Publication date: Available online 13 January 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Tom E. Nightingale, Richard S. Metcalfe, Niels BJ. Vollaard, James L.J. Bilzon
Spinal cord injury (SCI) is a life changing event that, as a result of paralysis, negatively influences habitual levels of physical activity and hence cardiometabolic health. Performing regular structured exercise therefore appears extremely important in persons with SCI. However, exercise options are mainly limited to the upper-body, which involves a smaller activated muscle mass compared to the mainly leg-based activities commonly performed by non-disabled individuals. Current exercise guidelines for SCI focus predominantly on relative short durations of moderate-intensity aerobic arm cranking exercise, yet contemporary evidence suggests this is not sufficient to induce meaningful improvements in risk factors for the prevention of cardiometabolic disease in this population. As such, these guidelines and their physiological basis, require reappraisal. In this special communication, we propose that high-intensity interval training (HIIT) may be a viable alternative exercise strategy, to promote vigorous-intensity exercise and prevent cardiometabolic disease in persons with SCI. Supplementing the limited data from SCI cohorts with consistent findings from studies in non-disabled populations, we present strong evidence to suggest that HIIT is superior to moderate-intensity aerobic exercise for improving cardiorespiratory fitness, insulin sensitivity and vascular function. The potential application and safety of HIIT in this population is also discussed. We conclude that increasing exercise intensity could offer a simple, readily available, time-efficient solution to improve cardiometabolic health in persons with SCI. We call for high-quality randomised controlled trials to examine the efficacy and safety of HIIT in this population.
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Πέμπτη 12 Ιανουαρίου 2017
Exercise guidelines to promote cardiometabolic health in spinal cord injured humans: time to raise the intensity?
Comparison between dexmedetomidine and verapamil as an adjuvant to local anesthesia in intravenous regional anesthesia in upper limb orthopedic surgery: a randomized double-blind prospective study
Ain-Shams Journal of Anaesthesiology 2016 9(4):576-583
Background The use of intravenous regional anesthesia has increased significantly in recent years. Adjuvants are frequently added to local anesthetics to prolong analgesia following peripheral nerve blockade. Objective This randomized double-blind prospective study was designed to compare the effectiveness of adding dexmedetomidine (α2 adrenoceptor agonist) or verapamil (calcium channel antagonist) as an adjunct to lidocaine in upper limb orthopedic surgery. Patients and methods Sixty adult patients scheduled for elective upper limb orthopedic surgery were divided into three groups: the lidocaine group, in which patients received 3 mg/kg of lidocaine 2% diluted with saline to a total volume of 40 ml; the lidocaine dexmedetomidine group, in which patients received 0.5 µg/kg of dexmedetomidine plus 3 mg/kg of lidocaine 2%; and the lidocaine verapamil group, in which patients received 2.5 mg of verapamil plus 3 mg/kg of lidocaine 2%. The onset and duration of sensory and motor block were recorded. Postoperative Visual Analog Score, onset of tourniquet pain, duration of analgesia, and total analgesic requirements at the 12th postoperative hour were monitored. Results Adding dexmedetomidine or verapamil to lidocaine causes faster onset and prolonged recovery of sensory and motor block and improvement of postoperative analgesia, without causing side effects compared with lidocaine alone. Conclusion The use of either verapamil or dexmedetomidine as an adjuvant to lidocaine solution causes equal improvement of the quality of anesthesia in intravenous regional anesthesia of upper limb orthopedic surgeries.
