Assessment of the efficacy and safety of a new complex skin cream in Asian women: A controlled clinical trial

Summary

Background

Medical products such as hydroquinone and tretinoin have been widely used to treat various types of skin hyperpigmentation. However, these products are limited in daily use given their adverse effects. Other alternative agents with fewer adverse side effects have been developed. However, single agents often do not produce satisfactory results.

Aims

To evaluate the efficacy and safety of a new brightening complex cream containing niacinamide, tranexamic acid, oxyresveratrol, glutathione disulfide, and linoleic acid.

Patients and Methods

A total of 26 Korean women seeking to lighten their skin were enrolled. The product was applied on the face two times per day for 12 weeks. Standardized photographs were taken at baseline, 4 weeks, 8 weeks, and 12 weeks. Efficacy was assessed using melanin index (MI), erythema index (EI), and chromatic aberration values (L*, a*, and b*). Improvement perceived by investigators and patients was measured as well.

Results

The L*-value was increased at 8 weeks (0.7±2.5, P<.05) and at 12 weeks (0.8±2.5, P<.05). The MI was significantly decreased at 8 weeks (−4.2±4.5, P<.05) and at 12 weeks (−3.8±4.8, P<.001). The EI was significantly improved at 12 weeks (−3.2±2.2, P<.001). More than 80% of patients were considered improved at 12 weeks based on the view of the investigators and patients.

Conclusions

The new brightening complex cream was proved to be effective and safe in Asian women.

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Tumescent anaesthesia: its applications and well tolerated use in the out-of-operating room setting.

Purpose of review: Tumescent anaesthesia is a method of administering dilute local anaesthetic into the subcutaneous tissue. Many anaesthesiologists are unfamiliar with the technique, its applications and potential risks. Recent findings: The maximum safe dose of lidocaine with epinephrine in tumescent anaesthesia for liposuction is probably between 35 and 55 mg/kg. Without liposuction, the maximum dose of lidocaine with epinephrine should be no more than 28 mg/kg. After tumescent infiltration for liposuction, serum lidocaine concentrations peak between 12 and 16 h after injection. When tumescent lidocaine without epinephrine is used for endovenous laser therapy, peak serum lidocaine concentrations are observed much earlier, between 1 and 2 h after injection. Slow administration of more dilute concentrations of local anaesthetic decreases the risk of local anaesthetic systemic toxicity. Summary: Although appealing because of its ability to provide prolonged analgesia, high doses of local anaesthetic are frequently administered using the tumescent technique, and absorption of local anaesthetic from the subcutaneous tissue is variable. When caring for patients having procedures in which tumescent anaesthesia is used, the risk of local anaesthetic toxicity should be acknowledged and lipid emulsion should be available for prompt treatment if needed. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Sedation for advanced procedures in the bronchoscopy suite: proceduralist or anesthesiologist?.

Purpose of review: This article focuses on the issue of sedation provided either by proceduralists or anesthesiologists for advanced bronchoscopy procedures. The relative merits of both approaches are presented. Current evidence from the literature and guideline recommendations relevant to this topic are reviewed. Recent findings: In general, patient and proceduralist satisfaction as well as patient safety are increased when intravenous sedation is provided for advanced bronchoscopic procedures. However, guidelines by various societies remain vague on defining the appropriate level of care required when providing sedation for these procedures. In addition, targeted depth of sedation varies considerably among practitioners. While in some settings, nonanesthesiologist-administered propofol sedation has been proven safe; nevertheless, its use is controversial, especially in the bronchoscopy suite. Summary: The role of the anesthesiologist in sedation for advanced bronchoscopy remains undefined. When deep sedation for prolonged interventional procedures is needed or when dealing with patients who have multiple comorbidities, an anesthesiologist should be involved. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Safety of deep sedation in the endoscopy suite.

Purpose of review: As the complexity of endoscopic procedures increases, the use of propofol and the desire for deep sedation are becoming more common in the endoscopy suite. This review explores sedation depth, agents used for sedation, recommended monitoring, and adverse event risks that occur during sedation for endoscopy. Recent findings: The sedation provider for endoscopy varies by practice location and with regulatory requirements. As increasingly deep levels of sedation are used in this setting, the need for all providers to have training in the ability to rescue patients from sedation-related side effects is paramount. Propofol has an important role for prolonged and uncomfortable endoscopic interventions and has a strong safety record in the endoscopy suite. Vital signs monitoring is recommended during all endoscopy sedation, and there is emerging interest in advanced monitoring (e.g., capnography, processed electroencephalogram, respiratory monitoring) in this setting. The reported rate of adverse events during endoscopy sedation varies widely; however, advanced age and increasing American Society of Anesthesiologists physical status score are consistently associated with increased risk. Whether anesthesiologist-administered sedation is safer than non-anesthesiologist-administered sedation remains controversial. Summary: This review provides some guidance to providers who administer sedation in the endoscopy suite and is intended to improve the safety of patients. The recommendations are based on best available evidence and expert opinion. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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The role of the anaesthesiologist in air ambulance medicine.

Purpose of review: The care administered on air ambulances has become increasing complex. This has led to a discussion among experts as to whether air ambulance travel should be manned by physicians. This review provides evidence in support of anaesthesiologists being the physician-leaders in air ambulance medicine, because of their training in advanced airway management, critical care, and resuscitation. Recent findings: Successful prehospital care requires the ability to perform a complex set of advanced diagnostics and interventions. These include airway management, haemorrhage control, pain management, point-of-care diagnostics, complex interfacility transport, and advanced interventions. This skill set closely mirrors the training and expertise of anaesthesiologists. Summary: There are few studies investigating the specific benefit of anaesthesiologists in air ambulance medicine. However, current evidence indicates that their presence does improve patient care and safety. Future studies on this topic should use evidence-based quality indicators and standardized data sets to seek answers to optimal staffing of air ambulance teams. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Perioperative management of antithrombotic therapies.

Purpose of review: Perioperative coagulation management is becoming increasingly frequent in the daily routine of the anesthesiologist and with the plethora of new substances on the market also increasingly complex. The perioperative setting poses unique challenges requiring an individualized evaluation and management of antithrombotic therapy. This review shall summarize the newest developments in this domain. Recent findings: New data in patients with atrial fibrillation have led to a paradigm change in the perioperative management of antithrombotics. The role of bridging therapy has been downgraded in the guidelines, which only foresee bridging in patients with high thromboembolic risk. Furthermore, direct oral anticoagulants are now a cornerstone in antithrombotic therapy, calling for specific perioperative management. The new reversal agents idarucizumab, and potentially in the future andexanet alfa and ciraparantag, will play an increasingly important role in the treatment of major bleeding in this group of patients. Summary: With the new evidence and treatment options available, perioperative coagulation management is experiencing a Renaissance, opening many interesting new doors, but also presenting the clinician with new challenges. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Importance of Group Therapeutic Support for Family Members of Children with Alopecia Areata: A Cross-Sectional Survey Study

Abstract

Background/Objectives

The psychological effect of alopecia areata (AA) is well documented, but group interaction may help lessen this burden. We aimed to determine factors that draw patients with AA and their families to group events.

Methods

Surveys were administered at the annual alopecia areata bowling social in 2015 and 2016. This event is a unique opportunity for children with AA and their families to meet others with the disease and connect with local support group resources from the Minnesota branch of the National Alopecia Areata Foundation. Data from 2015 and 2016 were combined. Comparisons of subgroups were performed using Fisher exact tests for response frequencies and percentages and two-sample t tests for mean values.

Results

An equal number of men and women participated in the study (n = 13 each). The average age was 41.1 years. There were no significant differences (p > 0.05) in survey responses based on respondent age or sex. Twenty-three (88.5%) attendees sought to connect with others with AA and met three or more people during the event. Seventeen (65.4%) also attended other support group events. Twelve respondents (46.2%) came to support a friend or family member. One hundred percent of attendees identified socializing with others with AA as important.

Conclusions

Group interaction is an important source of therapeutic support for people with AA and their families.

http://ift.tt/2roRpdf

Towards a Qualitative Assessment of Energy Practices: Illich and Borgmann on Energy in Society

Abstract

Energy consumption is central to both a number of pressing environmental issues and to people's attempts to improve their well-being. Although typically understood as essential for people to thrive, this paper sketches a theoretical foundation for the possibility that the form and amount of energy consumption in modern society may inhibit rather than enable human flourishing. It achieves this goal by connecting and critically assessing the writings of Ivan Illich and Albert Borgmann, which offer a number of concepts that enable a qualitative discussion on energy practices. For different reasons, both authors are highly critical of the societal tendency to command ever-increasing amounts of energy. Illich focuses on negative effects of high energy consumption at the societal level, whereas in my particular re-reading of Borgmann, one finds reasons why high energy consumption fails to realize intended positive effects. It is argued that therefore, energy transition should involve a re-appreciation of the function of energy consumption: to support, rather than to be central to life.

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Acceptability, Feasibility, and Effectiveness of Interdisciplinary Group Education Sessions for Women Veterans with a History of Sexual Trauma

Violence and Gender , Vol. 0, No. 0.


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Intervention for elevated intracranial pressure improves success rate after repair of spontaneous cerebrospinal fluid leaks

Objectives/Hypothesis

Spontaneous cerebrospinal fluid (CSF) leaks are associated with increased intracranial pressure (ICP) and considered a manifestation of idiopathic intracranial hypertension. Although postoperative acetazolamide and placement of CSF shunt systems are considered valuable interventions for elevated ICP, the impact on recurrence rate remains unclear. The objective of this study was to systematically review evidence from reported literature to evaluate whether postoperative ICP management reduces recurrence rates after primary endoscopic repair.

Study Design

Prospective case series and systematic review.

Methods

Demographics, defect location, success rates, and ICP management in spontaneous CSF leak patients were prospectively collected over 8 years. A search was also conducted in PubMed to identify studies reporting cases of spontaneous CSF rhinorrhea.

Results

Fifty-six articles with nonduplicated data were identified and combined with a prospective series of 108 patients for a total of 679 patients treated for spontaneous CSF rhinorrhea. Average age was 50.4 years with 77% female. Average body mass index was 35.8 kg/m². Defects were most commonly located in the sphenoid sinus (n = 334) followed by the ethmoid (n = 318) and the frontal sinus (n = 46). Successful primary repair was 92.82% in patient cohorts where ICP evaluation and intervention with acetazolamide or CSF shunt systems was performed, but was significantly decreased to 81.87% in series with no active management of elevated ICP (P < .001).

Conclusions

Evaluation and intervention for elevated ICP in spontaneous CSF leaks is associated with significantly improved success rates following primary endoscopic repair.

Level of Evidence

4. Laryngoscope, 2017

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Early neurocognitive improvements following parathyroidectomy for primary hyperparathyroidism

Objectives

To establish a time frame for postoperative improvements in neurocognitive function in patients who undergo parathyroidectomy for primary hyperparathyroidism by utilizing repeat neuropsychological assessment at multiple time points before and after surgery.

Study Design

Prospective cohort study.

Methods

A prospective study was conducted at a tertiary academic medical center between August 2014 and December 2015, including 50 patients with primary hyperparathyroidism who underwent parathyroidectomy. A panel of neurocognitive tests was administered at two separate time points: preoperative and 1-week postoperative. Validated neuropsychological assessment tools were utilized, including Rey Auditory-Verbal Learning Test, Trail Making Test A and B, Benton Controlled Oral Word Association, WAIS-IV Digit Span, Hospital Anxiety and Depression Scale, Positive and Negative Affect Schedule, and Insomnia Severity Index. Barona Information Sheet was used to collect demographic data. Paired t tests were to compare pre- and postoperative scores.

