Fat-Free Adipose Tissue Mass: Impact on Peak Oxygen Uptake ( V O 2peak ) in Adolescents with and without Obesity

Abstract

Fat-free body mass (FFM) is a surrogate for skeletal muscle mass and is often used for the normalization of several physiological variables (e.g., oxygen uptake). However, FFM includes non-skeletal muscle components such as the fat-free component of adipose tissue fat cells. As the amount of adipose tissue mass increases, the FFM will also increase and be included in the measurement of FFM. Therefore, FFM may not be an appropriate indicator of muscle mass when targeting individuals with a large amount of body fat. This review aimed (1) to examine the fat-free adipose tissue (FFAT) in adolescents with and without obesity and (2) to investigate the impact of FFAT on peak oxygen uptake (VO_2peak) by comparing VO_2peak expressed relative to FFM and FFM minus FFAT between adolescents with and without obesity. Calculated FFAT was threefold higher in adolescents with obesity compared to those without obesity (mean ± SD; 6.94 ± 1.40 vs. 2.22 ± 0.58 kg). The VO_2peak expressed relative to FFM-FFAT was similar between the two groups (56.5 ± 6.7 vs. 57.4 ± 8.9 ml min⁻¹ kg⁻¹ FFM-FFAT, respectively). On the other hand, VO_2peak expressed relative to FFM was approximately 8% different between groups. When normalizing VO_2peak by FFM, eliminating the FFAT component from FFM may be needed, especially when comparing groups with different body fat mass.

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Kinematic Parameters of Movement at the Shoulder Joint in Normal Gait in Humans

Study objective: to determine the kinematic parameters of the shoulder joint in the normal human gait. Materials and methods. A Vicon programmable system for motion capture and analysis was used to study 10 selected men with near-absolute symmetry of upper limb movements. Results. Quantitative measures of kinematic movement parameters at the shoulder joint in the arm transfer cycle during walking were obtained. Flexion-extension and abduction of the upper limbs during the stepping cycle were symmetrical and coincided with the minimal internal rotation only in the middle of the cycle. Swinging of the arms during walking can be compared with the movements of a pendulum with its center at the shoulder joint with a movement amplitude of 24.6 ± 2.4°. Conclusions. The data obtained here serve as standards and provide for comparative analysis of upper limb movements in patients with arm locomotion disorders, and are also of value in prosthetization and robotics.

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Both Bupivacaine and Levobupivacaine inhibit colon cancer cell growth but not melanoma cells in vitro

Abstract

Background

Retrospective studies indicate that the use of regional anaesthesia causes a reduction in cancer recurrence after oncological surgery, which could be due to anaesthetic's negating effect on immunosuppression related to the surgical stress response. Local anaesthetics may also exert direct suppressive effects on malignant cells, an area where further investigation is urgently needed.

Methods

Human colon cancer cells and human melanoma cells were cultured and then treated with 1 mM bupivacaine or levobupivacaine for up to 24 or 48 h. Their migratory ability was measured by scratch assay, proliferation determined with Ki67 immunofluorescence staining, and apoptosis accessed with annexin V and PI staining on flow cytometry. The effects of bupivacaine and levobupivacaine on cellular signaling and molecular response, specifically, on endoplasmic reticulum stress (ERS), were studied with immunostaining and western blot.

Results

In colon cancer cells, treatment with bupivacaine and levobupivacaine significantly inhibited cell migration (**p < 0.01, ***p < 0.001; n = 4) and proliferation (**p < 0.01; n = 4), while increasing the expression of CHOP (***p < 0.001; n = 4) and decreased the expression of Grp78 (*p < 0.05; n = 4). These effects were not mirrored by melanoma cells, such that no significant increase in apoptosis was seen in either melanoma cell lines following treatment.

Conclusion

These in vitro data suggested that both bupivacaine and levobupivacaine suppress colorectal adenocarcinoma cell proliferation and migration, which are concurrent with increased endoplasmic reticulum stress. Conversely, melanoma cells are more resilient to these two commonly used local anaesthetics. Further in vivo studies or clinical trials are needed.

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Anodal transcranial direct current stimulation does not influence the neural adjustments associated with fatiguing contractions in a hand muscle

Abstract

Purpose

The objective of the current study was to investigate the mechanisms responsible for the briefer time to failure of a submaximal contraction (C2) when performed 60 min after a similar contraction (C1), and the influence of anodal transcranial direct current stimulation (a-tDCS) applied over the motor cortex on these mechanisms.

Methods

In two sessions, ten adults sustained two isometric contractions (35% of maximum) to failure with the abductor pollicis brevis (APB). Before C2, either a-tDCS or sham stimulation was applied over the motor cortex. Fatigue-related changes in Hoffmann (H) and long-latency (LLR) reflexes, motor-evoked potential (MEP) induced by transcranial magnetic stimulation and associated silent period (SP), maximal motor wave (M_max), voluntary activation (VA), electromyographic (EMG) activity and peak force (PT₃) evoked by a 3 pulse-train (100 Hz) were investigated.

Results

The results indicate that regardless of session, the time to failure was briefer (− 13%, p < 0.05) for C2 than C1, with no a-tDCS effect. During C1, MEP amplitude, SP duration and LLR amplitude increased, H-reflex amplitude did not change, and M_max, VA and PT₃ decreased (p < 0.05). Except for EMG activity that was greater during C2 than C1 (p < 0.001), all variables were similar in C1 and C2 (p > 0.05), and recovered their initial values after the 60-min rest, except PT₃.

Conclusions

The results of the current study indicate that a-tDCS did not influence corticospinal excitability and time to failure of C2 when performed with the APB. These observations may reflect a peripheral origin of the briefer C2 time to failure in the APB.

