Long-term effects of adolescent concussion history on gait, across age

Publication date: Available online 22 July 2016
Source:Gait & Posture
Author(s): Douglas N. Martini, Grant C. Goulet, Deanna H. Gates, Steven P. Broglio
The aim of this study was to examine the possible long-term effects of high school concussion history on gait performance across the lifespan. Individuals with and without a concussion history were grouped into 20-year-old (yo) (n=40), 40yo (n=19), and 60yo (n=18) age groups. Participants completed five trials of four walking conditions: a normal walk, a dual task walk, an obstructed walk, and an obstructed, dual task walk. Spatiotemporal gait parameters for gait analyses during single and dual task conditions. Gait velocity, step width, stride length, percent of time in double support, and obstacle toe clearance were the gait variables assessed along with number correct from dual task. Gait was analyzed via optical motion capture. Data were analyzed by two-factor, multivariate ANOVAs and significant interactions were explored using post hoc contrasts. A significant (F=2.62, p=0.03) interaction was observed for the obstructed walk condition. Further analyses yielded no significant concussion history and control group differences, within age. The data indicate that an adolescent concussion history has a non-observable effect on gait across the lifespan.



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Moving from theory to practice: experience of implementing a learning supporting model designed to increase patient involvement and autonomy in care

In implementing new programs of care, such as person-centered care, there is a risk that the focus will be at an organizational level, instead of a level that describes what happens in the personal development...

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Identification and molecular characterization of Corynebacterium xerosis isolated from a sheep cutaneous abscess: first case report in Mexico

Corynebacterium xerosis is a commensal organism found in skin and mucous membranes of humans. It is considered an unusual pathogen, and it is rarely found in human and animal clinical ...

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The effect of simulated narratives that leverage EMR data on shared decision-making: a pilot study

Shared decision-making can improve patient satisfaction and outcomes. To participate in shared decision-making, patients need information about the potential risks and benefits of treatment options. Our team h...

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Acute pulmonary melioidosis presenting with multiple bilateral cavitary lesions in a healthy young adult: an authentic case report from Sri Lanka

Melioidosis is an emerging infectious disease in Sri Lanka. This disease usually develops in a host with an immunocompromised state. Acute pulmonary melioidosis commonly presents as a lobar consolidation with ...

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Mutiple keratocystic odontogenic tumors (KCOT) in a patient with Gorlin syndrome: a case report with late presentation and absence of skin manifestations

Gorlin syndrome is a rare autosomal dominant syndrome characterized by multiple basal cell carcinomas, keratocystic odontogenic tumors (KOT) and falx cerebral calcifications, which occur due to mutation in PTC...

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Female Mice are Resistant to Fabp1 Gene Ablation-Induced Alterations in Brain Endocannabinoid Levels

Abstract

Although liver fatty acid binding protein (FABP1, L-FABP) is not detectable in the brain, Fabp1 gene ablation (LKO) markedly increases endocannabinoids (EC) in brains of male mice. Since the brain EC system of females differs significantly from that of males, it was important to determine if LKO differently impacted the brain EC system. LKO did not alter brain levels of arachidonic acid (ARA)-containing EC, i.e. arachidonoylethanolamide (AEA) and 2-arachidonoylglycerol (2-AG), but decreased non-ARA-containing N-acylethanolamides (OEA, PEA) and 2-oleoylglycerol (2-OG) that potentiate the actions of AEA and 2-AG. These changes in brain potentiating EC levels were not associated with: (1) a net decrease in levels of brain membrane proteins associated with fatty acid uptake and EC synthesis; (2) a net increase in brain protein levels of cytosolic EC chaperones and enzymes in EC degradation; or (3) increased brain protein levels of EC receptors (CB1, TRVP1). Instead, the reduced or opposite responsiveness of female brain EC levels to loss of FABP1 (LKO) correlated with intrinsically lower FABP1 level in livers of WT females than males. These data show that female mouse brain endocannabinoid levels were unchanged (AEA, 2-AG) or decreased (OEA, PEA, 2-OG) by complete loss of FABP1 (LKO).

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In vivo toxicity and antitumor activity of essential oils extract from agarwood (Aquilaria crassna)

Aquilaria crassna has been used in traditional Asian medicine to treat vomiting, rheumatism, asthma, and cough. Furthermore, earlier studies from our laboratory have revealed that the ...

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Dig1 protects against locomotor and biochemical dysfunctions provoked by Roundup

Plant medicinal extracts may be claimed to prevent or cure chemical intoxications. Few of these are tested for their mechanisms of actions in vivo and for their cellular impacts. In 2011, we demonstrated that ...

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The influence of goutweed (Aegopodium podagraria L.) tincture and metformin on the carbohydrate and lipid metabolism in dexamethasone-treated rats

Diabetes mellitus and metabolic syndrome are the common problems of the modern society. The interest in herbal medicines increases, and often they are used in combination with conventional drugs. Aegopodium podag...

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Image assessment of Barrett’s esophagus using the simplified narrow band imaging classification

Abstract

Background

A simplified narrow band imaging (NBI) classification has been proposed with the objective of integrating multiple classifications of NBI surface patterns in Barrett's esophagus (BE). Little is known about the impact of the simplified NBI classification on the diagnosis of BE when using high-definition magnification endoscopy with NBI (HM-NBI). This study aimed to evaluate (a) the reproducibility of NBI surface patterns and predicted histology and (b) the diagnostic accuracy of interpreting HM-NBI images by using the simplified NBI classification.

Methods

Two hundred and forty-eight HM-NBI images from macroscopically normal areas in patients with BE were retrieved from endoscopy databases and randomized for review by four endoscopists (two experts, two non-experts). We evaluated inter- and intra-observer agreement of the interpretation of NBI surface patterns and the predicted histology (dysplasia vs. non-dysplasia), as calculated by using κ statistics, and diagnostic values of the prediction.