Results

Thirty-five patients completed the preoperative and 1-week postoperative testing. In cognitive testing, significant improvement was noted in immediate recall (P < 0.001), working memory (P = 0.011), and attention (P = 0.008) at 1-week postoperative. In mood testing, depression (P < 0.001), anxiety (P < 0.001), and negative affect (P = 0.001) scores were significantly improved at 1-week postoperative. Insomnia scores also were significantly improved at 1 week (P < 0.001).

Conclusion

Objective improvements in neurocognitive function following parathyroidectomy for primary hyperparathyroidism were noted as early as 1 week after surgery, which is earlier than previously reported.

Level of Evidence

2b. Laryngoscope, 2017

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In response to “Otolaryngology workforce analysis”

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Evaluation of leg wrapping for the prevention of postspinal hypotension in cesarean section under spinal anesthesia

Aparna Abhijit Bagle, Adithya Vishnu, Anil Kumar, Amit Malik, Vinit Garg, Gayatri Khanvilkar

Anesthesia: Essays and Researches 2017 11(2):439-443

Background: Spinal blockade provides excellent anesthesia for patients undergoing cesarean section. However, hypotension after spinal anesthesia is a common adverse effect that is commonly experienced in patients undergoing cesarean section. The aim of our study was to analyze if a simple technique like leg wrapping with elastic crepe bandage would be effective in controlling postspinal hypotension. Materials and Methods: Sixty full-term pregnant patients who were posted for cesarean section belonging to American Society of Anesthesiologists I and II were divided into two groups. Patients in Group W had their legs wrapped with elastic crepe bandage and in the other Group N, leg wrapping was not done. All the patients were preloaded with Ringer lactate at 10 ml/kg before the spinal anesthesia. The hemodynamic parameters were monitored every 3 min until the delivery of the baby and every 5 min until the end of surgery. If hypotension occurred, then along with crystalloid loading a bolus dose of mephentermine 6 mg was given intravenously. Statistical Analysis: Statistical software "Numbers version 3.6.1 (2566)" was used for statistical calculations. Results: Frequency of hypotension in Group W (10%) was significantly less compared to Group N (60%). Vasopressor requirement was significantly less in Group W (P = 0.009), which was highly significant. Conclusion: Wrapping of lower extremities was a simple, easy, and an effective method of decreasing episodes of hypotension and vasopressor requirement after spinal anesthesia in cesarean patients and needs to be practiced routinely.

http://ift.tt/2qpPTsC

Effect of single compared to repeated doses of intravenous S(+) ketamine on the release of pro-inflammatory cytokines in patients undergoing radical prostatectomy

Hassan Mohamed Ali, Ali M Mokhtar

Anesthesia: Essays and Researches 2017 11(2):282-286

Background: Radical prostatectomy is a major surgical procedure that is associated with marked inflammatory response and impairment of the immune system which may affect the postoperative outcome. The aim of this study was to evaluate the effect of preincision single or multiple doses of S(+) ketamine on the pro-inflammatory cytokines, namely tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6). Patients and Methods: This is a randomized controlled trial including 60 American Society of Anesthesiologists Physical Status I and II patients scheduled for radical prostatectomy under combined general-epidural anesthesia in Cairo university Teaching Hospital. Patients were randomly divided into three groups each of twenty patients: Group I received no S(+) ketamine (control group), Group II received S(+) ketamine as a single preincision dose, and Group III received preincision and repeated doses of S(+) ketamine. S(+) ketamine was injected as a single intravenous dose of 0.5 mg/kg in Group II and III, repeated as 0.2 mg/kg at 20 min interval until 30 min before the end of surgery. Results: The three groups were comparable in age, weight, and duration of the operation. The study also revealed that a single preincision dose of S(+) ketamine decreased TNF-α to reach 1027.04 ± 50.13 μ/ml and IL-6 to reach 506.89 ± 25.35 pg/ml whereas the repeated doses of S(+) ketamine decreased TNF-α to reach 905.64 ± 35065 μ/ml and IL-6 to reach 412.79 ± 16.5 pg/ml (P < 0.05). Conclusion: S(+) ketamine suppresses pro-inflammatory cytokine production, especially when given in repeated doses.

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Anesthetic management of a parturient with severe pulmonary restenosis posted for cesarean section

Rajkiran Babubhai Shah, Beena P Butala, Geeta P Parikh

Anesthesia: Essays and Researches 2017 11(2):517-519

Adults with congenital heart disease are increasing due to improvement in infant heart surgery and availability of better cardiac care. Pregnancy in these patients requires multidisciplinary team approach due to circulatory changes. We describe an anesthetic management of the parturient undergoing cesarean section having severe pulmonary restenosis.

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Comparison of usefulness of ketamine and magnesium sulfate nebulizations for attenuating postoperative sore throat, hoarseness of voice, and cough

Sunil Rajan, George Jacob Malayil, Rekha Varghese, Lakshmi Kumar

Anesthesia: Essays and Researches 2017 11(2):287-293

Context: Postoperative sore throat (POST) is a complication that is unresolved in patients undergoing endotracheal intubation. Aim: To compare the effects of ketamine and magnesium sulfate nebulizations in two strengths, on the incidence and severity of POST, hoarseness, and cough. Settings and Design: Sixty surgical patients undergoing elective abdominal and lower limb surgeries under combined epidural and general anesthesia were included in this prospective, randomized, double-blinded study. Subjects and Methods: Patients in each group were nebulized with the respective study drug 15 min prior to the surgery, i.e., ketamine in Group K, magnesium sulfate 250 mg, and 500 mg in Group M1 and Group M2, respectively, and normal saline as control in Group C. A standardized anesthesia protocol was followed for all patients. After extubation, the patients were asked to grade POST, hoarseness, and cough at 0, 2, 4, 12, and 24 h. Statistical Analysis Used: One-way analysis of variance, Chi-square test, Fisher's exact test, paired t-tests, and Wilcoxon's signed-rank test as applicable. Results: Ketamine and magnesium sulfate 500 mg demonstrated a statistically significant decrease in POST at 0, 2, and 4 h, and postoperative hoarseness at 0 h. There was decrease in the incidence and severity of sore throat, hoarseness, and cough at all periods in the study groups as compared with control. Conclusion: Nebulization with ketamine 50 mg and magnesium sulfate 500 mg, 15 min before induction of general anesthesia and intubation, reduce the incidence and severity of POST and hoarseness of voice.

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Prophylactic use of intravenous clonidine compared to tramadol in prevention of intraoperative shivering under regional anesthesia

Sarmila Guha (Banerjee), Pallab Kumar Nath, Rita Halder, Ujjwal Bandyopadhyay

Anesthesia: Essays and Researches 2017 11(2):477-482

Objectives: This study aimed to evaluate the relative efficacy of prophylactic intravenous (IV) clonidine and tramadol for control of intraoperative shivering following spinal anesthesia. Materials and Methods: After institutional ethical clearance, 142 patients were chosen from either gender, aged 20–60 years, physical status American Society of Anesthesiology Class I and II scheduled for elective infraumbilical surgery under spinal anesthesia. Patients were randomized into two groups: Group C (n = 71) received injection clonidine 50 μg) IV in 100 ml normal saline (NS) over 10 min and Group T (n = 71) received injection tramadol 50 mg IV. In 100 ml NS over 10 min after spinal anesthesia. Results: Incidence of shivering was not significant when compared between the two groups (P > 0.05). The axillary temperatures fell significantly in Group C from the baseline and remained at a significantly lower level up to 60 min after rescue drug was administered in patients who shivered. There was a similar fall in axillary temperature in Group T in patients having shivering, but the difference was not significant. When compared between the two groups among patients who shivered, the difference in fall of temperature was not significant. Side effects such as hypotension, bradycardia, and sedation were significantly more common in clonidine group, whereas nausea was significantly more common patients of tramadol group. Conclusion: Prophylactic administration of both tramadol and clonidine is effective for controlling shivering under spinal anesthesia. However, tramadol is better because of higher response rate, less sedation, and lesser hemodynamic alterations.

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Efficacy of dexmedetomidine infusion for procedural comfort and intraoperative sedation in patients undergoing surgeries with subarachnoid block: A randomized double-blind clinical trial

Dewan Roshan Singh, Kusha Nag, Amrutha Bindu Nagella, VR Hemanth Kumar, Antony John Charles

Anesthesia: Essays and Researches 2017 11(2):294-299

Introduction: There is increasing evidence to include sedation as an integral part of regional anesthesia to ensure patient comfort. This may compromise patient cooperation, an important component of regional anesthesia. We decided to determine the efficacy of dexmedetomidine (0.3 μg/kg/h and 0.5 μg/kg/h) for allaying procedural discomfort and ensuring their cooperation in patients undergoing surgery with subarachnoid block. Setting: Tertiary care center. Materials and Methods: Sixty patients with the American Society of Anesthesiologists physical status Class I and II posted for surgeries under subarachnoid block were randomized into two groups of 30 each to receive dexmedetomidine in a loading dose of 1 μg/kg in both groups followed by continuous infusion of 0.3 μg/kg/h in Group D 0.3 and 0.5 μg/kg/h in Group D 0.5. Observer assessment sedation score, ease of positioning score, response to spinal needle insertion, hemodynamic parameters, patient satisfaction (PS) score, and surgeon satisfaction (SS) score were evaluated. Results: Median observer Assessment Sedation Score ranged between four and three at all times during dexmedetomidine infusion in Group D 0.3. In Group D 0.5, median Observer assessment of alertness/sedation scale ranged between three and two. Ease of positioning (P = 1.000) and response to spinal needle insertion (P = 0.521) were comparable in both groups. PS was higher in Group D 0.5 as compared to Group D 0.3. SS score was comparable in both the groups. Conclusion: Intravenous dexmedetomidine infusion 0.3 μg/kg/h produces effective sedation in patients undergoing surgery with spinal anesthesia while ensuring patient cooperation for positioning and without any recall of the procedure in postoperative period.

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A simple novel technique to make any supraglottic airway device magnetic resonance imaging compatible: A fusion of the past with the present

Ashish Kannaujia, Saipriya Tewari, Alka Verma

Anesthesia: Essays and Researches 2017 11(2):535-536



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Lignocaine versus ropivacaine infiltration for postpartum perineal pain

Jyoti P Deshpande, Girish Y Saundattikar

Anesthesia: Essays and Researches 2017 11(2):300-303

Background: Millions of women worldwide undergo postpartum perineal repair under local infiltration. Inadequate postpartum pain management can negatively impact a mother's physical and psychological recovery. Aims: To study and compare the analgesic effect and maternal satisfaction with lignocaine versus ropivacaine infiltration for postpartum perineal pain relief. Materials and Methods: After clearance from the Institutional Ethics Committee, a double-blind prospective randomized study carried out on 100 parturients of aged 18–40 years who had spontaneous vaginal delivery, comparing 1% lignocaine and 0.75% ropivacaine infiltration for the repair of selective episiotomy or perineal injury. Time of the first analgesic (TFA) demand, maternal satisfaction at 24 h, and visual analog scale (VAS) pain score were studied. Statistical Analysis: Chi-square test and Student's t-test were used and P< 0.05 was considered as significant. Results: VAS pain score was significantly lower at 2 and 4 h in ropivacaine group versus lignocaine group (P < 0.0001). Significantly, longer TFA (10.2 ± 1.54 vs. 2.20 ± 0.44 h, P< 0.0001) and higher percentage of maternal satisfaction (86% vs. 44%) were observed in ropivacaine as compared to lignocaine group (P < 0.0001). Conclusions: Prolonged analgesia and higher rate of maternal satisfaction were found when ropivacaine infiltration was used for perineal repair as compared to lignocaine.