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Genotype Imputation in Winter Wheat Using First-Generation Haplotype Map SNPs Improves Genome-Wide Association Mapping and Genomic Prediction of Traits

Genome-wide single nucleotide polymorphism (SNP) variation allows for the capture of haplotype structure in populations and prediction of unobserved genotypes based on inferred regions of identity-by-descent (IBD). Here we have used a first-generation wheat haplotype map created by targeted re-sequencing of low-copy genomic regions in the reference panel of 62 lines to impute marker genotypes in a diverse panel of winter wheat cultivars from the U.S. Great Plains. The IBD segments between the reference population and winter wheat cultivars were identified based on SNP genotyped using the 90K iSelect wheat array and genotyping by sequencing (GBS). A genome-wide association study and genomic prediction of resistance to stripe rust in winter wheat cultivars showed that an increase in marker density achieved by imputation improved both the power and precision of trait mapping and prediction. The majority of the most significant marker-trait associations belonged to imputed genotypes. With the vast amount of SNP variation data accumulated for wheat in recent years, the presented imputation framework will greatly improve prediction accuracy in breeding populations and increase resolution of trait mapping hence, facilitate cross-referencing of genotype datasets available across different wheat populations.

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CRISPR/Cas9 Methodology for the Generation of Knockout Deletions in Caenorhabditis elegans

The Caenorhabditis elegans Gene Knockout Consortium is tasked with obtaining null mutations in each of the more than 20,000 open reading frames (ORFs) of this organism. To date, approximately 15,000 ORFs have associated putative null alleles. As there has been substantial success in using CRISPR/Cas9 in C. elegans, this appears to be the most promising technique to complete the task. To enhance the efficiency of using CRISPR/Cas9 to generate gene deletions in C. elegans we provide a web-based interface to access our database of guide RNAs (https://ift.tt/2lH39WK). When coupled with previously developed selection vectors, optimization for homology arm length, and the use of purified Cas9 protein, we demonstrate a robust and effective protocol for generating deletions for this large-scale project. Debate and speculation in the larger scientific community concerning off-target effects due to non-specific Cas9 cutting has prompted us to investigate through whole genome sequencing the occurrence of single nucleotide variants and indels accompanying targeted deletions. We did not detect any off-site variants above the natural spontaneous mutation rate and therefore conclude that this modified protocol does not generate off-target events to any significant degree in C. elegans. We did, however, observe a number of non-specific alterations at the target site itself following the Cas9-induced double-strand break and offer a protocol for best practice quality control for such events.

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Preferences for in‐person disclosure: Patients declining telephone disclosure characteristics and outcomes in the multi‐center COGENT Study

Telephone disclosure of cancer genetic test results is non‐inferior to in‐person disclosure. However, how patients who prefer in‐person communication of results differ from those who agree to telephone disclosure is unclear but important when considering delivery models for genetic medicine. Patients undergoing cancer genetic testing were recruited to a multi‐center, randomized, non‐inferiority trial (NCT01736345) comparing telephone to in‐person disclosure of genetic test results. We evaluated preferences for in‐person disclosure, factors associated with this preference and outcomes compared to those who agreed to randomization. Among 1178 enrolled patients, 208 (18%) declined randomization, largely given a preference for in‐person disclosure. These patients were more likely to be older (p=0.007) and to have had multi‐gene panel testing (p<0.001). General anxiety (p=0.007), state anxiety (p=0.008), depression (p=0.011), cancer‐specific distress (p=0.021) and uncertainty (p=0.03) were higher after pre‐test counseling. After disclosure of results, they also had higher general anxiety (p=0.003), depression (p=0.002) and cancer‐specific distress (p=0.043). While telephone disclosure is a reasonable alternative to in‐person disclosure in most patients, some patients have a strong preference for in‐person communication. Patient age, distress and complexity of testing are important factors to consider and requests for in‐person disclosure should be honored when possible.

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Phenotero: annotate as you write

In clinical genetics, the Human Phenotype Ontology as well as disease ontologies are often used for deep phenotyping of patients and coding of clinical diagnoses. However, assigning ontology classes to patient descriptions is often disconnected from writing patient reports or manuscripts in word processing software. This additional workload and the requirement to install dedicated software may discourage usage of ontologies for parts of the target audience.

Here we present Phenotero, a freely available and simple solution to annotate patient phenotypes and diseases at the time of writing clinical reports or manuscripts. We adopt Zotero, a citation management software to create a tool which allows to reference classes from ontologies within text at the time of writing. We expect this approach to decrease the additional workload to a minimum while ensuring high quality associations with ontology classes. Standardised collection of phenotypic information at the time of describing the patient allows for streamlining the clinic workflow and efficient data entry. It will subsequently promote clinical and molecular diagnosis with the ultimate goal of better understanding genetic diseases. Thus, we hope that Phenotero eases the usage of ontologies and controlled vocabularies in the field of clinical genetics.

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Spotlight: Cradlepoint’s 4G LTE cloud-managed solution creates a secure and reliable network for first responders

Cradlepoint is committed to making sure first responders can rely on them to keep them connected and protected.

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Visualization of the electrical activity of the cauda equina using a magnetospinography system in healthy subjects

In lumbar spinal diseases such as lumbar spinal canal stenosis, compression lesions in multiple vertebrae are often found in imaging examinations. However, it is often difficult to evaluate the true lesion sites responsible for symptoms by imaging techniques alone (Kent et al., 1992; Mamisch et al., 2012). In addition, it is often necessary to evaluate the locations of the spinal nerve compression, such as intra-canal, intra-foraminal, or extra-foraminal, to choose the appropriate surgical technique (Macnab, 1971; Wiltse et al., 1984; Kunogi and Hasue, 1991; Olsewski et al., 1991).