Results

The overall inter-observer agreements were substantial for mucosal pattern (κ = 0.73) and vascular pattern (κ = 0.71), and almost perfect for predicting dysplastic histology (κ = 0.80). The overall intra-observer agreements were almost perfect for mucosal (κ = 0.84) and vascular patterns (κ = 0.86), and predicting dysplastic histology (κ = 0.89). The mean accuracy in predicting dysplastic histology for all reviewers was 95 % (experts: 96.8 %, non-experts: 93.1 %).

Conclusions

The simplified NBI classification has the potential to provide high diagnostic reproducibility and accuracy when using HM-NBI.

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Effect of vertically aligned carbon nanotube density on the water flux and salt rejection in desalination membranes

In this paper, vertically aligned carbon nanotube (VACNT) membranes of different densities are developed and their performances are investigated. VACNT arrays of densities 5 × 109, 1010, 5 × 1010 and 1011 tubes c...

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Functional protein-based nanomaterial produced in GRAS microorganism: a new platform for biotechnology

Publication date: Available online 21 July 2016
Source:Acta Biomaterialia
Author(s): Olivia Cano-Garrido, Alejandro Sánchez-Chardi, Sílvia Parés, Irene Giró, Witold I. Tatkiewicz, Neus Ferrer-Miralles, Imma Ratera, Antonino Natalello, Rafael Cubarsi, Jaume Veciana, Àlex Bach, Antonio Villaverde, Anna Arís, Elena Garcia-Fruitós
Inclusion bodies (IBs) are protein-based nanoparticles formed in Escherichia coli through stereospecific aggregation processes during the overexpression of recombinant proteins. In the last years, it has been shown that IBs can be used as nanostructured biomaterials to stimulate mammalian cell attachment, proliferation, and differentiation. In addition, these nanoparticles have also been explored as natural delivery systems for protein replacement therapies. Although the production of these protein-based nanomaterials in E. coli is economically viable, important safety concerns related to the presence of endotoxins in the products derived from this microorganism need to be addressed. Lactic acid bacteria (LAB) are a group of food-grade microorganisms that have been classified as safe by biologically regulatory agencies. In this context, we have demonstrated herein, for the first time, the production of fully functional, IB-like protein nanoparticles in LAB. These nanoparticles have been fully characterized using a wide range of techniques, including field emission scanning electron microscopy (FESEM), transmission electron microscopy (TEM), dynamic light scattering (DLS), Fourier transform infrared (FTIR) spectroscopy, zymography, cytometry, confocal microscopy, and wettability and cell coverage measurements. Our results allow us to conclude that these materials share the main physico-chemical characteristics with IBs from E. coli but are devoid of any harmful endotoxin contaminant. These findings reveal a new platform for the production of protein-based safe products with high pharmaceutical interest.Statement of SignificanceThe development of both natural and synthetic biomaterials for biomedical applications is a field in constant development. In this context, Escherichia coli is a bacteria that has been widely studied for its ability to naturally produce functional biomaterials with broad biomedical uses. Despite being effective, products derived from this species contain membrane residues able to trigger a non-desired immunogenic responses. Accordingly, exploring alternative bacteria able to synthesize such biomaterials in a safe molecular environment is becoming a challenge. Thus, the presente study describes a new type of functional protein-based nanomaterial free of toxic contaminants with a wide range of applications in both human and veterinary medicine.

Graphical abstract

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Aerosol delivery with two ventilation modes during mechanical ventilation: a randomized study

Volume-controlled ventilation has been suggested to optimize lung deposition during nebulization although promoting spontaneous ventilation is targeted to avoid ventilator-induced diaphragmatic dysfunction. Co...

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News on FLEX

Flex is one of the newer rising platforms in surgical robotics. Here are some insights into their story:

"The year was 2005. Mr. Jordan, one of four executives-in-residence at the Pittsburgh Life Sciences Greenhouse on the South Side at the time, had just volunteered to help Howie Choset, a Carnegie Mellon University robotics professor, and Marco Zenati, then a cardiac surgeon at the University of Pittsburgh, develop and market a "snake robot" device for use in minimally-invasive surgeries.

The process of converting the snake robot model into a market-ready product was not easy or quick. Four years later, they had the first prototype ready for use on humans. The following year, 2010, the first clinical studies began in the Czech Republic and last summer, the U.S. Food and Drug Administration gave approval for its use for head and neck procedures.

By then, the device had been refined into something of an engineering marvel: a one-armed articulated robot equipped with a camera that allows the surgeon to see and reach tumors in tight places.

After several name changes ("People don't like thinking there's a snake in their body," said Mr. Choset), the Flex Robotic System is now the centerpiece of a $130 million privately-held Medrobotics based in Massachusetts which, a decade ago and before Google and Uber's arrival in Pittsburgh, was a hotbed for medical device and robotic product development.

The system is also the new darling in the world of robotics medicine.

Last week, the Flex Robotic System won best-of-show at the Medical Design Excellence Awards in New York City and next month UPMC surgeon Umamaheswar Duvvuri — the first to use the Flex Robotic System on a patient last December — will lead an afternoon-long session on the surgery at the American Head and Neck Society's international conference in Seattle."

Early clinical data on Medrobotics' Flex appeared:
"Of the 79 patients on whom Flex^® was used, doctors were able to expose, visualize and access the target area in 75 (94%) of the cases. Among patients who were treated or biopsied, 72 of 79 (91%) enjoyed successful completions. Fifty-eight percent of the successful procedures (42 of 72) were performed in areas the surgeons considered difficult to reach, such as the tongue base and vocal chords. There were no device-related adverse events reported."

A nice interview with Prof. Choset.


Source: Post Gazette, MedRobotics 




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The effect of mode of detection of breast cancer on stress and distress

Abstract

Objective

The number of women with screen-detected breast cancer is increasing, but it is not clear if these women experience the same levels of distress as women with symptomatic breast cancer. The current study compared stress and distress in women with screen-detected or symptomatic breast cancer at diagnosis and 12 months post-diagnosis.

