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18/11/2017 11:47 PM
Surgical deserts in California: an analysis of access to surgical care
Publication date: March 2018
Source:Journal of Surgical Research, Volume 223

Author(s): Tarsicio Uribe-Leitz, Micaela M. Esquivel, Naomi Y. Garland, Kristan L. Staudenmayer, David A. Spain, Thomas G. Weiser

Background Areas of minimal access to surgical care, often called “surgical deserts”, are of particular concern when considering the need for urgent surgical and anesthesia care. We hypothesized that California would have an appropriate workforce density but that physicians would be concentrated in urban areas, and surgical deserts would exist in rural counties. Methods We used a benchmark of six general surgeons, six orthopedists, and eight anesthesiologists per 100,000 people per county to define a “desert”. The number and location of these providers were obtained from the Medical Board of California for 2015. ArcGIS, version 10.3, was used to geocode the data and were analyzed in Redivis. Results There were a total of 3268 general surgeons, 3188 orthopedists, and 5995 anesthesiologists in California in 2015, yielding a state surgeon-to-population ratio of 7.2, 6.7, and 10.2 per 100,000 people, respectively; however, there was wide geographic variability. Of the 58 counties in California, 18 (31%) have a general surgery desert, 27 (47%) have an orthopedic desert, and 22 (38%) have an anesthesiology desert. These counties account for 15%, 25%, and 13% of the state population, respectively. Five, seven, and nine counties, respectively, have none in the corresponding specialty. Conclusions Overall, California has an adequate ratio of surgical and anesthesia providers to population. However, because of their uneven distribution, significant surgical care deserts exist. Limited access to surgical and anesthesia providers may negatively impact patient outcome in these counties.






18/11/2017 11:47 PM
Gaussian modelling characteristics changes derived from finger photoplethysmographic pulses during exercise and recovery
Publication date: March 2018
Source:Microvascular Research, Volume 116

Author(s): Anran Wang, Lin Yang, Weimin Wen, Song Zhang, Guanxiong Gu, Dingchang Zheng

Gaussian modelling method has been reported as a useful method to analyze arterial pulse waveform changes. This study aimed to provide scientific evidence on Gaussian modelling characteristics changes derived from the finger photoplethysmographic (PPG) pulses during exercise and recovery. 65 healthy subjects (18 female and 47 male) were recruited. Finger PPG pulses were digitally recorded with 5 different exercise loads (0, 50, 75, 100, 125W) as well as during each of 4minute (min) recovery period. The PPG pulses were normalized in both width and amplitude for each recording, which were decomposed into three independent Gaussian waves with nine parameters determined, including the peak amplitude (H1, H2, H3), peak time position (N1, N2, N3) and half-width (W1, W2, W3) from each Gaussian wave, and four extended parameters determined, including the peak time interval (T1,2, T1,3) and amplitude ratio (R1,2, R1,3) between 1st Gaussian wave and 2nd, 3rd Gaussian waves. These derived parameters were finally compared between different exercise loads and recovery phases. With gradually increased exercise loads, the peak amplitude H2, peak time position N1, N2, N3, and half-width W1, W2 increased, peak amplitude H3 decreased significantly (all P<0.05). The peak time interval T1,2 and T1,3 increased significantly from 10.6±1.2 and 36.0±4.4 at rest to 14.4±2.3 and 45.1±6.5 at 100W exercise load, respectively (both P<0.05). The amplitude ratio R1,2 also increased from 1.07±0.2 at rest to 1.22±0.2 at 100W, and the amplitude ratio R1,3 decreased from 1.10±0.3 at rest to 0.42±0.2 at 125W (all P<0.05). An opposite changing trend of these parameters was observed during recovery phases. In conclusion, this study has quantitatively demonstrated significant changes of Gaussian modelling characteristics derived from finger PPG pulse with exercise and during recovery, providing scientific evidence for the physiological mechanism that exercise increases cardiac ejection and vasodilation, and reduces the total peripheral vascular resistance.






18/11/2017 11:47 PM
Contributors
Publication date: February 2018
Source:Emergency Medicine Clinics of North America, Volume 36, Issue 1










18/11/2017 11:47 PM
Major Trauma Outside a Trauma Center
Publication date: February 2018
Source:Emergency Medicine Clinics of North America, Volume 36, Issue 1

Author(s): Preston J. Fedor, Brian Burns, Michael Lauria, Clare Richmond



Teaser

Care of the critically injured begins well before the patient arrives at a large academic trauma center. It is important to understand the continuum of care from the point of injury in the prehospital environment, through the local hospital and retrieval, until arrival at a trauma center capable of definitive care. This article highlights the important aspects of trauma assessment and management outside of tertiary or quaternary care hospitals. Key elements of each phase of care are reviewed, including management pearls and institutional strategies to facilitate effective and efficient treatment of trauma patients from the point of injury forward.




18/11/2017 11:47 PM
Spatial methods for evaluating critical care and trauma transport: A scoping review
Publication date: February 2018
Source:Journal of Critical Care, Volume 43

Author(s): Katia Vasilyeva, Michael J. Widener, Samuel M. Galvagno, Zachary Ginsberg

Purpose The objective of this scoping review is to inform future applications of spatial research regarding transportation of critically ill patients. We hypothesized that this review would reveal gaps and limitations in the current research regarding use of spatial methods for critical care and trauma transport research. Materials and methods Four online databases, Ovid Medline, PubMed, Embase and Scopus, were searched. Studies were selected if they used geospatial methods to analyze a patient transports dataset. 12 studies were included in this review. Results Majority of the studies employed spatial methods only to calculate travel time or distance even though methods and tools for more complex spatial analyses are widely available. Half of the studies were found to focus on hospital bypass, 2 studies focused on transportation (air or ground) mode selection, 2 studies compared predicted versus actual travel times, and 2 studies used spatial modeling to understand spatial variation in travel times. Conclusions There is a gap between the availability of spatial tools and their usage for analyzing and improving medical transportation. The adoption of geospatially guided transport decisions can meaningfully impact healthcare expenditures, especially in healthcare systems looking to strategically control expenditures with minimum impact on patient outcomes.






18/11/2017 11:47 PM
The quality of the post academic course ‘management of safety, health and environment (MoSHE) of Delft University of Technology
Publication date: February 2018
Source:Safety Science, Volume 102

Author(s): Paul Swuste, Simone Sillem

Objective This article discusses the rise of European postgraduate courses in safety science and the content and quality of the Management of Safety Health and Environment (MoSHE) course of Delft University of Technology. Materials and methods Literature search, document analysis, interviews. Results The different MoSHE years show a varied picture of this post academic program. In the Netherlands the course is unique with a central focus on risk management and sustainability, supported by scientific developments in the areas of safety, health, environment, organizational science and psychology. In all year-groups the quality of the course was assessed with a short questionnaire, collecting opinions of course members on individual presentations and the course as a whole. Quality of the course was regularly discussed through the contacts of the course coordinator with module leaders, and at meetings of course committees, and leading to changes in content of modules. After MoSHE 1 (1989), 14 (2008), and 17 (2012) the courses’ structure, organization and content was changed radically. Only, the quality system of the course remained implicit. Using the model of the European Foundation for Quality Management a first set-up for a quality system is presented. Over the years the academic nature of the program has changed substantially. This is one of the challenges for the future to find a balance between the domains taught and between an academic approach and practical skills. The course could benefit from a greater input of process safety and safety in high-tech-high-hazard sectors.






18/11/2017 11:47 PM
Resilience engineering: Current status of the research and future challenges
Publication date: February 2018
Source:Safety Science, Volume 102

Author(s): Riccardo Patriarca, Johan Bergström, Giulio Di Gravio, Francesco Costantino

This paper offers an extensive literature review on the field of Resilience Engineering (RE), encompassing 472 contributions, including journal articles, conference proceedings and book chapters. Adopting the numbers of co-citations as a metric of conceptual proximity, this paper details the application of Factor Analysis and Multi-Dimensional Scaling, as groundbreaking means to extract relevant research factors. A temporal analysis in a multi-variate two-dimensional space confirms the significance and relevance of the identified research factors. An in-depth analysis of the five research factors, labeled as the need of RE, RE for modelling, defining and exploring RE, reflecting on RE, RE and improvisation, guides the definition of future research paths and open research questions within the field and across several domains, suggesting the need for multi-disciplinary future studies.






