Σάββατο, 12 Ιανουαρίου 2019

Unmet Health Care Needs for Syrian Refugees in Canada: A Follow-up Study

Abstract

Unmet health care needs are under explored among refugees. Previously we found unmet health care needs in Syrian refugees may be higher than in the general Canadian population (Oda et al. CMAJ Open 5(2):E354–E358, 2017; Oda et al. J Immigr Minor Health, 2018. http://bit.ly/2VCP6SH). This follow-up study with Syrian refugees who entered Canada between July 2015 and July 2016 aimed to understand if there are changes in unmet health care needs 6 months to a year after baseline collection. The number reporting unmet needs was high (42.6%). Although some refugees had their needs met, unmet health needs persist, and it seems that they are linked with sponsorship pathway and post-migration socio-economic position. While caution should be used generalizing these results, they do suggest that greater coordination between services may be needed as many of the refugees report unmet needs within months of arriving and continue to report needs after being here for a period up to 2 years.



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Geospatial Analysis of Refugee Access to Primary Care Physicians in San Antonio, Texas

Abstract

This study investigated refugee access to primary care physicians (PCP) in San Antonio, Texas. Catholic Charities of San Antonio (CCSA) is the primary agency responsible for connecting refugees to a PCP. Data on refugees were collected from CCSA between May to September 2013 (N = 547). PCPs information was accessed at the Texas Medicaid and Healthcare Partnership (TMHP) website. The 2SFCA method was used in geographic information systems (GIS) to analyze the ratio of healthcare providers relative to refugees within varying walking distances. The highest concentration of accessibility was at 20 min distance in the Medical Center area. The highest concentration of accessibility at all walking distances were also in the Medical Center area. The univariate and multivariate analyses did not result in significant findings for the association between demographic variables and the accessibility scores. These findings recommend building new and more relationships with healthcare providers where PCPs access is low.



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Evaluation of three “beyond Baveno VI” criteria to safely spare endoscopies in compensated advanced chronic liver disease

Liver stiffness measurement (LSM) <20 kPa and platelet count >150,000/mm3 exclude varices needing treatment (VNT) in viral compensated advanced chronic liver disease (cACLD), saving-up to 20-25% endoscopies (Baveno VI criteria). Refinements of such criteria to further reduce endoscopies and an approach without LSM (Platelet 150/MELD 6) were later proposed.

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Uncommon appearance of concurrent liver cirrhosis and chronic pancreatitis: The alcohol metabolism theory



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Nonalcoholic fatty liver disease is associated with breast cancer in nonobese women

Growing evidence supports that nonalcoholic fatty liver disease (NAFLD) is associated with extrahepatic cancers. Nonalcoholic fatty liver disease (NAFLD) and breast cancer share similar risk factors, including obesity.

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Association of vitamin D levels and vitamin D-related gene polymorphisms with liver fibrosis in patients with biopsy-proven nonalcoholic fatty liver disease

Vitamin D has promising anti-proliferative and anti-fibrotic properties, but its clinical utility in nonalcoholic fatty liver disease (NAFLD) is unclear.

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Impact of the direct-acting antiviral agents (DAAs) on chronic hepatitis C in Sardinian patients with transfusion-dependent Thalassemia major

Direct antiviral agents (DAAs) have revolutionised the standard of care for the treatment of hepatitis even in patients with hemoglobinopathies. The aim of this study is to show how, thanks to DAAs, HCV infection has been substantially eradicated in one of the biggest Centres for the management of Thalassemia in Europe.

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Time To Revise The Definition of NAFLD: A Purist Vision



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Feasibility and reproducibility of liver and pancreatic stiffness in patients with alcohol-related liver disease

To date no studies evaluated liver stiffness and pancreatic stiffness by shear-wave elastography, in alcoholic liver disease setting.

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Epidemiological features and disease-related concerns of a large cohort of Italian patients with active Crohn’s disease

The SOLE study was conducted on a large cohort of Italian patients with moderate-severe Crohn's disease (CD) to assess epidemiological and disease characteristics and their correlation with disease-related worries, treatment satisfaction and adherence, workability.

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A neonate with pneumoperitoneum and cyanosis of lower limbs skin during esophagogastroduodenoscopy

A girl at 16 h after birth who was born in Week 39 of pregnancy, with a height, body weight, and hemoglobin level of 51 cm, 3400 g, and 14 g/dL, respectively, was referred to our hospital with fresh hematemesis and melena. Two mg of Vitamin K was intravenously injected, and gastrolavage was conducted. However, the hematemesis and melena persisted and laboratory tests showed a hemoglobin level of 5.9 g/dL. Erythrocyte transfusion at 150 mL was administered, and the hemoglobin level was increased to 12.1 g/dL.

