Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.
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Παρασκευή 15 Φεβρουαρίου 2019
The Distribution Volume of 18F-Albumin as a Potential Biomarker of Antiangiogenic Treatment Efficacy
Make EMS Week a year round celebration
Instead of relegating celebration to a single week of May consider how to recognize the accomplishments of EMS all year long.
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NAPNAP Position Statement on Health Risks and Needs of Lesbian, Gay, Bisexual, Transgender, and Questioning Youth
The overall goal in caring for all youth, including those who are lesbian, gay, bisexual, gender nonconforming, transgender, or questioning (LGBTQ), is to promote normal adolescent development, social and emotional well-being, physical health, and reduce any associated physical and mental health risks (Adelson, Stroeh, & Ng, 2016; American Academy of Pediatrics [AAP], 2013; AAP, 2018). While many LGBTQ youth navigate adolescence as well as their heterosexual peers, others are exposed to social stigma, discrimination, prejudice, and victimization (both mental and physical; Earnshaw et al., 2017).
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Trauma-Informed Care: Essential Elements for Pediatric Health Care
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It's Time to Lead, Before Someone Else Does
As you read this, we will be getting ready to meet in New Orleans for our annual meeting. One of my absolute favorite things about being a NAPNAP member is the opportunity to attend our annual conference. I always walk away with new knowledge that helps me develop clinically and professionally, and the networking opportunities are the best I have ever found. Through the years, I have met and made friends with people from all over the country, and most meetings feel like a family reunion as we all reconnect and share updates about the important things in our lives.
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NAPNAP Position Statement on Age Parameters for Pediatric Nurse Practitioner Practice
Creation of exclusive age limits for the provision of health care in pediatric, adolescent, and young adult patients may unnecessarily create barriers and limit access to care continuity for this population (American Nurses Association, National Association of Pediatric Nurse Practitioners [NAPNAP], & Society of Pediatric Nurses, 2015; Hardin, Hacknell, & Committee on Practice and Ambulatory Medicine, 2017; Licensure, Accreditation, Certification and Education [LACE] APRN Network, 2012). Pediatric nurse practitioners (PNPs) have the education, certification, and licensure to provide comprehensive care to all children from birth through young adulthood.
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Caring for Gender-Diverse Children and Youth
Youth who identify themselves as transgender and gender-diverse (TGD) are traditionally underserved by our current health care system and, as a result, encounter multiple associated risks as well as mental health issues. While society at large has been grappling with issues such as proper pronouns and restroom guidelines, the health care system has also been lacking in promoting gender-affirming clinical environments. Many providers acknowledge a lack of preparation and experience to adequately care for children and youth who identify as TGD, and have called for more formal training, standardized treatment approaches, and the funding of research to further examine approaches to care and health outcomes.
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The Distribution Volume of 18F-Albumin as a Potential Biomarker of Antiangiogenic Treatment Efficacy
Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.
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Full time tenured EMS Instructor - Del Mar college
**Position Summary Information** Job Description Summary The purpose of this position is to teach required contact hours/lecture equated per regular semester that could include online courses and/or dual-credit/early college classes. Travel may be required for dual-credit classes. Demonstrate skill, knowledge, and abilities in the teaching discipline. Teach assigned courses in a variety of times and ...
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Comparative Analysis of Antimicrobial Resistance, Integrons, and Virulence Genes Among Extended-Spectrum β-Lactamase-Positive Laribacter hongkongensis from Edible Frogs and Freshwater Fish
Microbial Drug Resistance, Ahead of Print.
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A Helicobacter pylor i screening and treatment program to eliminate gastric cancer among junior high school students in Saga Prefecture: a preliminary report
Abstract
Background
To present the strategies and preliminary findings of the first 3 years after implementing a Helicobacter pylori screening and eradication program to prevent gastric cancer in Saga Prefecture.
Methods
A screening and treatment program to eradicate H. pylori from third-grade junior high students was started in Saga Prefecture in 2016, using local governmental grants. Screening was with urinary anti-H. pylori antibody tests, followed by H. pylori stool antigen tests for students who were antibody positive. Those positive on both tests underwent H. pylori eradication by triple therapy based on a potassium-competitive acid blocker.
Results
From 2016 to 2018, the participation rate was 83.1% and the H. pylori infection rate was 3.1% (660/21,042). The participation rates were higher in 2017 (85.4%) and 2018 (85.9%) compared with 2016 (78.5%) (P < 0.0001), and the infection rate also decreased in a time-dependent manner (2016: 3.6%, 2017: 3.3%, 2018: 2.5%, P = 0.0001). In total, 501 students positive for H. pylori received eradication therapy (85.1% success) and adverse events occurred in 20 of these (4.0%). However, no serious complications occurred.
Conclusions
The H. pylori screening and eradication project for school students in Saga Prefecture has started successfully and we have seen both a steady increase in the participation rate and a steady decrease in the infection rate, without major safety concerns.
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Chromosome-Wide Evolution and Sex Determination in the Three-Sexed Nematode Auanema rhodensis
Trioecy, a mating system in which males, females and hermaphrodites co-exist, is a useful system to investigate the origin and maintenance of alternative mating In the trioecious nematode Auanema rhodensis, males have one X chromosome (XO), whereas females and hermaphrodites have two (XX). The female versus hermaphrodite sex determination mechanisms have remained elusive. In this study, RNA-seq analyses show a 20% difference between the L2 hermaphrodite and female gene expression profiles. RNAi experiments targeting the DM (doublesex/mab-3) domain transcription factor dmd-10/11 suggest that the hermaphrodite sexual fate requires the upregulation of this gene. The genetic linkage map (GLM) shows that there is chromosome-wide heterozygosity for the X chromosome in F2 hermaphrodite-derived lines originated from crosses between two parental inbred strains. These results confirm the lack of recombination of the X chromosome in hermaphrodites, as previously reported. We also describe conserved chromosome elements (Nigon elements), which have been mostly maintained throughout the evolution of Rhabditina nematodes. The seven-chromosome karyotype of A. rhodensis, instead of the typical six found in other rhabditine species, derives from fusion/rearrangements events involving three Nigon elements. The A. rhodensis X chromosome is the smallest and most polymorphic with the least proportion of conserved genes. This may reflect its atypical mode of father-to-son transmission and its lack of recombination in hermaphrodites and males. In conclusion, this study provides a framework for studying the evolution of chromosomes in rhabditine nematodes, as well as possible mechanisms for the sex determination in a three-sexed species.
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Lungensonografie für Anästhesie, Intensiv- und Notfallmedizin
Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 108-127
DOI: 10.1055/a-0664-5700
Die Lungensonografie ist in der Intensiv- und Notfallmedizin ein unterschätztes Werkzeug: Bei bestimmten klinischen Fragestellungen ist ihre Sensitivität drastisch höher als die der Röntgen-Thoraxuntersuchung 1. Ein standardisierter Untersuchungsgang verbessert dabei die Untersuchungsqualität 2. Dieser Artikel vermittelt Grundlagenwissen der Lungensonografie und stellt die Überlegenheit des Ultraschalls gegenüber Röntgenverfahren heraus.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Ultraschall in AINS
Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 88-89
DOI: 10.1055/a-0805-2279
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
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Extrakorporale kardiopulmonale Reanimation: Datenlage bis heute unklar
Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 85-86
DOI: 10.1055/a-0823-5785
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
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Kaffee, Kippe, Kaugummi – Mythen und Fakten zur präoperativen Nüchternheit
Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 142-145
DOI: 10.1055/s-0043-124943
Zur Reduktion des Aspirationsrisikos gelten strikte Vorgaben für präoperative Nüchternzeiten. Für klare Flüssigkeiten (2 Stunden) und feste Nahrung (6 Stunden) sind diese eindeutig definiert; der Einfluss von Kaffee, Rauchen und Kaugummi wird dagegen kontrovers diskutiert. Dieser Beitrag zeigt, welche Mythen zur präoperativen Nüchternheit bestehen und durch welche Fakten sich das Risiko verlässlich einordnen lässt.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Driving Pressure – ein neuer/alter Parameter zur Beatmungsoptimierung?
Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 85-85
DOI: 10.1055/a-0823-5844
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
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Die fokussierte transthorakale Echokardiografie in der perioperativen Versorgung
Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 90-106
DOI: 10.1055/a-0586-6146
Mithilfe der fokussierten transthorakalen Echokardiografie (TTE) erhalten wir rasch und nichtinvasiv aktuelle Informationen zum hämodynamischen Status eines Patienten. Diese können nachfolgend unsere aktuelle Therapie und dadurch unser Risikomanagement beeinflussen. Postoperativ hat sich die TTE als Untersuchungsmethode im Aufwachraum und auf der Intensivstation bewährt, um lebensbedrohliche Ursachen für eine Kreislaufdepression zeitnah zu diagnostizieren. Akutpathologika wie eine Perikardtamponade oder die fulminante Pulmonalarterienembolie können so schnell erfasst und evtl. auch zeitintensive Transporte in eine CT vermieden werden. Auch präoperativ kann der Einsatz der TTE sinnvoll sein zur Beurteilung des Volumenstatus, der Pumpfunktion oder hämodynamisch relevanter Vitien. Vor allem bei Operationen mit hohem perioperativem Komplikationsrisiko können diese Erkenntnisse mit in eine „goal-directed therapy" einfließen. Entsprechende Algorithmen für ein erweitertes hämodynamisches Monitoring und das Volumenmanagement existieren bereits in vielen Bereichen – sie werden aber häufig nicht konsequent umgesetzt und in die Abläufe der eigenen Klinik implementiert. Mit diesem Artikel legen wir Nutzen und Relevanz der hämodynamischen Evaluation mittels TTE in jeder Phase der Patientenversorgung dar. Darüber hinaus stellen wir einen möglichen Algorithmus für die Versorgung kritisch kranker Patienten vor, der auf den wichtigsten transthorakalen Untersuchungen und hämodynamischen Messverfahren basiert. Er soll im klinischen Alltag und insbesondere im Bereitschaftsdienst eine Hilfestellung für den sinnvollen Einsatz der TTE bieten.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Spinalanästhesie mit Chloroprocain 1% zeigt Vorteile bei ambulanten Arthroskopien
Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 86-87
DOI: 10.1055/a-0823-5577
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
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Abdominelle Notfallsonografie in der Intensiv- und Akutmedizin
Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 128-141
DOI: 10.1055/a-0585-5237
Die sonografischen Untersuchungstechniken unterstützen die Point-of-Care-Diagnostik (POC-Diagnostik) bei akutmedizinischen Fragestellungen. Für den Intensiv- und Notfallmediziner gilt: Kenntnisse und Fertigkeiten einer fokussierten Sonografie sind unabdingbar. Dieser Artikel beleuchtet die Optionen der abdominellen Notfallsonografie und gibt praktische Hilfestellung.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Gewalt in der Notfallmedizin – gegenwärtiger Stand in Deutschland
Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 146-154
DOI: 10.1055/s-0043-112189
Hintergrund In den letzten Jahren werden Mitarbeiter von Rettungsdiensten und Notaufnahmen immer häufiger Opfer von gewalttätigen Übergriffen während ihres Dienstes. Jedoch wird die Erfassung von Häufigkeiten, Arten, Ursachen, Täterprofilen sowie möglichen Lösungsansätzen und Schutzmaßnahmen in Deutschland bisher – im Vergleich zum angloamerikanischen Sprachraum – eher stiefmütterlich behandelt. Ziel Das Ziel dieser Arbeit war eine weitgehende Erfassung der bisher vorliegenden aktuellen Daten der letzten Jahre, um einen zusammenfassenden Überblick über die Situation in Deutschland geben zu können. Ergebnisse Es liegen nur sehr wenige Arbeiten aus Deutschland zu diesem Thema vor. Die gefundenen Arbeiten zeigten, dass Gewalt im Rettungsdienst und in der Notaufnahme nicht nur ein Problem im angloamerikanischen Sprachraum ist. Bis zu 90% der Studienteilnehmer einer Befragung von Rettungsdienstmitarbeitern und 75% der teilnehmenden Mitarbeiter aus Notaufnahmen gaben an, in den letzten Monaten vor der Befragung Opfer von verbaler und/oder physischer Gewalt geworden zu sein. Die Mehrheit der Studienteilnehmer (je nach Studie zwischen 60 und 80%) fühlt sich gar nicht bis unzureichend auf aggressives und gewalttätiges Verhalten vorbereitet und wünscht sich professionelle regelmäßige Weiterbildung in Deeskalationstechniken und Selbstverteidigung. Auch die ständige Anwesenheit von Sicherheitsdiensten wurde zur Verminderung gewaltsamer Übergriffe auf Mitarbeiter durch Studienteilnehmer als sinnvoll erachtet. Um konkretere Aussagen treffen zu können, bedarf es weiterer prospektiver Multicenterstudien.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Massiver Informationsverlust bei Übergaben auf Intensivstation!
Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 84-85
DOI: 10.1055/a-0823-5728
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
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Post-operative Direct Healthcare Costs of Lumbar Discectomy are Reduced with the Use of a Novel Annular Closure Device in High-Risk Patients
Lumbar discectomy is a largely successful surgical procedure; however, reherniation rates in patients with large annular defects are as high as 27%. The expense associated with a revision surgery places significant burden on the healthcare system.
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The Challenge of Accurate Spinal Growth Assessment in the Treatment of Early Onset Scoliosis with Growth-Friendly Systems
All scoliosis treatments in children share the common goal of maximizing control of deformity progression while minimizing the risk of negative impact in the short and long-term. Early onset scoliosis (EOS), a rare collection of multiple scoliosis types (idiopathic, congenital, neuromuscular and syndromic) in children younger than 10 years of age, often with other diagnoses and comorbidities, presents certain challenges to treatment that can affect both morbidity and mortality [1-11]. While non-operative treatments like bracing or cast techniques are attractive in EOS, in that they offer potential control of deformity progression in a reasonably physiologic manner (by preserving growth, motion and function of the spine), they are often not effective or definitive.
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Clinical Features and Prognostic Factors of Pediatric Spine Giant Cell Tumors: report of 31 clinical cases in a single center
Giant cell tumors (GCTs) of the bone are benign but locally aggressive. Pediatric spine giant-cell tumors (PSGCTs) have been infrequently reported in the literature because of the rarity of the disease.
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Use of the Xi robotic platform for total abdominal colectomy: a step forward in minimally invasive colorectal surgery
Abstract
Background
The use of the da Vinci robotic platform for total colectomy has been limited by the need to reposition the patient-side surgical cart from one side of the patient to the other, which increases operative time. In this study, we examined the feasibility of robotic total colectomy using the da Vinci Xi model, which offers a rotating boom-mounted system and laser-targeted trocar positioning.
Methods
The study cohort consisted of 23 patients who underwent minimally invasive total colectomy for cancer or polyposis syndromes at a comprehensive cancer center between 2015 and 2017. Of the 23 colectomies, 15 were robotic and eight were laparoscopic. For the robotic colectomies, trocars were placed in the supraumbilical region and all four quadrants. The da Vinci Xi robot was placed between the patient's legs, and the boom was rotated from left to right and then to the middle in order to work sequentially on the right colon, the left colon, and the pelvis. Operating time and short-term outcomes were compared between the patients who underwent robotic surgery and the patients who underwent laparoscopic surgery.
Results
The two groups of patients were comparable in age, gender, BMI, physical status, and disease types. In the robotic group, median length of stay (4 vs. 6 days, p = 0.047) was significantly shorter and median operative time (243 vs. 263 min, p = 0.97) and median estimated blood loss (50 vs. 100 ml; p = 0.08) were similar between the groups.
Conclusions
With the da Vinci Xi boom-mounted system, total abdominal colectomy can be performed without the need to move the patient-side surgical cart and is associated with shorter length of stay and similar operative time compared to the laparoscopic approach.
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Diagnosis and treatment of gastric antral webs in pediatric patients
Abstract
Background
Gastric antral webs are mucosal structures, varying from fenestrated diaphragms to mucosal crescents, resulting in varying degrees of foregut obstruction. Patients commonly present with vomiting, failure to thrive, and abdominal pain. Prevalence is unknown, and diagnosis can be difficult.
Methods
We performed an IRB-approved retrospective review of patients from 4/1/2015–4/1/2018 at a Level I Children's Surgery Center undergoing gastric antral web resection. Data obtained included demographics, preoperative workup, surgical repair, and outcomes.
Results
Twenty-one patients were identified; 67% were male with an average age of 30 months at diagnosis. Initial diagnosis was established by a combination of fluoroscopy and esophagogastroduodenoscopy (EGD) in all patients. Patients presented with emesis (76%), failure to thrive (57%), need for post-pyloric tube feeds (33%), and abdominal pain (14%). Web localization without intraoperative EGD (n = 3) was initially challenging. As a result, intraoperative EGD was combined with operative antral web resection to facilitate web localization (n = 18). Web marking techniques have evolved from marking with suture (n = 1) and tattoo (n = 2), to endoscopic clip application (n = 12). All 21 patients underwent web resection, 2 were performed laparoscopically. Twenty underwent Heineke-Mikulicz pyloroplasty during the initial surgery. Average length of stay was 5.5 days. There were no intraoperative complications or deaths. Permanent symptom resolution occurred in 90% of patients immediately, with a statistically significant decrease in emesis (p < 0.001), failure to thrive (p < 0.001), and need for post-pyloric tube feeding (p = 0.009) within 6 months of surgery.
Conclusion
Gastric antral webs should be considered in the differential diagnosis for a child with persistent vomiting. Web resection with the use of intraoperative endoscopic localization can result in permanent symptom resolution in the majority of these patients.
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Retroperitoneoscopic partial nephrectomy in children: a multicentric international comparative study between lateral versus prone approach
Abstract
Background
Very limited informations are currently available about the best approach to perform retroperitoneoscopic surgery. This multicentric international study aimed to compare the outcome of lateral versus prone approach for retroperitoneoscopic partial nephrectomy (RPN) in children.
Methods
The records of 164 patients underwent RPN in 7 international centers of pediatric surgery over the last 5 years were retrospectively reviewed. Sixty-one patients (42 girls and 19 boys, average age 3.8 years) were operated using lateral approach (G1), whereas 103 patients (66 girls and 37 boys, average age 3.0 years) underwent prone RPN (G2). The two groups were compared in regard to operative time, postoperative outcome, postoperative complications, and re-operations.
Results
The average operative time was significantly shorter in G2 (99 min) compared to G1 (160 min) (p = 0.001). Only 2 lateral RPN required conversion to open surgery. There was no significant difference between the two groups as for intraoperative complications (G1:2/61, 3.3%; G2:6/103, 5.8%; p = 0.48), postoperative complications (G1:9/61, 14.7%; G2:17/103, 16.5%; p = 0.80), and re-operations (G1:2/61, 3.3%; G2:4/103, 3.8%; p = 0.85). Regarding postoperative complications, the incidence of symptomatic residual distal ureteric stumps (RDUS) was significantly higher in G2 (7/103, 6.8%) compared to G1 (1/61, 1.6%) (p = 0.001). Most re-operations (4/6, 66.6%) were performed to remove a RDUS .