18/11/2017 11:47 PM
The Akt-like kinase of Leishmania panamensis: As a new molecular target for drug discovery
Publication date: January 2018
Source:Acta Tropica, Volume 177

Author(s): Didier Tirado-Duarte, Marcel Marín-Villa, Rodrigo Ochoa, Gustavo Blandón-Fuentes, Maurilio José Soares, Sara Maria Robledo, Rubén E. Varela-Miranda

The Akt-like kinase of Leishmania spp. is a cytoplasmic orthologous protein of the serine/threonine kinase B-PKB/human-Akt group, which is involved in the cellular survival of these parasites. By the application of a computational strategy we obtained two specific inhibitors of the Akt-like protein of L. panamensis (UBMC1 and UBMC4), which are predicted to bind specifically to the pleckstrin domain (PH) of the enzyme. We show that the Akt-like of Leishmania panamensis is phospho-activated in parasites under nutritional and thermic stress, this phosphorylation is blocked by the UBMC1 and UMBC2 and such inhibition leads to cell death. Amongst the effects caused by the inhibitors on the parasites we found high percentage of hypodiploidy and loss of mitochondrial membrane potential. Ultrastructural studies showed highly vacuolated cytoplasm, as well as shortening of the flagellum, loss of nuclear membrane integrity and DNA fragmentation. Altogether the presented results suggest that the cell death caused by UMBC1 and UMBC4 may be associated to an apoptosis-like process. The compounds present an inhibitory concentration (IC50) over intracellular amastigotes of L. panamensis of 9.2±0.8μM for UBMC1 and 4.6±1.9μM for UBMC4. The cytotoxic activity for UBMC1 and UBMC4 in human macrophages derived from monocytes (huMDM) was 29±1.2μM and >40μM respectively. Our findings strongly support that the presented compounds can be plausible candidates as a new therapeutic alternative for the inhibition of specific kinases of the parasite.

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18/11/2017 11:47 PM
A multinational clinical approach to assessing the effectiveness of catheter-based ultrasound renal denervation: The RADIANCE-HTN and REQUIRE clinical study designs
Publication date: January 2018
Source:American Heart Journal, Volume 195

Author(s): Laura Mauri, Kazuomi Kario, Jan Basile, Joost Daemen, Justin Davies, Ajay J. Kirtane, Felix Mahfoud, Roland E. Schmieder, Michael Weber, Shinsuke Nanto, Michel Azizi

Catheter-based renal denervation is a new approach to treat hypertension via modulation of the renal sympathetic nerves. Although nonrandomized and small, open-label randomized studies resulted in significant reductions in office blood pressure 6months after renal denervation with monopolar radiofrequency catheters, the first prospective, randomized, sham-controlled study (Symplicity HTN-3) failed to meet its blood pressure efficacy end point. New clinical trials with new catheters have since been designed to address the limitations of earlier studies. Accordingly, the RADIANCE-HTN and REQUIRE studies are multicenter, blinded, randomized, sham-controlled trials designed to assess the blood pressure–lowering efficacy of the ultrasound-based renal denervation system (Paradise) in patients with established hypertension either on or off antihypertensive medications, is designed to evaluate patients in 2 cohorts—SOLO and TRIO, in the United States and Europe. The SOLO cohort includes patients with essential hypertension, at low cardiovascular risk, and either controlled on 1 to 2 antihypertensive medications or uncontrolled on 0 to 2 antihypertensive medications. Patients undergo a 4-week medication washout period before randomization to renal denervation (treatment) or renal angiogram (sham). The TRIO cohort includes patients with hypertension resistant to at least 3 antihypertensive drugs including a diuretic. Patients will be stabilized on a single-pill, triple-antihypertensive-drug combination for 4weeks before randomization to treatment or sham. Reduction in daytime ambulatory systolic blood pressure (primary end point) will be assessed at 2months in both cohorts. A predefined medication escalation protocol, as needed for blood pressure control, is implemented between 2 and 6months in both cohorts by a study staff member blinded to the randomization process. At 6months, daytime ambulatory blood pressure and antihypertensive treatment score will be assessed. REQUIRE is designed to evaluate patients with resistant hypertension on standard of care medication in Japan and Korea. Reduction in 24-hour ambulatory systolic blood pressure will be assessed at 3months (primary end point). Both studies are enrolling patients, and their results are expected in 2018.






18/11/2017 11:47 PM
Pramipexole reduces soluble mutant huntingtin and protects striatal neurons through dopamine D3 receptors in a genetic model of Huntington's disease
Publication date: January 2018
Source:Experimental Neurology, Volume 299, Part A

Author(s): Diego Luis-Ravelo, Héctor Estévez-Silva, Pedro Barroso-Chinea, Domingo Afonso-Oramas, Josmar Salas-Hernández, Julia Rodríguez-Núñez, Abraham Acevedo-Arozena, Daniel Marcellino, Tomás González-Hernández

Huntington's disease (HD) is a neurodegenerative disorder caused by abnormal expansion of the polyglutamine tract in the huntingtin protein (HTT). The toxicity of mutant HTT (mHTT) is associated with intermediate mHTT soluble oligomers that subsequently form intranuclear inclusions. Thus, interventions promoting the clearance of soluble mHTT are regarded as neuroprotective. Striatal neurons are particularly vulnerable in HD. Their degeneration underlies motor symptoms and striatal atrophy, the anatomical hallmark of HD. Recent studies indicate that autophagy may be activated by dopamine D2 and D3 receptor (D2R/D3R) agonists. Since autophagy plays a central role in the degradation of misfolded proteins, and striatal neurons express D2R and D3R, D2R/D3R agonists may promote the clearance of mHTT in striatal neurons. Here, this hypothesis was tested by treating 8-week old R6/1 mice with the D2R/D3R agonist pramipexole for 4weeks. Pramipexole reduced striatal levels of soluble mHTT and increased the size of intranuclear inclusions in R6/1 mice. Furthermore, striatal DARPP-32 levels and motor functions were recovered. These effects were accompanied by an increase in LC3-II and a decrease in p62 in the striatum. Tollip, a selective adaptor of ubiquitinated polyQ proteins to LC3, was also reduced in the striata of R6/1mice but not in their wild-type littermates. No changes were detected in the cerebral cortex where D3R expression is very low, and behavioral and biochemical effects in the striatum were prevented by a D3R antagonist. The findings indicate that PPX protects striatal neurons by promoting the clearance of soluble mHTT through a D3R-mediated mechanism. The evidence of autophagy markers suggests that autophagy is activated, although it is not efficient at removing all mHTT recruited by the autophagic machinery as indicated by the increase in the size of intranuclear inclusions.






18/11/2017 11:47 PM
Acute and long-term effects of fingolimod on heart rhythm and heart rate variability in patients with multiple sclerosis
Publication date: January 2018
Source:Multiple Sclerosis and Related Disorders, Volume 19

Author(s): Ruken Özge Akbulak, Sina C. Rosenkranz, Benjamin N. Schaeffer, Hans O. Pinnschmidt, Stephan Willems, Christoph Heesen, Boris A. Hoffmann

Background Fingolimod can lead to increased risk of cardiac events such as bradycardia or atrioventricular (AV) block. Objective Evaluate acute and long-term effects of fingolimod on heart rhythm (HR), heart rate variability (HRV) and development of AV-blocks. Methods In 64 patients with relapsing–remitting multiple sclerosis Holter ECG monitoring (HEM) and HRV analysis were performed 24h before, six h during and 72h after initiation of fingolimod. We additionally analyzed a 24h HEM after a follow up of ≥ three months. Results Heart rate (HR) decreased significantly (p < 0.001) under fingolimod treatment with nadir at five hours after starting and maintained decreased for 72h. Five (7.8%) patients suffered from new-onset AV-block requiring cessation of treatment. In four of five patients (80%), the AV-block could only be documented in the 72h-HEM with a median time of occurrence at 14h. The mean heart rate was still significant lower after a mean follow up time of 14.1 ± 9.6 months (85.0 ± 9.8 vs. 75.3 ± 16.2 bpm; p = 0.002) in comparison to baseline. Conclusion The treatment with fingolimod leads to an increase of vagal activation which persists even after 14 months of treatment. These changes did not return to baseline levels on treatment with fingolimod. Based on our data an additional at least 24h hour-HEM after the initiation of fingolimod therapy should be considered.






18/11/2017 11:47 PM
Neural correlates of working memory deficits and associations to response inhibition in obsessive compulsive disorder
Publication date: 2018
Source:NeuroImage: Clinical, Volume 17

Author(s): Stephan Heinzel, Christian Kaufmann, Rosa Grützmann, Robert Hummel, Julia Klawohn, Anja Riesel, Katharina Bey, Leonhard Lennertz, Michael Wagner, Norbert Kathmann

Previous research in patients with obsessive-compulsive disorder (OCD) has indicated performance decrements in working memory (WM) and response inhibition. However, underlying neural mechanisms of WM deficits are not well understood to date, and empirical evidence for a proposed conceptual link to inhibition deficits is missing. We investigated WM performance in a numeric n-back task with four WM load conditions during functional Magnetic Resonance Imaging (fMRI) in 51 patients with OCD and 49 healthy control participants who were matched for age, sex, and education. Additionally, a stop signal task was performed outside the MRI scanner in a subsample. On the behavioral level, a significant WM load by group interaction was found for both accuracy (p<0.02) and reaction time measures (p<0.03), indicating increased reaction times as well as reduced accuracy specifically at high WM load (3-back) in patients with OCD. Whole-brain analyses of fMRI-data identified neural correlates of a load-dependent WM decrement in OCD in the supplementary motor area (SMA) and the inferior parietal lobule (IPL). Within the OCD sample, SMA-activity as well as n-back performance were correlated with stop signal task performance. Results from behavioral and fMRI-analyses indicate a reduced WM load-dependent modulation of neural activity in OCD and suggest a common neural mechanism for inhibitory dysfunction and WM decrements in OCD.