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Efficiency of dual siRNA mediated gene therapy for intervertebral disc degeneration (IVDD)

One of the common causes of LBP is intervertebral disc degeneration. The pathophysiology of disc degeneration involves apoptosis of nucleus pulposes (NP) cells and degradation of extra cellular matrix (ECM). Caspase 3 plays a central role in apoptosis and the ADAMTS 5 (A Disintegrin and Metalloproteinase with Thrombospondin motifs) gene plays a critical role in ECM degradation. Hence, we hypothesized that if one can silence these two genes, both apoptosis and ECM degradation can be prevented, thereby preventing the progression and even reverse disc degeneration.

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Effect of high-frequency alternating current transcutaneous stimulation over muscle strength: a controlled pilot study

High-frequency alternating currents of greater than 1 kHz applied on peripheral nerves has been used in animal studies to produce a motor nerve block. It has been evidenced that frequencies higher than 5 kHz a...

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Overground walking patterns after chronic incomplete spinal cord injury show distinct response patterns to unloading

Body weight support (BWS) is often provided to incomplete spinal cord injury (iSCI) patients during rehabilitation to enable gait training before full weight-bearing is recovered. Emerging robotic devices enab...

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Sempermed announces four Nitrile examination gloves tested and approved to provide protection against fentanyl exposure

CLEARWATER, FL — Sempermed, one of the world's leading manufacturers and suppliers of hand protection, is pleased to announce that fentanyl permeation testing has been conducted on four Sempermed glove brands, and they have all passed. The four brands are: SemperCare® Nitrile, SemperForce® Nitrile, StarMed® Ultra Nitrile, and Tender Touch® Nitrile. Fentanyl is the most...

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New Verizon 5G Lab will drive the development of 5G use cases for public safety

First responder technology innovators can go to 5GFirstResponderLab.com to apply for this first-of-its-kind program WASHINGTON DC – Verizon has been a trusted partner to public safety agencies nationwide for decades, and now we're looking for innovators to help us guide them into the future by accelerating the development of 5G technology for first responders. Today, Verizon, in...

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Rapid response: Firefighters battling catastrophic wildfires and EMS providers evacuating civilians deserve our attention and support

Most recent California wildfires have killed at least 29 people and destroyed more than 6,400 homes

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Paramedic - Team Captains Needed! - GAAA

Make a Difference in your community and join our Emergency Medical Service Team! Galveston County Health District is seeking a new Team Captain (Paramedic)! The right candidate will be for performing responsible and technical medical work dealing with emergency or non-emergency and/or lifesaving treatment of patients who are transported via Mobile Intensive Care Unit or Basic Life Support ambulance ...

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Advanced EMT's Needed! - GAAA

Make A Difference in your community and join our Emergency Medical Service Team! Galveston County Health District is seeking two (2) new Advanced EMTs at the Bacliff EMS Station! This position is responsible for performing responsible and technical medical work dealing with emergency or non-emergency and/or lifesaving treatment of patients who are transported via Mobile Intensive Care Unit or Basic ...

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Peak airway pressure is lower during pressure-controlled than during manual facemask ventilation for induction of anesthesia in pediatric patients—a randomized, clinical crossover trial

Abstract

Purpose

Facemask ventilation during the induction of general anesthesia in paediatric patients remains a challenge as it may result in hypoxic conditions and gastric insufflation with subsequent regurgitation and aspiration. So far, it is unclear if pressure-controlled or manual facemask ventilation is preferable in children. We hypothesized that pressure-controlled ventilation in apnoeic children results in lower peak airway pressure and flow rates compared to manual ventilation at comparable respiratory rates and tidal volumes.

Methods

Sixty-two lung-healthy children undergoing scheduled ear-nose-throat surgery were included in the study. After the induction of anesthesia, the patient's lungs were consecutively ventilated via a facemask in either manual or pressure-controlled mode, in randomized order. The primary outcome measure was peak airway pressure. Secondary outcome measures included positive end-expiratory pressure, airway compliance, tidal volume and airway flow.

Results

Data of 52 patients could be analyzed. Pressure-controlled ventilation resulted in a lower mean and peak inspiratory pressure (both p < 0.001), airway pressure amplitude (p = 0.01) and inspiratory peak flow rate (p = 0.005) compared to manual ventilation. The ratio of inspiration to expiration time was lower in pressure-controlled ventilation compared to manual ventilation (p < 0.001).

Conclusion

Pressure-controlled facemask ventilation during induction of anesthesia in pediatric patients results in lower airway pressure, and lower flow rates compared to manual ventilation, at comparable tidal and minute volumes.

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An Unexpected, Yet Welcomed Outcome of the St. Louis Healthy Start Program

Abstract

Introduction Racial disparities in birth outcomes are a significant problem in the U.S. The St. Louis Healthy Start (SLHS) program, funded for 14 years, had a goal of reducing disparate rates of poor birth outcomes in three disadvantaged communities in the St. Louis area. The Making Change Happen Leadership Academy (MCHLA) was an unanticipated community-driven effort that grew out of SLHS and continues today. The primary goal of the MCHLA is to empower women to gain mastery over their lives and use their power to improve birth outcomes in their communities. Methods Qualitative interviews were conducted with MCHLA participants to determine the impact of participation in the MCHLA on their leadership skills and attitudes. Results Participants reported positive attitudes about themselves including increased confidence and improved parenting skills. Through active participation in project work, they noted increased professional and advocacy skills and recognition of the importance of their voice. As leaders, they recognized the importance of giving and receiving emotional, tangible, and information social support. The small sample prevents us from confidently reporting that findings directly relate to the MCHLA. Discussion Leaders exist in all communities. Public health practitioners may help enhance and develop leaders with tangible support. We need to encourage more MCHLA type programs while systematically evaluating their impact on empowerment in underserved women.