Conclusions
Both lateral and prone approach are feasible and reasonably safe to perform RPN in children but the superiority of one approach over another is not still confirmed. Although prone technique resulted faster compared to lateral approach, the choice of the technique remains dependent on the surgeon's personal preference and experience. Our results would suggest that the lateral approach should be preferred to the prone technique when a longer ureterectomy is required, for example in cases of vesico-ureteral reflux into the affected kidney moiety, in order to avoid to leave a long ureteric stump that could become symptomatic and require a re-intervention.
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Peritoneal perforation during transanal endoscopic microsurgery is not associated with significant short-term complications
Abstract
Background
In patients treated by transanal endoscopic microsurgery (TEM), breach of the peritoneal cavity is a feared intraoperative challenge. Our aim is to analyze predictors and short-term outcomes of patients with peritoneal perforation (TEM-P) when compared to similar patients with no peritoneal compromise (TEM-N).
Methods
At St. Paul's Hospital, demographic, surgical, pathologic, and follow-up data for all patients treated by TEM is maintained in a prospectively populated database. A retrospective review was performed and two groups were established for comparison: TEM-P and TEM-N. Statistical analysis was performed using student's t or chi-squared test, where appropriate.
Results
Of 619 patients treated by TEM between 2007 and 2016, 39 (6%) patients were in the TEM-P group and 580 (94%) in the TEM-N group. There were no differences between the groups in patient age, gender, histology, or tumor size. Patients who had peritoneal perforations had more proximal lesions (11 vs. 7 cm, p < 0.0001), anterior lesions (56 vs. 43%, p < 0.05), and longer operations (80 vs. 51 min, p < 0.005). While most defects were closed endoluminally, 2 patients with perforation were converted to transabdominal surgery. There was a difference in overall hospital stay with TEM-P patients staying on average 2 days in hospital with fewer patients managed as day surgery (31 vs. 73%, p < 0.0001). There were no mortalities or significant 30-day complications in the TEM-P group and only one patient required readmission.
Conclusions
The St. Paul's Hospital TEM experience suggests patients with peritoneal breach during TEM can be safely managed with outcomes similar to patients without peritoneal entry. Proximal, anterior lesions are at highest risk of peritoneal perforation.
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Comparison of early experience of robotic and transanal total mesorectal excision using propensity score matching
Abstract
Background
Robotic surgery and transanal minimally invasive surgery are the two recently developed techniques, which can overcome the difficult pelvic dissection in conventional laparoscopy. This study aimed to compare the early cases of robotic and transanal total mesorectal excision (taTME) using propensity score matching.
Methods
The first 40 cases of taTME and the first 80 sphincter-saving robotic total mesorectal resection for rectal cancer were selected from the prospectively collected database. Using propensity score matching, the outcomes of 40 matched cases of robotic TME were compared with the 40 cases of taTME.
Results
Before matching, patients in the taTME group were significantly younger. The tumors were smaller but more distally located. Significantly more patients in the taTME group received preoperative chemoradiation. After matching, the two groups did not show any differences in gender, age, comorbidity, the level of tumors, and incidences of preoperative chemoradiation. The operating time was significantly shorter (254 vs. 170 min, p < 0.05) and the blood loss was less (50 vs. 150 ml, p = 0.002) in the taTME group. Conversion rate was 5% in both groups. There was no difference in the hospital stay, overall morbidity, the anastomotic leakage rate, and the urinary complication rate between the two groups. More patients in the taTME group did not require a separate abdominal incision. The distal margin, the number of lymph nodes examined, and the rate positive circumferential margin (0 vs. 5%, p = 0.494) were also similar between the two groups.
Conclusions
Both taTME and robotic surgery can achieve favorable outcomes in the rectal cancer resection. Comparison of the early experience of the two procedures with propensity score matching showed the taTME was associated with a shorter operating time, less blood loss, and a higher rate of transanal extraction of the specimen. Further evaluation by randomized trials is warranted.
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Concomitant ventral hernia repair and bariatric surgery: a retrospective analysis from a UK-based bariatric center
Abstract
Background
Ventral hernias (VH) are frequently encountered in patients with morbid obesity. Concomitant ventral hernia repair (VHR) and bariatric surgery (BS) is practiced but still controversial. Wound-related complications (seroma, hematoma, wound infection) and hernia recurrence rates are possible inhibitor factors. We aimed to estimate the rate of complications from concomitant BS (laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy) and VHR and identify patient subgroups at higher risk of complications from synchronous repair.
Methods
A retrospective analysis of successive 106 patients who underwent concomitant BS + VHR at our institute (09/2007 to 09/2015) was performed using data from patients' record. Parameters considered were: type of repair (open/laparoscopic and primary closure/mesh), size and type of hernia (< 5 cm, 5–10 cm, > 10 cm and primary/incisional), patient gender and comorbidities.
Results
One hundred and six patients underwent concomitant BS and VHR. Fifty-nine had laparoscopic VHR and 47 open. Hernias recurred in 5 (8.47%) laparoscopic and 7 (14.89%) open VHR. Wound-related complications were common in open (15%) vs. laparoscopic (11.7%) VHR. Patients with VH recurrence included 8 (75%) with defects > 5 cm, 10 (83%) female, and all had BMI > 45. Six patients had wound infection, 5 of which had type 2 diabetes mellitus. Six patients had hematoma, 5 of which underwent mesh repairs. Finally, four patients developed seroma (BMI > 48, defects > 5 cm, laparoscopic mesh repair).
Conclusion
Synchronous VHR and BS in a bariatric unit is feasible with low recurrence rate. Laparoscopic VHR has lower complication rates than open, apart from seroma formation. Patients with diabetes have higher risk of infection.
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Operating hurts: a study of EAES surgeons
Abstract
Background
Work-related pain and discomfort experienced by surgeons is widely reported in the literature. A survey was, therefore, conducted to explore this issue among members of the European Association for Endoscopic Surgery (EAES).
Methods
The survey was emailed to 2980 EAES members in 2017 enquiring about their working practice, musculoskeletal (MSK) pain and burnout.
Results
A total of 569 (19%) surgeons responded, of whom 556 were practicing surgeons; 86% were consultants, 84% were male, and 94% were right-handed. Respondents operated on average 3.3 days/week with 27% of their procedures lasting longer than 3 h. The 386 endoscopists surveyed reported performing an average of 5.3 procedures/day with 83% performing endoscopy at least once per week. Over half of practicing surgeons (62%) reported their worst pain score was 3 or higher (10-point scale) in the past 7 working days, encompassing 71% of their open, 72% laparoscopic, 48% robot-assisted cases and 52% of their endoscopies. Of the 120 surgeons who had ever sought medical help for aches, pain or discomfort, 38% were currently in pain and 16% had considered leaving surgery due to their MSK pain, 26% had reported work-related pain to their employer, 26% had been on short-term disability during their career and 4% long-term disability due to MSK disorders. A significant proportion of the respondents (49%) felt their physical discomfort would influence the ability to perform or assist with surgical procedures in the future. These surgeons reported significantly lower satisfaction from their work (p = 0.024), higher burnout (p = 0.005) and significantly higher callousness toward people (p < 0.001) than those not fearing loss of career longevity.
Conclusion
The results show that MSK pain is prevalent amongst EAES members. Nearly half the respondents had career longevity fears from pain/discomfort which, in turn, correlated with more prevalent feelings of burnout. More emphasis should be placed on the aetiology, prevention and management of musculoskeletal pain in the surgical workforce.
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Bile duct injuries (BDI) in the advanced laparoscopic cholecystectomy era
Abstract
Background
Laparoscopic cholecystectomy is the most commonly performed laparoscopic procedure. It is superior in nearly every regard compared to open cholecystectomies. The one significant aspect where the laparoscopic approach is inferior regards the association with bile duct injuries (BDI). The BDI rate with laparoscopic cholecystectomy is approximately 0.5%; nearly triple the rate compared to the open approach. We propose that 0.5% BDI rate with the laparoscopic approach is no longer accurate.
Methods
The National Surgical Quality Improvement Program (NSQIP) registry was retrospectively reviewed. All laparoscopic cholecystectomies performed between 2012 and 2016 were extracted. A total of 217,774 cases meeting inclusion criteria were analyzed. The primary data points were the overall BDI incidence rate and time of diagnosis. BDI were identified by ICD-9 and ICD-10 codes. Secondary data points were variables associated with BDI.
Results
The BDI rate was 0.19%. 77% of cases were diagnosed after the index surgical admission. Intra-operative cholangiography (IOC) use was associated with a higher BDI rate and higher identification rate of a BDI intraoperatively (P value < 0.0001). Resident teaching cases were protective with a RR score of 0.56 (P value < 0.0001). The presence of cholecystitis increased the risk of a BDI with a RR score of 1.20 (P value < 0.0001). There was a low conversion rate of 0.04% however converted cases had a nearly hundredfold increase in BDI at 15% (P value < 0.0001).
Conclusions
The performance of laparoscopic cholecystectomies in North America is no longer associated with higher BDI rates compared to open. IOC use still is not protective against BDI, and cholecystitis continues to be a risk factor for BDI. When a cholecystectomy requires conversion from a laparoscopic to an open approach the BDI increases a hundredfold; which may raise the concern if this approach is still a safe bailout method for a difficult laparoscopic dissection.