18/11/2017 11:47 PM
Implementation and evaluation of health passport communication tools in emergency departments
Publication date: January 2018
Source:Research in Developmental Disabilities, Volume 72

Author(s): Marina Heifetz, Yona Lunsky

Background People with IDD (intellectual or developmental disabilities) and their families consistently report dissatisfaction with their emergency department experience. Clear care plans and communication tools may not only improve the quality of patient care, but also can prevent unnecessary visits and reduce the likelihood of return visits. Aims To evaluate communication tools to be used by people with IDD in psychiatric and general emergency departments in three different regions of Ontario. Methods and procedures Health passport communication tools were locally tailored and implemented in each of the three regions. A total of 28 questionnaires and 18 interviews with stakeholders (e.g., hospital staff, community agency representatives, families) were completed across the regions to obtain feedback on the implementation of health passports with people with IDD. Outcomes and results Participants felt that the health passport tools provided helpful information, improved communication between patients with IDD and hospital staff, and were user friendly. Continued efforts are needed to work with communities on maintenance of this tool, ensuring all hospital staff are utilizing the information. Conclusions and implications These findings emphasize the merits of health passport tools being implemented in the health system to support communication between patients with IDD and health care practitioners and the importance of tailoring tools to local settings.






18/11/2017 11:47 PM
Factors associated with crewmember survival of cold water immersion due to commercial fishing vessel sinkings in Alaska
Publication date: January 2018
Source:Safety Science, Volume 101

Author(s): Devin L. Lucas, Samantha L. Case, Jennifer M. Lincoln, Joanna R. Watson

Occupational fatality surveillance has identified that fishing vessel disasters, such as sinkings and capsizings, continue to contribute to the most deaths among crewmembers in the US fishing industry. When a fishing vessel sinks at sea, crewmembers are at risk of immersion in water and subsequent drowning. This study examined survival factors for crewmembers following cold water immersion after the sinking of decked commercial fishing vessels in Alaskan waters during 2000–2014. Two immersion scenarios were considered separately: immersion for any length of time, and long-term immersion defined as immersion lasting over 30min. Logistic regression was used to predict the odds of crewmember survival. Of the 617 crewmembers onboard 187 fishing vessels that sank in Alaska during 2000–2014, 557 (90.3%) survived and 60 died. For crewmembers immersed for any length of time, the significant adjusted predictors of survival were: entering a life-raft, sinking within three miles of shore, the sinking not being weather-related, and working as a deckhand. For crewmembers immersed for over 30min, the significant adjusted predictors of survival were: wearing an immersion suit, entering a life-raft, working asa deckhand, and the sinking not being weather-related. The results of this analysis demonstrate that in situations where cold water immersion becomes inevitable, having access to well-maintained, serviceable lifesaving equipment and the knowledge and skills to use it properly are critical.






18/11/2017 11:47 PM
FPSO Cidade de São Mateus gas explosion – Lessons learned
Publication date: January 2018
Source:Safety Science, Volume 101

Author(s): Jan Erik Vinnem

The explosion accident in February 2015 on the Floating Production, Storage and Offloading (FPSO) unit Cidade de São Mateus in the Brazilian offshore sector was the most severe offshore petroleum accident since the Macondo blowout in the US in 2010. The paper aims to discuss the critical implications for the safety of such installations and to recommend solutions to improve safety of FPSO vessels. The root causes are discussed and compared with those of the Macondo blowout and gas leaks on offshore installations in the Norwegian sector. Most of the root causes of the Cidade de São Mateus accident are similar to those of the Macondo accident and gas leaks on offshore installations in the Norwegian sector. Two root causes of a technical nature, related to aspects of safe design, were completely neglected in the investigation into the Cidade de São Mateus accident. These safety features are implemented on virtually all Norwegian FPSO vessels: first, replacing the use of a pump room with individual deep well, submerged cargo pumps in order to eliminate the pump room explosion hazard and second, locating living quarters in the bow of the vessel to avoid exposure to fire.






18/11/2017 11:47 PM
Current insights on the role of iron and copper dyshomeostasis in the pathogenesis of bilirubin neurotoxicity
Publication date: 15 December 2017
Source:Life Sciences, Volume 191

Author(s): Alena Viktorinova


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18/11/2017 11:47 PM
An inhibitory mechanism of action of a novel syringic-acid derivative on α-melanocyte–stimulating hormone (α-MSH)-induced melanogenesis
Publication date: 15 December 2017
Source:Life Sciences, Volume 191

Author(s): Yoon Ju Jeong, Jae-Young Lee, Jino Park, Soo Nam Park

Aims To report the effects of a novel syringic-acid derivative, (R)-ethyl-2-acetamido-3-(4-hydroxy-3,5-dimethoxybenzoylthio)propanoate (EABTO), on melanin synthesis and to identify its mechanism of action in B16F1 melanoma cells. Methods The effects of EABTO on melanin synthesis in B16F1 cells and human epidermal melanocytes and the influence on cell-free tyrosinase activity were evaluated. EABTO-induced cellular signaling cascades were studied by western blotting. Key findings EABTO effectively decreased melanin synthesis in a dose-dependent manner but had no effect on cell-free tyrosinase activity. EABTO significantly decreased the expression of melanogenic enzymes such as tyrosinase, tyrosinase-related protein 1 (TRP-1), and TRP-2. EABTO decreased the amounts of phosphorylated cAMP response element–binding protein (CREB) and cyclic adenosine monophosphate (cAMP), thereby inhibiting expression of microphthalmia-associated transcription factor (MITF). Moreover, EABTO upregulated phosphorylated ERK. A specific ERK pathway inhibitor, PD98059, reduced EABTO-induced ERK phosphorylation and restored the expression of MITF and melanin content. Significance EABTO inhibits melanogenesis in B16F1 melanoma cells via suppression of the cAMP–CREB pathway and activation of ERK, thus decreasing expression of MITF and of melanogenic enzymes.

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18/11/2017 11:47 PM
Age-specific Cost Effectiveness of Using Intravenous Recombinant Tissue Plasminogen Activator for Treating Acute Ischemic Stroke
Publication date: December 2017
Source:American Journal of Preventive Medicine, Volume 53, Issue 6, Supplement 2

Author(s): Heesoo Joo, Guijing Wang, Mary G. George

Introduction Studies have demonstrated that intravenous recombinant tissue plasminogen activator (IV rtPA) is a cost-effective treatment for acute ischemic stroke. Age-specific cost effectiveness has not been well examined. This study estimated age-specific incremental cost-effectiveness ratios (ICERs) of IV rtPA treatment versus no IV rtPA. Methods A Markov model was developed to examine the economic impact of IV rtPA over a 20-year time horizon on four age groups (18–44, 45–64, 65–80, and ≥81 years) from the U.S. healthcare sector perspective. The model used health outcomes from a national stroke registry adjusted by parameters from previous literature and current hospitalization costs in 2013 U.S. dollars. Long-term annual costs and quality-adjusted life years (QALYs) in the years after a stroke were discounted at 3% per year. Incremental costs, incremental QALYs, and ICERs were estimated and sensitivity analyses were conducted between 2015 and 2017. Results Use of IV rtPA gained 0.55 QALYs and cost $3,941 more than no IV rtPA for stroke patients aged ≥18 years over a 20-year time horizon. IV rtPA was a dominant strategy compared to no IV rtPA for patients aged 18–44 and 45–64 years. For patients aged 65–80 years, IV rtPA gained 0.44 QALYs and cost $4,872 more than no IV rtPA (ICER=$11,132/QALY). For patients aged ≥81 years, ICER was estimated at $48,676/QALY. Conclusions IV rtPA saved costs and improved health outcomes for patients aged 18–64 years and was cost effective for those aged ≥65 years. These findings support the use of IV rtPA.






18/11/2017 11:47 PM
Tooth damage in captive orcas (Orcinus orca)
Publication date: December 2017
Source:Archives of Oral Biology, Volume 84

Author(s): John Jett, Ingrid N. Visser, Jeffrey Ventre, Jordan Waltz, Carolina Loch

Objectives Tooth damage as a result of oral stereotypies is evident in captive orca, yet little research on the topic exists. This study examines the associations between dental pathology, sex, facility, duration of captivity and other factors in captive orca. Design We evaluated mandibular and maxillary teeth from dental images of 29 captive orca owned by a US-based theme park. Each tooth was scored for coronal wear, wear at or below gum line and bore holes. Fractured and missing teeth were also noted. Summary statistics described the distribution and severity of pathologies; inferential statistics examined how pathologies differed between sexes, between wild-captured and captive-born orcas and between captive orca at four facilities. We also evaluated how dental pathology and duration of captivity were related. Results Approximately 24% of whales exhibited “major” to “extreme” mandibular coronal tooth wear, with coronal wear and wear at or below gum line highly correlated. More than 60% of mandibular teeth 2 and 3 exhibited fractures. Bore holes were observed primarily among anterior mandibular teeth, with more than 61% of teeth 2 and 3 bearing evidence of having been drilled. Four of five orca with the highest age-adjusted tooth pathology indices were captive-born. Conclusions Various dental pathologies were observed across all whales, with pathologies beginning at a young age. Oral stereotypies exhibited by captive orca contributed to the observed dental damage. By making dental and health records of captive whales publicly available, the theme park industry is uniquely positioned to provide further insight into dental pathology and resultant health consequences in captive orca.