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Pathogenesis of hypothyroidism-induced NAFLD: Evidence for a distinct disease entity?

Nonalcoholic fatty liver disease (NAFLD), the most common liver disease worldwide, may be associated with primary hypothyroidism. However, the pathogenesis underlying such an association is complex and not completely understood. Here, we specifically discuss the pathogenic mechanisms potentially involved in hypothyroidism-induced NAFLD. To this end, we summarize the general pathophysiology of thyroid hormones (TH). Next, we analyze the published data from rodent studies by discussing whether hypothyroid rats may develop NAFLD via hyperphagia; whether mitochondria become energetically more efficient; what the overall energy balance is and if diversion of fatty substrates occurs; and the latest advancements in molecular pathogenesis brought about by metabolomics, cell imaging, lipophagy, autophagy and genetically engineered mouse models.

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Editorial Board



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Meta-analysis of circulating microRNAs for the diagnosis of hepatocellular carcinoma

There are no existing biomarkers that demonstrate very reliable performance in the diagnosis of hepatocellular carcinoma (HCC), especially in the early stage. Studies have shown that numerous aberrantly expressed circulating microRNAs (miRNAs) can be used as a diagnostic tool for HCC; however, these studies have produced inconsistent results.

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Comparison of asymmetric (low morning-dose) and standard split-dose regimen of PEG plus bisacodyl for bowel preparation: A randomized controlled trial

Reducing the morning dose of PEG solution may be a reliable strategy to improve the patient compliance of split-dose regimens without affecting efficacy of bowel cleansing.

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Colon stenting as “Bridge-to-surgery”: A further piece of the puzzle toward…?

The incidence of acute colorectal obstruction due to colorectal cancer (CRC) requiring urgent decompression has been reported to be up to 13%, with approximately 70% of cases occurring in the left side of the colon [1].

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“Are the Expanded Baveno VI Criteria really safe to screen compensated cirrhotic patients for high-risk varices?”

The Expanded Baveno VI criteria [1] have been recently proposed as a new screening strategy for high-risk varices (HRV), able to increase the rate of spared upper endoscopies (EGDs) and improve upon the original Baveno VI Criteria [2]. To date, few studies have investigated the performance and safety of these criteria [3,4]. The recent work by Bae et al. [4] is the first one to report a high rate (>5%) of missed HRV by the expanded criteria, questioning their efficiency in safely ruling out HRV (sensitivity 81%, NPV 93%, LR- 0.30).

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Genetic depletion of Soat2 diminishes hepatic steatosis via genes regulating de novo lipogenesis and by GLUT2 protein in female mice

Depletion of the cholesterol esterifying enzyme acyl-Coenzyme A: cholesterol acyltransferase 2 (ACAT2, encoded by Soat2) protects mice from atherosclerosis, diet-induced hypercholesterolemia, and hepatic steatosis when fed high-cholesterol diet. The glucose transporter 2 (GLUT2) represents the main gate of glucose uptake by the liver. Lipid synthesis from glucose (de novo lipogenesis; DNL) plays a pivotal role in the development of hepatic steatosis. Inhibition of DNL is a successful approach to reverse hepatic steatosis, as shown by different studies in mice and humans.

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HepaDisk – A new Quality of Life Questionnaire for HCV patients

Since most patients with hepatitis C virus (HCV) infection now receive treatment irrespective of liver disease severity, special attention to patient quality of life (QoL), including psycho-social aspects, is required. No QoL questionnaire is specific for patients with HCV.

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Association of Time to Colonoscopy after a Positive Fecal Test Result and Fecal Hemoglobin Concentration with Risk of Advanced Colorectal Neoplasia

We evaluated the risk of advanced colorectal neoplasia (ACRN) and colorectal cancer (CRC) according to time to colonoscopy after positive fecal immunochemical test (FIT), fecal hemoglobin concentration, and combination of both.

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Early metabolic response to chemoradiotherapy by interim FDG PET/CT is associated with better overall survival and histological response in esophageal cancers

Early assessment of response to neoadjuvant chemoradiotherapy (CRT) is crucial in determining the most suitable treatment strategy in locally advanced oesophageal cancer (LAEC).

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Deep remission on magnetic resonance imaging impacts outcomes of perianal fistulizing Crohn’s disease

The long-term management of perianal Crohn's disease for patients on anti-TNF-α therapy remains challenging.