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Safety of laparoscopic hepatectomy in patients with hepatocellular carcinoma and portal hypertension: interim analysis of an open prospective study
Abstract
Background
The laparoscopic approach might increase the number of cirrhotic patients with hepatocellular carcinoma (HCC) indicated for liver resection, otherwise contraindicated due to portal hypertension. The goal of this study was to confirm the safety of laparoscopic liver resection (LLR) in patients with portal hypertension.
Methods
This prospective, single-center, open study (ClinicalTrials.gov ID: NCT02145013) included all consecutive cirrhotic patients who underwent LLR for HCC from 2014 to 2017. Short-term outcomes were compared between patients with and without clinically significant portal hypertension (CSPH, defined by hepatic venous pressure gradient ≥ 10 mmHg).
Results
The study population included 45 patients, comprising 27 patients (60%) in the no CSPH group and 18 patients (40%) in the CSPH group. All planned procedures could be performed. The two groups did not differ in the extent of resection, transfusion, duration of clamping, and need for conversion. Overall, the 90-day mortality and severe morbidity rates were nil. Moderate morbidity was significantly higher in the CSPH group (39 vs. 4%, p = 0.01); however, the two groups did not differ in the rate of unresolved liver decompensation. Intensive care unit and hospital stays were significantly longer in the CSPH group. At 2 years, overall survival was 77% in the no CSPH group and 100% in the CSPH group (p = 0.17), and recurrence-free survival was 55% in the no CSPH group and 79% in the CSPH group (p = 0.10).
Conclusion
LLR is safe in BCLC 0-A patients with CSPH, with no mortality and good short-term outcomes. Re-evaluation of the BCLC guidelines is needed.
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Correction to: Facilitating endoscopic submucosal dissection: double balloon endolumenal platform significantly improves dissection time compared with conventional technique (with video)
Gerd Silberhumer's name was misspelled in the original publication; it is correct as displayed here.
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Comparison of impacts of intraperitoneal saline instillation with and without pulmonary recruitment maneuver on post-laparoscopic shoulder pain prevention: a randomized controlled trial
Abstract
Background
Intraperitoneal isotonic saline instillation (SI) and pulmonary recruitment maneuver (RM) were indicated to alleviate post-laparoscopic shoulder pain (PLSP) effectively. The aim of this study was to compare the effects of the single strategy using SI alone and the combined strategy using SI and RM on PLSP reduction.
Methods
Subjects undergoing elective gynecologic laparoscopy were randomly allocated to a control group (no intervention, n = 48) and two intervention groups (single strategy of SI alone, n = 48; combined strategy of SI and RM, n = 48). In the control group, carbon dioxide was removed only via passive evacuation through the port sites at the completion of the laparoscopic procedure. In the saline instillation group, 20-mL/kg of body weight SI was performed. In the combined strategy group, RM using five pulmonary inflations was performed, in addition to SI. The PLSP scores, which were the primary outcome, were recorded using a visual analog scale postoperatively.
Results
The PLSP scores 24 and 48 h after surgery were significantly lower in the two intervention groups than in the control group (P = 0.014 and P = 0.001, respectively), while no significant differences were observed between the two intervention groups.
Conclusions
The single strategy using SI alone is as effective as the combined strategy of SI and RM for removing residual carbon dioxide and consequently preventing PLSP. Therefore, considering the potential risks of pulmonary or hemodynamic complications associated with RM, the single strategy using SI alone might be a better choice than the combined strategy.
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Clinicopathological characteristics of patients with pain after endoscopic submucosal dissection for gastric epithelial neoplasm
Abstract
Background
Endoscopic submucosal dissection (ESD) is widely used for large superficial gastrointestinal tumors. Epigastric pain is a frequent complication of ESD. However, little is known about its incidence and associated factors. This study evaluated pain incidence and characteristics of patients with pain after gastric ESD.
Methods
We retrospectively analyzed a prospectively collected registry of clinical, endoscopic, and pathologic results of patients who underwent ESD for gastric adenoma or cancer from January 2010 to December 2015. A Visual Analogue Scale (VAS) was used to assess pain immediately after, and 2, 12, and 24 h after ESD. The primary outcome was the use of painkillers (VAS score > 4). Analyzed data included age, sex, pathology, specimen and tumor size, procedure time, and tumor location.
Results
Of 1226 patients, 461 (36.4%) needed a painkiller at least once after ESD (pain group). Compared with the no pain group, the pain group had more females, less alcohol consumption, larger tumor and specimen size, and more antral lesions. In multivariate analysis, female sex (OR 1.559, 95% CI 1.217–1.996, p < 0.001), antral tumor location (OR 1.780, 95% CI 1.398–2.265, p < 0.001), and procedure time over 30 min (OR 1.443, 95% CI 1.130–1.842, p = 0.003) were predictive factors for pain.
Conclusion
This study showed that a considerable number of patients needed one or more painkiller doses after gastric ESD. The factors affecting pain included sex, procedure time, and lesion location. Endoscopists should use preemptive or aggressive pain management in high-risk patients after ESD.
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Assessing variation in technique for sleeve gastrectomy based on outcomes of surgeons ranked by safety and efficacy: a video-based study
Abstract
Background
Considerable technical variation exists when performing laparoscopic sleeve gastrectomy (LSG). However, little is known about which techniques are associated with optimal outcomes.
Objective
To compare technical variation among surgeons with the lowest complication rates and whose patients achieved the most weight loss.
Methods
Practicing bariatric surgeons (n = 30) voluntarily submitted a video of a typical LSG performed between 2015 and 2016. Technique-specific data captured from videos and a questionnaire included bougie size, stapler vendor, number of staple loads, use of staple line reinforcement, fibrin sealant, intraoperative leak test, endoscopy, and drain placement. Surgeon-specific outcomes were obtained from cases performed by surgeons during the study period (n = 7023) using a state-wide bariatric-specific data registry. Surgeons were ranked based on 30-day risk-adjusted surgical complication rates ("safety") and excess body weight loss (EBWL) % ("efficacy") at 1 year after surgery. Technique-specific variables were compared between surgeons ranked in the top and bottom quartile for both safety and efficacy.
Results
Surgical complication rates ranged from 0 to 4.32% while EBWL varied from 45.3 to 65.3%. There was no correlation between surgeon rankings for safety and efficacy (Pearson's r = 0.063, p = 0.741). Surgeons ranked in the top quartile for safety and efficacy had significantly shorter mean operative times than surgeons ranked in the bottom quartile (65 min vs. 69 min, p < 0.0001). Surgeons with the highest leak rates were more likely to use buttressing (85.7% vs 40.0%, p = 0.032), otherwise operative techniques varied considerably.
Conclusions
Technical variation appears to have minimal effect on the safety or efficacy of sleeve gastrectomy among surgeons participating in a state-wide quality improvement collaborative. Top ranked surgeons did have faster mean operative times indicating that there may be other metrics of technical quality that correlate to optimal outcomes.
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Laparoscopic versus open resection of gastrointestinal stromal tumors: survival outcomes from the NCDB
Abstract
Background
Studies comparing laparoscopic versus open resection of gastrointestinal stromal tumors (GIST) typically involve small comparative groups and often do not control for tumor size or stage of disease. The objective of this study was to compare adjusted survival outcomes for laparoscopic versus open GIST.
Method
The National Cancer Database (NCDB) from 2010 to 2014 was evaluated for gastric and small intestinal GIST resections. After stratification by disease stage and adjustment for patient demographics, comorbidity score, tumor size, and tumor location, 90-day mortality rates were compared based on laparoscopic versus open resection. Kaplan–Meier estimates of long-term survival were also compared. A Cox proportional hazards model was used to determine hazard ratios (HR) for survival.
Results
There were 5096 cases analyzed, including 2910 (57%) stage I, 954 (19%) stage II, and 1232 (24%) stage III cases. The distribution of laparoscopic versus open cases was 1291 (44%) versus 1619 (56%) for stage I, 318 (33%) versus 636 (67%) for stage II, and 286 (23%) versus 946 (77%) for stage III. There was no significant difference in adjusted 90-day mortality between laparoscopic and open resection. Kaplan–Meier estimates of long-term survival demonstrated improved overall survival curves for laparoscopic resection for stage I and stage II disease, but no significant difference for stage III disease. Factors associated with statistically significant higher adjusted overall mortality included older age (HR 1.06; p < 0.001), black race (HR 1.33; p = 0.04), higher comorbidity score (HR 1.47; p < 0.001), and small intestinal versus gastric tumor location (HR 1.28; p = 0.03). The hazards model suggested improved overall survival for females (HR 0.59; p < 0.001) and laparoscopic approach (HR 0.80; p = 0.06).
Conclusion
Laparoscopic and open GIST resection have comparable 90-day mortality with possible improved long-term survival with laparoscopy for early-stage disease. These findings support the use of laparoscopy as a viable and potentially more effective approach to GIST resection.
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Sclerotherapy needle injections can expand the subserosal and muscularis propria layers and cause a stable mucosal lift in ESD/EMR patients
Abstract
Background
A mucosal lift is needed for ESD and EMR. Most lifts are made via sclerotherapy needle injection. The firm push needed to penetrate the mucosa often leaves the needle tip in the deep wall. The needle is next withdrawn and fluid injected until a sharp lift (due to submucosal expansion) begins to form; the needle is then held steady and the injection finished. The initial injection may result in a subtle deep lift that resolves quickly. It was the authors' belief that only submucosal expansion could lead to a stable mucosal lift. A colonic ESD case in which a polyp was inadvertently resected via needle knife in an expanded subserosal plane led to a questioning of this position. This study's purpose was to determine if stable deep wall mucosal lifts can be generated via bowel wall injection.