18/11/2017 11:47 PM
Associations between smoking and alcohol use and arterial elasticity in patients with newly diagnosed essential hypertension: A cross-sectional study
Publication date: December 2017
Source:Artery Research, Volume 20

Author(s): Noor-Ahmed Jatoi, Waleed-Ibrahim Al-Baker, Afnan Al-Muhanna, Fahad Al-Muhanna, Stella-Maria Kyvelou, Faisal Sharif

Objective To assess the relationship between smoking and alcohol use (separately and combined) on arterial stiffness in patients with essential hypertension. Materials and Methods We assessed never-treated newly diagnosed patients with essential hypertension (n = 446) aged 18–80 years (52% males). Measurements included aortic stiffness, assessed as pulse wave velocity (PWV) (Complior), wave reflection (augmentation index [AIx]), and transit time [T R] SphygmoCor). Results The 446 patients were categorized as: non-smokers (n = 204), ex-smokers (n = 121), current smokers (n = 121), non-drinkers (n = 59), moderate drinkers (n = 281), heavy drinkers (n = 106). Both AIx and PWV were significantly higher in current smokers than in ex-smokers and non-smokers [(p < 0.02), (p < 0.01), respectively]. AIx and PWV were higher in non-drinkers followed by heavy drinkers and moderate drinkers [(p < 0.003), (p < 0.008), respectively]. Among current and ex-smokers there was no significant difference in PWV or AIx by alcohol consumption (p = NS), while in non-smokers AIx was significantly (p < 0.001) higher in the non-drinkers followed by heavy drinkers and those with moderate alcohol consumption and PWV was significantly (p < 0.001) higher in heavy drinkers followed by non-drinkers and those with moderate alcohol consumption. Conclusion Moderate alcohol consumption exerts a favorable effect on arterial stiffness in essential hypertensive patients. However, the combined effect of smoking cancels this favorable effect.






18/11/2017 11:47 PM
Effects of dietary modification with weight loss on central blood pressure during oral glucose tolerance test in overweight/obese men
Publication date: December 2017
Source:Artery Research, Volume 20

Author(s): Toru Yoshikawa, Hiroshi Kumagai, Kanae Myoenzono, Asako Zempo-Miyaki, Takehiko Tsujimoto, Kiyoji Tanaka, Seiji Maeda

Background Postprandial regulation of central systolic blood pressure (cSBP) is impaired by obesity-related disorders. The present study aimed to examine the effect of hypocaloric diet intervention on cSBP when performing oral glucose tolerance test (OGTT) in overweight/obese men and explore its mechanism. Methods Fifteen overweight/obese men (mean ± SD; age, 52 ± 10 years; BMI, 29.1 ± 2.3 kg/m2) completed a 12-week dietary modification program (group lectures and individual counseling conducted 8 times in 12 weeks, 1680 kcal/day). Before and after the program, body mass, daily intakes of total energy and major macronutrients, serum lipid profiles, and homeostasis model assessment for insulin resistance (HOMA-IR) were measured, and plasma glucose, serum insulin, and cSBP (i.e., radial second systolic pressure) were assessed when fasting and at 60 min and 120 min after 75 g oral glucose loading. Results The 12-week program led to successful weight loss (−10.1 kg or −12.1%) with significant reductions in the daily intakes of total energy and major macronutrients. Consequently, low-density lipoprotein cholesterol, triglycerides, HOMA-IR (2.1 ± 1.3 to 0.8 ± 0.3, p < 0.01), and glucose and insulin during OGTT were substantially decreased after 12 weeks. The diet program had also resulted in significantly reduced 2-h averaged cSBP during OGTT (111 ± 11 to 103 ± 10 mmHg, p < 0.01). There was a significant correlation between the changes from baseline in both HOMA-IR and 2-h averaged cSBP (r s  = 0.69, p < 0.01). Conclusions The current results suggest that the dietary modification–induced improvement in insulin resistance has contributed to a significant reduction in cSBP during OGTT in overweight/obese men.






18/11/2017 11:47 PM
Sex hormones and quantitative ultrasound parameters at the heel in men and women from the general population
Publication date: December 2017
Source:Bone Reports, Volume 7

Author(s): Konrad Pätzug, Nele Friedrich, Hanna Kische, Anke Hannemann, Henry Völzke, Matthias Nauck, Brian G. Keevil, Robin Haring

Purpose/introduction The present study investigates potential associations between liquid chromatography-mass spectrometry (LC-MS) measured sex hormones, dehydroepiandrosterone sulphate, sex hormone-binding globulin (SHBG) and bone ultrasound parameters at the heel in men and women from the general population. Methods Data from 502 women and 425 men from the population-based Study of Health in Pomerania (SHIP-TREND) were used. Cross-sectional associations of sex hormones including testosterone (TT), calculated free testosterone (FT), dehydroepiandrosterone sulphate (DHEAS), androstenedione (ASD), estrone (E1) and SHBG with quantitative ultrasound (QUS) parameters at the heel, including broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness index (SI) were examined by analysis of variance (ANOVA) and multivariable quantile regression models. Results Multivariable regression analysis showed a sex-specific inverse association of DHEAS with SI in men (Beta per SI unit=3.08, standard error (SE)=0.88), but not in women (Beta=0.01, SE=2.09). Furthermore, FT was positively associated with BUA in men (Beta per BUA unit=29.0, SE=10.1). None of the other sex hormones (ASD, E1) or SHBG was associated with QUS parameters after multivariable adjustment. Conclusions This cross-sectional population-based study revealed independent associations of DHEAS and FT with QUS parameters in men, suggesting a potential influence on male bone metabolism. The predictive role of DHEAS and FT as a marker for osteoporosis in men warrants further investigation in clinical trials and large-scale observational studies.






18/11/2017 11:47 PM
Hipotiroidismo e hipertiroidismo infantil
Publication date: December 2017
Source:EMC - Tratado de Medicina, Volume 21, Issue 4

Author(s): K. Busiah, É. Giabicani

El médico de cabecera es el que suele descubrir las perturbaciones de las pruebas tiroideas en el niño. Los signos que conducen a estas pruebas son muy heterogéneos (dificultades de concentración, trastornos digestivos, trastornos del apetito, etc.), pero los trastornos del crecimiento son una puerta de entrada frecuente hacia el diagnóstico en la población pediátrica. En el niño, el análisis de un estudio tiroideo anormal requiere un buen conocimiento de la fisiología y la regulación de las hormonas tiroideas, pero también de las especificidades de las enfermedades con respecto al adulto. Ante las importantes consecuencias en términos de desarrollo neurocognitivo, de crecimiento y de repercusión cardíaca, estas enfermedades deben reconocerse precozmente y tratarse de manera adecuada, y suelen requerir una consulta especializada. Además, la vigilancia de los tratamientos y del equilibrio terapéutico debe dominarse bien, para asegurar una buena evolución sin imponer a los pacientes unos seguimientos demasiado pesados. Finalmente, gracias a la detección neonatal, a la precisión de las determinaciones de laboratorio, a los diagnósticos y los tratamientos precoces, la mayoría de estas enfermedades, aunque no son curables, permiten una calidad de vida perfectamente satisfactoria para los pacientes.






18/11/2017 11:47 PM
Proposing a new stroke-specific screening tool for depression: Examination of construct validity and reliability
Publication date: December 2017
Source:eNeurologicalSci, Volume 9

Author(s): Akin Ojagbemi, Mayowa Owolabi, Joshua Akinyemi, Bruce Ovbiagele

Objectives The optimal tool for identifying depression after stroke is yet to be identified. In the present study, we propose a new context-specific screening tool for PSD and examined its construct validity and reliability within existing data on recent stroke survivors. Methods We assessed baseline data being collected as part of an intervention to improve one-year blood pressure control among recent (≤one month) stroke survivors. Depression was measured using the Hospital Anxiety and Depression Scale (HADS-D). We also independently administered the 26-items Health Related Quality of Life in Stroke Patients (HRQOLISP-26), a stroke-specific measure developed from a large cross-cultural sample. Using standard protocol, we identified 6 psychoemotional-domain items of the HRQOLISP-26 fitting a single dimensional model with phenomenological and conceptual overlap with the depression framework in the 10th revision of the International Classification of Diseases (ICD-10). We examined construct validity by comparing HRQOLISP-E with the HADS-D, and known group validity by comparing with age, gender, and stroke severity using both the Pearson product moment coefficient and multivariate regression analyses. Internal consistency and split-half reliability were also determined. Results Each HRQOLISP-E item (r=0.40 to −0.53, all p<0.001), as well as the total HRQOLISP-E score (−0.53, p<0.001) showed significant correlation with the HADS-D. The HRQOLISP-E scores also correlated significantly with age and stroke severity. Depression assessed using the HRQOLIPS-E was independently associated with older age and stroke severity. All HRQOLISP-E items scale correlations were >0.8 (0.81–0.93) compared with 0.56–0.68 for the HADS-D (Cronbach's alpha =0.939, versus 0.742 for the HADS-D, Split-half reliability=0.899, versus 0.739 for HADS-D). Conclusion These results provides preliminary support for further development of the HRQOLISP-E as a context-specific screening tool for PSD through an investigation comparing the proposed measure against a referent-standard clinical diagnostic criteria such as the ICD 10 or Diagnostic and Statistical Manual of Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders.