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The postdural puncture headache and back pain: The comparison of 26-gauge atraucan and 26-gauge quincke spinal needles in obstetric patients

Mehmet Salim Akdemir, Ayhan Kaydu, Yonca Yanlı, Mehtap Özdemir, Erhan Gökçek, Haktan Karaman

Anesthesia: Essays and Researches 2017 11(2):458-462

Background: The postdural puncture headache (PDPH) and postdural puncture backache (PDPB) are well-known complications of spinal anesthesia. There are some attempts to reduce the frequency of complication such as different design of the spinal needles. Aims: The primary outcome of this study is to compare the incidence of PDPH between 26-gauge Atraucan and 26-gauge Quincke spinal needles in elective cesarean operations. The severity of symptoms, the incidence of backache, technical issues, and comparison of cost of needles are secondary outcomes. Materials and Methods: After Investigational Review Board approval, a randomized, prospective, double-blinded study was designed in 682 American Society of Anesthesiologists I–II women having elective cesarean operations under spinal anesthesia. Patients were divided into two groups as 26-gauge Atraucan Group A (n = 323) and 26-gauge Quincke spinal needles Group Q (n = 342). All patients were questioned about backache 1 week later. Differences between categorical variables were evaluated with Chi-square test. Continuous variables were compared by Student's t-test for two independent groups. A two-sided P< 0.05 was considered statistically significant for all analyses. Results: There were no significant differences between groups in all demographic data. The one attempt success rate of the dural puncture in Group A (70,58%) and in Group Q (69.3%) was similar (P > 0.05). The incidence of PDPH was 6.5% in Group A and 4.9% in Group Q (P > 0.05). The epidural blood patch was performed to the three patients in Group A and five patients in Group Q who had severe headache (P > 0.05). The incidence of PDPB was 4.33% versus 2.04% in Group A and Group Q (P > 0.05). Conclusions: The incidence of complication rates and technical handling characteristics did not differ between two groups. Quincke needle is cheaper than Atracaun needle, so it can be a cost-effective choice in obstetric patients.

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Financial implications of intravenous anesthetic drug wastage in operation room

Suvarna Kaniyil, A Krishnadas, Arun Kumar Parathody, KT Ramadas

Anesthesia: Essays and Researches 2017 11(2):304-308

Background and Objectives: Anesthetic drugs and material wastage are common in operation rooms (ORs). In this era of escalating health-care expenditure, cost reduction strategies are highly relevant. The aim of this study was to assess the amount of daily intravenous anesthetic drug wastage from major ORs and to estimate its financial burden. Any preventive measures to minimize drug wastage are also looked for. Methods: It was a prospective study conducted at the major ORs of a tertiary care hospital after getting the Institutional Research Committee approval. The total amount of all drugs wasted at the end of a surgical day from each major OR was audited for five nonconsecutive weeks. Drug wasted includes the drugs leftover in the syringes unutilized and opened vials/ampoules. The total cost of the wasted drugs and average daily loss were estimated. Results: The drugs wasted in large quantities included propofol, thiopentone sodium, vecuronium, mephentermine, lignocaine, midazolam, atropine, succinylcholine, and atracurium in that order. The total cost of the wasted drugs during the study period was Rs. 59,631.49, and the average daily loss was Rs. 1987.67. The average daily cost of wasted drug was maximum for vecuronium (Rs. 699.93) followed by propofol (Rs. 662.26). Interpretation and Conclusions: Financial implications of anesthetic drug wastage can be significant. Propofol and vecuronium contributed maximum to the financial burden. Suggestions for preventive measures to minimize the wastage include education of staff and residents about the cost of drugs, emphasizing on the judicial use of costly drugs.

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The analgesic efficacy of dexamethasone added to ropivacaine in transversus abdominis plane block for transabdominal hysterectomy under subarachnoid block

Jyoti P Deshpande, Poonam S Ghodki, Shalini P Sardesai

Anesthesia: Essays and Researches 2017 11(2):499-502

Background and Aims: Ultrasound-guided transversus abdominis plane (TAP) block has been proven as a safe and effective analgesic technique for several lower abdominal surgeries. Various adjuvants have been used to intensify the quality and prolong the local anesthetic effect. We evaluated the analgesic efficacy of dexamethasone addition to ropivacaine in TAP block following open abdominal hysterectomy. Materials and Methods: After clearance from the Institutional Ethics Committee, a double-blind, prospective, randomized study was carried out on sixty patients aged 40–60 years posted for elective open abdominal hysterectomy comparing bilateral TAP block using 20 ml of 0.5% ropivacaine + 1 ml of 0.9% saline (control Group R) or 20 ml of 0.5% ropivacaine + 4 mg dexamethasone (Group RD). The aim of our study was to observe postoperative pain score (visual analog scale [VAS]), time for first analgesic (TFA) demand, total analgesic consumption, and incidence of nausea or vomiting. Statistical Analysis: Chi-square test and Student's t-test were used, and P< 0.05 was considered as statistically significant. Results: Postoperative VAS pain scores were significantly lower at 4, 6, and 12 h in Group RD as compared to Group R (P < 0.05). Significantly longer TFA (13.2 ± 7.6 vs. 7.1 ± 4.6 h, P< 0.001) with lesser tramadol requirement in first 24 h (50.2 ± 34 vs. 94 ± 35 mg, P< 0.001) were observed in Group RD as compared to Group R. Incidence of nausea or vomiting was statistically insignificant between the groups (P > 0.05). Conclusions: Addition of dexamethasone to ropivacaine TAP block prolonged the postoperative analgesia and reduced analgesic requirement following abdominal hysterectomy.

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Dexmedetomidine as an anesthetic adjuvant in intracranial surgery

Ankita Batra, Reetu Verma, VK Bhatia, Girish Chandra, Shashi Bhushan

Anesthesia: Essays and Researches 2017 11(2):309-313

Background: The basic principle of neuroanesthesia is to provide hemodynamic stability, provision of optimal operative conditions, maintenance of cerebral perfusion pressure, and cerebral oxygenation. Aim: This study was undertaken to see the effect of dexmedetomidine infusion on hemodynamics and its ability to act as an anesthetic adjuvant in patients undergoing supratentorial tumor surgery. Setting and Design: Prospective randomized control double blind study. Subjects and Methods: In this study, we compared two groups with 25 patients in each group. Group C patients received saline infusion during surgery and 4 μg/kg of fentanyl intravenously (i.v.) at the induction and at pin head application. Group D patients received dexmedetomidine infusion during surgery at the rate of 0.4 μg/kg/h and 2 μg/kg of fentanyl i.v. at the induction and at pin head application Statistical Analyses Used: Parametric data were analyzed using Student's t-test. The categorical data were studied using Chi-squared test or Fisher's test as appropriate. Results: The vitals remained within 20% of baseline in both groups during the study period except at the time of extubation where the rise in heart rate was more than 20% in control group. The requirement of thiopentone for induction was significantly less in dexmedetomidine group. In dexmedetomidine group, less number of patients required intraoperative fentanyl (P < 0.05), and the time to rescue analgesic was also more in Group D (P < 0.05). Conclusion: Dexmedetomidine infusion started before surgery maintains hemodynamic stability intraoperatively and is effective in attenuating the cardiovascular responses to intubation, skull pin application, and extubation. It decreases the requirement of other anesthetic agents as well.

http://ift.tt/2pUWgko

Continuous positive airway pressure prevents hypoxia in dental patient with obstructive sleep apnea syndrome under intravenous sedation

Anton A Kasatkin, Aleksei P Reshetnikov, Aleksandr L Urakov, Dmitrii Y Baimurzin

Anesthesia: Essays and Researches 2017 11(2):528-530

Use of sedation in patients with obstructive sleep apnea (OSA) in dentistry is limited. Hypoxia may develop during medication sleep in dental patients with OSA because of repetitive partial or complete obstruction of the upper airway. In this regard, anesthesiologists prefer not to give any sedative to surgical patients with OSA or support the use of general anesthesia due to good airway control. We report a case where we could successfully sedate a dental patient with OSA using intraoperative continuous positive airway pressure (CPAP) without hypoxia. Use of sedation and intraoperative CPAP in patients with OSA may be considered only if the effectiveness at home CPAP therapy is proven.

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Hemodynamic responses at intubation, change of position, and skin incision: A comparison of multimodal analgesia with conventional analgesic regime

Keelara Shivalingaiah Savitha, Radhika Dhanpal, MS Vikram

Anesthesia: Essays and Researches 2017 11(2):314-320

Background: Lumbar spine surgery is associated with hemodynamic variations at intubation, change of position, and skin incision. A balanced anesthesia with multimodal analgesia (MMA) is necessary to attenuate these changes. Aim: To assess the relative effectiveness of preemptive MMA compared with the conventional analgesic regime in suppressing the hemodynamic response to endotracheal intubation, prone positioning, and skin incision. Settings and Design: A randomized, prospective study involving 42 patients belonging to the American Society of Anesthesiologists Physical Status 1 and II scheduled to undergo elective lumbar spine surgery were allocated into two groups of 21 each. Materials and Methods: Forty-two patients were randomly allocated into Groups A and B. Group A (study group) received diclofenac, paracetamol, clonidine, and bupivacaine with adrenaline skin infiltration and Group B (control group) injection paracetamol and saline with adrenaline skin infiltration. Statistical Analysis Used: Hemodynamic parameters (heart rate [HR], systolic blood pressure [SBP], diastolic blood pressure [DBP], and mean arterial pressure [MAP]) between the groups following intubation, prone position, and skin incision were noted and compared using repeated measure analysis of variance. One sample t-test was used to compare the standard mean concentration with the means of the study and control groups. P< 5% being considered statistically significant. Results: In the study group, HR, SBP, DBP, and MAP were lower at intubation and change of position as compared to the control group and were statistically significant. Conclusion: Preemptive MMA with balanced anesthesia is effective in attenuating the hemodynamic responses to multiple noxious stimuli during lumbar spine surgery.

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An audit of comparison of perioperative outcomes with the introduction of standardized preoperative evaluation form at a tertiary care hospital in rural India

Shraddha Vidyadhar Naik, Bilal Mohammad, Vitthal K Dhulkhed

Anesthesia: Essays and Researches 2017 11(2):426-430

Introduction: Preoperative evaluation of a patient is the fundamental component of anaesthetic practice. Inadequate documentation and record keeping on the preoperative evaluation form (PEF) can be a major obstacle to attaining good practice and improving patient outcomes following operative procedures. Aim: The aim of the study was to conduct an audit to assess the quality of the preoperative anaesthetic information gathered and to observe the quality profile after the introduction of a standardized pre-operative evaluation form. Study Design: This was a retrospective study, using a sample of 3000 files of patients who underwent elective surgery in a tertiary care hospital of rural India. We devised 11 quality indicators, looking at factors in the pre-operative, peri-operative and post-operative period, and used them to audit 3000 patient records in our Hospital. Results: We found several areas where quality could be significantly improved;last minute postponement/change of plan of planned surgeries has reduced from 134 (8.9%) to 23 (1.53%) cases after implementation of standardised PEF. 784 (52.26%) patients were not formally handed over to the theatre recovery staff before implementation of standardised PEF compared to 147(9.8%) after implementation of standardised PEF. Conclusion: This audit found several areas of practice that fall below expected standards before the introduction of standardised PEF, but after the introduction of standardised PEF there is a significant improvement in quality of pre anaesthetic evaluation and overall outcome of the patient. We therefore advocate the use of such standardised PEFs for performing preoperative and perioperative assessment of surgical patients.