Methods
Transmucosal and intramural injections into bovine large bowel were carried out. Stable lifts and lift cross sections were made and examined grossly and histologically to determine the location of the lift fluid. Clinical ESD videos were also reviewed.
Results
Over 200 intact and cross-sectioned lifts were assessed. Gross inspection revealed two types of lifts (superficial and deep), whereas cross sections and histologic analyses revealed examples of stable expansion of the submucosal, muscularis propria, and subserosal layers post injection. Clinical "deep" lifts were also found. Superficial lifts are more focal and taller, whereas deep wall lifts are broader and less prominent.
Conclusion
Stable deep wall mucosal lifts occur and are likely due to the deep starting point of the needle post insertion. If ESD/EMR are attempted with a deep lift, the chances of failure or perforation are high. Lifts must be carefully scrutinized before starting ESD/EMR. Other means of lift establishment should be evaluated and considered.
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Near-infrared fluorescence laparoscopy of the ureter with three preclinical dyes in a pig model
Abstract
Background
Ureteric injury is reported to occur in 1–7.6% of colorectal surgeries. To reduce the incidence of ureteral injury, it is essential to identify the ureters. The use of near-infrared fluorescence (NIRF) imaging with intravenously administered dyes might be of added value for ureteral visualization during laparoscopy. The aim of this study is to assess the performance of three preclinical dyes; IRDye® 800BK, IRDye® 800NOS and IRDye® 800CW, for near-infrared fluorescence laparoscopy of the ureter in pigs.
Methods
In three female Dutch landrace pigs, the new dyes were evaluated. In each pig, 1 dye was tested using a 6-mg intravenous dose in a concentration of 1 mg/ml. Imaging was performed in fluorescence mode and white light mode with a laparoscopic imaging system. In order to further evaluate the dyes, an ex vivo imaging experiment was performed, in which 8 decreasing concentrations per dye, diluted in PBS, were evaluated in a transparent test tube with NIRF mode at a distance of 1, 5 and 10 cm from the laparoscope.
Results
All three dyes were effective in allowing the identification of the ureter with NIRF imaging. The ureter became fluorescent after 35, 45 and 10 min, respectively, for IRDye® 800BK, IRDye® 800NOS and IRDye® 800CW with a maximum target-to-background ratio (TBR) of 2.14, 0.66 and 1.44, respectively. In the ex vivo imaging experiment, all three dyes produced a strong fluorescence signal at all concentrations and all distances evaluated.
Conclusions
Intravenous administration of the preclinical dyes IRDye® 800CW, IRDye® 800 BK and IRDye® 800NOS facilitated successful identification of the anatomical course of the ureter in living pig models. The highest measured TBR occurred with the use of IRDye® 800BK. Ex vivo, a correlation was observed between the fluorescence intensities of the signal with the concentration of the dye and with the distance to the object.
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Developing minimally invasive procedure quality metrics: one step at a time
Abstract
Background
Despite extensive first-hand surgical experience, rank and file members of surgical societies are generally not trained in and have not therefore been included in surgical quality measure development. The purpose of this exercise was to determine if a structured quality metric design tool could bridge this gap, facilitating rapid development of focused quality metrics by minimally invasive surgeon attendees of the April 2018 SAGES Annual Meeting.
Methods
Expert minimally invasive surgeons attended a 90-min workshop with didactic and interactive quality metric design sessions during the Annual Meeting. The interactive portion was formed around a novel structured quality measure development tool that graded presenting symptoms, short-term complications, and long-term disutility of care.
Results
For first-time symptomatic inguinal hernia repair, first-time small to moderate size ventral hernia repair, and elective laparoscopic cholecystectomy, each workgroup was able to develop one quality, one short-term complication, and one long-term disutility metric.
Conclusions
A structured quality metric design tool facilitates application of knowledge through rapid development of multifaceted, patient-centric outcomes measures by expert minimally invasive surgeons, otherwise not formally trained in metric development. The exercise also highlighted the need to rigorously define denominator populations and to guard against metric-driven undertreatment.
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A minimally invasive approach for peritonectomy procedures and hyperthermic intraperitoneal chemotherapy (HIPEC) in limited peritoneal carcinomatosis: The American Society of Peritoneal Surface Malignancies (ASPSM) multi-institution analysis
Abstract
Background
Minimally invasive surgery is playing an increasing role in the treatment of patients with gastrointestinal and gynaecological malignancies as the data show reduced morbidity, faster recovery and similar oncological outcome when compared to open procedures.
Materials and methods
The American Society of Peritoneal Surface Malignancies (ASPSM) conducted a retrospective study to analyse peritonectomy procedures and HIPEC done via the laparoscopic route. A database with standard clinical and pathological parameters was set up and distributed amongst ASPSM members. Rate of relapse, morbidity and mortality were the primary endpoints of the study.
Results
A total of 90 patients from 7 centres around the world were identified. Sixty percent were female. Mean age was 50 years. Peritoneal carcinomatosis from appendiceal origin was the most common diagnosis in a 64.9% of patients and colon origin was diagnosed in 16.5% of patients. Mean peritoneal cancer index (PCI) was 4.1 (0–10). Forty-one percent of patients had a bowel resection. Mean operative time was 4.7 h (2.5–8). All patients had a complete cytoreduction and HIPEC. Grade 3 and 4 morbidity was 3.0 and 6.5%, respectively. The most common reason for re-operation was an internal hernia in 2 out of 5 cases. Operative mortality and re-admission rates were 0 and 5%, respectively. Mean hospital stay was 7.4 days (1–18). At a mean follow-up of 31.6 months, 15/90 patients have a disease relapse but loco-regional relapse was identified in only five patients.
Conclusions
Analysis of these data suggests that minimally invasive approach for peritonectomy procedures and HIPEC is feasible, safe and should be considered as part of the armamentarium for highly selected patients with peritoneal surface malignancies with limited tumour burden, defined as PCI of 10 or less and borderline tumours as low-grade pseudomyxoma and benign multicystic mesothelioma.
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Laparoscopic pyloroplasty versus endoscopic per-oral pyloromyotomy for the treatment of gastroparesis
Abstract
Background
Gastroparesis is a debilitating functional disorder of the stomach characterized by delayed gastric emptying absent an obstructive etiology. Surgical or endoscopic disruption of the pylorus has been utilized to treat this disease, but there is little evidence comparing laparoscopic pyloroplasty (LP) with endoscopic per-oral pyloromyotomy (POP). Herein we describe our experience at our institution using a propensity-matched cohort study to compare outcomes between these procedures.
Methods
All patients who underwent LP for the treatment of gastroparesis from October 2014 through September 2017 at our institution were retrospectively reviewed. Propensity scoring was used to match these patients 1:1 to patients undergoing POP during this time period based on gender, age, and etiology of gastroparesis. Symptom scores using the Gastroparesis Cardinal Symptom Index (GCSI), scintigraphic gastric emptying studies (GES), and perioperative outcomes were compared between matched cohorts. Thirty patients underwent LP for gastroparesis during the study period which were matched 1:1 with patients undergoing POP. The etiology of gastroparesis was 63.3% idiopathic (n = 19), 20.0% post-surgical (n = 6), and 16.7% diabetic (n = 5) in both cohorts.
Results
Patients who underwent LP had a longer average length of stay (4.6 vs. 1.4 days, p = 0.003), operative time (99.3 vs. 33.9 min, p < 0.001), and estimated blood loss (12.9 vs. 0.4 mL, p < 0.001). There were more complications in the LP cohort (16.7 vs. 3.3%, p = 0.086), which included surgical site infection (6.7 vs. 0%, p = 0.153), pneumonia (6.7 vs. 0.0%, p = 0.153), and unplanned ICU admission (10.0 vs. 0.0%, p = 0.078). LP and POP both resulted in similar, significant improvements in both in GCSI scores and objective gastric emptying.
Conclusions
Per-oral endoscopic pyloromyotomy (POP) is safe and effective for the treatment of medical refractory gastroparesis. POP has less perioperative morbidity compared to LP with comparative functional outcomes.
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Predicting venous thromboembolism following laparoscopic bariatric surgery: development of the BariClot tool using the MBSAQIP database
Abstract
Background
Bariatric surgery is an effective treatment for severe obesity; however, postoperative venous thromboembolism (VTE) remains a leading cause of morbidity and mortality. The objective of this study is to develop a tool to stratify individuals undergoing laparoscopic bariatric surgery according to their 30-day VTE risk.
Methods
This is a retrospective cohort study of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. This registry collects data specific for metabolic or bariatric surgery with 30-day outcomes from 791 centers. Individuals undergoing primary laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) were included. Characteristics associated with 30-day VTE were identified using univariate and multivariable analyses. A predictive model, BariClot, was derived from a randomly-generated derivation cohort using a forward selection algorithm. BariClot's robustness was tested against a validation cohort of subjects not included in the derivation cohort. The calibration and discrimination of two previously published VTE risk tools were assessed in the MBSAQIP population and compared to BariClot.
Results
A total of 274,221 patients underwent LRYGB or LSG. Overall, 1106 (0.4%) patients developed VTE, 452 (0.2%) developed pulmonary embolism, and 43 (0.02%) died due to VTE. VTE was the most commonly identified cause of 30-day mortality. A prediction model to assess for risk of VTE, BariClot, was derived and validated. BariClot consists of history of VTE, operative time, race, and functional status. It stratifies individuals into very high (> 2%), high (1–2%), medium (0.3–1%), and low risk groups (< 0.3%). This model accurately predicted events in the validation cohort and outperformed previously published scoring systems.