18/11/2017 11:47 PM
Sexual dimorphism of metabolic and vascular dysfunction in aged mice and those lacking the sphingosine 1-phosphate receptor 3
Publication date: 1 December 2017
Source:Experimental Gerontology, Volume 99

Author(s): Amanda T. Cao, Martina Mackova, Daniel Kerage, David N. Brindley, Denise G. Hemmings

Elderly people often suffer adverse health because of inflammation associated with poor metabolism and cardiovascular dysfunction, but these conditions present differently in men and women. We performed experiments in aged male and female mice to understand this sexual dimorphism. We focused on sphingosine 1-phosphate (S1P) signaling, which has both protective and detrimental effects on vascular and metabolic function. We examined vascular function of mesenteric (resistance) arteries from aged male and female wild-type (WT) mice compared to littermate S1P receptor 3 (S1PR3) knockouts (KO). We also measured plasma glucose, insulin, triglycerides, adiponectin, corticosterone and inflammatory cytokines. The novel results of this study are: 1) methacholine-induced vasodilation relied completely on S1PR3 in both sexes, but was dependent on nitric oxide synthase (NOS) only in arteries from aged female mice; 2) S1P-induced vasoconstriction depended solely on S1PR3 in arteries from males, but only partly in females; 3) vasoconstriction to a thromboxane mimetic was decreased by endogenous NOS activity only in arteries from females, regardless of genotype; 4) myogenic responses were lower in arteries from aged WT males compared to females and responses in arteries from KO females were lower than WT females, while the opposite was true of arteries from male mice; 5) aged male mice showed higher fasting glucose and triglycerides with lower plasma adiponectin compared to females and 6) lack of signaling through S1PR3 in females was associated with decreased plasma adiponectin and increased inflammatory mediators. This study showed that there is considerable sexual dimorphism in the vascular and metabolic responses of aged mice and that reduced signaling through S1PR3 could be one mechanism to explain these effects. These results also emphasize that different treatments for mitigating the deleterious effects on vascular health in aged males versus females should be considered.






18/11/2017 11:47 PM
Is thoracoscopic-laparoscopic esophagectomy a better alternative to thoracoscopic esophagectomy?
Publication date: December 2017
Source:International Journal of Surgery, Volume 48

Author(s): Fei Yao, Jian Wang, Ju Yao, Lei Xu, Junling Qian, Yongke Cao

Background Minimally invasive esophagectomy (MIE) is gaining rapid popularity as an alternative to conventional open esophagectomy. However, whether incorporating laparoscopy into MIE can further help the patients with esophageal cancer has rarely been studied. The aim of this study was to evaluate the short-term clinical efficacy of thoracoscopic-laparoscopic esophagectomy (TLE) compared with thoracoscopic esophagectomy (TE) in treating esophageal cancer. Methods From September 2014 to December 2016, a total of 131 patients with esophageal cancer who had consecutively undergone MIE were included in the analysis; of them, TLE was performed in 71 patients and TE in 60 patients. Characteristics and perioperative outcomes of all patients were collected and compared to determine differences between the 2 groups. Results Operation time (p = 0.172), chest drainage volume (p = 0.656), and pathologic staging (p = 0.671) were similar in the 2 groups. Compared with the TE approach, the TLE approach was associated with less blood loss during the operation (median, 100 vs 150 ml, p < 0.001), shorter chest drainage time (median, 2 vs 3 days, p < 0.001), a larger number of harvested lymph nodes (median, 24 vs 20, p < 0.001), and shorter postoperative hospital stay (median, 10 vs 11 days, p = 0.008). There was no significant difference between groups with regard to the major (grade ≥ III) and minor (grade < III) complications. Conclusions TLE is a safe and effective alternative to TE. Patients undergoing TLE may benefit from less blood loss, a larger number of harvested lymph nodes and faster postoperative recovery. Additional randomized controlled trial with longer follow-up is needed.






18/11/2017 11:47 PM
Effectiveness of physical activity intervention among government employees with metabolic syndrome
Publication date: December 2017
Source:Journal of Exercise Science & Fitness, Volume 15, Issue 2

Author(s): Chee Huei Phing, Hazizi Abu Saad, M.Y. Barakatun Nisak, M.T. Mohd Nasir

Background/Objective Our study aimed to assess the effects of physical activity interventions via standing banners (point-of-decision prompt) and aerobics classes to promote physical activity among individuals with metabolic syndrome. Methods We conducted a cluster randomized controlled intervention trial (16-week intervention and 8-week follow-up). Malaysian government employees in Putrajaya, Malaysia, with metabolic syndrome were randomly assigned by cluster to a point-of-decision prompt group (n = 44), an aerobics group (n = 42) or a control group (n = 103) based on sample size calculation formula. Step counts were evaluated by Lifecorder e-STEP accelerometers for all participants. Metabolic syndrome was defined according to the ‘harmonizing’ definition, in which individuals who have at least three of the five metabolic risk factors (waist circumference, high-density lipoprotein cholesterol, triglycerides, fasting glucose levels, systolic and diastolic blood pressure) will be classified as having metabolic syndrome. A total of 80% of the enrolled government employees with metabolic syndrome completed the programme. Data were analyzed using SPSS for Windows (version 20, SPSS, Chicago, IL). Results There were significantly higher step counts on average in the aerobics group compared to the control group over assessments. Assessments at baseline, post-intervention and follow-up showed a significant difference in step counts between the intervention and control groups. The greatest reductions in the proportions of individuals with metabolic syndrome were observed in the aerobics group with a reduction of 79.4% in the post-intervention assessment compared to the assessment at baseline. Conclusion The findings of this study suggest that physical activity intervention via aerobics classes is an effective strategy for improving step counts and reducing the prevalence of metabolic syndrome.






18/11/2017 11:47 PM
Mindfulness mediates the physiological markers of stress: Systematic review and meta-analysis
Publication date: December 2017
Source:Journal of Psychiatric Research, Volume 95

Author(s): Michaela C. Pascoe, David R. Thompson, Zoe M. Jenkins, Chantal F. Ski

Meditation is a popular form of stress management, argued to mediate stress reactivity. However, many studies in this field commonly fail to include an active control group. Given the frequency with which people are selecting meditation as a form of self-management, it is important to validate if the practice is effective in mediating stress-reactivity using well-controlled studies. Thus, we aimed to conduct a meta-analysis investigating the neurobiological effects of meditation, including focused attention, open monitoring and automatic self-transcending subtypes, compared to an active control, on markers of stress. In the current meta-analysis and systematic review, we included randomised controlled trials comparing meditation interventions compared to an active control on physiological markers of stress. Studied outcomes include cortisol, blood pressure, heart-rate, lipids and peripheral cytokine expression. Forty-five studies were included. All meditation subtypes reduced systolic blood pressure. Focused attention meditations also reduced cortisol and open monitoring meditations also reduced heart rate. When all meditation forms were analysed together, meditation reduced cortisol, C - reactive protein, blood pressure, heart rate, triglycerides and tumour necrosis factor-alpha. Overall, meditation practice leads to decreased physiological markers of stress in a range of populations.






18/11/2017 11:47 PM
The Relationship between Functional Outcome and Prehospital Time Interval in Patients with Cerebral Infarction
Publication date: December 2017
Source:Journal of Stroke and Cerebrovascular Diseases, Volume 26, Issue 12

Author(s): Soichiro Seno, Satoshi Tomura, Kenichiro Ono, Shinji Akitomi, Yasumasa Sekine, Yuya Yoshimura, Yoshihiro Tanaka, Hisashi Ikeuchi, Daizoh Saitoh

Background When symptoms of cerebral infarction are recognized in a patient, he or she should be transported to a hospital and should be started on the appropriate treatments. The effectiveness of delayed treatment of cerebral infarction with respect to the initial diagnosis or perception of the disease is still unclear. Methods We retrospectively investigated whether the functional outcomes would improve if patients with cerebral infarction were transported to the hospital with minimum delay. One-hundred twenty-two patients who were transported to Mishuku Hospital from January 2012 to August 2015 were included. We conducted multiple regression analyses. The criterion variable included the BI at discharge, and the explanatory variables were age, sex, days of hospital stay, the Barthel Index (BI) on admission, time from symptom onset to hospital arrival, time from emergency medical service perception to hospital arrival, recombinant tissue plasminogen activator (rt-PA) treatment, and the occluded artery type. Results In all 122 cases, the BI at the time of discharge was not related to onset time (P = .453) but was significantly related to perception time (P = .026). BI scores at discharge were high for young patients (P = .002) and for patients with short hospital stays (P <.001). In the rt-PA group (52 cases), BI scores at discharge were also high when the perception time was short (P = .036). Conclusions A short interval between perception and hospital arrival improves the functional outcomes for patients with cerebral infarction. Thus, patients with cerebral infarctions must be treated with minimal delay after diagnosis of the condition.