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The exhausting work of acclimating to chronically elevated CO2



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Monte Carlo simulation of dose coefficients for a fish eye lens model exposed to monoenergetic electrons

Publication date: April 2019

Source: Journal of Environmental Radioactivity, Volumes 199–200

Author(s): P. Nogueira, M. Hiller, M.-O. Aust

Abstract

Vision is an important sense for the majority of the wildlife species, affecting their ability to find food and escape predation. Currently, no study on radiation induced cataract frequency on the fish eyes lens has been done. However, any thorough future study of this subject will require more accurate dose estimates for the fish eye lens than those currently available. For this purpose, the eye lens absorbed dose per unit fluence conversion coefficients for electron irradiation were calculated using the MCNPX Monte Carlo radiation transport code package. All results were validated against three different fish voxel models. The discrepancies between model results mainly originate from the different fish eye dimensions used in the different studies and in two of the cases the lack of a defined eye lens region.

The dose conversion coefficients calculated in this work can be used to estimate the dose to the fish eye lens based on the activity concentration of the surrounding water. The model developed in this work has also demonstrated that the mathematical models still have several advantages over the voxel models.



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Investigation of gas flow through soils and granular fill materials for the optimisation of radon soil depressurisation systems

Publication date: March 2019

Source: Journal of Environmental Radioactivity, Volume 198

Author(s): Marta Fuente, Eduardo Muñoz, Isabel Sicilia, Jamie Goggins, Le Chi Hung, Borja Frutos, Mark Foley

Abstract

The purpose of this study is to investigate gas flow through different types of granular fill materials and soil by means of a series of experimental laboratory tests, in relation to soil depressurisation systems for radon reduction under buildings and the soil surrounding the foundation. Gas permeability characterisation of materials used as granular fill material beneath the slab in buildings is a key parameter for the optimum performance of soil depressurisation systems to mitigate radon. A test apparatus was developed, adapted from previous studies, to measure the gas permeability of the samples and Finite Element Method numerical simulations were validated to simulate the flow behaviour through them. Theoretical expressions for permeability were discussed based on the analysis of experimental results and numerical simulations, finding that Darcy-Forchheimer equation provides the best match to the experimental results. Darcy's law also proved to be suitable for low gas velocities, whereas Ergun's equation resulted in a poor fit of the experimental data. Benchmark analysis of the granular fill materials under study and other European standards (Spanish, Irish and British) is also presented.



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Measurement of secondary cosmic-ray neutrons near the geomagnetic North Pole

Publication date: March 2019

Source: Journal of Environmental Radioactivity, Volume 198

Author(s): Richard S. Woolf, Laurel E. Sinclair, Reid A. Van Brabant, Bradley J.A. Harvey, Bernard F. Phlips, Anthony L. Hutcheson, Emily G. Jackson

Abstract

The spectrum of cosmogenic neutrons at Earth's surface covers a wide energy range, from thermal to several GeV. The flux of secondary neutrons varies with latitude, elevation, solar activity, and nearby material, including ground moisture. We report the results from a campaign to measure count rates in neutron detectors responding to three different energy ranges conducted near the geomagnetic North Pole at CFS Alert, Nunavut, Canada (82.5°N, 62.5°W; vertical geomagnetic cutoff rigidity, RC = 0 GV) in June of 2016. In November 2016, we performed a follow-on measurement campaign in southern Canada at similar RC (1.5 GV) and elevations. We conducted these measurements, at varying elevation and ground moisture content, with unmoderated and moderated 3He detectors for thermal and epithermal-to-MeV sensitivity, and with EJ-299-33 pulse shape discrimination plastic scintillator detectors for fast neutrons. Background gamma rays were monitored with NaI(Tl) detectors. Using these data sets, we compared the measured count rates to a predictive model. This is the first ever data set taken from this location on Earth. We find that for the thermal and epithermal-to-MeV neutron measurements the predictive model and data are in good agreement, except at one location on rock-covered ground near 1 km elevation. The discrepancy at that location may be attributable to ground moisture variability. Other measurements, during this campaign and prior, support the assertion that ground moisture plays a critical role in determining neutron flux.



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Engineering stable heterosis

Publication date: Available online 11 January 2019

Source: Journal of Genetics and Genomics

Author(s): Yingxiang Wang



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Do a few tools necessarily mean a few people? A techno-morphological approach to the question of group size at Gesher Benot Ya'aqov, Israel