Methods

Ninety-two women with screen-detected breast cancer and 129 women with symptomatic breast cancer completed measures of perceived stress, anxiety, and depression at diagnosis and 12 months post-diagnosis. Women also completed a measure of cancer-related stress 12 months post-diagnosis.

Results

Both groups reported similar levels of perceived stress, anxiety, and depression at diagnosis. A third of women in both groups reported clinical levels of anxiety at diagnosis, which decreased over time. There were no differences in depression. Analyses revealed that at 12 months post-diagnosis, the symptomatic group reported a significant reduction in anxiety but the screen-detected group reported a non-significant trend for a reduction over time. The screen-detected group reported significantly higher cancer-related stress at 12 months than the symptomatic group.

Conclusions

Screen-detected women report similar distress at diagnosis, but may be more at risk for greater distress requiring further psychological support one year after diagnosis. Future interventions which focus on preparation for screening may help to reduce ongoing levels of anxiety and cancer-related stress for this group.

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How preconceptions about lung cancer treatment interact with medical discourse for patients who accept chemotherapy?

Abstract

Objective

Chemotherapy is widely prescribed for lung cancer with palliation as primary end-point. This study aimed at determining how preconceptions about lung cancer and its treatment interact with medical discourse into acceptance of chemotherapy.

Methods

Twenty three purposively selected patients who recently accepted chemotherapy were invited to participate in this survey consisting of semi-structured in-depth interviews. Grounded theory was applied to investigate participants' perceptions of the context that have surrounded their decision to undergo chemotherapy.

Results

Major drivers of social representation of illness were linked with stigma. Participants also evoked the disease itself as a stereotype representation of incurable disease. Significant others' experiences were major components of participants' knowledge of chemotherapy. Searching for information regarding lung cancer actively confronted participants with the disease and its prognosis. However, the searching process was self-limited because of the poor prognosis of the disease insofar as complete information would have precluded from any hope. We therefore identified three domains that provide insights into the participant's views and attitude towards chemotherapy: (i) Synthesizing preconceptions of disease and chemotherapy with personal medical case; (ii) Slowly constructing complex knowledge of cancer and treatment; (iii) Accepting chemotherapy as a surrogate for acknowledging incurable disease.

Conclusion

Patients have preconceptions about chemotherapy that result from complex features involving social perception, stigma and significant others' experiences. In this context, developing a personal knowledge about lung cancer and its treatment is a slow construction. This process needs time to be explained and reformulated, so that patients might give their informed consent.

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IJMS, Vol. 17, Pages 1196: Homocysteine Aggravates Cortical Neural Cell Injury through Neuronal Autophagy Overactivation following Rat Cerebral Ischemia-Reperfusion

Elevated homocysteine (Hcy) levels have been reported to be involved in neurotoxicity after ischemic stroke. However, the underlying mechanisms remain incompletely understood to date. In the current study, we hypothesized that neuronal autophagy activation may be involved in the toxic effect of Hcy on cortical neurons following cerebral ischemia. Brain cell injury was determined by hematoxylin-eosin (HE) staining and TdT-mediated dUTP Nick-End Labeling (TUNEL) staining. The level and localization of autophagy were detected by transmission electron microscopy, western blot and immunofluorescence double labeling. The oxidative DNA damage was revealed by immunofluorescence of 8-Hydroxy-2′-deoxyguanosine (8-OHdG). Hcy treatment aggravated neuronal cell death, significantly increased the formation of autophagosomes and the expression of LC3B and Beclin-1 in the brain cortex after middle cerebral artery occlusion-reperfusion (MCAO). Immunofluorescence analysis of LC3B and Beclin-1 distribution indicated that their expression occurred mainly in neurons (NeuN-positive) and hardly in astrocytes (GFAP-positive). 8-OHdG expression was also increased in the ischemic cortex of Hcy-treated animals. Conversely, LC3B and Beclin-1 overexpression and autophagosome accumulation caused by Hcy were partially blocked by the autophagy inhibitor 3-methyladenine (3-MA). Hcy administration enhanced neuronal autophagy, which contributes to cell death following cerebral ischemia. The oxidative damage-mediated autophagy may be a molecular mechanism underlying neuronal cell toxicity of elevated Hcy level.

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Service-integration approaches for families with low income: a Families First Edmonton, community-based, randomized, controlled trial

Increasing access to health and social services through service-integration approaches may provide a direct and sustainable way to improve health and social outcomes in low-income families.

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Is using multiple imputation better than complete case analysis for estimating a prevalence (risk) difference in randomized controlled trials when binary outcome observations are missing?

Missing outcomes can seriously impair the ability to make correct inferences from randomized controlled trials (RCTs). Complete case (CC) analysis is commonly used, but it reduces sample size and is perceived ...

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Smart Anesthesia—Another Way of Communication During Emergence from Anesthesia Using a Smartphone

No abstract available

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Clinical Pattern in Hypotensive Transfusion Reactions

BACKGROUND: Hypotensive transfusion reactions (HyTRs) may be underreported and have been associated with patients taking angiotensin-converting enzyme inhibitors (ACEIs) receiving poststorage leukoreduced blood products through negatively charged filters. Although bedside leukoreduction is no longer commonplace, HyTRs still occur and are insufficiently characterized in the prestorage leukoreduction era. We describe recently reported cases at our institution. METHODS: We reviewed transfusion reaction records at Stanford Healthcare from January 2014 to April 2015. HyTRs were defined by National Health Safety Network Hemovigilance Module classification. RESULTS: Eleven HyTRs occurred in 10 patients. All were adults (mean age 71.7 years; range 45–92 years), 7 were male, and all underwent major surgery 0 to 2 days before the reaction. Nine patients underwent cardiac or vascular surgery, and all 10 were taking ACEIs with the last dose taken within 48 hours of the transfusion reaction in 9 patients. Nine patients were on extracorporeal circuits within 24 hours before the reaction (median duration 180 minutes; range 87–474 minutes). In 5 reactions, the implicated unit was restarted with resultant recurrent hypotension. Implicated units included 9 packed red blood cells, 1 apheresis platelet, and 1 plasma frozen within 24 hours. CONCLUSIONS: Contrary to what has been previously reported in the era of prestorage leukoreduction, HyTRs at our institution showed consistent patterns in patients at risk. Patients scheduled to undergo major surgery with cardiopulmonary bypass may benefit from earlier preoperative cessation of ACEIs or temporarily switching to an alternative drug class.

