October, 2018 Conflicts of interest and Sources of funding Financial support: This study was supported by the following NIH Grants: NIH/NIDDK DK07202 T32 Gastroenterology Training Grant (MH), NIH/NIAID AI092135 (SA), UL1TR001442 CTSA Funding (J.P) Potential competing interests: The authors declare no conflicts of interest. Specific author contributions: Experimental design: M.H, H.M, S.A, R.D; experimental execution: M.H, H.M, S.A, R.D, R.N; data processing: A.G; data analysis and interpretation: M.H, H.M, S.A, R.D, A.G.,J.P; manuscript writing/editing: M.H, H.M, S.A, R.D, A.G.,J.P. All authors have approved the final draft. Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Cochrane Corners to Enhance Access to Evidence-Based Physiatry (EBP)

No abstract available

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Comparing assessments of physical functional independence in older adults with mobility limitations

Objectives 1) To assess the agreement and correlation between self-reported functional independence and observations of family caregivers in a heterogeneous population of community-dwelling older adults with disabilities. 2) To determine how self- and caregiver-reports correlate with evaluator rated functional independence over time. Design Data were drawn from a larger, randomized controlled trial examining the effects of a caregiver-inclusive intervention on outcomes of care recipients and their family caregivers. Functional independence measures were obtained using a self-report version of the Functional Independence Measure (care recipient FIM-SR, caregiver FIM-SR) and the Functional Autonomy Measurement System (evaluator perspective). They were administered at baseline (pre-intervention), and following the intervention at 6-, 22-, and 58-weeks. Results Bivariate correlation analyses of ninety dyads consisting of older care recipients and their family caregivers reported moderate to very strong correlations between the three functional independence measures across all time points (rS=0.45-0.91; P

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Clinical Laboratory Predictors of the Outcome of the Acute Period of Atherothrombotic Ischemic Stroke

Objectives. To clarify clinical and laboratory predictors of the acute period of atherothrombotic ischemic stroke (ATS). Materials and methods. Clinical symptomatology, the numbers of peripheral blood leukocytes in apoptosis and necrosis, and the state of the intracellular antioxidant system were assessed in 199 patients. Results and discussion. Among the clinical factors with negative influences on the course of the acute period of ATS, the most important were focus size, impairment to consciousness on day 1, initial SBP, and patient's age (regression parameter R including clinical factors on day 1 was 0.496, p = 0.01, R on day 7 was 0.739, p < 0.0001; R on day 14 was 0.620, p < 0.0001). Mitochondrial dysfunction and mitochondrion-induced apoptosis were found to have direct influences on the course of ATS in the acute period. Direct relationships were found between the severity of ATS and the number of Mito+ cells on days 1 (r = 0.742, p = 0.009) and 7 (r = 0.717; p = 0.002) and between the severity of ATS and the content of ANV+ leukocytes on days 7 (r = 0.595; p = 0.015) and 14 (r = 0.670; p = 0.007), along with a negative correlation between total SOD and Mn-SOD activities of day 7 (r = 0.628; p = 0.010 and r = 0.675; p = 0.008, respectively), which is evidence for the prognostic value of these indicators.

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Changes in the Spectral Characteristics of the Electroencephalogram during Biocontrol of Heart Rate Variability Parameters in Healthy Subjects

Objectives. To assess changes in the spectral characteristics of the electroencephalogram (EEG) in humans during single sessions of biocontrol of hart rate variability parameters using biological feedback (BFB). Materials and Methods. A total of 150 adolescents aged 16–17 years were studied. Adolescents of the BFB group (n = 110) took part in biocontrol sessions to increase vagal influences on heart rate; the control group (n = 40) remained in the state of calm wakefulness. EEG recordings were made with the eyes closed before and after BFB training. EEG characteristics were studied in terms of changes in absolute power levels (μV²) in artifact-free trace segments in each frequency range. Results and conclusions. The ability of human subjects to change the activity of heart rate parameters determines the level of action on the functions of the central autonomic regulatory structures. This biocontrol method promotes improvements in cortical stability, with increases in α and decreases in β EEG activity. Brain activity synchronization processes during biocontrol were more clearly apparent in the right hemisphere, often involving the prefrontal areas.

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