18/11/2017 11:47 PM
A Pilot Trial of a Lifestyle Intervention for Stroke Survivors: Design of Healthy Eating and Lifestyle after Stroke (HEALS)
Publication date: December 2017
Source:Journal of Stroke and Cerebrovascular Diseases, Volume 26, Issue 12

Author(s): Valerie A. Hill, Barbara G. Vickrey, Eric M. Cheng, Natalie P. Valle, Monica Ayala-Rivera, Lilian Moreno, Cynthia Munoz, Heidi Dombish, Annaliese Espinosa, Debbie Wang, Dina Ochoa, Allison Chu, Rebecca Heymann, Amytis Towfighi

Background Stroke survivors have high rates of subsequent cardiovascular and recurrent cerebrovascular events, and mortality. While healthy lifestyle practices - including a diet rich in fruits and vegetables, limited alcohol intake, and regular physical activity - can mitigate these outcomes, few stroke survivors adhere to them. Minorities from socioeconomically disadvantaged communities who obtain care in safety-net health systems experience the most barriers to implementing healthy lifestyle changes after stroke. Purpose To report the design of Healthy Eating and Lifestyle After Stroke (HEALS), a randomized controlled trial (RCT) was designed to test the feasibility of using a manualized, lifestyle management intervention in a safety-net setting to improve lifestyle practices among ethnically diverse individuals with stroke or transient ischemic attack (TIA). Methods Design: Pilot RCT. Participants: Inclusion criteria: 1) Adults (≥40 years) with ischemic stroke or TIA (≥ 90 days prior); 2) English- or Spanish-speaking. Setting: Outpatient clinic, safety-net setting. Intervention: Weekly two-hour small group sessions led by an occupational therapist for six weeks. The sessions focused on implementing nutrition, physical activity, and self-management strategies tailored to each participant's goals. Main Outcome Measures: Body mass index, diet, and physical activity. Conclusions Recruitment for this study is complete. If the HEALS intervention study is feasible and effective, it will serve as a platform for a large-scale RCT that will investigate the efficacy and cost-effectiveness of life management interventions for racially and ethnically diverse, low-income individuals with a history of stroke or TIA who seek healthcare in the safety-net system.






18/11/2017 11:47 PM
Yoga, mindfulness-based stress reduction and stress-related physiological measures: A meta-analysis
Publication date: December 2017
Source:Psychoneuroendocrinology, Volume 86

Author(s): Michaela C. Pascoe, David R. Thompson, Chantal F. Ski

Background and objectives Practices that include yoga asanas and mindfulness-based stress reduction for the management of stress are increasingly popular; however, the neurobiological effects of these practices on stress reactivity are not well understood. Many studies investigating the effects of such practices fail to include an active control group. Given the frequency with which people are selecting such interventions as a form of self-management, it is important to determine their effectiveness. Thus, this review investigates the effects of practices that include yoga asanas, with and without mindfulness-based stress reduction, compared to an active control, on physiological markers of stress. Materials and methods A systematic review and meta-analysis of randomised controlled trials published in English compared practices that included yoga asanas, with and without mindfulness-based stress reduction, to an active control, on stress-related physiological measures. The review focused on studies that measured physiological parameters such as blood pressure, heart rate, cortisol and peripheral cytokine expression. MEDLINE, AMED, CINAHL, PsycINFO, SocINDEX, PubMed, and Scopus were searched in May 2016 and updated in December 2016. Randomised controlled trials were included if they assessed at least one of the following outcomes: heart rate, blood pressure, heart rate variability, mean arterial pressure, C-reactive protein, interleukins or cortisol. Risk of bias assessments included sequence generation, allocation concealment, blinding of assessors, incomplete outcome data, selective outcome reporting and other sources of bias. Meta-analysis was undertaken using Comprehensive Meta-Analysis Software Version 3. Sensitivity analyses were performed using ‘one-study-removed’ analysis. Subgroup analysis was conducted for different yoga and control group types, including mindfulness-based stress reduction versus non-mindfulness-based stress reduction based interventions, different populations, length of intervention, and method of data analysis. A random-effects model was used in all analyses. Results Forty two studies were included in the meta-analysis. Interventions that included yoga asanas were associated with reduced evening cortisol, waking cortisol, ambulatory systolic blood pressure, resting heart rate, high frequency heart rate variability, fasting blood glucose, cholesterol and low density lipoprotein, compared to active control. However, the reported interventions were heterogeneous. Conclusions Practices that include yoga asanas appear to be associated with improved regulation of the sympathetic nervous system and hypothalamic-pituitary-adrenal system in various populations.






18/11/2017 11:47 PM
Oxytocin receptor gene polymorphisms exert a modulating effect on the onset age in patients with obsessive-compulsive disorder
Publication date: December 2017
Source:Psychoneuroendocrinology, Volume 86

Author(s): Jee In Kang, Hae Won Kim, Chul Hoon Kim, Eun Hee Hwang, Se Joo Kim

The oxytocin receptor (OXTR) is a potential candidate in the pathophysiology of obsessive-compulsive disorder (OCD). The present study investigated the association between common single-nucleotide polymorphism (SNPs) of the OXTR gene and the affected status of OCD or distinct clinical subtypes of OCD including the age at onset and symptom dimensions. Ten SNPs of OXTR were examined in 615 patients with OCD and 581 healthy controls. Single-marker and haplotype-based association analyses were conducted. While OXTR variants were not associated with the affected status of OCD or its clinical symptom dimensions, rs2268493 (p = 0.00185) and rs13316193 (p = 0.00461) of the OXTR gene were associated with the age at onset in patients with OCD. In addition, in haplotype-based association analyses, there was a significant association between the OXTR gene and the onset age in patients with OCD. In particular, the G-C-G haplotype of rs2268493-rs2254298-rs11316193 and the T-G-A haplotype of rs237887-rs2268490-rs4686301 were positively associated with late-onset OCD. Our results suggest that common variants of OXTR may exert a modulating effect on the onset age in OCD pathophysiology. The potential involvement of the oxytocin system in the development and expression of OCD warrants further longitudinal research.






18/11/2017 11:47 PM
An assessment of food safety information provision for UK chemotherapy patients to reduce the risk of foodborne infection
Publication date: December 2017
Source:Public Health, Volume 153

Author(s): E.W. Evans, E.C. Redmond

Objectives Given the increased risk of foodborne infection to cancer patients receiving chemotherapy treatment, and the risk of listeriosis reportedly five-times greater to this immunocompromised patient group, there is a need to ensure the implementation of domestic food safety practices among chemotherapy patients and their family caregivers. However, information regarding the adequacy of resources to inform and enable patients to implement domestic food safety practices to reduce the risk of foodborne infection is limited. Consequently, this study aimed to evaluate the provision of food safety information available to UK chemotherapy patients. Study design In-depth semi-structured interviews and content analysis of online patient information resources. Methods Interviews with patients and family caregivers (n = 15) were conducted to explore food-related experiences during chemotherapy treatment. Online food-related information resources for chemotherapy patients (n = 45) were obtained from 35 of 154 National Health Service chemotherapy providers in England, Scotland, and Wales, the Department of Health (DoH) and three of 184 identified UK cancer charities. Identified food-related information resources were reviewed using a content-analysis approach to assess the inclusion of food safety information for chemotherapy patients. Results In-depth interviews established that many patients indicated awareness of immunosuppression during treatment. Although patients reported practicing caution to reduce the risk of communicable diseases by avoiding crowded spaces/public transport, food safety was reported to be of minimal concern during treatment and the risk of foodborne infection was often underestimated. The review of online food-related patient information resources established that many resources failed to highlight the increased risk of foodborne infection and emphasize the importance of food safety for patients during chemotherapy treatment. Considerable information gaps exist, particularly in relation to listeriosis prevention practices. Cumulatively, information was inconsistent, insufficient, and varied between resources. Conclusion The study has identified the need for an effective, standardized food safety resource specifically targeting chemotherapy patients and family caregivers. Such intervention is essential to assist efforts in reducing the risks associated with foodborne infection among chemotherapy patients.






18/11/2017 11:47 PM
The biomarkers neuron-specific enolase and S100b measured the day following admission for severe accidental hypothermia have high predictive values for poor outcome
Publication date: December 2017
Source:Resuscitation, Volume 121

Author(s): Sebastian Wiberg, Jesper Kjaergaard, Benedict Kjærgaard, Bjarne Møller, Bo Nørnberg, Anne Marie Sørensen, Christian Hassager, Michael Wanscher

Aim The aim of the present study was to assess the ability of the biomarkers neuron-specific enolase (NSE) and S100 calcium-binding protein b (S100b) to predict mortality and poor neurologic outcome after 30days in patients admitted with severe accidental hypothermia. Methods Consecutive patients with severe accidental hypothermia, defined as a core temperature <32°C, were included. Patients were treated with active rewarming and/or extracorporeal life support (ECLS) using extra corporeal circulation (ECC) and/or extra corporeal membrane oxygenation (ECMO). The day following admission blood was analyzed for NSE and S100b. Follow-up was conducted after 30days and poor neurologic outcome was defined as a Cerebral Performance Category (CPC) score of 3–5. The predictive value of NSE and S100b was assessed as the area under the receiver-operating characteristics curve (AUC). Results A total of 34 patients were admitted with a diagnosis of severe accidental hypothermia and 29 (85%) were resuscitated from cardiac arrest. ECLS was initiated in 27 (79%) of patients. The day following admission three (9%) patients had died and one (3%) patient was awake, and accordingly, NSE and S100b were analyzed in 30 unconscious and/or sedated patients. NSE and S100b achieved AUCs of 0.93 and 0.88, respectively, for prediction of 30day mortality and AUCs of 0.88 and 0.87, respectively, for prediction of poor neurologic outcome. Conclusions In patients remaining unconscious the day following admission for severe accidental hypothermia, the biomarkers NSE and S100b appear to be solid predictors of mortality and poor neurologic outcome after 30days.