Publication date: March 2019

Source: Journal of Human Evolution, Volume 128

Author(s): Gadi Herzlinger, Naama Goren-Inbar

Abstract

The question of Paleolithic group size has been addressed by scholars in many disciplines applying different methods. In our study we apply a novel analytical approach in an attempt to assess the group size of hominins that occupied the Acheulian site of Gesher Benot Ya'aqov, Israel (GBY). Within this framework, we subjected the handaxe assemblages from several archaeological horizons at the site to a morpho-technological analysis. The analysis combined high-resolution three-dimensional geometric morphometric analysis with typo-technological attribute analysis to assess the inter- and intra-assemblage morpho-technological variability. The analysis was also applied to an experimental handaxe assemblage produced by an expert knapper. The results of the analysis show high morphological homogeneity coupled with high technological variability in each of the archaeological assemblages. This pattern is highly indicative of the work of expert knappers, as is also suggested by the comparison between the archaeological and experimental assemblages. The high density of archaeological remains in some of the GBY occupations and their pristine taphonomic condition provide additional support for the involvement of large groups of hominins, although some horizons are far poorer in archaeological remains and hence do not allow such an interpretation. Nevertheless, the fact that in all assemblages the handaxes show the same techno-morphological pattern indicates that they were all produced by expert knappers. As shown by numerous models and ethnographic data, the presence of experts can be viewed as an indication of large and socially complex societies. Thus, although some of the GBY occupations were not formed by large groups, the smaller groups whose activities are recorded were very likely to be part of larger, socially complex cultural groups. This variability in occupational intensity is interpreted as representing an aggregation-dispersal mechanism, similar to those documented in many hunter-gatherer societies.



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Vestibular dysfunction is a manifestation of 22q11.2 deletion syndrome

Abstract

The 22q11.2 deletion syndrome (22q11.2DS) is the second most common cause of developmental delay after Down syndrome. Impaired cognitive development is highly prevalent, but also motor abnormalities such as hypotonia and delays in achieving motor milestones are described. Instability is frequently detected in children, adolescents, and adults and is mostly attributed to their limited motor performance. Until now, vestibular function has not been investigated in these patients, despite the growing evidence that they often have inner ear malformations. The aim of this prospective study was to identify the presence and character of vestibular dysfunction in 22q11.2DS. We investigated 23 subjects with proven 22q11.2DS, older than the age of 12. We performed caloric testing and pendular rotation chair tests with videonystagmography, cervical vestibular‐evoked myogenic potential (c‐VEMP)‐testing, and posturography. Additional otoscopy and audiometry were performed on all subjects. We found a unilateral caloric hypofunction in 55% of patients, a certain absent c‐VEMP response in 15% of ears, an inconclusive c‐VEMP response in 33% of ears, and abnormal posturography in 68% of patients, of whom 42% displayed a typical vestibular pattern. Remarkably, 90% revealed uni‐ or bilateral weak caloric responses, independent of caloric symmetry. Vestibular dysfunction is frequent in subjects with 22q11.2DS. This knowledge should be taken into account when assessing motor performance in these patients. Additional larger studies are needed to determine whether this dysfunction implicates a therapeutic potential.



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Genome-wide identification and expression analyses of WRKY transcription factor family members from chickpea ( Cicer arietinum L.) reveal their role in abiotic stress-responses

Abstract

Background

WRKY proteins play a vital role in the regulation of several imperative plant metabolic processes and pathways, especially under biotic and abiotic stresses. Although WRKY genes have been characterized in various major crop plants, their identification and characterization in pulse legumes is still in its infancy. Chickpea (Cicer arietinum L.) is the most important pulse legume grown in arid and semi-arid tropics.

Objective

In silico identification and characterization of WRKY transcription factor-encoding genes in chickpea genome.

Methods

For this purpose, a systematic genome-wide analysis was carried out to identify the non-redundant WRKY transcription factors in the chickpea genome.

Results

We have computationally identified 70 WRKY-encoding non-redundant genes which were randomly distributed on all the chickpea chromosomes except chromosome 8. The evolutionary phylogenetic analysis classified the WRKY proteins into three major groups (I, II and III) and seven sub-groups (IN, IC, IIa, IIb, IIc, IId and IIe). The gene structure analysis revealed the presence of 2–7 introns among the family members. Along with the presence of absolutely conserved signatory WRKY domain, 19 different domains were also found to be conserved in a group-specific manner. Insights of gene duplication analysis revealed the predominant role of segmental duplications for the expansion of WRKY genes in chickpea. Purifying selection seems to be operated during the evolution and expansion of paralogous WRKY genes. The transcriptome data-based in silico expression analysis revealed the differential expression of CarWRKY genes in root and shoot tissues under salt, drought, and cold stress conditions. Moreover, some of these genes showed identical expression pattern under these stresses, revealing the possibility of involvement of these genes in conserved abiotic stress–response pathways.

Conclusion

This genome-wide computational analysis will serve as a base to accelerate the functional characterization of WRKY TFs especially under biotic and abiotic stresses.