Conclusions
BariClot is a predictive tool that stratifies individuals undergoing bariatric surgery based on 30-day VTE risk. Stratifying low- and high-risk populations for VTE allows for informed clinical decision-making and potentially enables further research on customized prophylactic measures for low- and high-risk populations.
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Make EMS Week a year round celebration
Instead of relegating celebration to a single week of May consider how to recognize the accomplishments of EMS all year long.
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Prevalence and Correlates of Injecting with Visitors from the United States Among People Who Inject Drugs in Tijuana, Mexico
Abstract
Cross-border infectious disease transmission is a concern related to drug tourism from the U.S. to Mexico. We assessed this risk among people who inject drugs (PWID) in Tijuana, Mexico. We measured the prevalence and identified correlates of injecting with PWID visiting from the U.S. among PWID in Tijuana using univariable and multivariable logistic regression. Of 727 participants, 18.5% injected during the past 6 months in Mexico with U.S. PWID described mostly as friends (63%) or acquaintances (26%). Injecting with U.S. PWID was independently associated with higher education [adjusted odds ratio (aOR) = 1.13/year], deportation from the U.S. (aOR = 1.70), younger age at first injection (aOR = 0.96/year), more lifetime overdoses (aOR = 1.08), and, in the past 6 months, backloading (aOR = 4.00), syringe confiscation by the police (aOR = 3.02) and paying for sex (aOR = 2.98; all p-values < 0.05). Nearly one-fifth of PWID in Tijuana recently injected with U.S. PWID, and their reported risk behaviors could facilitate cross-border disease transmission.
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A new rapid protocol for 226Ra separation and preconcentration in natural water samples using molecular recognition technology for ICP-MS analysis
Publication date: June 2019
Source: Journal of Environmental Radioactivity, Volume 202
Author(s): M. Verlinde, J. Gorny, G. Montavon, S. Khalfallah, B. Boulet, C. Augeray, D. Larivière, C. Dalencourt, A. Gourgiotis
Abstract
A new rapid protocol for 226Ra separation and preconcentration in natural water samples was developed before its determination by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). For this purpose, the commercially available Ra specific resin AnaLig® Ra-01 was used. This resin shows a high selectivity for radium in a large range of acid concentrations and no affinity or possible elution of 226Ra interfering elements. The distribution coefficients of Ra and other elements over a wide range of acid (HCl and HNO3) concentrations were obtained. Due to the high radium selectivity, the new developed protocol uses only 50 mg of dry resin and its performance was evaluated using 100 mL of three natural waters with different ionic strengths, spiked with a known quantity of 226Ra. Radium was successfully separated and preconcentrated yielding recoveries ranging between 72% and 86%. In parallel with the characterisation of the resin sorption properties, a detailed study of polyatomic interferences was performed on our ICP-MS allowing to identify the prominent elements favouring interferences at m/z = 226. Furthermore, a 226Ra sensitivity comparison between different ICP-MS instruments and configurations was done in order to determine high sensitivity conditions for radium analysis.
Graphical abstract
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Field evidence of significant effects of radiation on wildlife at chronic low dose rates is weak and often misleading. A comment on “Is non-human species radiosensitivity in the lab a good indicator of that in the field? Making the comparison more robust” by Beaugelin-Seiller et al
Publication date: Available online 14 February 2019
Source: Journal of Environmental Radioactivity
Author(s): Jim Smith
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Sensitivity and reliability of cerebral oxygenation responses to postural changes measured with near-infrared spectroscopy
Abstract
Purpose
Cerebral oxygenation as measured by near-infrared spectroscopy (NIRS) might be useful to discriminate between physiological and pathological responses after standing up in individuals with orthostatic hypotension. This study addressed the physiological sensitivity of the cerebral oxygenation responses as measured by NIRS to different types and speeds of postural changes in healthy adults and assessed the reliability of these responses.
Methods
Cerebral oxygenated hemoglobin (O2Hb), deoxygenated hemoglobin (HHb) and tissue saturation index (TSI) were measured bilaterally on the forehead of 15 healthy individuals (12 male, age range 18–27) using NIRS. Participants performed three repeats of sit to stand, and slow and rapid supine to stand movements. Responses were defined as the difference between mean, minimum and maximum O2Hb, HHb and TSI values after standing up and baseline. Test–retest, interobserver and intersensor reliabilities were addressed using intraclass correlation coefficients (ICCs).
Results
The minimum O2Hb response was most sensitive to postural changes and showed significant differences (− 4.09 µmol/L, p < 0.001) between standing up from sitting and supine position, but not between standing up at different speeds (− 0.31 µmol/L, p = 0.70). The minimum O2Hb response was the most reliable parameter (ICC > 0.6).
Conclusions
In healthy individuals, NIRS-based cerebral oxygenation parameters are sensitive to postural change and discriminate between standing up from supine and sitting position with minimum O2Hb response as the most sensitive and reliable parameter. The results underpin the potential value for future clinical use of NIRS in individuals with orthostatic hypotension.
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Role of phase angle in the evaluation of effect of an immuno-enhanced formula in post-surgical cancer patients: a randomized clinical trial
OBJECTIVE: Neoplastic disease is frequently associated with poor nutritional status or severe malnutrition. Diet and nutritional intervention are becoming increasingly important for prognosis and quality of life in cancer patients. Accessible and repeatable tools for assessing nutritional status with body composition techniques seems to be fundamental. The aim of this study was to evaluate the effects of immunonutrition on body composition parameters, inflammatory response and nutritional status in patients at stage III of head and neck squamous carcinoma (HNSCC).
PATIENTS AND METHODS: In our work, 50 malnourished subjects with HNSCC staging III were recruited and treated with oral diet (OD) or enteral nutrition (EN). Patient under EN followed, for the first three days, enteral standard nutrition (ESN) and then enteral immunonutrition (EIN). Nutrition state was evaluated on days 0, 3, and 8 through body composition and biochemical analyses.
RESULTS: After 8 days, the EIN treatment showed a significant improvement in phase angle, pre-albumin, retinol binding protein and transferrin compared to the OD treatment.
CONCLUSIONS: Our results showed that immunonutrition treatment improves the nutritional status of neoplastic patients, supporting chemotherapy. The phase angle is not only a predictor of cancer survival, but has also proved to be useful in the surveillance of nutritional status improvement as well as biochemical indices.
L'articolo Role of phase angle in the evaluation of effect of an immuno-enhanced formula in post-surgical cancer patients: a randomized clinical trial sembra essere il primo su European Review.
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Taste, olfactory and texture related genes and food choices: Implications on health status
OBJECTIVE: The food choices are due to a mixture of sensory signals including gustatory, olfactory, and texture sensations. The aim of this quality review was to update data about studies concerning genetics of taste, olfactory and texture receptors and their influence on the health status in humans.
MATERIALS AND METHODS: An electronic search was conducted in MEDLINE, Pubmed database and Scopus, for articles published in English until December 2018. Two independent researches selected the studies and extracted the data.
RESULTS: The review confirms the importance of inter-individual variations in taste, olfactory and texture related genes on food choices and their implications in the susceptibility to nutrition-related conditions such as obesity, dental caries, diabetes, cardiovascular disease, hypertension, hyperlipidemia and cancer.
CONCLUSIONS: The knowledge of variants in taste, olfactory and texture related genes can contribute to the prevention of diseases related to unhealthy nutrition. Further studies would be useful to identify other variants in the genes involved in these systems.
L'articolo Taste, olfactory and texture related genes and food choices: Implications on health status sembra essere il primo su European Review.
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Impact of Peppermint Therapy on Dysphagia and Non-cardiac Chest Pain: A Pilot Study
Abstract
Background
Due to its smooth muscle relaxing properties, peppermint oil (PO) may relieve dysphagia and chest pain due to esophageal motility disorders.
Aim
To explore the impact of PO on dysphagia and/or chest pain in patients referred for motility testing.
Methods
Patients initiated on PO for dysphagia and/or chest pain from 2013 to 2016 were identified. We excluded patients with obstructing esophageal lesions, patients lost to follow-up, and those with preexisting cardiac conditions. Concentrated PO was given as commercially available dissolvable peppermint tablets; two tablets before meals were prescribed to patients with dysphagia and on an as-needed basis for patients with chest pain. Patient-reported symptom response was assessed using a modified five-point Likert scale.
Results
Thirty-eight patients were included. Twenty-four patients (63%) reported improvement; 12 were much better and 12 were slightly better. Fourteen experienced no change and none reported feeling worse. Based on pre-treatment HRM, patients with distal esophageal spasm (DES) (n = 10) and esophagogastric junction outflow obstruction (EGJOO) (n = 8) appeared to demonstrate the best subjective improvement (83% and 100%, respectively) (P < 0.05).
Conclusion
PO appears to provide symptomatic relief in some patients with dysphagia and CP. Presence of a well-defined manometric disorder, particularly DES or EGJOO, appeared to predict response.
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Motor unit action potential amplitudes and firing rates during repetitive muscle actions of the first dorsal interosseous in children and adults
Abstract
Purpose
Previous research has indicated greater muscle activation is needed for children (CH) to match relative intensity submaximal contractions in comparison with adults (AD). However, no study has compared motor unit (MU) firing and recruitment patterns between children and adults. Therefore, MU action potential amplitudes (MUAPAMP) and firing rates were examined during two repetitive submaximal contractions of the first dorsal interosseous in children and adults.