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Effect of Stem Cell Treatment on Acute Liver Failure Model Using Scaffold

Abstract

Background

Injecting MSCs via blood vessel is most commonly used method, which has a major drawback of safety. The aim of our study was to evaluate efficacy using scaffold-loaded MSCs in acute liver failure model.

Method

Acute liver failure was induced in mice using thioacetamide (TAA) (200 mg/kg, i.p) once a day for two consecutive days. The animals were divided in four acute liver failure groups: (1) TAA; (2) empty scaffold; (3) MSCs injected through tail vein; (4) MSC + Scaffold, scaffold loaded with MSCs, to evaluate the mortality and changes in liver function. Polylactic-co-glycolic acid scaffold alone and loaded with human MSCs was implanted on mice dorsum.

Results

TAA dose was titrated until one-third mortality rate was achieved. TAA (200 mg/kg) once daily for two consecutive days was injected to establish the acute liver failure model. The mortality of TAA and scaffold groups was 55.9% and 63.2%, respectively. Although, mortality of MSC-TV group decreased 14.7% as compared to TAA group (p = 0.200), MSC + Scaffold group had the lowest mortality (31.4%) (p = 0.013). Cells implanted in PLGA biomaterial were survived until 3 weeks, and their function was increased. Area of hepatic inflammation and necrosis was significantly reduced in MSC-TV and MSC + Scaffold groups; but there was no difference between the two groups. Gene expressions related to inflammation were significantly decreased in MSC-TV and MSC + Scaffold groups compared to TAA group. In MSC + Scaffold group, no migration of stem cells to liver tissue was observed. Although, not all cells in scaffold were stained, some of them were differentiated into hepatocyte-like cells which stained positive for PAS and CYP2E1 antibody.

Conclusion

Scaffold loaded with MSCs showed protective effects via paracrine signaling on acute liver failure model.

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Limb blood flow and tissue perfusion during exercise with blood flow restriction

Abstract

Introduction

Exercise with blood flow restriction (BFR) is emerging as an effective modality for improving muscular function in clinical and athletic populations. Selection of cuff pressure is critical because it should maximize metabolic stress without completely occluding blood flow or compromising user safety. It is unknown how cuff pressures determined at rest influence blood flow hemodynamics during exercise.

Purpose

We evaluated changes in blood flow and tissue perfusion before, during, and after exercise with BFR.

Methods

Ten males performed rhythmic handgrip exercise (30 contractions, 30% MVC) at 0%, 60%, 80%, 100%, and 120% of limb occlusion pressure (LOP). Brachial artery blood flow and tissue saturation were assessed using Doppler ultrasound and near-infrared spectroscopy, respectively.

Results

At rest blood flow generally decreased with increased pressure (0% > 60% ≈ 80% > 100% ≈ 120% LOP). During 60% and 80% LOP conditions, blood flow increased during exercise from rest and decreased after exercise (all P < 0.05). Compared to 0% LOP, relative blood flow at 60% and 80% LOP decreased by 22–47% at rest, 22–48% during exercise, and 52–71% after exercise (all P < 0.05). Increased LOP decreased tissue saturation during exercise with BFR (P < 0.05). Heart rate, mean arterial pressure, and cardiac output did not differ across LOP.

Conclusion

At pressures below LOP the cardiovascular system overcame the external pressure and increased blood flow to exercising muscles. Relative reductions in blood flow at rest were similar to those during exercise. Thus, the relative occlusion measured at rest approximated the degree of occlusion during exercise. Moderate cuff pressures increased metabolic stress without completely occluding blood flow.

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Blink synchronization is an indicator of interest while viewing videos

Publication date: Available online 11 November 2018

Source: International Journal of Psychophysiology

Author(s): Tamami Nakano, Yuta Miyazaki

Abstract

The temporal pattern of spontaneous blinks changes greatly depending on an individual's internal cognitive state. For instance, when several individuals watch the same video, blinks can be synchronized at attentional breakpoints. The present study examined the degree of this blink synchronization, as reflecting an interest level, while viewing various video clips. In the first experiment, participants interested in soccer, shogi (Japanese chess), or a specific musical group watched a video clip related to each category and rated their interest level after viewing. Results revealed that blink synchronization increased with a rise in interest level in the video clips of soccer and shogi. Moreover, while blink synchronization increased when viewing preferred video clips for the soccer and music group fans, synchronization decreased when viewing videos from the other categories, except for the shogi fans. In contrast, the blink rates did not correlate with the interest level on the video content but changed with the number of shot transitions of it. In the second experiment, participants viewed a video in which a professional salesperson gave descriptions of several products for a few minutes each. When participants reported an interest in the product, blinks were synchronized to the salesperson's blinks. However, when feeling uninterested, blink synchronization did not occur. These results suggest that blink synchronization could be used as an involuntary index to assess a person's interest.

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Visualization of the electrical activity of the cauda equina using a magnetospinography system in healthy subjects

Publication date: Available online 12 November 2018

Source: Clinical Neurophysiology

Author(s): Shuta Ushio, Yuko Hoshino, Shigenori Kawabata, Yoshiaki Adachi, Kensuke Sekihara, Satoshi Sumiya, Dai Ukegawa, Kyohei Sakaki, Taishi Watanabe, Yuki Hasegawa, Atsushi Okawa

Abstract

Objective

To establish a method to measure cauda equina action fields (CEAFs) and visualize the electrical activities of the cauda equina in a broadly aged group of healthy adults.

Methods

Using a 124-channel magnetospinography (MSG) system with superconducting interference devices, the CEAFs of 43 healthy volunteers (22–64 years of age) were measured after stimulation of the peroneal nerve at the knee. Reconstructed currents were obtained from the CEAFs and superimposed on the X-ray image. Conduction velocities were also calculated from the waveform of the reconstructed currents.