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To study the efficacy of intravenous dexamethasone in prolonging the duration of spinal anesthesia in elective cesarean section

Priyanka Sunil Shalu, Poonam Sachin Ghodki

Anesthesia: Essays and Researches 2017 11(2):321-325

Background and Aims: Various additives have been evaluated for the purpose of enhancing quality of analgesia and prolonging duration of spinal anesthesia. This randomized, double-blind study was conducted to evaluate the efficacy of intravenous dexamethasone in spinal anesthesia. Methods: A total of sixty patients scheduled for lower segment cesarean section under spinal anesthesia were randomly allocated into two groups, group SD and group SN, including thirty patients each. All the patients received injection bupivacaine 0.5% heavy 10 mg through spinal anesthesia. Group SD received injection dexamethasone 8 mg intravenously, and group SN received injection normal saline (NS) 2 cc immediately after spinal anesthesia. Duration of sensory block, motor block, postoperative analgesia, visual analog pain scale (VAS) score, time of rescue analgesia, total analgesic requirement in the first 24 h, intra- and post-operative hemodynamics, and side effects if any were recorded. Whenever demanded rescue analgesia was given in the form of injection tramadol 100 mg. Results: The mean duration of sensory block (min) in group SD and group SN was 162.50 and 106.17, respectively which was highly significant. Similarly, time to the requirement of first rescue analgesia was prolonged in group SD (8.67 h) as compared to group SN (4.40 h). Significant changes were also seen in VAS score in postoperative period after 1 h of surgery in group SD and group SN. Duration of motor block, intra- and post-operative hemodynamic parameters were comparable in both the groups. No side effects were recorded in both the groups. Conclusion: We concluded that administration of dexamethasone 8 mg intravenously prolongs the duration of postoperative analgesia and sensory block in patients undergoing lower segment cesarean section under spinal anesthesia.

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Anesthesiologist's role in relieving patient's anxiety

Brij Mohan, Rajan Kumar, Joginder Pal Attri, Veena Chatrath, Neeru Bala

Anesthesia: Essays and Researches 2017 11(2):449-452

Introduction: Anesthesia and surgery have proved to be highly anxiety provoking and with the rise of elective surgery, its aspect of patient's experience has become prominent in time. However, our fault as anesthesiologists is that we have not made people get versed with what we people as anesthesiologist do in the operating room. Hence, keeping in view all this, a study was carried out, in which video information/images regarding anesthesia and surgical procedure was shown to patients on PowerPoint Presentation. Different images showing previous patient's hospital journey were shown to educate patients. Methods: Two hundred patients scheduled to undergo elective surgery were taken and were divided into two groups of 100 each. Patients (study group or Group I) were shown video clippings/images of other previously operated patients and their hospital journey including surgery and anesthesia for which patient came in hospital. The study was carried out on the patient in each group while Group II was treated in normal way and not shown any type of images/videos. Hamilton Anxiety Rating Scale was used as a criterion to measure the level of anxiety in Group I and II at four different intervals that are before pre anesthetic check up (PAC), after showing videos and images in Group I, 1 h before surgery and 8 h after surgery. Statistical Analysis: The results of observation of both the groups at different intervals time were statistically compared and analyzed. These characteristics were analyzed using the "Chi-square tests" and "unpaired t-test." Results: Video and images information if done preoperatively have been shown to reduce patient's anxiety, although little is known regarding the effects of the method. Conclusion: Showing videos/images of hospital journey for educating the patients before the operation is beneficial to patients undergoing elective surgery.

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Randomized controlled trial for evaluating the analgesic effect of nalbuphine as an adjuvant to bupivacaine in supraclavicular block under ultrasound guidance

Nazia Nazir, Shruti Jain

Anesthesia: Essays and Researches 2017 11(2):326-329

Introduction: Benefits of regional anesthesia can be prolonged by adding adjuvants to local anesthetics. This study was designed to test the efficacy of adding nalbuphine to bupivacaine in supraclavicular brachial plexus blockade using ultrasound (US) guidance. Methodology: This was a prospective, randomized, double-blind study involving sixty patients of either sex undergoing elective orthopedic procedures of upper limb. In control Group C (n = 30), 30 mL of 0.375% bupivacaine + 1 mL normal saline and in study Group N (n = 30), 30 mL of 0.375% bupivacaine + 1 mL (10 mg) nalbuphine were used for giving supraclavicular block under US guidance. Parameters assessed were onset and duration of sensory and motor block, duration of analgesia (DOA), and any adverse events. Data between the groups were analyzed using independent t-test with SPSS 16.0 software. Results: In Group N, there was a statistically significant shorter time to onset of sensory blockade (4.89 ± 1.5 vs. 14.62 ± 1.73 min, P = 0.000), longer duration of sensory block (373.17 ± 15.56 min vs. 157.82 ± 11.02 min, P = 0.000), shorter onset time to achieve motor block (8.83 ± 1.9 min vs. 18.76 ± 1.75 min, P = 0.000), longer duration of motor block (313.92 ± 16.22 min vs. 121.87 ± 16.62 min, P = 0.000), and prolonged analgesia (389.33 ± 14.52 min vs. 171.65 ± 19.79 min, P = 0.000). Conclusion: Nalbuphine when added to bupivacaine as an adjuvant in supraclavicular block significantly shortened the onset of sensory and motor block and enhanced the duration of sensory and motor block and DOA.

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Comparison between conventional and ultrasound-guided supraclavicular brachial plexus block in upper limb surgeries

Kiran Abhayakumar Honnannavar, Mahantesh Shivangouda Mudakanagoudar

Anesthesia: Essays and Researches 2017 11(2):467-471

Introduction: Brachial plexus blockade is a time-tested technique for upper limb surgeries. The classical approach using paresthesia technique is a blind technique and may be associated with a higher failure rate and injury to the nerves and surrounding structures. To avoid some of these problems, use of peripheral nerve stimulator and ultrasound techniques were started which allowed better localization of the nerve/plexus. Ultrasound for supraclavicular brachial plexus block has improved the success rate of the block with excellent localization as well as improved safety margin. Hence, this study was planned for comparing the efficacy of conventional supraclavicular brachial plexus block with ultrasound-guided technique. Subjects and Methods: After obtaining the Institutional ethical committee approval and patient consent total of 60 patients were enrolled in this prospective randomized study and were randomly divided into two groups: US (Group US) and C (Group C). Both groups received 0.5% bupivacaine. The amount of local anesthetic injected calculated according to the body weight and was not crossing the toxic dosage (injection bupivacaine 2 mg/kg). The parameters compared between the two groups were lock execution time, time of onset of sensory and motor block, quality of sensory and motor block success rates were noted. The failed blocks were supplemented with general anesthesia. Results: Demographic data were comparable in both groups. The mean time taken for the procedure to administer a block by eliciting paresthesia is less compared to ultrasound, and it was statistically significant. The mean time of onset of motor block, sensory blockade, the duration of sensory and motor blockade was not statistically significant. The success rate of the block is more in ultrasound group than conventional group which was not clinically significant. The incidence of complications was seen more in conventional method. Conclusion: Ultrasound guidance is the safe and effective method for the supraclavicular brachial plexus block. Incidence of complications are less as ultrasound provides real-time visulaization of underlying structures and the spread of local anaesthetic.

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Effect of pregabalin premedication on the requirement of anesthetic and analgesic drugs in laparoscopic cholecystectomy: Randomized comparison of two doses

Prasoon Gupta, Anudeep Saxena, Lalita Chaudhary

Anesthesia: Essays and Researches 2017 11(2):330-333

Background: Preoperative medication has a vital role in anesthesia. Pregabalin (PG) is a newer drug of gabapentinoid class and is six times more potent than gabapentin. Our study was designed to evaluate the effect of PG as premedication on the perioperative anesthetic requirement and analgesia. Materials and Methods: The study was conducted on ninety patients of American Society of Anesthesiologists Grade I and II of age group 20–60 years, allocated to one of the three groups of thirty patients each. Group I received tablet diazepam 10 mg HS and 5 mg 1 h before surgery, Group II received capsule PG 75 mg HS and 150 mg 1 h before surgery, and Group III received capsule PG 75 mg HS and 300 mg 1 h before surgery. Patients were induced with injection fentanyl citrate, thiopentone sodium, and rocuronium bromide and maintained by 66% N2O + 33% O2gas mixture with sevoflurane and intermittent boluses of fentanyl. Results: Perioperative consumption of thiopentone sodium was 5.59 ± 0.49 mg/kg in Group I, 4.29 ± 0.53 mg/kg in Group II, and 4.06 ± 0.59 mg/kg in Group III; fentanyl was 1.55 ± 0.42 μg/kg in Group I, 1.00 ± 0.00 μg/kg in Group II, and 1.05 ± 0.20 μg/kg in Group III; sevoflurane (%) was 1.20 ± 0.31 in Group I, 0.933 ± 0.25 in Group II, and 1.00 ± 0.00 in Group III. Perioperative requirement of thiopentone sodium, opioid, and inhalational agent was significantly less in Group II and III when compared with Group I. Maximum number of patients required postoperative rescue analgesia within 0–2 h of surgery in Group I, 2–4 h of surgery in Group II, and 6–8 h after surgery in Group III. Patients were more comfortable and asleep with a longer pain-free postoperative period in PG groups. Conclusion: PG premedication effectively reduced the consumption of all anesthetic agents during induction and maintenance of anesthesia as compared to diazepam. Patient's postoperative comfort and pain-free duration were also greater with PG premedication; more so with PG 300 mg as compared to PG 150 mg.

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Exploring the Concern about Food Allergies among Secondary School and University Students in Ontario, Canada: A Descriptive Analysis

Our objective was to explore the perceived risk of food allergies among students in Ontario, Canada. We analyzed blinding questions ("I am concerned about food allergies"; "food allergies are currently a big threat to my health") from three existing food safety surveys, given to high school and university undergraduate students () circa February 2015, using descriptive analysis, and explored how concern related to demographics and self-reported cooking ability using linear regression. Overall, high school students were neutral in their concern, although Food and Nutrition students specifically were significantly less concerned () than high school students overall. University undergraduates were moderately unconcerned about food allergies. Concern was highest in younger students, decreasing between 13 and 18 years of age and plateauing between 19 and 23 years. Among students aged 13–18 years, concern was higher among those who worked or volunteered in a daycare and who had previously taken a food preparation course. Among students aged 19–23 years, concern was higher among females and those with less advanced cooking abilities. Concern was significantly correlated with perceiving food allergies as a personal threat. This study offers a first exploration of perceived risk of food allergies among this demographic and can guide future, more rigorous assessments.

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Editorial Board

Publication date: May–June 2017
Source:American Journal of Otolaryngology, Volume 38, Issue 3





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Table of Contents

Publication date: May–June 2017
Source:American Journal of Otolaryngology, Volume 38, Issue 3





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Guidelines for Contributing Authors

Publication date: May–June 2017
Source:American Journal of Otolaryngology, Volume 38, Issue 3





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New Gene Therapy for Vision Loss Proven Safe in Humans

In a small and preliminary clinical trial, Johns Hopkins researchers and their collaborators have shown that an experimental gene therapy that uses viruses to introduce a therapeutic gene into the eye is safe and that it may be effective in preserving the vision of people with wet age-related macular degeneration (AMD). AMD is a leading cause of vision loss in the U.S., affecting an estimated 1.6 million Americans. The disease is marked by growth of abnormal blood vessels that leak fluid into the central portion of the retina called the macula, which we use for reading, driving and recognizing faces.

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Half of US Men Have Penile HPV, But What Does This Mean?