18/11/2017 11:47 PM
Resuscitation for Hypovolemic Shock
Publication date: December 2017
Source:Surgical Clinics of North America, Volume 97, Issue 6

Author(s): Kyle J. Kalkwarf, Bryan A. Cotton



Teaser

Hemorrhage is the leading cause of preventable deaths in trauma patients. After presenting a brief history of hemorrhagic shock resuscitation, this article discusses damage control resuscitation and its adjuncts. Massively bleeding patients in hypovolemic shock should be treated with damage control resuscitation principles including limited crystalloid, whole blood or balance blood component transfusion to permissive hypotension, preventing hypothermia, and stopping bleeding as quickly as possible.




18/11/2017 11:47 PM
Table of Contents
Publication date: December 2017
Source:The American Journal of Surgery, Volume 214, Issue 6










18/11/2017 11:47 PM
Surgical education: Lessons from parenthood
Publication date: December 2017
Source:The American Journal of Surgery, Volume 214, Issue 6

Author(s): Clay Cothren Burlew

Although one might think surgery and parenting have little in common, there are clear parallels. Historically there has been little formal education for either role. Educators and parents relied on modelling the behavior of others, or trial and error techniques. Mentorship and role models have played a critical role in professional development and continue to have a profound impact. Over the past two decades there has been a marked increase in the resources that are available. Coaching, debriefing, deliberate practice, and formal training are now incorporated in residency programs. Specific lessons from parenthood that can be applied to surgical education include: providing a framework, learning through graduated responsibility, communicating expectations, creating a culture, setting the example, encouraging resilience, promoting autonomy, providing feedback, and navigating failure. The final lesson from parenthood: trust that you have taught them well. And you have to let them go.






18/11/2017 11:47 PM
Endostapler versus Hem-O-Lok clip to secure the appendiceal stump and mesoappendix during laparoscopic appendectomy
Publication date: December 2017
Source:The American Journal of Surgery, Volume 214, Issue 6

Author(s): Mohammed H. Al-Temimi, Mendy A. Berglin, Edwin G. Kim, Deron J. Tessier, Samir D. Johna

Background Our study evaluates the safety and cost of using the Hem-O-Lok (HOL) clip in laparoscopic appendectomy (LA). Method We prospectively compared 30-day postoperative outcomes and cost between HOL clip and endoscopic stapler (ES) in LA at a single institution. Results HOL clip was used in 45 out of 92 LA. Perforated appendicitis (29.8% vs. 11.1%, P = 0.027) and postoperative complications were more common in the ES group (19.2% vs. 2.2%, p = 0.009). In multivariate analysis, HOL clip was associated with lower complications rate (OR = 0.05, 95% CI 0.003–0.744; p = 0.030). In propensity score matched cohort, complications were not different (p > 0.05). In patients with non-perforated appendicitis, HOL use increased operative time by 10 min on average (p = 0.004). Minimum ES cost per single appendectomy was $273.13, while HOL clip cost was $32.14. Conclusion The use of HOL clip in LA is safe and it reduced the costs of the procedure in comparison to the use of ES.






18/11/2017 11:47 PM
Discussion of: “Endostapler versus Hem-O-Lok clip to secure the appendiceal stump and mesoappendix during laparoscopic appendectomy”
Publication date: December 2017
Source:The American Journal of Surgery, Volume 214, Issue 6

Author(s): Mohammed H. Al-Temimi, Mendy A. Berglin, Edwin G. Kim, Deron J. Tessier, Samir D. Johna








18/11/2017 11:47 PM
Not every trauma patient with a radiographic head injury requires transfer for neurosurgical evaluation: Application of the brain injury guidelines to patients transferred to a level 1 trauma center
Publication date: December 2017
Source:The American Journal of Surgery, Volume 214, Issue 6

Author(s): Gweniviere Kayla Capron, Mary Beth Voights, Henry R. Moore, Derek B. Wall

Background Patients with radiographically-identified traumatic brain injury are often transferred to our regional trauma center for neurosurgical evaluation, yet few injuries require neurosurgical intervention. Transfer is costly, inconvenient, and potentially risky in inclement weather. We propose that previously-published brain injury guidelines (BIG)1 can help to determine which patients could avoid mandatory transfer. Methods Retrospective chart review of patients transferred between January 2012 and December 2013 was performed. Patients were classified as having minor (BIG 1), moderate (BIG 2), or severe (BIG 3) head injuries based on previously-published guidelines. Patient characteristics and outcomes were compared. Results No BIG 1 patients deteriorated or required surgical intervention. One BIG 2 patient required a non-emergent operation and another was readmitted with a worsened injury. In the BIG 3 group, 11.9% required neurosurgical procedures and 20% died. Conclusions The BIG classification can help stratify patients for whom transfer is considered.






18/11/2017 11:47 PM
Discussion of: “Not every trauma patient with a radiographic head injury requires transfer for neurosurgical evaluation: Application of the brain injury guidelines to patients transferred to a level 1 trauma center”
Publication date: December 2017
Source:The American Journal of Surgery, Volume 214, Issue 6

Author(s): Gweniviere Kayla Capron, Mary Beth Voights, Henry R. Moore, Derek B. Wall








18/11/2017 11:47 PM
Re: Clinical Effectiveness and Cost-Effectiveness of Surgical Options for the Management of Anterior and/or Posterior Vaginal Wall Prolapse: Two Randomised Controlled Trials within a Comprehensive Cohort Study—Results from the PROSPECT Study
Publication date: December 2017
Source:The Journal of Urology, Volume 198, Issue 6

Author(s): Alan J. Wein








18/11/2017 11:47 PM
Re: Pelvic Floor Muscle Training for Secondary Prevention of Pelvic Organ Prolapse (PREVPROL): A Multicentre Randomised Controlled Trial
Publication date: December 2017
Source:The Journal of Urology, Volume 198, Issue 6

Author(s): Alan J. Wein








18/11/2017 11:47 PM
Robotic versus Open Level I-II Inferior Vena Cava Thrombectomy: A Matched Group Comparative Analysis
Publication date: December 2017
Source:The Journal of Urology, Volume 198, Issue 6

Author(s): Liangyou Gu, Xin Ma, Yu Gao, Hongzhao Li, Xintao Li, Luyao Chen, Baojun Wang, Yongpeng Xie, Yang Fan, Xu Zhang

Purpose We compared treatment outcomes of robotic vs open inferior vena cava thrombectomy for renal tumors with level I-II inferior vena cava tumor thrombus. Materials and Methods We retrospectively reviewed the medical records of patients who underwent robotic or open inferior vena cava thrombectomy between 2006 and 2016. To reduce the inherent biases of a nonrandomized study the robotic and open groups were matched 1:1 based on key variables. Perioperative data and oncologic outcomes were reviewed. Progression-free and overall survival was analyzed using Kaplan-Meier survival curves and compared between groups using the log rank test. Results A total of 31 and 37 patients underwent robotic and open inferior vena cava thrombectomy, respectively. After matching there were no significant differences in baseline characteristics between the groups. Of the matched cohorts the robotic cohort had significantly shorter median operative time (150 vs 230 minutes, p <0.001), lower median estimated blood loss (250 vs 1,000 ml, p <0.001), a lower rate of blood transfusion (6.5% vs 54.8%, p <0.001), a lower median transfusion requirement (420 vs 790 ml, p = 0.012) and a shorter median postoperative hospital stay (5 vs 9 days, p <0.001). The postoperative complication rate was lower in the robotic group than in the open group (9.7% vs 29.0%, p = 0.070). However, there were no significant differences in oncologic outcomes between the groups. Conclusions Robotic inferior vena cava thrombectomy can achieve more favorable perioperative results and similar oncologic outcomes compared with open inferior vena cava thrombectomy. Prospective studies with a larger sample size and longer followup are needed to validate our findings.