Results

The reconstructed currents were successfully visualized. They flowed into the L5/S1 foramen about 8.25–8.95 ms after the stimulation and propagated cranially along the spinal canal. In 32 subjects (74%), the conduction velocities of the reconstructed currents in the cauda equina could be calculated from the peak latency at the L2–L5 level.

Conclusions

MSG visualized the electrical activity of the cauda equina after peroneal nerve stimulation in healthy adults. In addition, the conduction velocities of the reconstructed currents in the cauda equina could be calculated, despite previously being difficult to measure.

Significance

MSG has the potential to be a novel and noninvasive functional examination for lumbar spinal disease.

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Mosaic MECP2 variants in males with classical Rett syndrome features, including stereotypical hand movements

Rett syndrome is rarely suspected in males because of the X‐linked dominant inheritance. In the literature only six male patients have been reported with MECP2 mosaicism. NGS methods have enabled better detection of somatic mosaicism compared to conventional Sanger sequencing, however mosaics can still be difficult to detect. We present clinical and molecular findings in two males mosaic for a pathogenic MECP2 variant. Both have been reexamined using deep sequencing of DNA isolated from four different cell tissues (blood, muscle, fibroblasts and oral mucosa). Deep sequencing of the different tissues revealed that the variants were present in all tissues. In one patient the molecular diagnosis could only be established by reexamination after a normal whole exome sequencing, and the other case is an example of reverse genetic diagnostics. Rett syndrome should be considered in males with neurodevelopmental delay and stereotypical hand movements. Subsequent to clinical diagnosis males should be investigated with NGS based technologies of MECP2 with high read depth and a low threshold for variant calls. If the initial analysis on full blood derived DNA fails to confirm the suspicion, we recommend repeating the analysis on another tissue, preferentially fibroblasts to increase the diagnostic yield.

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Invasive Respiratory or Vasopressor Support and/or Death as a Proposed Composite Outcome Measure for Perioperative Care Research

BACKGROUND: There is a need for a clinically relevant and feasible outcome measure to facilitate clinical studies in perioperative care medicine. This large-scale retrospective cohort study proposed a novel composite outcome measure comprising invasive respiratory or vasopressor support (IRVS) and death. We described the prevalence of IRVS in patients undergoing major abdominal surgery and assessed the validity of combining IRVS and death to form a composite outcome measure. METHODS: We retrospectively collected perioperative data for 2776 patients undergoing major abdominal surgery (liver, colorectal, gastric, pancreatic, or esophageal resection) at Kyoto University Hospital. We defined IRVS as requirement for mechanical ventilation for ≥24 hours postoperatively, postoperative reintubation, or postoperative vasopressor administration. We evaluated the prevalence of IRVS within 30 postoperative days and examined the association between IRVS and subsequent clinical outcomes. The primary outcome of interest was long-term survival. Multivariable Cox proportional regression analysis was performed to adjust for the baseline patient and operative characteristics. The secondary outcomes were length of hospital stay and hospital mortality. RESULTS: In total, 85 patients (3.1%) received IRVS within 30 postoperative days, 15 of whom died by day 30. Patients with IRVS had a lower long-term survival rate (1- and 3-year survival probabilities, 66.1% and 48.5% vs 95.2% and 84.0%, respectively; P

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Side Effect Rates of Opioids in Equianalgesic Doses Via Intravenous Patient-Controlled Analgesia: A Systematic Review and Network Meta-analysis

BACKGROUND: Side effects of opioids used for the treatment of acute pain frequently limit their analgesic quality. Many studies have compared opioid side effects in patient-controlled analgesia (PCA), but it remains unclear whether there are specific side effect profiles that can be exploited when choosing an opioid for a patient. In this review, we wanted to determine the risk ratios (RRs) for the most common side effects when using different opioids for intravenous PCA in equianalgesic doses and rank the substances accordingly. METHODS: A search of MEDLINE, EMBASE, the Cochrane Library (CENTRAL), and Web of Science identified 63 randomized controlled trials comparing opioids under equianalgesic conditions. Inclusion criteria were comparable pain stimulus between groups, equal coanalgesic treatment, and comparable resulting pain scores. Quality of studies was assessed using the Cochrane risk of bias tool with 6 items. Frequentistic network meta-analysis was conducted with morphine as the comparator. This method not only summarizes all estimated effects from direct comparisons of different interventions but also allows for indirect comparisons between interventions that can be linked via the common comparator, in which case the indirect evidence can be used to enhance the precision of the direct comparisons. Primary end points of this study were RRs for nausea and vomiting, pruritus, and events of sedation, as well as mean differences for scores of sedation. Events of respiratory depression were counted. Secondary end point was patient satisfaction (mean difference). The study protocol was registered at PROSPERO (CRD42017062355). RESULTS: Sixteen opioid interventions were compared in the largest network (nausea and vomiting outcome) and 7 opioid interventions in the smallest network (sedation events outcome). Most interventions did not differ from morphine on the primary outcomes (side effects), with some exceptions. Buprenorphine had a significantly higher RR of nausea and vomiting, whereas fentanyl had a lower RR of nausea and vomiting. Nalbuphine, butorphanol, methadone, and pethidine/meperidine had a lower risk of pruritus. Respiratory depression was rare (22 of 2452 patients). Pethidine/meperidine, fentanyl, and oxymorphone caused significantly lower sedation scores. Tramadol caused significantly lower satisfaction scores, whereas oxycodone, alfentanil, remifentanil, fentanyl, and pethidine/meperidine caused significantly higher satisfaction scores. CONCLUSIONS: The opiate chosen for treatment most likely has little effect on the incidence of pruritus and nausea/vomiting, although considerable differences exist in terms of better and worse opioids in the presented rankings. Larger differences between drugs were observed with regard to sedation and patient satisfaction, and choosing the appropriate opioid may help to improve PCA in this regard. Accepted for publication September 25, 2018. Funding: This work was supported by the institutional funds from the Department of Anesthesiology and Intensive Care of the University Hospital Marburg. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Study Registration: PROSPERO: CRD42017062355. Reprints will not be available from the authors. Address correspondence to Hanns-Christian Dinges, MD, Department of Anesthesia and Intensive Care, University Hospital Marburg, Baldingerstrasse, 35033 Marburg, Germany.Address e-mail to dingesh@staff.uni-marburg.de. © 2018 International Anesthesia Research Society