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Factors Influencing the Choice of Anesthesia as a Career by Undergraduates of the University of Rwanda

BACKGROUND: Rwanda currently faces a severe shortage of trained medical personnel, including physician anesthesiologists. The recruitment of residents into the anesthesia program has been consistently low. This study aimed at determining the factors that influence undergraduates' decision to pursue anesthesia as a career choice. METHODS: A questionnaire was created and administered to final year undergraduate medical students at the University of Rwanda. The questionnaire was created based on factors identified from literature review and key informant interviews. The questionnaire was translated, field-tested, and refined. The final survey questionnaire contains 27 4-point Likert scale items and 4 free-text questions. RESULTS: Seventy-nine final year undergraduate medical students responded to the survey. Only 2 students (2.5%) chose anesthesia as their top choice for postgraduate training. The most frequently named factors for not choosing anesthesiology were long work hours and high stress level, insufficient mentorship, and low job opportunity. CONCLUSIONS: The issues identified by our survey must be considered when making efforts toward increasing anesthesia recruitment in Rwanda. Factors such as lack of material resources and high workload will not be easily addressed. Others can be addressed through changes in medical student anesthesiology rotations and better mentorship by anesthesiologists during formative years. Focusing on factors that can be changed now may increase enrollment into anesthesiology. Future studies will include broadening the survey population and further investigating the influencing factors elucidated by this study.

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The Impact of Surgery and Stored Red Blood Cell Transfusions on Nitric Oxide Homeostasis

BACKGROUND: Cell-free hemoglobin (Hb) forms in stored red blood cells (RBCs) as a result of hemolysis. Studies suggest that this cell-free Hb may decrease nitric oxide (NO) bioavailability, potentially leading to endothelial dysfunction, vascular injury, and multiorgan dysfunction after transfusion. We tested the hypothesis that moderate doses of stored RBC transfusions increase cell-free Hb and decrease NO availability in postoperative surgical patients. METHODS: Twenty-six patients undergoing multilevel spine fusion surgery were studied. We compared those who received no stored RBCs (n = 9) with those who received moderate amounts (6.1 ± 3.0 units) of stored RBCs over 3 perioperative days (n = 17). Percent hemolysis (cell-free Hb), RBC-NO (heme-NO), and plasma nitrite and nitrate were measured in samples from the stored RBC bags and from patients' blood, before and after surgery. RESULTS: Posttransfusion hemolysis was increased approximately 3.5-fold over preoperative levels (P = 0.0002) in blood samples collected immediately after surgery but not on postoperative days 1 to 3. Decreases in both heme-NO (by approximately 50%) and plasma nitrite (by approximately 40%) occurred postoperatively, both in nontransfused patients (P = 0.036 and P = 0.026, respectively) and transfused patients (P = 0.0068 and P = 0.003, respectively) and returned to preoperative baseline levels by postoperative day 2 or 3. Postoperative plasma nitrite and nitrate were decreased significantly in both groups, and this change was slower to return to baseline in the transfused patients, suggesting that blood loss and hemodilution from crystalloid administration contribute to this finding. CONCLUSIONS: The decrease in NO metabolites occurred irrespective of stored RBC transfusions, suggesting this decrease may be related to blood loss during surgery and hemodilution rather than to scavenging of NO or inhibition of NO synthesis by stored RBC transfusions.

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Postoperative Cognitive Dysfunction and the Change of Regional Cerebral Oxygen Saturation in Elderly Patients Undergoing Spinal Surgery

BACKGROUND: In this study, we examined the relationship between postoperative cognitive dysfunction (POCD) and intraoperative regional cerebral oxygen saturation (rSO2) in elderly patients undergoing spinal surgery. METHODS: We enrolled 87 patients older than 65 years. All patients were tested using a battery of cognitive function tests (Korean Mini-Mental State Examination and visuomotor test of Dynamic Lowenstein Occupational Therapy Cognitive Assessment–Geriatric Version) the day before their surgical operation and on the seventh postoperative day. Our threshold for defining POCD for a given patient was a Reliable Change Index score of

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A Clinical Prediction Model for Postcardiac Surgery Atrial Fibrillation in an Asian Population

BACKGROUND: Postoperative atrial fibrillation (AF) is associated with increased morbidity, mortality, and resource utilization. Current prediction models for postoperative AF are based primarily on Western populations. In this study, we sought to develop a clinical prediction rule for postcardiac surgery AF for a multiethnic Asian population. METHODS: Two thousand one hundred sixty-eight patients undergoing coronary artery bypass graft or valve surgery with cardiopulmonary bypass were prospectively enrolled in this observational study between August 2008 and July 2012 at Singapore's 2 national heart centers. Postoperative AF was defined as an irregularly irregular electrocardiogram rhythm without identifiable P wave after surgery and before hospital discharge that lasted more than an hour, or affected hemodynamics (ie, systolic blood pressure 120 minutes (OR, 1.92; 95% CI, 1.47–2.52, P

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Amitriptyline, but Not Pregabalin, Reverses the Attenuation of Noxious Stimulus–Induced Analgesia After Nerve Injury in Rats