18/11/2017 11:47 PM
Ureterocalicostomy for Reconstruction of Complicated Ureteropelvic Junction Obstruction in Adults: Long-Term Outcome and Factors Predicting Failure in a Contemporary Cohort
Publication date: December 2017
Source:The Journal of Urology, Volume 198, Issue 6

Author(s): Devarshi Srivastava, Sanjoy K. Sureka, Priyank Yadav, Ankur Bansal, Shashikant Gupta, Rakesh Kapoor, M.S. Ansari, Aneesh Srivastava

Purpose Ureterocalicostomy is a well established treatment option in patients who have recurrent ureteropelvic junction obstruction with postoperative fibrosis and a relatively inaccessible renal pelvis. We evaluated the long-term outcome of ureterocalicostomy and factors predicting its failure. Materials and Methods We retrospectively analyzed data on 72 patients who underwent open or laparoscopic ureterocalicostomy from 2000 to 2014. Variables that may affect the outcomes of ureterocalicostomy were assessed with regard to primary pathology findings, patient age, serum creatinine, preoperative renal size (less than and greater than 15 cm), renal cortical thickness (less than and greater than 5 mm), hydronephrosis grade and preoperative renal function (glomerular filtration rate less than and greater than 20 ml/minute/1.73 m2). The surgery outcome was calculated in terms of success or failure. Factors predicting failure were evaluated by univariate and multivariate analysis. Failure was defined as an additional procedure required postoperatively due to persistent symptoms and/or followup renal scan showing persistent significant obstruction with deterioration of renal function on at least 2 occasions 3 months apart. Patients with less than 2-year followup were excluded from study. Results We analyzed data on 72 patients who underwent ureterocalicostomy during this period. Mean ± SD age of the study group was 28.9 ± 12.3 years and mean baseline serum creatinine was 1.1 ± 0.3 mg/dl. The mean glomerular filtration rate was 27.8 ± 11.6 ml/minute/1.73 m2 and mean cortical thickness of the operated kidney was 7 ± 3.86 mm. Common indications for ureterocalicostomy were failed previous pyeloplasty and/or endopyelotomy in 35 patients (48.6%) and secondary ureteropelvic junction obstruction after pyelolithotomy or percutaneous nephrolithotomy in 24 (33.3%). The most common complication was urinary tract infection, which was seen in 22 patients (30.6%). At a mean followup of 60.3 ± 13.6 months 50 patients (69.5%) had a successful outcome. Treatment failed in 22 patients (30.5%), including 6 who required nephrectomy, while 13 were treated with frequent changes of Double-J® stents or with balloon dilation. In 3 patients ureterocalicostomy was repeated. The rate of failed ureterocalicostomy was higher in patients with a low preoperative glomerular filtration rate (less than 20 ml/minute/1.73 m2), attenuated cortical thickness (less than 5 mm) and higher creatinine (greater than 1.7 mg/dl) on univariate analysis. However, on multivariate analysis poor cortical thickness and a low glomerular filtration rate were independent predictors of failure. Conclusions Ureterocalicostomy is an acceptable salvage option with a satisfactory long-term outcome. Patients with a low preoperative glomerular filtration rate (less than 20 ml/minute/1.73 m2) and a thinned out cortex (less than 5 mm) showed a poor outcome after ureterocalicostomy.






18/11/2017 11:47 PM
Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research
Publication date: December 2017
Source:The Lancet Neurology, Volume 16, Issue 12

Author(s): Andrew I R Maas, David K Menon, P David Adelson, Nada Andelic, Michael J Bell, Antonio Belli, Peter Bragge, Alexandra Brazinova, András Büki, Randall M Chesnut, Giuseppe Citerio, Mark Coburn, D Jamie Cooper, A Tamara Crowder, Endre Czeiter, Marek Czosnyka, Ramon Diaz-Arrastia, Jens P Dreier, Ann-Christine Duhaime, Ari Ercole, Thomas A van Essen, Valery L Feigin, Guoyi Gao, Joseph Giacino, Laura E Gonzalez-Lara, Russell L Gruen, Deepak Gupta, Jed A Hartings, Sean Hill, Ji-yao Jiang, Naomi Ketharanathan, Erwin J O Kompanje, Linda Lanyon, Steven Laureys, Fiona Lecky, Harvey Levin, Hester F Lingsma, Marc Maegele, Marek Majdan, Geoffrey Manley, Jill Marsteller, Luciana Mascia, Charles McFadyen, Stefania Mondello, Virginia Newcombe, Aarno Palotie, Paul M Parizel, Wilco Peul, James Piercy, Suzanne Polinder, Louis Puybasset, Todd E Rasmussen, Rolf Rossaint, Peter Smielewski, Jeannette Söderberg, Simon J Stanworth, Murray B Stein, Nicole von Steinbüchel, William Stewart, Ewout W Steyerberg, Nino Stocchetti, Anneliese Synnot, Braden Te Ao, Olli Tenovuo, Alice Theadom, Dick Tibboel, Walter Videtta, Kevin K W Wang, W Huw Williams, Lindsay Wilson, Kristine Yaffe








18/11/2017 11:47 PM
Severe Cerebral Complications Secondary to Perforation Injury of the Anterior Skull Base During Sinonasal Surgery: An Underappreciated Problem?
Publication date: December 2017
Source:World Neurosurgery, Volume 108

Author(s): Shadi Al-Afif, Elvis J. Hermann, Gökce Hatipoglu Majernik, Makoto Nakamura, Peter Raab, Thomas Lenarz, Joachim K. Krauss

Objective Functional endonasal sinus surgery (FESS) is widely practiced and is considered a generally safe procedure. Skull base injuries occur in <1% of procedures and are typically associated with cerebrospinal fluid leaks. Rarely, skull base injuries might result in cerebral lesions. Here we present a series of 4 patients with iatrogenic perforating injuries of the anterior skull base and cerebral lesions after routine FESS. Methods Four patients with iatrogenic perforating cerebral lesions after routine FESS, performed at other institutions, were referred to a tertiary neurosurgery department. Within a 10-year period these procedures were performed in 3 patients as endoscopic FESS and as a microscopic FESS in 1 patient. Results There were 3 men and 1 woman. Mean age at the time of surgery was 50 years. In 3 instances (in which an endoscope was used), the ear, nose, and throat physician had noted perforation of the skull base during surgery, but it went unnoticed in 1 patient operated with the microscope. Frontal lobe hematoma occurred in all patients, and in 3 of them cerebral infarction developed secondary to injury of branches of the anterior cerebral artery. Three patients developed acute hydrocephalus. Two had rapid global brain swelling and they succumbed within days. The other 2 patients survived without apparent neurological deficits. Conclusions Cerebral lesions during FESS still occur in contemporary surgery and they are possibly underreported. Even with prompt conservative and surgical measures, these lesions may result in catastrophic outcome. Associated vascular injuries have a worse prognosis. The only risk factor associated with lethal outcome in our series was younger age.






18/11/2017 11:47 PM
Risk of type 2 diabetes mellitus associated with plasma lipid levels: The Rural Chinese Cohort Study
Publication date: Available online 15 November 2017
Source:Diabetes Research and Clinical Practice

Author(s): Ming Zhang, Junmei Zhou, Yu Liu, Xizhuo Sun, Xinping Luo, Chengyi Han, Lu Zhang, Bingyuan Wang, Yongcheng Ren, Yang Zhao, Dongdong Zhang, Xuejiao Liu, Dongsheng Hu

Aim To investigate the association of type 2 diabetes mellitus (T2DM) risk and plasma lipid levels in rural Chinese. Methods Each lipid variable was divided into quartiles and dichotomized by clinical cutoff points. Cox proportional-hazards model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of T2DM risk and plasma lipid levels and explore the interaction between plasma lipid levels and other risk factors. Results 11,929 participants were included in the analysis. We documented 720 incident cases of T2DM over 70,720.84 person-years of follow-up, for an incidence of 10.18/1,000 person-years. In the multivariable-adjusted model, risk of T2DM was increased with the highest versus lowest quartiles of total cholesterol (TC) and triglycerides (TG) levels and TC/high-density lipoprotein-cholesterol (HDL-C) and TG/HDL-C ratios. The HRs (95% CIs) for the fourth quartiles, for example, were 1.34 (1.03-1.74), 2.32 (1.73-3.13), 1.66 (1.23-2.25), and 1.84 (1.38-2.45), respectively. In addition, risk of T2DM was increased with high TG level and TC/HDL-C and TG/HDL-C ratios by clinical cutoffs. The HRs (95% CIs) were 1.50 (1.25-1.80), 1.24 (1.03-1.48), and 1.44 (1.18-1.75), respectively. Risk of T2DM was associated with interactions between all lipid variables and age and BMI. TG level and TG/HDL-C ratio additionally interacted with gender (all Pinteraction <0.0001). Conclusions Risk of T2DM was increased with elevated serum levels of TC and TG and TC/HDL-C and TG/HDL-C ratios and also with interactions between high TC and TG levels and TC/HDL-C and TG/HDL-C ratios and age and BMI in a rural Chinese population.






18/11/2017 11:47 PM
International Humanitarian Law: the legal framework for humanitarian forensic action
Publication date: Available online 15 November 2017
Source:Forensic Science International

Author(s): Gloria Gaggioli

In armed conflicts, death is not an exceptional occurrence, but becomes the rule and occurs on a daily basis. Dead bodies are sometimes despoiled, mutilated, abandoned without any funeral rite and without a decent burial. Unidentified remains may be counted by hundreds or thousands. As a result, families look for years for missing relatives, ignorant of the fate of their loved ones. International humanitarian law, also called the laws of war or the law of armed conflict, is an international law branch, which has been developed to regulate and, as far as possible, to humanize armed conflicts. It contains a number of clear and concrete obligations incumbent to belligerent parties on the management of dead bodies, which provide the legal framework for humanitarian forensic action. The purpose of this article is to present, in a simple and concise manner, these rules with a view to extrapolate some key legal principles, such as the obligation to respect the dignity of the dead or the right to know the fate of relatives, which shall guide anyone dealing with human remains.






18/11/2017 11:47 PM
Predictive accuracy of medical transport information for in-hospital mortality
Publication date: Available online 15 November 2017
Source:Journal of Critical Care

Author(s): Andrew P. Reimer, Jarrod E. Dalton