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Anesthesiology: A Practical Approach

No abstract available

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Analgesic Efficacy and Safety of Intravenous Meloxicam in Subjects With Moderate-to-Severe Pain After Open Abdominal Hysterectomy: A Phase 2 Randomized Clinical Trial

BACKGROUND: An intravenous (IV) formulation of meloxicam was developed for moderate-to-severe pain management. This study evaluated the safety and efficacy of meloxicam IV after open abdominal hysterectomy. Meloxicam IV is an investigational product not yet approved by the US Food and Drug Administration. METHODS: Women (N = 486) with moderate-to-severe pain after open abdominal hysterectomy were enrolled in this multicenter, randomized, double-blind, placebo- and active-controlled trial. Subjects were randomized to receive a single dose of meloxicam IV (5–60 mg), placebo, or morphine (0.15 mg/kg) in ≤6 hours after morphine dosing on postoperative day 1 and were evaluated for 24 hours. Rescue morphine (≈0.15 mg/kg IV) was available if needed for pain not relieved by the study medication. In an open-label extension (N = 295), meloxicam IV was administered once daily for the remaining hospital stay (or per the investigator's discretion). The coprimary efficacy end points were the summed pain intensity difference (SPID24) and total pain relief (TOTPAR24) from hour 0 to 24 hours after dosing. Effect size, the standardized difference between means reported in standard deviation (SD) units, was calculated to indicate the magnitude of the difference in the mean analgesic effect measured for different intervention groups. RESULTS: Subjects who received morphine or meloxicam IV had a median time to first perceptible pain relief within 6–8 minutes. Morphine and meloxicam IV 5–60 mg produced statistically significant differences than placebo in SPID24 and TOTPAR24. SPID24 (standard error [SE]) for meloxicam IV 5–60 mg ranged from −56276.8 (3926.46) to −33517.1 (3930.1; P

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Essentials of Trauma Anesthesia, 2nd ed

No abstract available

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An Observational Study of Cerebral Blood Flow Velocity Evaluation in the Prone Position During Posterior Lumbar Surgery

BACKGROUND: Prone positioning (PP) is necessary for surgical access during posterior spine procedure. However, physiological changes occur in the PP. Typical findings are a decrease in arterial blood pressure and in cardiac output that could potentially lead to an alteration in cerebral perfusion. Therefore, we decided to study cerebral blood flow velocity (CBFV) with transcranial Doppler ultrasonography to evaluate the effect of the PP on cerebral hemodynamics. METHODS: Twenty-two patients undergoing spine surgery in the PP were studied. General anesthesia was induced using 250 μg of fentanyl, 2 mg/kg of propofol, and 0.1 mg/kg of vecuronium, and was maintained with 0.25%–0.5% isoflurane, 50% nitrous oxide in oxygen, continuous infusion of 100 μg/kg/min of propofol, 1.5 μg/kg/h of fentanyl, and 0.15 mg/kg/h of ketamine. Continuous invasive arterial blood pressure, heart rate, electrocardiogram, and end-tidal carbon dioxide were monitored. CBFV with transcranial Doppler in the middle cerebral artery was first measured with the patients under general anesthesia in the supine position. Patients were then placed in the PP and remained in this position throughout surgery. CBFV, end-tidal carbon dioxide, heart rate, and blood pressure were measured continuously for 75 minutes after initiation of PP. This coincided with surgical exposure and minimal blood loss. Data were analyzed every 15 minutes for statistical significant change over time. RESULTS: Mean arterial blood pressure decreased 15 minutes after the installation of the PP and onward, but this decrease was not statistically significant. CBFVsyst (the maximal CBFV during the systolic phase of a cardiac cycle) and CBFVmean (the time averaged value of the maximal velocity envelope over 1 cardiac cycle) did not vary at any time points. CBFVdiast (the CBFV just before the acceleration phase [systole] of the next waveform) was lower at T3 (30 minutes after PP) compared to T1 (value derived averaging the first measure in the PP with the ones at 5 and 10 minutes) (P = .01), and the pulsatility index was higher at T5 (60 minutes after PP) compared to T0 (baseline, patient supine under general anesthesia) (P = .04). Data were analyzed at specific time points (T0 and T1). This value was derived by computing an average of the CBFV values collected at the first measure in the PP and at 5 and 10 minutes thereafter: T2, 15 minutes after PP; T3, 30 minutes after PP; T4, 45 minutes after PP; T5, 60 minutes after PP; and T6, 75 minutes after PP. CONCLUSIONS: Our data on CBFV during PP for spine surgery demonstrate preservation of cerebral perfusion during stable systemic hemodynamic conditions. The present results do not allow us to determine whether the PP would be similarly tolerated with increasing length of surgery, variations in systemic hemodynamics, and in different patient populations. Accepted for publication September 19, 2018. Anna Maria Bombardieri, MD, PhD, is currently affiliated with the Department of Anesthesiology, Washington University School of Medicine, St Louis, Missouri. Funding: This study was supported by funds from the Department of Anesthesiology at the Hospital for Special Surgery, New York City, NY Conflicts of Interest: See Disclosures at the end of the article. Institutional review board: Edward Jones, MD, Chairman, Hospital for Special Surgery, 535 E 70th St. E-mail: JonesE@hss.edu. This article describes human research (institutional review board number 10092) from a cohort observational clinical study. The authors state that the report includes every item in the Strengthening the Reporting of Observational studies in Epidemiology checklist for cohort observational clinical studies. Funding: This study was supported by funds from the Department of Anesthesiology at the Hospital for Special Surgery, New York City, NY. This study was presented in part at the annual meeting of the American Society of Anesthesiologists, Chicago, IL, October 18, 2011. This study was conducted with written informed consent from the study subjects. Reprints will not be available from the authors. Address correspondence to Anna Maria Bombardieri, MD, PhD, Department of Anesthesiology, Washington University School of Medicine, 660 S. Euclid Ave, Box 8054, St Louis, MO 63110. Address e-mail to annamariabombardieri@wustl.edu. © 2018 International Anesthesia Research Society