BACKGROUND: Noxious stimulus–induced analgesia (NSIA) is a type of conditioned pain modulation in rats that has been used to assess endogenous pain control systems. The descending noradrenergic system is involved in NSIA, and nerve injury induces plastic changes of descending noradrenergic neurons. Thus, we hypothesized that nerve injury would affect NSIA strength and that amitriptyline and pregabalin, which often are used for treating neuropathic pain, might further modulate NSIA through effects on the descending noradrenergic system. METHODS: We examined the change in NSIA over time after right L5 spinal nerve ligation (SNL) in rats by measuring the contralateral hind paw withdrawal threshold after left forepaw capsaicin injection. In addition, we examined NSIA after 5 daily intraperitoneal injection of amitriptyline or pregabalin. Microdialysis studies were performed to measure noradrenaline levels after left forepaw capsaicin injection in the left spinal dorsal horn in noninjured rats, SNL rats, and SNL rats that had received 5 daily intraperitoneal injections of amitriptyline or pregabalin. RESULTS: NSIA was dramatically attenuated 5 and 6 weeks after SNL (P

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Heterogeneity in the Structure of the Left Ventricular Outflow Tract: A 3-Dimensional Transesophageal Echocardiographic Study

BACKGROUND: The left ventricular outflow tract (LVOT) is a composite of adjoining structures; therefore, a circular or elliptical shape at one point may not represent its entire structure. The purpose of this study was to evaluate the presence of heterogeneity in the LVOT. METHODS: Patients with normal valvular and ventricular function undergoing elective coronary revascularization surgery were included in the study. Intraoperative R-wave gated 3-dimensional (3D) transesophageal echocardiographic imaging of the LVOT was performed at end-systole, with the midesophageal long axis as the reference view. Acquired data were analyzed with the Philips Q-Lab software with multiplanar reformatting in the sagittal (minor axis), transverse (major axis), and coronal (cross-sectional area by planimetry) views of the LVOT. These measurements were made on the left ventricular side or proximal LVOT, aortic side, or distal LVOT and mid-LVOT. RESULTS: Fifty patients were included in the study. The LVOT minor (sagittal) axis dimension did not differ across the mid-LVOT, proximal LVOT, and distal LVOT (P = .11). The major axis diameter of LVOT differed among the 3 regions of the LVOT (P

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Anesthetizing Patients and Their Immune Systems: Volatile Anesthetics at Work

No abstract available

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Predicting the Best Fit: A Comparison of Response Surface Models for Midazolam and Alfentanil Sedation in Procedures With Varying Stimulation

BACKGROUND: Selecting an effective dose of sedative drugs in combined upper and lower gastrointestinal endoscopy is complicated by varying degrees of pain stimulation. We tested the ability of 5 response surface models to predict depth of sedation after administration of midazolam and alfentanil in this complex model. The procedure was divided into 3 phases: esophagogastroduodenoscopy (EGD), colonoscopy, and the time interval between the 2 (intersession). METHODS: The depth of sedation in 33 adult patients was monitored by Observer Assessment of Alertness/Scores. A total of 218 combinations of midazolam and alfentanil effect-site concentrations derived from pharmacokinetic models were used to test 5 response surface models in each of the 3 phases of endoscopy. Model fit was evaluated with objective function value, corrected Akaike Information Criterion (AICc), and Spearman ranked correlation. A model was arbitrarily defined as accurate if the predicted probability is

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The Effects of Fentanyl on Hepatic Mitochondrial Function

BACKGROUND: Remifentanil interferes with hepatic mitochondrial function. The aim of the present study was to evaluate whether hepatic mitochondrial function is affected by fentanyl, a more widely used opioid than remifentanil. METHODS: Human hepatoma HepG2 cells were exposed to fentanyl or pretreated with naloxone (an opioid receptor antagonist) or 5-hydroxydecanoate (5-HD, an inhibitor of mitochondrial adenosine triphosphate (ATP)-sensitive potassium [mitoKATP] channels), followed by incubation with fentanyl. Mitochondrial function and metabolism were then analyzed. RESULTS: Fentanyl marginally reduced maximal mitochondrial complex–specific respiration rates using exogenous substrates (decrease in medians: 11%–18%; P = 0.003–0.001) but did not affect basal cellular respiration rates (P = 0.834). The effect on stimulated respiration was prevented by preincubation with naloxone or 5-HD. Fentanyl reduced cellular ATP content in a dose-dependent manner (P

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The Effect of Local Anesthetic Volume Within the Adductor Canal on Quadriceps Femoris Function Evaluated by Electromyography: A Randomized, Observer- and Subject-Blinded, Placebo-Controlled Study in Volunteers

BACKGROUND: Single-injection adductor canal block (ACB) provides analgesia after knee surgery. Which nerves that are blocked by an ACB and what influence—if any—local anesthetic volume has on the effects remain undetermined. We hypothesized that effects on the nerve to the vastus medialis muscle (which besides being a motor nerve innervates portions of the knee) are volume-dependent. METHODS: In this assessor- and subject-blinded randomized trial, 20 volunteers were included. On 3 separate days, subjects received an ACB with different volumes (10, 20, and 30 mL) of lidocaine 1%. In addition, they received a femoral nerve block and a placebo ACB. The effect on the vastus medialis (primary endpoint) and the vastus lateralis was evaluated using noninvasive electromyography (EMG). Quadriceps femoris muscle strength was evaluated using a dynamometer. RESULTS: There was a statistically significant difference in EMG response from the vastus medialis, dependent on volume. Thirty-five percent (95% confidence interval [CI], 18–57) of the subjects had an affected vastus medialis after an ACB with 10 mL compared with 84% (95% CI, 62–94) following 20 mL (P = 0.03) and 100% (95% CI, 84–100) when 30 mL was used (P = 0.0001). No statistically significant differences were found between volume and effect on the vastus lateralis (P = 0.81) or in muscle strength (P = 0.15). CONCLUSIONS: For ACB, there is a positive correlation between local anesthetic volume and effect on the vastus medialis muscle. Despite the rather large differences in EMG recordings, there were no statistically significant differences in quadriceps femoris muscle strength. Subsequent clinical studies comparing different volumes in a surgical setting, powered to show differences not only in analgesic efficacy, but also in adverse events, are required.