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Constitutional mosaicism in RASA1‐related capillary malformation‐arteriovenous malformation (CM‐AVM)

Clinical Genetics Constitutional mosaicism in RASA1‐related capillary malformation‐arteriovenous malformation (CM‐AVM)

Capillary malformation‐arteriovenous malformation (CM‐AVM) is caused by germline RASA1 and EPHB4 alterations. RASA1 intralesional second hits have also been reported. Here we report RASA1 constitutional mosaicism, defined here as the presence of a mosaic variant in all cell types of an individual, in two patients with CM‐AVM. High‐throughput sequencing was used to search for RASA1 pathogenic variants in blood samples from two unrelated patients with CM‐AVM. An affected tissue sample from one of the patients was also analyzed. Both patients showed different nonsense RASA1 variants in mosaic, ranging from 7% to 21,5%, in blood samples and in the corresponding affected tissue sample from one of the patients. In conclusion, we report for the first time the presence of RASA1 constitutional mosaicism in CM‐AVM. Constitutional mosaicism has implications for accurate molecular diagnosis and recurrence risk, and helps to explain the great phenotypic variability in CM‐AVM.

This article is protected by copyright. All rights reserved.



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Bupivacaine infiltration in children for postoperative analgesia after tonsillectomy: A randomised controlled study

BACKGROUND Adenotonsillectomy is a frequently performed procedure in paediatric day-case surgery. Postoperative pain can be significant and standard analgesia protocols are often insufficient. OBJECTIVE Our primary objective was to investigate if infiltration of the peritonsillar space with bupivacaine would reduce the need for postoperative opioids compared with pre-emptive intravenous tramadol. DESIGN A prospective, double-blind, randomised controlled trial. SETTING Ambulatory surgical day care centre, University Hospitals of Leuven, Belgium, from January 2012 to September 2016. PATIENTS Two hundred children, between 4 and 10 years old, undergoing elective adenotonsillectomy were included in the study. INTERVENTION Children were randomly allocated to receive either a bolus of 3 mg kg−1 intravenous tramadol or infiltration of the tonsillar lodge with 5-ml bupivacaine 0.25%. Reasons for exclusion were American Society of Anesthesiologists classification greater than 2, allergies to the investigated products, psychomotor retardation, bleeding disorders and lack of proficiency in Flemish. MAIN OUTCOME MEASURES The primary endpoint was the number of children in need of piritramide postoperatively. Secondary outcomes included the cumulative dose of postoperative piritramide, pain scores and the incidence of postoperative nausea and vomiting during the first 24 postoperative hours, time to discharge and adverse effects. RESULTS The proportion of children in need of postoperative piritramide was significantly lower in the tramadol group than in children with peritonsillar infiltration (57 vs. 81%, P 

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Epidemiology and incidence of severe respiratory critical events in ear, nose and throat surgery in children in Europe: A prospective multicentre observational study

BACKGROUND Ear, nose and throat (ENT) surgery, the most frequently performed surgical procedure in children, is a strong predictor for peri-operative respiratory complications. However, there is no clear information about peri-operative respiratory severe critical events (SCEs) associated with anaesthesia management of ENT children in Europe. OBJECTIVE To characterise the epidemiology and incidence of respiratory SCEs during and following ENT surgery in Europe and to identify the risk factors for their occurrence. DESIGN A secondary analysis of the Anaesthesia PRactice In Children Observational Trial, a prospective observational multicentre cohort trial. SETTING The study included 261 centres across 33 European countries and took place over a consecutive 2-week recruitment period between April 2014 and January 2015. PATIENTS We extracted data from 5592 ENT surgical procedures that were performed on 5572 children aged 6.0 (3.6) years (mean (SD)) from the surgical database and compared these with data from 15 952 non-ENT surgical children aged 6.7 (4.8) years. MAIN OUTCOME MEASURES The primary outcome was the incidence of respiratory SCEs (laryngospasm, bronchospasm and new onset of postoperative stridor). Secondary outcomes were the differences in epidemiology between ENT children and non-ENT surgical children and the risk factors for the occurrence of respiratory SCEs. RESULTS The incidence (95% confidence interval) of any respiratory SCE (laryngospasm, bronchospasm and postoperative stridor) was 3.93% (3.46 to 4.48) and was significantly higher than that observed in non-ENT surgical children [2.61% (2.37 to 2.87)], with a relative risk of 1.51 (1.28 to 1.77), P less than 0.0001. Younger age (14% decrease in critical events by increasing year, P 

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A comparison of the analgesic efficacy of local infiltration analgesia vs. intrathecal morphine after total knee replacement: A randomised controlled trial