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Trends in Authorship in Anesthesiology Journals

Despite increasing representation in medicine, women continue to be a minority in academic practice and leadership, especially in male-dominated fields like anesthesiology. Differences in compensation and participation in leadership may represent barriers to career advancement for women in anesthesiology. Key factors for promotion in academic anesthesiology are research, funding, and publication. As such, designation as a first or senior author on a publication in a professional journal may act as currency for promotion. Here, we examine the prevalence of female first and senior authorship of original research articles published in Anesthesiology and Anesthesia& Analgesia during the years 2002, 2007, 2012, and 2017. Other manuscript characteristics assessed in relation to author gender included study type, subspecialty topic, and total number of authors. Of 2600 manuscripts studied, analysis of authorship by year demonstrated an increase in female first authorship, senior authorship, and editorial board membership by 10%, 9%, and 6%, respectively. Women made up a higher percentage of first authors on manuscripts with female senior authors. More nonexperimental studies had female senior authors than experimental studies. Female first authors had greater representation in the subspecialties of neuroanesthesia, obstetrical anesthesia, pain management, and pediatric anesthesia. Median number of authors was unrelated to senior author gender. This study shows increasing female first and senior authorship, as well as editorial board composition in 2 popular, high-impact anesthesiology journals. Recognizing gender-based trends in publications is important to develop strategies for the recruitment, retention, and advancement of women in anesthesiology. Accepted for publication October 18, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Joanna Miller, MD, Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, One Gustave Levy Pl, PO Box 1010, New York, NY 10029. Address e-mail to Joanna.miller@mountsinai.org. © 2018 International Anesthesia Research Society

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Distribution of Extreme Vital Signs and Complete Blood Count Values of Healthy Parturients: A Retrospective Database Analysis and Review of the Literature

BACKGROUND: The impact of physiological adjustments throughout pregnancy on maternal vital signs and laboratory values has yet to be fully defined. The present study was designed to determine the normal range of these parameters among healthy pregnant women during the peripartum period. METHODS: This is a retrospective analysis of data collected during real-time deliveries in a single medical center. Vital signs and laboratory results from the 24 hours preceding delivery room admission and up to 72 hours postpartum were collected. Only pregnant women at term (370/7 to 416/7 weeks' gestation) with a liveborn, singleton gestation, and no chronic disease or obstetric complication that could affect the physiological parameters under study were included. The mean, range, and standard deviations of the extremes of all parameters at 3 distinct time points (prelabor, intrapartum, and postpartum) were calculated. The 2.5 and 97.5 percentiles for each parameter were reported as the normal range. RESULTS: A total of 32,161 cases fulfilled inclusion criteria. The average gestational age at delivery was 393/7 weeks ± 8 days, and one-third of the cases were primiparous. During labor and after delivery, the upper limits of normal blood pressure values were 147/94 and 145/94 mm Hg, respectively. The lower limits were 83/43 and 83/42 mm Hg, respectively. Normal heart rates were 60–115 beats/min prelabor, 51–120 beats/min intrapartum, and 50–120 beats/min postpartum. Lowest normal temperatures ranged between 36.0°C and 36.3°C in the 3 study time points, and highest normal temperatures were 37.2°C prelabor and 37.6°C intra- and postpartum. The normal ranges of white blood cell counts were 6.1–16.8 prelabor, 6.5–22.5 intrapartum, and 6.4–23.9 K/µL postpartum. Normal low values of hemoglobin were 9.7, 8.7, and 7.1 g/dL and of platelets were 117, 113, and 105 K/µL, respectively. CONCLUSIONS: Our findings justify the practice of using ≥2 repeated measurements for diagnosing hypertensive disorders of pregnancy. Lower normal blood pressure limits may be below those defining hypotensive shock. Normal heart rates exceed the accepted definitions of both tachy- and bradycardia. Normal temperatures at all times have a more narrow range than previously thought, and the normal range of white blood cell count has outliers exceeding the current definitions of leukocytosis or leukopenia at all times. The normal lower range of hemoglobin was constantly below 10 g/dL, and normal platelet counts were considerably lower than those previously described. The vital signs and complete blood count values thus far considered normal for the peripartum period may require some adjustment. New definitions for hypotension, tachy- and bradycardia, fever, and leukocyte quantitative disorders should be considered. Accepted for publication September 18, 2018. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Institutional review board at Helsinki Committee, Rabin Medical Center, Jabotinsky St 39, Petah Tikva, Israel provided approval: 0421-15-RMC, submitted July 2015, approved October 2015. E-mail: avitalbe1@clalit.org.il. Reprints will not be available from the authors. , Address correspondence to Roi Gat, MD, Helen Schneider's Hospital for Women, Rabin Medical Center, Ze'ev Jabotinsky Rd 39, Petah-Tikva 4941492, Israel. Address e-mail to Gatroimd@googlemail.com. © 2018 International Anesthesia Research Society