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Pre-Hospital Anesthesia Handbook, 2nd ed.

No abstract available

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The Accuracy of 6 Inexpensive Pulse Oximeters Not Cleared by the Food and Drug Administration: The Possible Global Public Health Implications

BACKGROUND: Universal access to pulse oximetry worldwide is often limited by cost and has substantial public health consequences. Low-cost pulse oximeters have become increasingly available with limited regulatory agency oversight. The accuracy of these devices often has not been validated, raising questions about performance. METHODS: The accuracy of 6 low-cost finger pulse oximeters during stable arterial oxygen saturations (SaO2) between 70% and 100% was evaluated in 22 healthy subjects. Oximeters tested were the Contec CMS50DL, Beijing Choice C20, Beijing Choice MD300C23, Starhealth SH-A3, Jumper FPD-500A, and Atlantean SB100 II. Inspired oxygen, nitrogen, and carbon dioxide partial pressures were monitored and adjusted via a partial rebreathing circuit to achieve 10 to 12 stable target SaO2 plateaus between 70% and 100% and PaCO2 values of 35 to 45 mm Hg. Comparisons of pulse oximeter readings (SpO2) with arterial SaO2 (by Radiometer ABL90 and OSM3) were used to calculate bias (SpO2 – SaO2) mean, precision (SD of the bias), and root mean square error (ARMS). RESULTS: Pulse oximeter readings corresponding to 536 blood samples were analyzed. Four of the 6 oximeters tested showed large errors (up to −6.30% mean bias, precision 4.30%, 7.53 ARMS) in estimating saturation when SaO2 was reduced

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Surveying the Literature: Synopses of Recent Key Publications

No abstract available

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Ventilation-Induced Modulation of Pulse Oximeter Waveforms: A Method for the Assessment of Early Changes in Intravascular Volume During Spinal Fusion Surgery in Pediatric Patients

BACKGROUND: Scoliosis surgery is often associated with substantial blood loss, requiring fluid resuscitation and blood transfusions. In adults, dynamic preload indices have been shown to be more reliable for guiding fluid resuscitation, but these indices have not been useful in children undergoing surgery. The aim of this study was to introduce frequency-analyzed photoplethysmogram (PPG) and arterial pressure waveform variables and to study the ability of these parameters to detect early bleeding in children during surgery. METHODS: We studied 20 children undergoing spinal fusion. Electrocardiogram, arterial pressure, finger pulse oximetry (finger PPG), and airway pressure waveforms were analyzed using time domain and frequency domain methods of analysis. Frequency domain analysis consisted of calculating the amplitude density of PPG and arterial pressure waveforms at the respiratory and cardiac frequencies using Fourier analysis. This generated 2 measurements: The first is related to slow mean arterial pressure modulation induced by ventilation (also known as DC modulation when referring to the PPG), and the second corresponds to pulse pressure modulation (AC modulation or changes in the amplitude of pulse oximeter plethysmograph when referring to the PPG). Both PPG and arterial pressure measurements were divided by their respective cardiac pulse amplitude to generate DC% and AC% (normalized values). Standard hemodynamic data were also recorded. Data at baseline and after bleeding (estimated blood loss about 9% of blood volume) were presented as median and interquartile range and compared using Wilcoxon signed-rank tests; a Bonferroni-corrected P value

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The Association Between Preoperative Frailty and Postoperative Delirium After Cardiac Surgery

Delirium is common after cardiac surgery, and preoperative identification of high-risk patients could guide prevention strategies. We prospectively measured frailty in 55 patients before cardiac surgery and assessed postoperative delirium using a validated chart review. The prevalence of frailty was 30.9%. Frail patients had a higher incidence of delirium (47.1%) compared with nonfrail patients (2.6%; P

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Perioperative Troponin Screening

Myocardial injury is the most common cause of death during the 30 days after noncardiac surgery. Only 14% of patients who are experiencing a perioperative myocardial infarction will have chest pain, and 65% are entirely clinically silent, which means that they will go undetected without routine troponin screening. Although it is tempting to dismiss asymptomatic troponin elevation, mortality is similar with and without symptoms. Furthermore, mortality at 30 days in patients who have postoperative troponin elevation is a concerning 10%, which represents a 5-fold increase from background risk. Among inpatients ≥45 years of age who are having noncardiac surgery, the number necessary to screen to detect myocardial injury after noncardiac surgery, that would otherwise be missed, is only about 15 patients. Thus, troponin screening seems appropriate for most surgical inpatients who are ≥45 years of age. Potential acute interventions include initiating therapy such as aspirin, statins, and angiotensin-converting enzyme (ACE) inhibitor antihypertensives, along with chronic lifestyle improvements such as smoking cessation, healthful eating, and exercise.

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Glioblastoma multiforme versus pleomorphic xanthoastrocytoma with anaplastic features in the pathological diagnosis: a case report

Pleomorphic xanthoastrocytoma (PXA) with anaplastic features should be strictly distinguished from glioblastoma multiforme (GBM).

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ChikDenMaZika Syndrome: the challenge of diagnosing arboviral infections in the midst of concurrent epidemics

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Neural correlates of older adults’ self-overestimation of stepping-over ability

Abstract

A growing body of literature indicates that cognitively intact older adults tend to overestimate their physical functioning (e.g., step-over ability), which may lead to fall risk. However, the neural correlates underlying this phenomenon are still unclear. We therefore investigated the neural basis of older adults' self-overestimation of stepping-over ability. A total of 108 well-functioning community dwelling older adults (mean age = 73.9 years) performed step-over tests (SOT) in two ways: self-estimation of step-over ability and an actual step-over task. During the self-estimation task, participants observed a horizontal bar at a distance of 7 m and estimated the maximum height (EH) of successful SOT trials. The actual SOT was then performed to determine the actual maximum height (AH) of successful trials. Participants also underwent positron emission tomography with ¹⁸F-fluorodeoxyglucose at rest to assess cerebral neural activity. The SOT showed that 22.2 % of participants overestimated their step-over ability. A regression analysis adjusted for potential covariates showed that increased self-estimation error (difference between EH and AH) was correlated with lower glucose metabolism in the bilateral orbitofrontal cortex (OFC) and left frontal pole. Only the significant correlation between self-estimation error and OFC activity persisted after correcting for multiple comparisons. For well-functioning healthy older adults, overlooking one's own functional decline may be influenced by reduced metabolic activity in the anterior prefrontal cortex, particularly in the OFC. Our findings also suggest that functional decline in the OFC prevents older adults from updating the qualitative/quantitative values of their impaired physical abilities.