BACKGROUND Local infiltration analgesia (LIA) is an effective pain management technique following total knee arthroplasty (TKA). OBJECTIVE To investigate if LIA provides better analgesia for patients undergoing unilateral TKA than intrathecal morphine. DESIGN Randomised controlled trial. SETTING Single tertiary referral centre. PATIENTS Consecutive American Society of Anesthesiologists Physical Status I to III patients scheduled to undergo unilateral TKA were randomised to two groups. INTERVENTION The control group received spinal anaesthesia with intrathecal bupivacaine and preservative-free morphine 0.3 mg. The intervention group received opioid-free spinal anaesthesia with bupivacaine, followed by intra-operative infiltration of the knee with levobupivacaine 2 mg kg−1 and adrenaline 0.5 mg diluted to a volume of 100 ml with 0.9% saline. An intra-articular catheter was placed during surgery and used to give a bolus of 15 ml of levobupivacaine 0.5% on the morning of the first postoperative day. MAIN OUTCOME MEASURES Visual analogue scale (VAS) scores for pain were assessed repeatedly for 48 h postoperatively, at rest and on passive knee flexion to 30°. The primary outcome was VAS scores for pain at rest and on movement at 24 postoperative hours. Secondary outcomes were VAS scores at rest and on movement at 2, 6, 12 and 48 postoperative hours, opioid consumption, degree of active flexion of operative knee achieved in the first 48 h and the incidence of opioid-related side effects. RESULTS Forty three patients completed the study. Mean (± SD) VAS scores for pain at 24 h were lower in the intervention group than the control group at rest; 16.43 (± 20.3) vs. 37.2 (± 33.6), (P = 0.029). VAS scores for pain at 24 h on movement were also lower in the intervention group vs. the control group; 39.1 (± 22.8) vs. 57.0 (± 30.9), (P = 0.037). VAS scores were also lower on movement; 25.9 (± 16.8) vs. 40.5 (± 24.0), (P = 0.028) at 48 h. CONCLUSION We conclude that LIA conferred superior analgesia compared with intrathecal morphine 0.3 mg at 24 and 48 h following TKA. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT01312415. Correspondence to John McNamara, MB, BCh, BAO, Cork University Hospital and University College Cork, Cork, Ireland E-mail: johnmcnamara9@gmail.com 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 (http://bit.ly/2ylyqmW). © 2019 European Society of Anaesthesiology

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Smartphone applications validated for joint angle measurement: a systematic review

Mobile health apps are growing constantly in number and popularity. Some mobile apps are used for clinical assessment, and consequently need to be verified and validated appropriately, along with the mobile platform, to ensure their safe and effective operation. We review the current literature on available smartphone goniometric apps validated for joint angle measurement and their main psychometric characteristics. A literature search of Medline and Scopus databases was performed to select papers on smartphone commercial apps validated for joint angle measurement and relevant to Physical Medicine and Rehabilitation. A platform search verified whether the selected apps were still available for download. The literature search identified 126 papers in Medline and 113 in Scopus, 49 of which were selected. They dealt with the validation of 23 apps, eight of which were no longer available and therefore excluded from the review. Psychometric characteristics of the selected apps were robust, but heterogeneity of the studies did not enable comparisons between apps to identify the most valid one. The increase in the number of apps and validation studies highlights the growing interest in this new approach for measuring body angles. Given the precarious commercial availability of some apps, when research is the goal, it is advisable to select apps with the longest durability. A need continues to exist for validation studies on available apps focused on goniometric measurement in gait or during performance of therapeutic exercises in neurological and orthopedic disorders. Correspondence to Giorgio Ferriero, MD, PhD, Istituti Clinici Scientifici Maugeri, Pavia 20851, Italy Tel: +39 039 46571; fax: +39 039 465 7279; e-mail: giorgio.ferriero@icsmaugeri.it Received October 10, 2018 Accepted November 26, 2018 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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Similar Isokinetic Strength Preinjury and at Return to Sport after Hamstring Injury

Introduction Side-to-side strength differences are often used in return to sport (RTS) decision making following hamstring injury. In football (soccer), there is little consensus, and a side-to-side difference of 95% compared to pre-injury strength. Overall, 63.4% of the players had a >10% negative strength difference (i.e. the injured limb being weaker) and 57.9% of the players had a >10% positive strength difference (i.e. the injured limb being stronger) in at least one of the five isokinetic variables. Conclusion The distribution of isokinetic strength differences when comparing strength at RTS to pre-injury measures were similar, urging clinical caution when interpreting these results. Small changes in isokinetic strength of the injured limb at RTS compared to pre-injury strength suggest that isokinetic cut-off values are not useful to guide restoration of strength as a criterion for RTS after hamstring injury. Corresponding author: Nicol van Dyk, Aspetar Orthopaedic and Sports Medicine Hospital, PO Box 29222, Doha, Qatar. nicol.vandyk@aspetar.com. Telephone: ++974 4413 2000. Fax: +974 44132020 Competing interests - None Funding - Nothing to declare This present study do not constitute endorsement by ACSM. Accepted for publication: 26 December 2018. © 2019 American College of Sports Medicine