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Relationship Between Preoperative Antidepressant and Antianxiety Medications and Postoperative Hospital Length of Stay

BACKGROUND: Patients on antidepressant or antianxiety medications often have complex perioperative courses due to difficult pain management, altered coping mechanisms, or medication-related issues. This study examined the relationship between preoperative antidepressants and antianxiety medications on postoperative hospital length of stay while controlling for confounding variables. METHODS: From an administrative database of 48,435 adult patients who underwent noncardiac surgery from 2011 to 2014 at a single, large urban academic institution, multivariable zero-truncated negative binomial regression analyses controlling for age, sex, medical comorbidities, and surgical type were performed to assess whether preoperative exposure to antidepressant or antianxiety medication use was associated with postoperative hospital length of stay. RESULTS: There were 5111 (10.5%) patients on antidepressants and 4912 (10.1%) patients on antianxiety medications. The median length of stay was 3 days (interquartile range = 2–6). After controlling for confounding variables, preoperative antidepressant medication was associated with increased length of stay with an incidence rate ratio of 1.04 (99% confidence interval, 1.0–1.08, P

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Clockwise Versus Counterclockwise Rotation of Endotracheal Tube When Using Videolaryngoscopy in Children

No abstract available

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Intravascular Cooling Device Versus Esophageal Heat Exchanger for Mild Therapeutic Hypothermia in an Experimental Setting

BACKGROUND: Targeted temperature management is a standard therapy for unconscious survivors of cardiac arrest. To date, multiple cooling methods are available including invasive intravascular cooling devices (IVDs), which are widely used in the clinical setting. Recently, esophageal heat exchangers (EHEs) have been developed providing cooling via the esophagus that is located close to the aorta and inferior vena cava. The objective was to compare mean cooling rates, as well as differences, to target temperature during maintenance and the rewarming period of IVD and EHE. METHODS: The study was conducted in 16 female domestic pigs. After randomization to either IVD or EHE (n = 8/group), core body temperature was reduced to 33°C. After 24 hours of maintenance (33°C), animals were rewarmed using a target rate of 0.25°C/h for 10 hours. All cooling phases were steered by a closed-loop feedback system between the internal jugular vein and the chiller. After euthanasia, laryngeal and esophageal tissue was harvested for histopathological examination. RESULTS: Mean cooling rates (4.0°C/h ± 0.4°C/h for IVD and 2.4°C/h ± 0.3°C/h for EHE; P

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Smith’s Anesthesia for Infants and Children, 9th ed

No abstract available

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Noninvasive Continuous Blood Pressure Monitoring: Are the Intraoperative Episodes of Hypotension in Clear Sight?

No abstract available

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Acute Kidney Injury and Risk of Death After Elective Surgery: Prospective Analysis of Data From an International Cohort Study

BACKGROUND: Postoperative acute kidney injury (AKI) is associated with a high mortality rate. However, the relationship among AKI, its associations, and mortality is not well understood. METHODS: Planned analysis of data was collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. AKI was defined using Kidney Disease Improving Global Outcomes criteria. Patients missing preoperative creatinine data were excluded. We used multivariable logistic regression to examine the relationships among preoperative creatinine-based estimated glomerular filtration rate (eGFR), postoperative AKI, and hospital mortality, accounting for the effects of age, major comorbid diseases, and nature and severity of surgical intervention on outcomes. We similarly modeled preoperative associations of AKI. Data are presented as n (%) or odds ratios (ORs) with 95% confidence intervals. RESULTS: A total of 36,357 patients were included, 743 (2.0%) of whom developed AKI with 73 (9.8%) deaths in hospital. AKI affected 73 of 196 (37.2%) of all patients who died. Mortality was strongly associated with the severity of AKI (stage 1: OR, 2.57 [1.3–5.0]; stage 2: OR, 8.6 [5.0–15.1]; stage 3: OR, 30.1 [18.5–49.0]). Low preoperative eGFR was strongly associated with AKI. However, in our model, lower eGFR was not associated with increasing mortality in patients who did not develop AKI. Conversely, in older patients, high preoperative eGFR (>90 mL·minute−1·1.73 m−2) was associated with an increasing risk of death, potentially reflecting poor muscle mass. CONCLUSIONS: The occurrence and severity of AKI are strongly associated with risk of death after surgery. However, the relationship between preoperative renal function as assessed by serum creatinine-based eGFR and risk of death dependent on patient age and whether AKI develops postoperatively. Accepted for publication October 3, 2018. Funding: This was an investigator-initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (United Kingdom) Professorship held by R.M.P. H.C. was part-supported for this research project by the John Snow Award jointly administered by the Royal College of Anaesthetics, the British Journal of Anaesthesia, and the National Institute of Academic Anaesthesia. This study was sponsored by Queen Mary University of London. Conflicts of Interest: See Disclosures at the end of the article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Members of International Surgical Outcomes Study (ISOS) group are listed in Supplemental Digital Content, https://ift.tt/2DgrGfj. International Surgical Outcomes Study investigators were entirely responsible for study design, conduct, and data analysis. The authors had full data access and were solely responsible for data interpretation, drafting, and critical revision of the manuscript, and the decision to submit for publication. Reprints will not be available from the authors. Address correspondence to John R. Prowle MD, Adult Critical Care Unit, Royal London Hospital, London, E1 1BB, United Kingdom. Address e-mail to j.prowle@qmul.ac.uk. © 2018 International Anesthesia Research Society

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