Population-level testing for penile HPV infection showed a high and 'surprising' prevalence of HPV. But what does it mean clinically?
Medscape Medical News

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EpiPens Should Work At Least a While Past Expiration Dates

It's worth a shot to use an expired EpiPen, if that's all that's available, a new study suggests.
Reuters Health Information

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Preparing pathology for precision medicine: challenges and opportunities

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Mortality Risk Reductions from Substituting Screen Time by Discretionary Activities

Purpose: Leisure screen time, including TV viewing, is associated with increased mortality risk. We estimated the all-cause mortality risk reductions associated with substituting leisure screen time with different discretionary physical activity types, and the change in mortality incidence associated with different substitution scenarios. Methods: A total of 423,659 UK Biobank participants, without stroke, myocardial infarction, or cancer history, were followed for 7.6 (1.4) yr, median (interquartile range [IQR]). They reported leisure screen time (TV watching and home computer use) and leisure/home activities, categorized as daily life activities (walking for pleasure, light do-it-yourself [DIY], and heavy DIY) and structured exercise (strenuous sports and other exercises). Isotemporal substitution modeling in Cox regression provided hazard ratios (95% confidence intervals) for all-cause mortality when substituting screen time (30 min·d−1) with different discretionary activity types of the same duration. Potential impact fractions estimated the proportional change in mortality incidence associated with different substitution scenarios. Results: During 3,202,105 person-years of follow-up, 8928 participants died. Each 30-min·d−1 difference in screen time was associated with lower mortality hazard when modeling substitution of screen time by an equal amount of daily life activities (0.95, 0.94–0.97), as well as structured exercise (0.87, 0.84–0.90). Reallocations from screen time into specific activity subtypes suggested different reductions in mortality hazard: walking for pleasure (0.95, 0.92–0.98), light DIY (0.97, 0.94–1.00), heavy DIY (0.93, 0.90–0.96), strenuous sports (0.87, 0.79–0.95), and other exercises (0.88, 0.84–0.91). The lowest hazard estimates were found when modeling replacement of TV viewing. Potential impact fractions ranged from 4.3% (30-min·d−1 substitution of screen time into light DIY) to 14.9% (TV viewing into strenuous sports). Conclusion: Substantial public health benefits could be gained by replacing small amounts of screen time with daily life activities and structured exercise. Daily life activities may provide feasible screen time alternatives, if structured exercise is initially too ambitious.

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Sedentary Behavior, Cadence, and Physical Activity Outcomes after Knee Arthroplasty

Purpose: This study comprehensively examined sedentary behavior and physical activity patterns in people with severe knee osteoarthritis awaiting total knee arthroplasty (TKA) and in individuals after TKA. Methods: Preoperative (n = 32, mean ± SD = 69.9 ± 5.3 yr) and 1-yr postoperative participants with TKA (n = 38, 67.9 ± 7.3 yr) wore ActiGraph GT3X+ activity monitors for 6.8 ± 0.6 d. Total sedentary time, time in long sedentary bouts (≥30 min), and physical activity outcomes (steps, time in moderate-to-vigorous physical activity [MVPA], cadence) were examined. Results: There were no differences between pre- and postoperative groups for total sedentary time (9.3 ± 1.4 vs 9.2 ± 1.4 h·d−1, P = 0.62) and number of long sedentary bouts per day (median [interquartile range] = 3.4 [1.9] vs 3.1 [2.0], P = 0.37). Daily steps, peak 30-min cadence, and peak 1-min cadence values were greater in people after TKA compared with those awaiting surgery (5935 [3316] vs 3724 [2338], 55.6 [31.0] vs 35.9 [19.3], and 91.5 ± 20.6 vs 70.0 ± 23.7, respectively, all P

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Differential Motor Unit Changes after Endurance or High-Intensity Interval Training

Purpose: Using a novel technique of high-density surface EMG decomposition and motor unit (MU) tracking, we compared changes in the properties of vastus medialis and vastus lateralis MU after endurance (END) and high-intensity interval training (HIIT). Methods: Sixteen men were assigned to the END or the HIIT group (n = 8 each) and performed six training sessions for 14 d. Each session consisted of 8–12 × 60-s intervals at 100% peak power output separated by 75 s of recovery (HIIT) or 90–120 min continuous cycling at ~65% V˙O2peak (END). Pre- and postintervention, participants performed 1) incremental cycling to determine V˙O2peak and peak power output and 2) maximal, submaximal (10%, 30%, 50%, and 70% maximum voluntary contraction [MVC]), and sustained (until task failure at 30% MVC) isometric knee extensions while high-density surface EMG signals were recorded from the vastus medialis and vastus lateralis. EMG signals were decomposed (submaximal contractions) into individual MU by convolutive blind source separation. Finally, MU were tracked across sessions by semiblind source separation. Results: After training, END and HIIT improved V˙O2peak similarly (by 5.0% and 6.7%, respectively). The HIIT group showed enhanced maximal knee extension torque by ~7% (P = 0.02) and was accompanied by an increase in discharge rate for high-threshold MU (≥50% knee extension MVC) (P 0.05). Conclusions: HIIT and END induce different adjustments in MU discharge rate despite similar improvements in cardiopulmonary fitness. Moreover, the changes induced by HIIT are specific for high-threshold MU. For the first time, we show that HIIT and END induce specific neuromuscular adaptations, possibly related to differences in exercise load intensity and training volume.

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Metástasis de adenocarcinoma de vesícula biliar a piel de conducto auditivo externo, a propósito de un caso

Publication date: Available online 15 May 2017
Source:Acta Otorrinolaringológica Española
Author(s): Valery Nuñez Carrasco, Jose Luis Serdio Arias, Juan Jose Artazkoz del Toro, Leticia Melgar Vilaplana




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Comments on “Alveolar sarcoma of the parapharyngeal space: A case report”

Publication date: Available online 15 May 2017
Source:Acta Otorrinolaringológica Española
Author(s): Ana María Cano-Valdez, Diana Brisa Sevilla-Lizcano, Abelardo Meneses-García




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Vértigo posicional paroxístico benigno, ese gran desconocido

Publication date: Available online 15 May 2017
Source:Acta Otorrinolaringológica Española
Author(s): Virginia Franco-Gutiérrez, Paz Pérez




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Does calcemia influence the onset of myringosclerosis after myringotomy with the insertion of ventilation tubes?

Publication date: Available online 15 May 2017
Source:Acta Otorrinolaringológica Española
Author(s): Carla Branco, João Paço
IntroductionMyringosclerosis is one of the most frequent late complications of the insertion of ventilation tubes, and its aetiopathogenesis remains unknown. The calcification that occurs in the formation of myringosclerosis plaque raises the hypothesis of the presence of a calcium metabolism disorder. The objective is to determine whether calcemia contributes to the development of myringoscelerosis after insertion of ventilation tubes.Material and methodsA longitudinal, prospective, analytical cohort study was conducted in patients undergoing myringotomy with the insertion of ventilation tubes due to otitis media with effusion. Calcemia was evaluated pre-operatively and in the follow-up the appearance of myringosclerosis and the percentage of the tympanum involved were evaluated.ResultsThe study included 156 patients (297 ears), with calcemia values ranging from 7.6 to 10.2mg/dl. Myringosclerosis was identified in 35.4% of the operated ears. No relationship was found between the appearance of myringosclerosis and calcemia (p=.596). It was found, however, that the greater the percentage of the tympanum affected by myringosclerosis, the lower the calcemia values (p=.014).ConclusionThe population studied had calcemia values within the normal range, which allows us to infer that no changes in calcium metabolism are required for the development of myringosclerosis. Moreover, unlike in previous studies, higher calcium levels are not associated with more myringosclerosis. Calcemia did not influence the appearance of myringosclerosis after myringotomy with the insertion of ventilation tubes.



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Correction for Hobbie et al., Contrasting nitrogen and phosphorus budgets in urban watersheds and implications for managing urban water pollution [Correction]

ENVIRONMENTAL SCIENCES, SUSTAINABILITY SCIENCE Correction for "Contrasting nitrogen and phosphorus budgets in urban watersheds and implications for managing urban water pollution," by Sarah E. Hobbie, Jacques C. Finlay, Benjamin D. Janke, Daniel A. Nidzgorski, Dylan B. Millet, and Lawrence A. Baker, which appeared in issue 16, April 18, 2017, of...

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Correction for Chen et al., Intestinal NCoR1, a regulator of epithelial cell maturation, controls neonatal hyperbilirubinemia [Correction]

DEVELOPMENTAL BIOLOGY Correction for "Intestinal NCoR1, a regulator of epithelial cell maturation, controls neonatal hyperbilirubinemia," by Shujuan Chen, Wenqi Lu, Mei-Fei Yueh, Eva Rettenmeier, Miao Liu, Johan Auwerx, Ruth T. Yu, Ronald M. Evans, Kepeng Wang, Michael Karin, and Robert H. Tukey, which appeared in issue 8, February 21, 2017,...

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Correction for Burak and Fiete, Fundamental limits on persistent activity in networks of noisy neurons [Correction]

NEUROSCIENCE, PHYSICS Correction for "Fundamental limits on persistent activity in networks of noisy neurons," by Yoram Burak and Ila R. Fiete, which appeared in issue 43, October 23, 2012, of Proc Natl Acad Sci USA (109:17645–17650; first published October 9, 2012; 10.1073/pnas.1117386109). The authors note that, due to a printer's...

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Evidence of strain structure in Plasmodium falciparum var gene repertoires in children from Gabon, West Africa [Population Biology]

Existing theory on competition for hosts between pathogen strains has proposed that immune selection can lead to the maintenance of strain structure consisting of discrete, weakly overlapping antigenic repertoires. This prediction of strain theory has conceptual overlap with fundamental ideas in ecology on niche partitioning and limiting similarity between coexisting...

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Folate rescues vitamin B12 depletion-induced inhibition of nuclear thymidylate biosynthesis and genome instability [Physiology]

Clinical vitamin B12 deficiency can result in megaloblastic anemia, which results from the inhibition of DNA synthesis by trapping folate cofactors in the form of 5-methyltetrahydrofolate (5-methylTHF) and subsequent inhibition of de novo thymidylate (dTMP) biosynthesis. In the cytosol, vitamin B12 functions in the remethylation of homocysteine to methionine, which...

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A normalization model suggests that attention changes the weighting of inputs between visual areas [Neuroscience]

Models of divisive normalization can explain the trial-averaged responses of neurons in sensory, association, and motor areas under a wide range of conditions, including how visual attention changes the gains of neurons in visual cortex. Attention, like other modulatory processes, is also associated with changes in the extent to which...

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Opposing roles of primate areas 25 and 32 and their putative rodent homologs in the regulation of negative emotion [Neuroscience]

Disorders of dysregulated negative emotion such as depression and anxiety also feature increased cardiovascular mortality and decreased heart-rate variability (HRV). These disorders are correlated with dysfunction within areas 25 and 32 of the ventromedial prefrontal cortex (vmPFC), but a causal relationship between dysregulation of these areas and such symptoms has...

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Evolutionarily conserved TRH neuropeptide pathway regulates growth in Caenorhabditis elegans [Neuroscience]

In vertebrates thyrotropin-releasing hormone (TRH) is a highly conserved neuropeptide that exerts the hormonal control of thyroid-stimulating hormone (TSH) levels as well as neuromodulatory functions. However, a functional equivalent in protostomian animals remains unknown, although TRH receptors are conserved in proto- and deuterostomians. Here we identify a TRH-like neuropeptide precursor...

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Universal transition from unstructured to structured neural maps [Neuroscience]

Neurons sharing similar features are often selectively connected with a higher probability and should be located in close vicinity to save wiring. Selective connectivity has, therefore, been proposed to be the cause for spatial organization in cortical maps. Interestingly, orientation preference (OP) maps in the visual cortex are found in...