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DTI metrics can be used as biomarkers to determine the therapeutic effect of stem cells in acute peripheral nerve injury

Purpose

To determine the role of diffusion tensor imaging (DTI) metrics as biomarkers for the therapeutic effects of mesenchymal stem cells (MSCs) in acute peripheral nerve injury.

Materials and Methods

Forty-four adult rats received subepineurial microinjection of MSCs (n = 22) or phosphate buffered saline (PBS, n = 22) 1 week after the sciatic nerve trunk crush injury. Sequential fat-suppressed T2-weighted imaging, T2 measurement, DTI and sciatic nerve functional assessment were performed at a 3.0 Tesla MR unit over an 8-week follow-up, with histological assessments performed at regular intervals. The sciatic nerve function index, T2 value, and DTI metrics, including fractional anisotropy (FA), axial diffusivity, radial diffusivity (RD), and mean diffusivity values of the distal stumps of crushed nerves were measured and compared between the two groups.

Results

Nerves treated with MSCs showed better functional recovery and exhibited more pronounced nerve regeneration compared with nerves treated with PBS. T2 values in nerves treated with MSCs or PBS showed a similar change pattern (P = 0.174), while FA and RD values in nerves treated with MSCs showed more rapid return (one week earlier) to baseline level than nerves treated with PBS (P = 0.045; 0.035). Nerves treated with MSCs had higher FA and lower RD values than nerves treated with PBS during the period from 2 to 3 weeks after surgery (P ≤ 0.0001, 0.004; P = 0.004, 0.006).

Conclusion

FA and RD values derived from DTI might be used as sensitive biomarkers for detecting the therapeutic effect of stem cells in acute peripheral nerve crush injuries. J. Magn. Reson. Imaging 2016.

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A model for hepatic fibrosis: the competing effects of cell loss and iron on shortened modified Look-Locker inversion recovery T1 (shMOLLI-T1) in the liver

Purpose

To propose a simple multicompartment model of the liver and use Bloch-McConnell simulations to demonstrate the effects of iron and fibrosis on shortened-MOLLI (shMOLLI) T₁ measurements. Liver T₁ values have shown sensitivity to inflammation and fibrosis, but are also affected by hepatic iron content. Modified Look-Locker inversion recovery (MOLLI) T₁ measurements are biased by the lower T₂ associated with high iron.

Materials and Methods

A tissue model was generated consisting of liver cells and extracellular fluid (ECF), with iron-dependent relaxation rates. Fibrosis was imitated by increasing the ECF proportion. Simulations of the shMOLLI sequence produced a look-up table (LUT) of shMOLLI-T₁ for a given ECF fraction and iron content. The LUT was used to calculate ECF(shMOLLI-T₁), assuming normal hepatic iron content (HIC), and ECF(shMOLLI- ), accounting for HIC determined by , for 77 patients and compared to fibrosis assessed by liver biopsy.

Results

Simulations showed that increasing HIC decreases shMOLLI-T₁, with an increase in HIC from 1.0 to 2.5 mg/g at normal ECF fraction decreasing shMOLLI-T₁ by 160 msec, while increasing ECF increased ShMOLLI-T₁, with an increase of 20% ECF at normal iron increasing shMOLLI-T₁ by 200 msec. Calculated patient ECF(shMOLLI-T₁) showed a strong dependence on Ishak score (3.3 ± 0.8 %ECF/Ishak stage) and (–0.23 ± 0.04 %ECF/Hz). However, when iron was accounted for to produce ECF(shMOLLI- ), it was independent of HIC but retained sensitivity to Ishak score.

Conclusion

Use of this multicompartment model of the liver with Bloch-McConnell simulation should enable compensation of iron effects when using shMOLLI-T₁ to assess fibrosis. J. Magn. Reson. Imaging 2016.

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Characterization of axonal transport defects in Drosophila Huntingtin mutants

10.1080/01677063.2016.1202950<br/>Kurt R. Weiss

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A study of stress hyperglycemia and its relationship with the neurological outcome in patients presenting with acute ischemic stroke

2016-07-23T04-22-34Z
Source: International Journal of Advances in Medicine
Siva Ranganathan Green, Lokesh S., Tony Kadavanu Mathew, Jayasingh K., Ragupathy S..
Background: Cerebrovascular accident (CVA) continues to be the most common neurological disease in the developed and developing countries. It also stands as the 3rd more common cause of death after cardiovascular disease and cancer. Stroke related burden keeps rising among the patients, their relatives and treating consultants. The neurological outcome depends on various modifiable and non-modifiable risk factors. Among the modifiable risk factors, admission (stress) hyperglycemia has a deleterious effect on the neurological outcome. It is well known by various studies that diabetic patients have more severe outcome and neurological disability after acute stroke than the non-diabetic patients. Now stress hyperglycemia is also becoming a second serious marker to affect the neurological outcome of these stroke patients. The aim was to study the blood sugar level and it`s correlation with the neurological outcome among the acute ischemic stroke patients on admission and at third month of follow-up. Methods: It is a prospective and comparative study done in a tertiary care hospital. Adult patients (> 40 years) presenting with acute ischemic stroke were neurologically stratified based on National Institutes of Health Stroke Scale (NIHSS) and admission blood sugars were noted. They were subdivided into 3 groups. Group 1 consisting of 31 normoglycemic patients, group 2 consisting of 32 stress hyperglycemic patients and group 3 consisting of 40 Type 2 diabetes mellitus (T2DM) patients. They were again reassessed after 3 months with FBS, PPBS and neurological recovery by NHISS. Chi- square test / fischer exact test was used to compare between 3 groups. A p-value of


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Screening based on incidence of severe retinopathy of prematurity in a tertiary care center in India: are Indian infants different?