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Effects of Obesity and Exercise on Bone Marrow Progenitor Cells following Radiation

INTRODUCTION The late effects of radiation therapy can have significant consequences for the health and quality of life of long-term cancer survivors. Radiation induces persistent alterations in hematopoietic stem/progenitor cells (HSPCs) and the bone marrow environment; however, how relevant host factors such as obesity and exercise differentially regulate HSPC content and the bone marrow environment following radiation exposure remains unknown. The purpose of this investigation was to evaluate how the combination of obesity and exercise training modulate HSPCs and their niche following sub-lethal radiation exposure in mice. METHODS Mice fed either a control or high-fat-diet to induce obesity remained sedentary or underwent a progressive treadmill exercise program. At 13 weeks of age, mice were irradiated (3 Gy), and continued their specific diets and exercise program for four more weeks. RESULTS Exercise trained mice had significantly higher quantities of several HSPC subpopulations and bone marrow stromal cell populations, while HSPC subpopulations were significantly lower in obese mice following radiation. Reactive oxygen species content was significantly decreased in HSPCs with exercise training. Proteomics analysis of bone marrow supernatant revealed clustering of biologically relevant changes in exercise trained mice. Functional evaluation of bone marrow supernatant revealed a significant increase in leukemia blast viability in obese mice but not in the exercise trained mice (p

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Functional Resistance Training and Affective Response in Female College-Age Students

ABSTRACT INTRODUCTION While resistance training (RT) can lead to acute improvements in psychological, physiological and psychosocial outcomes, prevalence rates remain low in college-age females likely due to perceived barriers. This study compared the effects of an acute bout of both a functional (FRT) and traditional resistance training (TRT) session on affect, state anxiety enjoyment and physiological measures. METHODS Females (n=34, mean age = 27±4.5 years) not currently meeting ACSM RT guidelines completed 4 sessions (2 FRT, 2 TRT) within 4-weeks in a randomized crossover design. Session 1 familiarized participants to the RT exercises. Session 2 consisted of 2x10 moderate intensity repetitions. Outcome measures included affect and state anxiety (pre, post, and 15-minutes post-exercise); enjoyment (post), and manipulation measures were RPE and heart rate HR). RESULTS Between condition comparisons indicate change scores in state anxiety pre- to post-15 (p=0.028) and enjoyment levels post- (p=0.02) were significantly greater in FRT than TRT. Within condition analyses revealed pre- to post-15 changes in affect were positive and greater in FRT (d=0.79) than TRT (d=0.53, p=0.47), and greater in decreases in state anxiety (FRT, d=-0.58; TRT, d=-0.37, p=0.028). Mean session RPE was not significantly different between conditions (FRT 6±1.2 units; TRT 6.3±1.1 units; p=0.11), though average % of age predicted max HR (FRT 68.7±7.6; TRT 57.1±8.4) was significantly different (p

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HIIT Improves Left Ventricular Exercise Response in Adults with Type 2 Diabetes

Type 2 diabetes is associated with reduced left ventricular reserve. It is unclear whether exercise training improves left ventricular function in people with type 2 diabetes. PURPOSE To determine whether three months of high intensity interval training (HIIT) improves left ventricular function during exercise in adults with type 2 diabetes. METHODS Participants performed a V[Combining Dot Above]O2peak test and received a DXA scan and total blood volume measurement at baseline. Left ventricular end diastolic volume (LVEDV), end systolic volume (LVESV) and stroke volume (LVSV) were then measured at rest and during low- and moderate-intensity semi-recumbent exercise in adults with type 2 diabetes before and after three-months of HIIT (N = 11) or no training (control) (N = 5). The effects of HIIT were determined using ANOVA with repeated measures. RESULTS HIIT increased V[Combining Dot Above]O2peak by approximately 15% (P 0.05). HIIT augmented the reduction in LVESV from rest to moderate intensity exercise (P 0.05). CONCLUSIONS HIIT training increased the LVSV response to exercise in adults with type 2 diabetes. These data suggest HIIT can improve LV filling and emptying during exercise and reverse early cardiac consequences of type 2 diabetes. Corresponding Author: James Christopher Baldi, Ph.D., Department of Medicine, 9th Floor, Dunedin Hospital, Great King Street, Dunedin 9016, New Zealand. Chris.baldi@otago.ac.nz This study was funded by Anderson's Trust and Healthcare Otago Charitable Trust obtained by J.C. Baldi. The authors have no conflict of interest to declare. The results of the present study do not constitute endorsement by the American College of Sports Medicine. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 14 December 2018 © 2019 American College of Sports Medicine