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MEF2D haploinsufficiency downregulates the NRF2 pathway and renders photoreceptors susceptible to light-induced oxidative stress [Neuroscience]

Gaining mechanistic insight into interaction between causative factors of complex multifactorial diseases involving photoreceptor damage might aid in devising effective therapies. Oxidative stress is one of the potential unifying mechanisms for interplay between genetic and environmental factors that contribute to photoreceptor pathology. Interestingly, the transcription factor myocyte enhancer factor 2d...

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Protein-mediated viral latency is a novel mechanism for Merkel cell polyomavirus persistence [Microbiology]

Viral latency, in which a virus genome does not replicate independently of the host cell genome and produces no infectious particles, is required for long-term virus persistence. There is no known latency mechanism for chronic small DNA virus infections. Merkel cell polyomavirus (MCV) causes an aggressive skin cancer after prolonged...

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{Delta}Np63{alpha} is a common inhibitory target in oncogenic PI3K/Ras/Her2-induced cell motility and tumor metastasis [Cell Biology]

Activation of phosphatidylinositol 3 kinase (PI3K), Ras, and Her2 signaling plays a critical role in cancer development. Hotspot constitutive activating mutations in oncogenes, such as PIK3CA encoding the p110α catalytic subunit or RAS, as well as overexpression of Her2, are frequently found in human tumors and cancers. It has been...

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Minimizing irreversible losses in quantum systems by local counterdiabatic driving [Physics]

Counterdiabatic driving protocols have been proposed [Demirplak M, Rice SA (2003) J Chem Phys A 107:9937–9945; Berry M (2009) J Phys A Math Theor 42:365303] as a means to make fast changes in the Hamiltonian without exciting transitions. Such driving in principle allows one to realize arbitrarily fast annealing protocols...

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SP and IL-33 together markedly enhance TNF synthesis and secretion from human mast cells mediated by the interaction of their receptors [Immunology and Inflammation]

The peptide substance P (SP) and the cytokine tumor necrosis factor (TNF) have been implicated in inflammatory processes. Mast cells are recognized as important in inflammatory responses. Here, we report that IL-33 (30 ng/mL), a member of the IL-1 family of cytokines, administered in combination with SP (1 µM), markedly...

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Compositional data supports decentralized model of production and circulation of artifacts in the pre-Columbian south-central Andes [Anthropology]

The circulation and exchange of goods and resources at various scales have long been considered central to the understanding of complex societies, and the Andes have provided a fertile ground for investigating this process. However, long-standing archaeological emphasis on typological analysis, although helpful to hypothesize the direction of contacts, has...

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Structural variants caused by Alu insertions are associated with risks for many human diseases [Genetics]

Interspersed repeat sequences comprise much of our DNA, although their functional effects are poorly understood. The most commonly occurring repeat is the Alu short interspersed element. New Alu insertions occur in human populations, and have been responsible for several instances of genetic disease. In this study, we sought to determine...

http://ift.tt/2rncp3f

Molecular mechanism of multispecific recognition of Calmodulin through conformational changes [Biochemistry]

Calmodulin (CaM) is found to have the capability to bind multiple targets. Investigations on the association mechanism of CaM to its targets are crucial for understanding protein–protein binding and recognition. Here, we developed a structure-based model to explore the binding process between CaM and skMLCK binding peptide. We found the...

http://ift.tt/2qsOtfj

GRP78 haploinsufficiency suppresses acinar-to-ductal metaplasia, signaling, and mutant Kras-driven pancreatic tumorigenesis in mice [Medical Sciences]

Pancreatic ductal adenocarcinoma (PDAC) remains a highly lethal disease in critical need of new therapeutic strategies. Here, we report that the stress-inducible 78-kDa glucose-regulated protein (GRP78/HSPA5), a key regulator of endoplasmic reticulum homeostasis and PI3K/AKT signaling, is overexpressed in the acini and PDAC of Pdx1-Cre;KrasG12D/+;p53f/+ (PKC) mice as early as...

http://ift.tt/2rnlJUQ

Spinal motor neuron protein supersaturation patterns are associated with inclusion body formation in ALS [Biochemistry]

Amyotrophic lateral sclerosis (ALS) is a heterogeneous degenerative motor neuron disease linked to numerous genetic mutations in apparently unrelated proteins. These proteins, including SOD1, TDP-43, and FUS, are highly aggregation-prone and form a variety of intracellular inclusion bodies that are characteristic of different neuropathological subtypes of the disease. Contained within...

http://ift.tt/2pH7sWu

Molecular codes for cell type specification in Brn3 retinal ganglion cells [Developmental Biology]

Visual information is conveyed from the eye to the brain by distinct types of retinal ganglion cells (RGCs). It is largely unknown how RGCs acquire their defining morphological and physiological features and connect to upstream and downstream synaptic partners. The three Brn3/Pou4f transcription factors (TFs) participate in a combinatorial code...

http://ift.tt/2rnkEMw

Focusgroepen

http://ift.tt/2rcJouo

De communautarisering van de drughulpverlening: herstel centraal

Following the sixth reform of Belgian state and government institutions, responsibility for important aspects of drug treatment policy has been transferred from the federal state to the regions. The specialised drug treatment services subsidised by the Belgian National Health Insurance Institute (day centres, crisis intervention centres, medical-social care centres and therapeutic communities) are henceforth a regional responsibility. In response to this development, a policy note on addiction 'recovery' in Flanders has been formulated. In this contribution we describe the current situation arising from these reforms alongside the concept of recovery and how this has been interpreted and incorporated into the policy options set out in the recent policy note. We conclude with reflections on the future challenges for (Flemish) drug treatment policy.

http://ift.tt/2pRF2VO

SOP – Palliative Sedierung

http://ift.tt/2rnf5hQ

SOP – Schmerztherapie bei Palliativpatienten

http://ift.tt/2qNMzZT

Epistaxis in anticoagulated patients: Fewer hospital admissions and shorter hospital stays on rivaroxaban compared to phenprocoumon

Abstract

Objectives

Treatment of epistaxis in patients on anticoagulants is challenging and associated with higher admission rates and longer hospital stays compared to patients without anticoagulation. However, there is little information about epistaxis in patients taking new direct oral anticoagulants such as rivaroxaban compared to patients on traditional vitamin-K antagonists such as phenprocoumon.

Design

Retrospective cohort study.

Setting

The study was conducted at the emergency department of the University Hospital Inselspital, Bern, Switzerland.

Participants

All admissions to the emergency department of the University Hospital Inselspital, Bern, Switzerland from July 1st 2012 to June 30th 2016 with non-traumatic epistaxis on anticoagulant therapy with phenprocoumon or rivaroxaban were included.

Main outcome measures

We compared clinical outcome parameters (admission rates, length of hospital stay and mortality) for both anticoagulant groups.

Results

We included 440 patients with epistaxis, 123 (28%) on rivaroxaban and 317 (72%) on phenprocoumon. Fewer hospital admissions and shorter hospital stays were found in patients under rivaroxaban (12 (10.4%) vs. 57 (18.0%) patients, p=0.033; 0.7±2.2 vs. 1.5±3.7 days, p=0.011) compared to phenprocoumon. Anterior epistaxis was more common in the rivaroxaban group in contrast to posterior epistaxis in patients on phenprocoumon (74 (60.2%) vs. 139 (43.8%) patients, p=0.002; 7 (5.7%) vs. 39 (12.3%) patients, p=0.042).

Conclusions

Our data suggests that epistaxis on direct oral anticoagulation with rivaroxaban is associated with shorter hospital stays and fewer hospital admissions than epistaxis on vitamin-K antagonist phenprocoumon.

This article is protected by copyright. All rights reserved.

http://ift.tt/2rnbErA

Observational study of free public sunscreen dispenser use at a major US outdoor event

To the Editor: The American Academy of Dermatology and Centers for Disease Control and Prevention currently recommend sun protection measures in outdoor public spaces as part of a strategy to combat the rising incidence of skin cancer.1,2 However, few venues have opted to offer free sunscreen, and to our knowledge the use in such venues has not been described in detail.

http://ift.tt/2qodzO5

Physiological Striae Atrophicae of Adolescence with Involvement of the Axillae and Proximal Arms

We report a 16-year-old adolescent male with multiple violaceous, atrophic, vertical linear striae isolated to the axillae and proximal arms of approximately one-year duration. In the past two years, he indulged in heavy weight-lifting. He experienced a growth spurt over the past few years. The patient was otherwise in good health and was not on any medications. Physiological striae atrophicae of adolescence where the striae were restricted to the axillae and proximal arms have very rarely been reported.

http://ift.tt/2qnPt6D

Children’s Rights Law in the Global Human Rights Landscape: Isolation, Inspiration, Integration?

Children's rights law is often studied and perceived in isolation from the broader field of human rights law. This volume explores the inter-relationship between children's rights law and more general human rights law in order to see whether elements from each could successfully inform the other. Children's rights law has a number of distinctive characteristics, such as the emphasis on the 'best interests of the child', the use of general principles, and the inclusion of 'third parties' (e.g. parents and other care-takers) in treaty provisions. The first part of this book questions whether these features could be a source of inspiration for general human rights law. In part two, the reverse question is asked: could children's rights law draw inspiration from developments in other branches of human rights law that focus on other specific categories of rights holders, such as women, persons with disabilities, indigenous peoples, or older persons? Finally, the interaction between children's rights law and human rights law – and the potential for their isolation, inspiration or integration – may be coloured or determined by the thematic issue under consideration. Therefore the third part of the book studies the interplay between children's rights law and human rights law in the context of specific topics: intra-family relations, LGBTQI marginalization, migration, media, the environment and transnational human rights obligations.

http://ift.tt/2qs7ZIZ

Zelfmoorden van Elisabeth de Vulder en Clara Venant in Ieper, 1465-1466

http://ift.tt/2pGriBj

A mathematical model of neonatal rat atrial monolayers with constitutively active acetylcholine-mediated K+ current

Atrial fibrillation (AF) is the most frequent form of arrhythmia occurring in the industrialized world. Because of its complex nature, each identified form of AF requires specialized treatment. Thus, an in-depth understanding of the bases of these arrhythmias is essential for therapeutic development. A variety of experimental studies aimed at understanding the mechanisms of AF are performed using primary cultures of neonatal rat atrial cardiomyocytes (NRAMs). Previously, we have shown that the distinct advantage of NRAM cultures is that they allow standardized, systematic, robust re-entry induction in the presence of a constitutively-active acetylcholine-mediated K+ current (IKACh-c). Experimental studies dedicated to mechanistic explorations of AF, using these cultures, often use computer models for detailed electrophysiological investigations. However, currently, no mathematical model for NRAMs is available. Therefore, in the present study we propose the first model for the action potential (AP) of a NRAM with constitutively-active acetylcholine-mediated K+ current (IKACh-c). The descriptions of the ionic currents were based on patch-clamp data obtained from neonatal rats. Our monolayer model closely mimics the action potential duration (APD) restitution and conduction velocity (CV) restitution curves presented in our previous in vitro studies. In addition, the model reproduces the experimentally observed dynamics of spiral wave rotation, in the absence and in the presence of drug interventions, and in the presence of localized myofibroblast heterogeneities.

http://ift.tt/2qsgMuB

Mechano-electric heterogeneity of the myocardium as a paradigm of its function

Myocardial heterogeneity is well appreciated and widely documented, from sub-cellular to organ levels. This paper reviews significant achievements of the group, led by Professor Vladimir S. Markhasin, Russia, who was one of the pioneers in studying and interpreting the relevance of cardiac functional heterogeneity.

http://ift.tt/2pGenzo

Perpetuation of torsade de pointes in heterogeneous hearts : competing foci or re-entry?