Methods
Twenty-two children (age 9.0 ± 0.8 years) and 13 adults (age 22.9 ± 4.8 years) completed three maximum voluntary contractions (MVC) and two repetitive isometric contractions at 30% MVC for 40 s. Surface electromyography (EMG) was recorded and decomposed into action potential trains. MUAPAMPS, recruitment thresholds (RTs), and mean firing rates (MFRs) were calculated, and EMG amplitude was normalized (N-EMG) to MVC. For each subject and repetition, linear MFR vs. RT and exponential MUAPAMP vs. RT and MFR vs. MUAPAMP relationships were calculated.
Results
N-EMG (P = 0.001, CH = 56.5 ± 31.7%, AD = 30.3 ± 9.1%), MFRs regardless of RT, according to greater y-intercepts of the MFR vs. RT relationships [P = 0.013, CH = 31.1 ± 5.1 pulses per second (pps), AD = 25.9 ± 4.3 pps] and MFRs of MUs with smaller action potential amplitudes (P = 0.017, CH = 29.4 ± 6.8 pps, AD = 23.5 ± 3.5 pps), were greater for children. MUAPAMPS in relation with RT were similar between groups except the highest threshold MUs (RT = 28% MVC) were greater for the adults (1.02 ± 0.43 mV) than children (0.67 ± 0.24 mV) (P = 0.010).
Conclusions
Muscle activation and MU firing rates were greater for children, which likely indicated a greater operating point of MU control in comparison with adults during an isometric contraction performed at a relative submaximal intensity.
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Mutations in IFT80 cause SRPS Type IV. Report of two families and review
We report novel causative mutations in the IFT80 gene identified in four fetuses from two unrelated families with Beemer‐Langer syndrome (BLS) or BLS‐like phenotypes. We discuss the implication of the IFT80 gene in ciliopathies, and its diagnostic value for BLS among other SRPS.
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Obituary for Dr Kester Brown 9/12/1935 – 14/11/2018
Abstract
Kester Brown was a giant of paediatric anaesthesia on whose shoulders so many of us stood. In the spirit of his valuing the importance of publishing as a key tool for others to benefit from his clinical, educational, research or administrative ideas, Kester summarised and published the story of his life and his philosophy. That story, not surprisingly, required two parallel volumes.
This article is protected by copyright. All rights reserved.
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Gut microbiota diversity associates with cardiorespiratory fitness in post‐primary treatment breast cancer survivors
New Findings
What is the central question of this study?
Does the link between cardiorespiratory fitness and gut microbiota diversity persist after adjusting for the potential effects of %body fat and activity‐related energy expenditure (AEE)?
What is the main finding and its importance?
This is the first study to examine the link between cardiorespiratory fitness and gut microbiota diversity while accounting for the underlying effects of %body fat and free‐living AEE. Results from the present work suggest cardiorespiratory fitness, not physical activity, is a superior correlate of gut microbiota diversity among post‐primary treatment, non‐metastatic breast cancer survivors.
Abstract
Cancer treatment uniquely triggers multiple physiologic shifts detrimental to overall health. Though previous research indicates a link between gut microbiota and cardiorespiratory fitness, it is unclear whether these findings are due to potential underlying effects %body fat or free‐living activity energy expenditure (AEE). Microbe composition of fecal specimens from 37 breast cancer survivors were determined using 16S microbiome analyses. Individual‐sample microbiota diversity (α‐diversity) and between‐sample community differences (β‐diversity) were examined. Peak oxygen uptake (V̇O2peak) was estimated from a graded exercise test (GXT) consistent with the modified‐Naughton protocol, in which, exercise terminates at 85% age‐predicted heart rate max (HRmax). AEE was measured over 10‐days using doubly‐labeled water wherein %body fat was calculated from total body water. Pearson correlations revealed α‐diversity indices (Chao1, Observed Species, PD Whole Tree, Shannon) positively associated with V̇O2peak (r = 0.34 to 0.51; p < 0.05) whereas %HRmax during Stages 1–4 of the GXT (r = ‐0.34 to ‐0.50; p < 0.05) and %body fat (r = ‐0.32 to ‐0.41; p < 0.05) were negatively associated with the same α‐diversity indices. Multiple linear regression models showed V̇O2peak accounted for 22% and 26% of the variance in taxonomic richness (Observed Species) and phylogenic diversity after adjustment for %body fat and menopausal status. Unweighted UniFrac (β‐diversity) was significant for several outcomes involving cardiorespiratory fitness and significant taxa comparisons were found. Associations between gut microbiota and free‐living AEE were not found. Results from the present work suggest cardiorespiratory fitness, not physical activity, is a superior correlate of gut microbiota diversity.
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Update on the Diagnosis and Management of Gastric Intestinal Metaplasia in the USA
Abstract
Gastric intestinal metaplasia (GIM) is a premalignant condition that can lead to intestinal-type gastric adenocarcinoma. It is characterized by a change in the gastric mucosa to a small-intestinal phenotype. Infection with Helicobacter pylori is the most common factor associated with GIM. Although GIM is typically a histologic diagnosis, various techniques have been developed to enable the endoscopic identification of GIM. There are presently no widely accepted guidelines on screening and surveillance strategies in patients with GIM in the USA. The aim of this review is to provide an update regarding the problem, diagnosis, and management of GIM in the USA.
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Acute Exercise Prevents Angry Mood Induction but Does Not Change Angry Emotions
Introduction Exercise is well-known to enhance a variety of mood states, but few studies have been specifically designed to investigate whether acute aerobic exercise alters feelings of anger. The goal of this study was to determine the magnitude of the effects of acute exercise on both angry mood and angry emotions. Methods Angry mood and angry emotions were assessed in 16 men with elevated trait anger who viewed a variety of emotionally evocative scenic pictures before and after 30 minutes of moderate-to-vigorous intensity aerobic exercise. Angry mood, captured by self-reports of state anger, as well as angry emotions, as indexed by event-related brain activity (e.g., EPN, and the LPP), and self-reports of anger intensity, were measured. Results The results indicate that acute exercise both 1) reduces angry mood and 2) mitigates angry mood induction, but does not change the intensity of angry emotions or the associated ERP responses to anger-inducing pictures in college-aged men who have elevated trait-anger. Conclusion Future studies should explore the mechanisms underlying the effect of exercise on preventing angry mood induction, consider alternative anger-induction methods that might induce higher levels of angry emotions, and test the effects of chronic exercise training on anger and its expression. Author Correspondence: Nathaniel J Thom, Department of Biology, Wheaton College, Wheaton, IL 60187. Nate.thom@wheaton.edu. 630-752-7112 Conflicts of Interest and Source Funding: The authors declare no conflicts of interest. This work was partially supported by the G.W. Aldeen Memorial Fund and the Summer Research in Residence program at Wheaton College. In addition, the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation, and do not constitute endorsement by ACSM. Submitted for publication August 2018. Accepted for publication January 2019. © 2019 American College of Sports Medicine
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Cerebral Blood Flow during Interval and Continuous Exercise in Young and Old Men
Purpose Ageing is associated with impaired cerebral blood flow (CBF) and increased risk of cerebrovascular disease. Acute increases in CBF during exercise may initiate improvements in cerebrovascular health, but the CBF response is diminished during continuous exercise in older adults. The effect of interval exercise for promoting increases in CBF in young and old adults is unknown. Methods We compared middle cerebral artery blood velocity (MCAv), end-tidal CO2 (PETCO2) and blood pressure (MAP) during intensity- and work-matched bouts of continuous (10-min 60%Wmax, followed by 10-min rest) and interval cycling (10x1-min 60%Wmax, separated by 1-min rest) in 11 young (25±3y) and 10 old (69±3y) men. Results MCAv was higher during continuous compared with interval exercise in the young (p
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Predicting Energy Expenditure of an Acute Resistance Exercise
Energy expenditure of resistance exercise (RE) is an important consideration for exercise prescription and weight management, yet prediction models are lacking. Purpose To develop regression equations to predict energy expenditure (kcal) for RE involving each major muscle group using commonly measured demographic and exercise variables as predictors. Methods Fifty-two healthy, active subjects (27 men, 25 women, age 20-58 years, height 174.1 ± 10.5 cm, weight 188.7 ± 42.6 kg, VO2max 36.8 ± 9.2 ml/kg/min) were strength tested to estimate their 1-repetition max (1RM) one week prior to their experimental RE bout. The experimental RE bout consisted of a warm-up set followed by 2-3 sets (2-min turnover) of 8-12 reps at 60-70% of predicted 1 repetition max for leg press, chest press, leg curl, lat pull, leg extension, triceps push down, biceps curl. Kcals were estimated from VO2 measured continuously throughout the RE bout via an automated metabolic cart. Total exercise volume (TV) was calculated as sets*reps*weight lifted. Multiple Linear Regression (Stepwise Removal) was used to determine the best model (highest adjusted R2) to predict the kcal consumption of the total workout and of the individual RE lifts. Results The derived regression equation for the net kcal consumption of a RE bout was: Total Net Kcal = 0.874(Height, cm) - 0.596(Age, years) - 1.016(Fat Mass, kg) + 1.638(Lean Mass, kg) + 2.461(TV x 10-3) - 110.742 (R2 = 0.773, SEE=28.5 kcal). Significant equations were also derived for individual lifts (R2 = 0.62 to 0.83). Conclusions Net energy expenditure for a total RE bout and for individual resistance exercises can be reasonably estimated in adult men and women using commonly measured demographic and RE variables. Corresponding Author: Brad S. Lambert Ph.D. Department of Orthopedics and Sports Medicine Houston Methodist Hospital 6670 Bertner Ave, Houston, TX 77030 Email: bslambert@houstonmethodist.org Disclosures: The authors declare no conflict of interest. No funding was received for this research. Submitted for publication August 2018. Accepted for publication February 2019. © 2019 American College of Sports Medicine