2016-07-23T03-57-49Z
Source: International Journal of Contemporary Pediatrics
Umamaheswari Balakrishnan, Shafi Jan Mohammad Shaik, Nivetha Manian*, Muthayya Muthukumar, Mary Thomas, Prakash Amboiram, Binu Ninan, Ashok Chandrasekaran, Saravanan Ramaswamy.
Background: Incidence of retinopathy of prematurity (ROP) and screening criteria among the preterm infants varies widely. The incidence of ROP and severe ROP in different Birth Weight (BW) and Gestational Age (GA) groups were studied. The aim of the study was to review the existing screening criteria for ROP based on the highest birth weight and or gestational age of infants who developed severe ROP. Methods: This is a retrospective descriptive study of neonates with GA of ≤ 34 weeks and/or BW of ≤ 1750 gm screened for ROP by experienced ophthalmologist from January, 2011 to December, 2015. End point was either complete vascularisation or need for laser therapy as per ETROP guidelines. Severe ROP was defined as ROP needing treatment. Highest BW and or GA of infants who developed severe ROP were taken as cut off points for revising the existing screening criteria for ROP. Results: Among 1366 infants included in this study, 252 (18.4%) and 86 (6.2%) developed ROP and severe ROP, respectively. Mean GA was 29.2±1.4 weeks and 28.7±2.3 among infants with ROP and severe ROP, respectively. Stratified analysis showed a significant increase in the incidence of ROP with decreasing BW and GA (p


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Society of Anesthesia and Sleep Medicine Guidelines on Preoperative Screening and Assessment of Adult Patients With Obstructive Sleep Apnea

The purpose of the Society of Anesthesia and Sleep Medicine guideline on preoperative screening and assessment of adult patients with obstructive sleep apnea (OSA) is to present recommendations based on the available clinical evidence on the topic where possible. As very few well-performed randomized studies in this field of perioperative care are available, most of the recommendations were developed by experts in the field through consensus processes involving utilization of evidence grading to indicate the level of evidence upon which recommendations were based. This guideline may not be appropriate for all clinical situations and all patients. The decision whether to follow these recommendations must be made by a responsible physician on an individual basis. Protocols should be developed by individual institutions taking into account the patients' conditions, extent of interventions and available resources. This practice guideline is not intended to define standards of care or represent absolute requirements for patient care. The adherence to these guidelines cannot in any way guarantee successful outcomes and is rather meant to help individuals and institutions formulate plans to better deal with the challenges posed by perioperative patients with OSA. These recommendations reflect the current state of knowledge and its interpretation by a group of experts in the field at the time of publication. While these guidelines will be periodically updated, new information that becomes available between updates should be taken into account. Deviations in practice from guidelines may be justifiable and such deviations should not be interpreted as a basis for claims of negligence.

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Mechanisms of the Immunological Effects of Volatile Anesthetics: A Review

Volatile anesthetics (VAs) have been in clinical use for a very long time. Their mechanism of action is yet to be fully delineated, but multiple ion channels have been reported as targets for VAs (canonical VA targets). It is increasingly recognized that VAs also manifest effects outside the central nervous system, including on immune cells. However, the literature related to how VAs affect the behavior of immune cells is very limited, but it is of interest that some canonical VA targets are reportedly expressed in immune cells. Here, we review the current literature and describe canonical VA targets expressed in leukocytes and their known roles. In addition, we introduce adhesion molecules called β2 integrins as noncanonical VA targets in leukocytes. Finally, we propose a model for how VAs affect the function of neutrophils, macrophages, and natural killer cells via concerted effects on multiple targets as examples.

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Adjustments of the amplitude mapping function: Sensitivity of cochlear implant users and effects on subjective preference and speech recognition

10.1080/14992027.2016.1202454<br/>Femke L. Theelen–van den Hoek

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Evaluation of training program on knowledge of stroke among anganwadi workers in Chintamani taluk of Karnataka state, India

2016-07-23T03-16-18Z
Source: International Journal of Community Medicine and Public Health
Suman G., Lalitha K., Aravind B.A., Mahendra J.V., Arjunan I., Shivaraj N.S., Pruthvish S..
Background: Established population based disease registry provides data on incidence, risk factors, determinants and trends of the disease. Population based rural stroke registry was started on a pilot basis with an objective to evaluate the feasibility of establishing population-based stroke registry in Chintamani taluk of Karnataka state, India. Training of health care personnel was undertaken to facilitate reporting of case. The objective of the present communication is to evaluate the training conducted for anganwadi workers by trained investigators in 2012. Methods: Training was conducted using a validated training manual. Among the existing 438 anganwadi workers in the taluk, 405 (92.4%) attended the training. Pre and post-test questionnaire was administered before and after the training session to assess the improvement in the knowledge of stroke. Results: Only 362 (89.38%) with both pre and post-test answered were included for analysis. Overall there was statistical significant improvement in knowledge of anganwadi workers on symptoms, risk factors and prevention of stroke. Regarding Knowledge on symptoms of Stroke, 85 (95.5%) who scored poor, 81 (98.8%) who scored average in pre-test improved to good in post test. It was observed that 94 (100%) and 120 (94.4%) of the workers who scored poor regarding knowledge on prevention and risk factors of stroke respectively improved to good in the post-test. Conclusions: This endeavor substantiates the fact that anganwadi workers can be trained to identify suspects.


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