Torsade de pointes (TdP) can be the consequence of cardiac remodelling, drug effects or a combination of both. The mechanism underlying TdP is unclear, and may involve triggered focal activity or re-entry. Recent work by our group has indicated that both cases may exist, i.e. TdPs induced in the chronic atrioventricular block (CAVB) dog model may have a focal origin or are due to re-entry. Also it was found that heterogeneities might play an important role. In the current study we have used computational modelling to further investigate the mechanisms involved in TdP initiation and perpetuation, especially in the CAVB dog model, by the addition of heterogeneities with reduced repolarization reserve in comparison with the surrounding tissue. For this, the TNNP computer model was used for computations. We demonstrated in 2D and 3D simulations that ECGs with the typical TdP morphology can be caused by both multiple competing foci and re-entry circuits as a result of introduction of heterogeneities, depending on whether the heterogeneities have a large or a smaller reduced repolarization reserve in comparison with the surrounding tissue. Large heterogeneities can produce ectopic TdP, while smaller heterogeneities will produce re-entry-type TdP.

http://ift.tt/2qrZ2zi

Distinction between interleukin-1-induced necrosis and apoptosis of islet cells

Interleukin (IL)-1 beta is known to cause beta -cell death in isolated rat islets. This effect has been attributed to induction of nitric oxide (NO) synthase in beta -cells and subsequent generation of toxic NO levels; it was not observed, however, in dispersed rat beta -cells. The present study demonstrates that IL-1 beta induces NO-dependent necrosis in rat beta -cells cultured for 3 days at high cell density or in cell aggregates but not as single cells. Its cytotoxic condition is not explained by higher NO production rates but might result from higher intercellular NO concentrations in statically cultured cell preparations with cell-to-cell contacts; nitrite levels in collected culture medium are not a reliable index for these intercellular concentrations. Absence of IL-1-induced necrosis in rat alpha -cells or in human beta -cells is attributed to the cytokine's failure to generate NO in these preparations, not to their reduced sensitivity to NO: the NO donor GEA 3162 (15 min, 50-100 mu mol/l) exerts a comparable necrotic effect in rat and human alpha- or beta -cells. In preparations in which IL-1 beta does mot cause beta -cell necrosis, its combination with gamma -interferon (IFN-gamma) results in NO-independent apoptosis, starting after 3 days and increasing with the duration of exposure. Because IFN-gamma alone was apoptotic far rat alpha -cells, it is proposed that IL-1 beta can make beta -cells susceptible to this effect, conceivably through altering their phenotype. It is concluded that IL-1 beta can cause NO-dependent necrosis or NO-independent apoptosis of islet cells, depending on the species and on the environmental conditions. The experiments in isolated human beta -cell preparations suggest that these cells may preferentially undergo apoptosis when exposed to IL-1 beta plus IFN-gamma unless neighboring non-beta -cells produce toxic NO levels.

http://ift.tt/2pGx2Lb

Role of pancreatic beta-cells in the process of beta-cell death

Studies on the pathogenesis of type 1 diabetes have mainly focused on the role of the immune system in the destruction of pancreatic beta -cells. Lack of data on the cellular and molecular events at the beta -cell level is caused by the inaccessibility of these cells during development of the disease. Indirect information has been collected from isolated rodent and human islet cell preparations that were exposed to cytotoxic conditions. This article reviews in vitro experiments that investigated the role of beta -cells in the process of beta -cell death. beta -Cells rapidly die in necrosis because of toxic levels of oxidizing radicals or of nitric oxide; they progressively become apoptotic after prolonged culture at low glucose or with proinflammatory cytokines. Their susceptibility to necrosis or apoptosis varies with their functional state and thus with the environmental conditions. A change in cellular phenotype can alter its recognition of potentially cytotoxic agents and its defense mechanisms against cell death. These observations support the view that beta -cells are not necessarily passive victims of a cytotoxic process but can actively participate in a process of beta -cell death. Their role will be influenced by neighboring non-beta -cells, which can make the islet internal milieu more protective or toxic for the beta -cells. We consider duct cells as potentially important contributors to this local process.

http://ift.tt/2qs7puF

Multistatic Radar: System Requirements and Experimental Validation

Inggs, M; Griffiths, H; Fioranelli, F; Ritchie, M; Woodbridge, K; (2015) Multistatic Radar: System Requirements and Experimental Validation. In: Radar 2014: Proceedings of 2014 International Radar Conference. (pp. pp. 1028-1033). IEEE Green open access

http://ift.tt/2rmwhEq

The role of second-person narration in representing mental states in Sylvia Plath's Smith Journal

Demjén, Z; (2011) The role of second-person narration in representing mental states in Sylvia Plath's Smith Journal. Journal of Literary Semantics , 40 (1) pp. 1-21. 10.1515/jlse.2011.001 . Green open access

http://ift.tt/2qNm2fq

The role of 1α,25-dihydroxyvitamin D3 and cytokines in the promotion of distinct Foxp3 + and IL-10 + CD4 + T cells

Urry, Z; Chambers, ES; Xystrakis, E; Dimeloe, S; Richards, DF; Gabryšová, L; Christensen, J; Urry, Z; Chambers, ES; Xystrakis, E; Dimeloe, S; Richards, DF; Gabryšová, L; Christensen, J; Gupta, A; Saglani, S; Bush, A; O'Garra, A; Brown, Z; Hawrylowicz, CM; - view fewer (2012) The role of 1α,25-dihydroxyvitamin D3 and cytokines in the promotion of distinct Foxp3 + and IL-10 + CD4 + T cells. European Journal of Immunology , 42 (10) pp. 2697-2708. 10.1002/eji.201242370 . Green open access

http://ift.tt/2rmDbt8

Globalisation, Gender and Curriculum 2005

Unterhalter, ES; (1999) Globalisation, Gender and Curriculum 2005. Agenda: empowering women for gender equity , 41 pp. 26-31. 10.2307/4066193 .

http://ift.tt/2qNlXZa

Serum 25-dihydroxyvitamin D levels correlate with CD4+Foxp3+ T-cell numbers in moderate/severe asthma

Chambers, ES; Nanzer, AM; Richards, DF; Ryanna, K; Freeman, AT; Timms, PM; Martineau, AR; Chambers, ES; Nanzer, AM; Richards, DF; Ryanna, K; Freeman, AT; Timms, PM; Martineau, AR; Griffiths, CJ; Corrigan, CJ; Hawrylowicz, CM; - view fewer (2012) Serum 25-dihydroxyvitamin D levels correlate with CD4+Foxp3+ T-cell numbers in moderate/severe asthma. Journal of Allergy and Clinical Immunology , 130 (2) pp. 542-544. 10.1016/j.jaci.2012.04.022 .

http://ift.tt/2rmAJTL

Self-organised transients in a neural mass model of epileptogenic tissue dynamics

Goodfellow, M; Schindler, K; Baier, G; (2012) Self-organised transients in a neural mass model of epileptogenic tissue dynamics. NeuroImage , 59 (3) pp. 2644-2660. 10.1016/j.neuroimage.2011.08.060 .

http://ift.tt/2qN7Q6a

Phase space approach for modeling of epileptic dynamics

Wang, Y; Goodfellow, M; Taylor, PN; Baier, G; (2012) Phase space approach for modeling of epileptic dynamics. Physical Review E , 85 (6) 10.1103/PhysRevE.85.061918 .

http://ift.tt/2rmAFmZ

Spiral-wave dynamics in a mathematical model of human ventricular tissue with myocytes and Purkinje fibers

We present systematic numerical studies of the possible effects of the coupling of human endocardial and Purkinje cells at cellular and two-dimensional tissue levels. We find that the autorhythmic-activity frequency of the Purkinje cell in a composite decreases with an increase in the coupling strength; this can even eliminate the autorhythmicity. We observe a delay between the beginning of the action potentials of endocardial and Purkinje cells in a composite; such a delay increases as we decrease the diffusive coupling, and eventually a failure of transmission occurs. An increase in the diffusive coupling decreases the slope of the action-potential-duration-restitution curve of an endocardial cell in a composite. By using a minimal model for the Purkinje network, in which we have a two-dimensional, bilayer tissue, with a layer of Purkinje cells on top of a layer of endocardial cells, we can stabilize spiral-wave turbulence; however, for a sparse distribution of Purkinje-ventricular junctions, at which these two layers are coupled, we can also obtain additional focal activity and many complex transient regimes. We also present additional effects resulting from the coupling of Purkinje and endocardial layers and discuss the relation of our results to the studies performed in anatomically accurate models of the Purkinje network.

http://ift.tt/2rmqa2J

Prognostic markers in oropharyngeal squamous cell carcinoma: focus on CD70 and tumour infiltrating lymphocytes

http://ift.tt/2qNaEzT

Diagnostic utility of cyclin D1 in the diagnosis of small round blue cell tumors in children and adolescents: Beware of cyclin D1 expression in clear cell sarcoma of the kidney and CIC-DUX4 fusion–positive sarcomas. Comment on Magro et al. (2016)

http://ift.tt/2rmzROM

Islam und Transkulturalität in Navid Kermanis 'Wer ist wir? Deutschland und seine Muslime' und SAIDs 'Das Niemandsland ist unseres. West-östliche Betrachtungen'

http://ift.tt/2qNqtqi

Abscisic Acid as Pathogen Effector and Immune Regulator

Abscisic acid (ABA) is a sesquiterpene signaling molecule produced in all kingdoms of life. To date, the best known functions of ABA are derived from its role as a major phytohormone in plant abiotic stress resistance. Different organisms have developed different biosynthesis and signal transduction pathways related to ABA. Despite this, there are also intriguing common themes where ABA often suppresses host immune responses and is utilized by pathogens as an effector molecule. ABA also seems to play an important role in compatible mutualistic interactions such as mycorrhiza and rhizosphere bacteria with plants, and possibly also the animal gut microbiome. The frequent use of ABA in inter-species communication could be a possible reason for the wide distribution and re-invention of ABA as a signaling molecule in different organisms. In humans and animal models, it has been shown that ABA treatment or nutrient-derived ABA is beneficial in inflammatory diseases like colitis and type 2 diabetes, which confer potential to ABA as an interesting nutraceutical or pharmacognostic drug. The anti-inflammatory activity, cellular metabolic reprogramming, and other beneficial physiological and psychological effects of ABA treatment in humans and animal models has sparked an interest in this molecule and its signaling pathway as a novel pharmacological target. In contrast to plants, however, very little is known about the ABA biosynthesis and signaling in other organisms. Genes, tools and knowledge about ABA from plant sciences and studies of phytopathogenic fungi might benefit biomedical studies on the physiological role of endogenously generated ABA in humans.

http://ift.tt/2rmmpdQ

Phase-locked scroll waves defy turbulence induced by negative filament tension

Scroll waves in a three-dimensional media may develop into turbulence due to negative tension of the filament. Such negative tension-induced instability of scrollwaves has been observed in the Belousov-Zhabotinsky reaction systems. Here we propose a method to restabilize scroll wave turbulence caused by negative tension in three-dimensional chemical excitable media using a circularly polarized (rotating) external field. The stabilization mechanism is analyzed in terms of phase-locking caused by the external field, which makes the effective filament tension positive. The phase-locked scrollwaves that have positive tension and higher frequency defy the turbulence and finally restore order. A linear theory for the change of filament tension caused by a generic rotating external field is presented and its predictions closely agree with numerical simulations.