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Physiotherapy versus physiotherapy plus cognitive training on cognition and quality of life in Parkinson´s disease: randomized clinical trial

Objective Verify the effectiveness of physiotherapy associated with cognitive training to improve cognition and quality of life in individuals with Parkinson's disease (PD). Design randomized clinical trial involving 58 individuals with mild to moderate PD, randomly distributed into two groups: motor group (MG) and cognitive-motor group (CMG). Both groups were assessed for cognition and quality of life at the beginning of the study, at the end of the intervention protocols, and three months after the end of the intervention. The following instruments were used to assess cognition and quality of life: Mini Mental State Examination, Montreal Cognitive Assessment, Verbal fluency test, Rey Auditory Verbal Learning Test, Cognitive and perceptual assessment by pictures, Trail Making Test, Clock Drawing Executive Test, and Parkinson's Disease Quality of Life Questionnaire. The MG engaged in motor physiotherapy, while the CMG underwent combined motor physiotherapy with cognitive training. Results The intragroup analysis revealed that both groups presented improved cognition (memory and visuospatial function domains) and quality of life after execution of the protocols, but without statistically significant intergroup differences. Conclusions when comparing the intervention moments, the two treatment approaches used were effective for the outcomes: memory, visuospatial function, and quality of life in both groups. Corresponding author: Natália Mariano Barboza, Universidade Estadual de Londrina, Avenida Robert Koch, n 60, Vila Operária, Londrina, Paraná, Brazil, CEP 86038-350. Phone number: (43)3371-2320. E-mail: nat_barboza@hotmail.com No funding was received. Patients provided written consent for the use of their images. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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Identifying the dorsal scapular artery optimizes the safety and precision of the ultrasound-guided 5-in-1 injection

No abstract available

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Artifacts and Artistic facts: A Visual Simulation for Ultrasound Training

For innumerous reasons, ultrasound (US) imaging is becoming more and more popular in musculoskeletal medicine. Herewith, since this imaging technique is user dependent, prompt and sufficient training is crucial for its better clinical utility. In this regard, with this paper, we aimed to focus on common artifacts that are observed in routine US scanning during daily musculoskeletal practice. Yet, those imaging findings need to be well recognized in order not to be misinterpreted. Likewise, we have illustrated and discussed those artifacts in similarity with particular natural photographs. Rather than exemplifying with the same physical principles, our purpose was to provide 'visual analogy' for better remembrance of these artifacts. Corresponding author: Vincenzo Ricci, IRCCS Rizzoli Orthopaedic Institute, Department of Biomedical and Neuromotor Science, Physical and Rehabilitation Medicine Unit, Bologna, Italy. E-mail: vincenzo.ricci58@gmail.com Author Disclosures: Conflict of interest: None No funding was received. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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Is electromechanical and robot-assisted arm training effective for improving arm function in people who have had a stroke? A Cochrane Review summary with commentary.

No abstract available

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Network meta-analysis of various non-pharmacological interventions on pain relief in older adults with osteoarthritis

To compare the effectiveness of different non-pharmacological interventions on pain relief in older adults with osteoarthritis (OA), literature databases, bibliographies, and other relevant sources were searched. No language limitations were applied. Thirty-two trials published from 1997 to 2017 were included in the systematic review and network meta-analyses. We included only RCTs and studies that evaluated the effects of non-pharmacological interventions on alleviating pain in elderly adults (age 60 years or more or mean age over 65) who suffer from OA, irrespective of gender. In the network meta-analysis, resistance training was ranked as the most effective among all non-pharmacological interventions (SUCRA: 82.9%, SMD: 1.96, CI: -1.39 to 5.31). In subgroup analyses, resistance training still ranked the most effective pain reduction intervention, followed by strengthening exercise and yoga. Among female subjects with intervention adherence rate greater than 90%, the most effective intervention was yoga. Strengthening exercise was superior to all other forms of interventions when comparing long-term effect of selected interventions. Among older adults with OA, resistance training can be considered a treatment option for pain relief. Yoga is an effective intervention strategy for female elderly, and strengthening exercise has a better long-term beneficial effect. Abbreviations: SUCRA=surface under the cumulative ranking. Correspondence Author: Feng Li, PhD, College of Nursing, Jilin University, Changchun130021, Jilin Province, China, Tel.: +86 18243066197. E-mail address: fli@jlu.edu.cn This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Acknowledgement Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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Can botulinum toxin help prevent migraine in adults? - A Cochrane Review summary with commentary

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Sonoanatomy of Muscles Attaching to the Medial Scapular Border (Levator Scapulae, Rhomboid Minor and Serratus Anterior) Revisited

No abstract available

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