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High-Intensity Interval Training Improves Erythrocyte Osmotic Deformability
Introduction Physical exercise or hypoxic exposure influences erythrocyte susceptibility to osmotic stress, and the aquaporin 1 (AQP1) facilitates the transport of water in erythrocytes. This study investigated whether high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) affect erythrocyte osmotic deformability by modulating AQP1 function under hypoxic stress. Methods Forty-five healthy sedentary males were randomized to engage in either HIIT (3-min intervals at 40 % and 80 % VO2 reserve, n=15) or MICT (sustained 60 % VO2 reserve, n=15) on a bicycle ergometer for 30 min/day, 5 days/week for 6 weeks, or to a control group that did not perform any exercise (n=15). All subjects were analyzed with osmotic gradient ektacytometry for assessing erythrocyte membrane stability and osmotic deformability following hypoxic exercise (HE) (100W under 12%O2 for 30 min). Results Before the intervention, HE increased the shear stress at 50% of maximal elongation (SS1/2) and the ratio of SS1/2 to maximal elongation index (SS1/2/EImax) on erythrocytes pretreated with 50 Pa of shear stress for 30 min and diminished HgCl2-depressed osmolality at 50%EImax (Ohyper). However, both HIIT and MICT for 6 weeks diminished the elevations of erythrocyte SS1/2 and SS1/2/EImax caused by HE. Moreover, HIIT also increased contents of erythrocyte AQP1 proteins while enhancing HgCl2-depressed Ohyper and area under elongation index-osmolarity curve (AUC) following HE. Additionally, changes in erythrocyte AQP1 contents were associated with changes in HgCl2-depressed erythrocyte Ohyper and AUC. Conclusion Acute HE reduces erythrocyte membrane stability, whereas either HIIT or MICT attenuates the depression of erythrocyte membrane stability by HE. Moreover, HIIT increases the AQP1 content and facilitates the HgCl2-mediated osmotic deformability of erythrocytes following HE. Please send correspondence to: Professor, Jong-Shyan Wang, Graduate Institute of Rehabilitation Science, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, 333, Taiwan. Fax # 886-3-2118700. s5492@mail.cgu.edu.tw This work was supported by the National Science Council of Taiwan (grant number NSC 106-2314-B-182-048-MY3), Chang Gung Medical Research Program (grant number CMRPD1E0263 and CMRPD3G0032), and Healthy Aging Research Center, Chang Gung University (grant number EMRPD1A0841). The results of the present study do not constitute endorsement by ACSM. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. No conflicts of interest, financial or otherwise, are declared by the authors. Submitted for publication October 2018. Accepted for publication February 2019. © 2019 American College of Sports Medicine
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Diffuse Gastric Bleed Managed with Hemospray in a 15-Year-Old Patient
No abstract available
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Development of Infliximab Target Concentrations during Induction in Pediatric Crohn's Disease Patients
Objectives: Subtherapeutic drug concentrations contribute to both primary and secondary nonresponse to infliximab in children with Crohn's disease (CD). The aim of this study was to evaluate treatment outcomes and infliximab concentrations at infusions 2 and 3 with an objective to establish infliximab targets during induction for primary responders. Methods: Single-center, prospective cohort of anti-TNF naïve CD patients 50% improvement in fecal calprotectin) and maintenance concentrations ≥5 μg/ml were secondary outcomes. Results: We enrolled 72 CD patients with 70/72 receiving infliximab monotherapy. Clinical response, biological response, and start of maintenance concentrations ≥5 μg/ml were achieved in 64%, 54% and 22% respectively. The median (interquartile range) infliximab concentrations at infusion 2 and 3 in clinical responders were 27.8 μg/ml (19.5–40) and 14 μg/ml (8.3–24) compared to 18.8 μg/ml (9.1–23, p 5 μg/ml (AUC 0.85). Independent predictors for infusion 3 levels
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Gastric Adenocarcinoma: A Rare Cause of Abdominal Pain and Anemia in a 14 y/o Patient
No abstract available
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Unilateral strength training and mirror therapy in chronic stroke patients: A pilot randomised trial
Objective This study aimed to investigate the feasibility and potential effectiveness of mirror-aided cross-education compared to cross-education alone in post-stroke upper limb recovery. Design A pilot randomized controlled parallel group study was carried out. Thirty-two chronic stroke patients followed a 4-week isometric strength-training programme performed with the less-affected upper limb 3 times per week. Participants in the mirror and strength training group observed the reflection of the exercising arm in the mirror; Participants in the strength training only group exercised without a mirror entirely. Participant compliance, adverse effects and suitability of outcome measures assessed feasibility. Effectiveness outcomes included maximal isometric strength measured with the Biodex Dynamometer, the Modified Ashworth Scale and the Chedoke Arm and Hand Activity Inventory. Results Compliance was high with no adverse effects. The use of the Biodex Dynamometer must be reviewed. Mirror therapy did not augment the cross-education effect (p>0.05) in chronic stroke patients when training isometrically. Conclusion This pilot trial established the feasibility of a randomised controlled trial comparing mirror-aided cross-education to cross-education alone for post-stroke upper limb recovery. Mirror therapy did not augment cross-education when training isometrically. However, results indicate that the combination of interventions should be investigated further applying an altered training protocol. (Trial Registration Number NCT 03500705) Corresponding author: Monika Ehrensberger, Clinical Health & Nutrition Centre (CHANCE), Department of Life Sciences, Institute of Technology, Sligo, Ireland. Email: s00083283@mail.itsligo.ie / Tel: (+353) (0) 7191 55222 Disclosure of Interest Statement: All contributors to this article are independent authors; there are no conflicts of interest. Funding/ Support Statement Monika Ehrensberger: Institute of Technology Sligo President's Bursary Fund and Irish Research Council Postgraduate Scholarship (GOIPG/2016/1662) Daniel JC Simpson: Institutes of Technology Ireland Postgraduate Research Scholarship and Institute of Technology Sligo Capacity Building Fund Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
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Could the clinical effectiveness be improved under the integration of orthotic intervention and scoliosis specific exercise in managing adolescent idiopathic scoliosis? -A randomized controlled trial study
Objective To compare the effectiveness of the integration of orthotic intervention (OI) and scoliosis specific exercise (SSE) with orthotic intervention only via assessing the spinal deformity, back muscle endurance and pulmonary function of the patients with adolescent idiopathic scoliosis (AIS). Design It is a prospective randomized controlled study. Patients who fulfilled the SRS criteria for OI were randomly assigned to the OE group (combined orthotic and exercise intervention) or the OI group (orthotic intervention only). All the subjects were prescribed with a rigid thoracolumbosacral orthosis and SSE program was provided to the subjects in the OE group. Cobb angle, back muscle endurance and pulmonary function of subjects were measured at baseline, 1-month and 6-month follow-up visits. Results After 6 months of intervention, the subjects in the OE group showed better Cobb angle correction than those in the OI group. The back muscle endurance and pulmonary function decreased in the subjects of the OI group, while some improvement happened in the subjects of the OE group. Between-group statistical significance was detected at the 6-month follow-up among back muscle endurance time and parameters of pulmonary function. Conclusion In this study, OI combined with SSE offered better Cobb angle correction and improvement of the respiratory parameters and back muscle endurance of the patients with AIS as compared with OI only. Corresponding authors: Chengqi He, Center of Rehabilitation Medicine, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China. E-mail: hxkfhcq2015@126.com, Tel: +86 18980601618; Mansang Wong, Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, 999077, China. E-mail: m.s.wong@polyu.edu.hk, Tel: +852 27667680 These authors contributed equally to this work (Chengfei Gao and Yu Zheng). Disclosures: No conflicts of interest relevant to this article was reported. The authors have no financial relationships relevant to this article to disclose. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
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Perceptions of Fall Circumstances, Recovery Methods and Community Participation in Manual Wheelchair Users
Objective To examine the circumstances surrounding the worst fall experienced by full time manual wheelchair users in the past 12 months, the recovery process, and influence on community participation. Design Mixed-methods. Semi-structured interviews were conducted to understand the circumstances of the worst fall experienced and the recovery process. A quantitative fear of falling assessment and the Community Participation Indicators (CPI) were used to further evaluate the influence of the fall. Results 20 manual wheelchair users, 47 ± 13 years old (mean ± SD), 55% male. Falls most commonly occurred outside during wheelchair propulsion. Falls were attributed to both intrinsic and extrinsic factors. 70% of participants reported a fear of falling and 80% required assistance to recovery. No significant correlations were found between fall frequency and CPI scores. Participants who needed assistance to recover (56.70 ± 17.66) had lower CPI importance scores compared to participants able to recover independently (88.93 ± 22.13), P= 0.05. Conclusion Falls are complex and the majority of manual wheelchair users need assistance to recover. Comprehensive programs including education on prevention and post fall management are needed. Results may increase understanding of the circumstances associated with falls and inform the development of evidenced-based clinical practice guidelines. Correspondence: Laura A. Rice, 219 Freer Hall, 906 S. Goodwin Ave., Urbana, IL 61801. 217-333-4650. ricela@illinois.edu Author Disclosures: The authors have no conflicts of interest to disclose Funding provided for the project from Permobil, AB; No financial benefits were provided to authors; This data has not been presented at a professional conference Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
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