http://ift.tt/2qN49gE

Spiral wave chimeras in locally coupled oscillator systems

The recently discovered chimera state involves the coexistence of synchronized and desynchronized states for a group of identical oscillators. In this work, we show the existence of (inwardly) rotating spiral wave chimeras in the three-component reaction-diffusion systems where each element is locally coupled by diffusion. A transition from spiral waves with the smooth core to spiral wave chimeras is found as we change the local dynamics of the system or as we gradually increase the diffusion coefficient of the activator. Our findings on the spiral wave chimera in the reaction-diffusion systems suggest that spiral chimera states may be found in chemical and biological systems that can be modeled by a large population of oscillators indirectly coupled via a diffusive environment.

http://ift.tt/2rmrhjf

Spiral-wave dynamics in a mathematical model of human ventricular tissue with myocytes and fibroblasts

Cardiac fibroblasts, when coupled functionally with myocytes, can modulate the electrophysiological properties of cardiac tissue. We present systematic numerical studies of such modulation of electrophysiological properties in mathematical models for (a) single myocyte-fibroblast (MF) units and (b) two-dimensional (2D) arrays of such units; our models build on earlier ones and allow for zero-, one-, and two-sided MF couplings. Our studies of MF units elucidate the dependence of the action-potential (AP) morphology on parameters such as , the fibroblast resting-membrane potential, the fibroblast conductance , and the MF gap-junctional coupling . Furthermore, we find that our MF composite can show autorhythmic and oscillatory behaviors in addition to an excitable response. Our 2D studies use (a) both homogeneous and inhomogeneous distributions of fibroblasts, (b) various ranges for parameters such as , and , and (c) intercellular couplings that can be zero-sided, one-sided, and two-sided connections of fibroblasts with myocytes. We show, in particular, that the plane-wave conduction velocity decreases as a function of , for zero-sided and one-sided couplings; however, for two-sided coupling, decreases initially and then increases as a function of , and, eventually, we observe that conduction failure occurs for low values of . In our homogeneous studies, we find that the rotation speed and stability of a spiral wave can be controlled either by controlling or . Our studies with fibroblast inhomogeneities show that a spiral wave can get anchored to a local fibroblast inhomogeneity. We also study the efficacy of a low-amplitude control scheme, which has been suggested for the control of spiral-wave turbulence in mathematical models for cardiac tissue, in our MF model both with and without heterogeneities.

http://ift.tt/2qN8FeT

Use of propranolol in a remote region of rural Guatemala to treat a large facial infantile haemangioma

We present a female infant with a right-sided facial and neck haemangioma, from a remote, resource-poor community in rural Guatemala. She received first-line treatment, propranolol, with marked reduction in tumour size and erythema. Treatment was stopped after 35 weeks due to recurrent diarrhoea and sustained weight loss. Propranolol can be used to safely treat infants with haemangiomas in remote, rural communities if there is adequate follow-up, education and communication. Periocular haemangiomas should be treated promptly to avoid visual impairment. Infants with large facial haemangiomas should be screened for Posterior fossa anomalies, Hemangioma, Arterial anomalies, Cardiac anomalies, and Eye anomalies (PHACE) syndrome, and specialists should be involved. The case also highlights the difficulty of providing treatment for a complex illness when basic health needs, such as food security and water sanitation, are limited.

http://ift.tt/2qnyEZ0

Full-thickness gaping wound in the inguinal region of prenatal origin in an extremely premature baby

Description

This baby boy weighing 810 g at birth was born at 24 6/7 weeks to a healthy primigravida with uncomplicated pregnancy until 24 weeks. She was hospitalised from 24 weeks' gestation onwards for threatened preterm labour. Serial bedside ultrasound showed the baby to be in a breech position with bulging membranes and a visible loop of umbilical cord within the cervical os. About 48 hours prior to delivery, there was some leaking of amniotic fluid indicating possible rupture of membranes. She was not in active labour apart from intermittent contractions. Elective caesarean section was done for concerns with cord prolapse. Delivery was unremarkable with no surgical trauma or traction to the leg as confirmed by the obstetrician. The infant was resuscitated per protocol and transferred to the neonatal intensive care unit. At birth, the baby was found to have a full-thickness deep gaping wound in the right inguinal...

http://ift.tt/2pSnsjQ

Treatment of severe hypocalcaemia due to osteoblastic metastases in a patient with post-thyroidectomy hypoparathyroidism with 153Sm-EDTMP

Symptomatic hypocalcaemia is an uncommon finding in patients with malignant tumours. We describe a patient with advanced metastatic breast cancer who developed severe hypocalcaemia caused by the combination of osteoblastic metastases and a permanent postoperative hypoparathyroidism. The patient failed to be treated with the conventional replacement therapy and was submitted effectively to radionucleotide therapy with ¹⁵³Sm.

http://ift.tt/2qnLdUp

SynRinse Irrigation Pilot (SIP) Trial

Conditions:   Sinusitis, Chronic;   Cystic Fibrosis With Other Manifestations
Intervention:   Drug: Synrinse
Sponsor:   University of Washington
Not yet recruiting - verified May 2017

http://ift.tt/2rc3FAv

Health Care Coach Support in Reducing Acute Care Use and Cost in Patients With Cancer

Conditions:   Acute Myeloid Leukemia;   Brain Glioblastoma;   Estrogen Receptor Negative;   Extensive Stage Small Cell Lung Carcinoma;   Head and Neck Carcinoma;   HER2/Neu Negative;   Hormone-Resistant Prostate Cancer;   Limited Stage Small Cell Lung Carcinoma;   Myelodysplastic Syndrome;   Progesterone Receptor Negative;   Progressive Disease;   Recurrent Carcinoma;   Stage II Pancreatic Cancer;   Stage II Rectal Cancer;   Stage IIA Pancreatic Cancer;   Stage IIA Rectal Cancer;   Stage IIB Pancreatic Cancer;   Stage IIB Rectal Cancer;   Stage IIC Rectal Cancer;   Stage III Colon Cancer;   Stage III Esophageal Cancer;   Stage III Gastric Cancer;   Stage III Non-Small Cell Lung Cancer;   Stage III Ovarian Cancer;   Stage III Pancreatic Cancer;   Stage III Rectal Cancer;   Stage III Skin Melanoma;   Stage IIIA Colon Cancer;   Stage IIIA Esophageal Cancer;   Stage IIIA Gastric Cancer;   Stage IIIA Non-Small Cell Lung Cancer;   Stage IIIA Ovarian Cancer;   Stage IIIA Rectal Cancer;   Stage IIIA Skin Melanoma;   Stage IIIB Colon Cancer;   Stage IIIB Esophageal Cancer;   Stage IIIB Gastric Cancer;   Stage IIIB Non-Small Cell Lung Cancer;   Stage IIIB Ovarian Cancer;   Stage IIIB Rectal Cancer;   Stage IIIB Skin Melanoma;   Stage IIIC Colon Cancer;   Stage IIIC Esophageal Cancer;   Stage IIIC Gastric Cancer;   Stage IIIC Ovarian Cancer;   Stage IIIC Rectal Cancer;   Stage IIIC Skin Melanoma;   Stage IV Bladder Cancer;   Stage IV Bone Sarcoma;   Stage IV Breast Cancer;   Stage IV Colon Cancer;   Stage IV Esophageal Cancer;   Stage IV Gastric Cancer;   Stage IV Non-Small Cell Lung Cancer;   Stage IV Ovarian Cancer;   Stage IV Pancreatic Cancer;   Stage IV Rectal Cancer;   Stage IV Renal Cell Cancer;   Stage IV Skin Melanoma;   Stage IV Soft Tissue Sarcoma;   Stage IVA Bone Sarcoma;   Stage IVA Colon Cancer;   Stage IVA Rectal Cancer;   Stage IVB Bone Sarcoma;   Stage IVB Colon Cancer;   Stage IVB Rectal Cancer;   Triple-Negative Breast Carcinoma
Interventions:   Other: Best Practice;   Other: Laboratory Biomarker Analysis;   Procedure: Supportive Care;   Other: Survey Administration
Sponsor:   Stanford University
Recruiting - verified May 2017

http://ift.tt/2pQN1SV

A Study of Taselisib + Fulvestrant Versus Placebo + Fulvestrant in Participants With Advanced or Metastatic Breast Cancer Who Have Disease Recurrence or Progression During or After Aromatase Inhibitor Therapy

Condition:   Breast Cancer
Interventions:   Drug: Taselisib;   Drug: Placebo;   Drug: Fulvestrant
Sponsor:   Hoffmann-La Roche
Recruiting - verified May 2017

http://ift.tt/2rc1yMX

A case of refractory chronic rhinosinusitis with anti-desmoglein 3 IgG4 autoantibody

Publication date: Available online 15 May 2017
Source:Allergology International
Author(s): Yasushi Ota, Fumio Ishikawa, Toshiya Sato, Nobuyuki Hiruta, Makoto Kitamura, Hiromitsu Yokota, Yoshihiro Ikemiyagi, Hideaki Bujo, Mutsunori Fujiwara, Mitsuya Suzuki




http://ift.tt/2rbCJAX

Effect of myocyte-fibroblast coupling on the onset of pathological dynamics in a model of ventricular tissue

Managing lethal cardiac arrhythmias is one of the biggest challenges in modern cardiology, and hence it is very important to understand the factors underlying such arrhythmias. While early afterdepolarizations (EAD) of cardiac cells is known to be one such arrhythmogenic factor, the mechanisms underlying the emergence of tissue level arrhythmias from cellular level EADs is not fully understood. Another known arrhythmogenic condition is fibrosis of cardiac tissue that occurs both due to aging and in many types of heart diseases. In this paper we describe the results of a systematic insilico study, using the TNNP model of human cardiac cells and MacCannell model for (myo) fibroblasts, on the possible effects of diffuse fibrosis on arrhythmias occurring via EADs. We find that depending on the resting potential of fibroblasts (VFR), M-F coupling can either increase or decrease the region of parameters showing EADs. Fibrosis increases the probability of occurrence of arrhythmias after a single focal stimulation and this effect increases with the strength of the M-F coupling. While in our simulations, arrhythmias occur due to fibrosis induced ectopic activity, we do not observe any specific fibrotic pattern that promotes the occurrence of these ectopic sources.

http://ift.tt/2qrDPWk

The mutation nrpb1-A325V in the largest subunit of RNA polymerase II suppresses compromised growth of Arabidopsis plants deficient in a function of the general transcription factor IIF

http://ift.tt/2pGeCKP

Nieuwe methoden voor lichtsturing en aanpasbare lenzen met vloeibare kristallen

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Islands of spatially discordant APD alternans underlie arrhythmogenesis by promoting electrotonic dyssynchrony in models of fibrotic rat ventricular myocardium

Fibrosis and altered gap junctional coupling are key features of ventricular remodelling and are associated with abnormal electrical impulse generation and propagation. Such abnormalities predispose to reentrant electrical activity in the heart. In the absence of tissue heterogeneity, high-frequency impulse generation can also induce dynamic electrical instabilities leading to reentrant arrhythmias. However, because of the complexity and stochastic nature of such arrhythmias, the combined effects of tissue heterogeneity and dynamical instabilities in these arrhythmias have not been explored in detail. Here, arrhythmogenesis was studied using in vitro and in silico monolayer models of neonatal rat ventricular tissue with 30% randomly distributed cardiac myofibroblasts and systematically lowered intercellular coupling achieved in vitro through graded knockdown of connexin43 expression. Arrhythmia incidence and complexity increased with decreasing intercellular coupling efficiency. This coincided with the onset of a specialized type of spatially discordant action potential duration alternans characterized by island-like areas of opposite alternans phase, which positively correlated with the degree of connexinx43 knockdown and arrhythmia complexity. At higher myofibroblast densities, more of these islands were formed and reentrant arrhythmias were more easily induced. This is the first study exploring the combinatorial effects of myocardial fibrosis and dynamic electrical instabilities on reentrant arrhythmia initiation and complexity.

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