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Addition of dexamethasone–chlorpheniramine mixture reduces the incidence of vomiting associated with oral ketamine premedication after pediatric dental procedures
Ain-Shams Journal of Anaesthesiology 2016 9(4):478-484
Background Oral ketamine has been shown to induce safe and effective sedation in children, but with a high incidence of postoperative vomiting. Vendexine (dexamethasone–chlorpheniramine mixture) is a commercially available syrup used primarily to treat allergic conditions. Each of its components has antiemetic effects. In the present study, we aimed to determine whether the addition of vendexine to oral ketamine premedication affects the incidence of postoperative vomiting. Patients and methods Sixty-four children scheduled for elective dental procedures under general anesthesia were enrolled in this prospective, randomized, double-blind study. They received an oral premedication mixture (total volume of 0.42 ml/kg) of either ketamine 6 mg/kg (0.12 ml/kg) mixed with dextrose 50% and apple juice (the K group), or ketamine 6 mg/kg (0.12 ml/kg) mixed with dextrose 50% and vendexine syrup (0.25 ml/kg) (the VK group). Sedation onset was noted. Scores for drug acceptance, sedation, emotional status, and behavior during parents' separation, on venipuncture, and face mask application were rated. Incidence of postoperative vomiting, emergence agitation score, fentanyl consumption, and recovery time were also recorded. Results The two groups were comparable as regards sedation onset, scores for drug acceptance, sedation, emotional status, and behavior during parents' separation, on venipuncture, and face mask application. However, a significant reduction of postoperative vomiting in the VK group was noticed compared with the K group (9.3 vs. 37.5%). In addition, emergence agitation and fentanyl consumption were significantly reduced in the VK group. Conclusion Vendexine added to oral ketamine reduces the incidence of postoperative vomiting associated with ketamine premedication in children.
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Severe pre-eclampsia masquerading as peripartum cardiomyopathy in an emergency cesarean section: a challenge to the perioperative physician
Ain-Shams Journal of Anaesthesiology 2016 9(4):623-625
Peripartum cardiomyopathy (PPCM) is a rare and unusual form of cardiac failure of unknown etiology that is observed in late pregnancy or early postpartum. Although the complete pathogenesis of PPCM is not completely understood, the signs and symptoms are similar to those of left-ventricular heart failure. PPCM is diagnosed in a parturient woman only after other causes of cardiac failure have been ruled out. Its management is similar to that of congestive heart failure. This report describes the role of an anesthesiologist in the postoperative management of a parturient woman who was admitted with severe preeclampsia and developed pulmonary edema and heart failure in the postoperative period necessitating management in the ICU. Subsequently, PPCM was diagnosed and managed successfully. The diagnosis of PPCM is challenging and requires a high index of suspicion by the perioperative physician. Routine medical management in the form of digoxin, diuretics, vasodilators, β-blockers, and anticoagulants should be the first step but may also require vasoactive drugs and circulatory support. Future pregnancies are generally avoided in such patients.
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Dexmedetomidine infusion versus fentanyl for analgesia and prevention of emergence agitation and delirium in children undergoing adenotonsillectomy
Ain-Shams Journal of Anaesthesiology 2016 9(4):485-492
Background This randomized controlled study aimed to evaluate whether an intraoperative infusion of dexmedetomidine would be a safe and effective substitute to fentanyl intraoperatively, and whether it would be effective in reducing the incidence and severity of emergence agitation and delirium in children undergoing adenotonsillectomy. Patients and methods This study was conducted on 70 pediatric patients, aged 3–7 years, of both sexes, of ASA I and II, who were scheduled for elective adenotonsillectomy. The patients were randomly assigned to two groups: group D (dexmedetomidine infusion group; 35 patients) received intravenous dexmedetomidine (2 μg/kg) over 10 min, followed by 0.7 μg/kg/h until 5 min before the end of the surgery, and group F (intravenous fentanyl group; 35 patients) received intravenous fentanyl 1 μg/kg as a bolus. No premedication was given to any of the patients. The number of patients in each group who needed intraoperative fentanyl, the fentanyl dose, time of administration of fentanyl, duration of surgery and anesthesia, and the time to awakening were recorded. Pain was evaluated using the objective pain scale score in the postanesthesia care unit (PACU), which was managed with rescue intravenous pethidine. Emergence agitation was evaluated in the PACU using two scales: the Pediatric Anesthesia Emergence Delirium scale and the five-point agitation scale described by Cole. Results The time to awakening in group D was significantly shorter compared with that in group F (P<0.05). Group D showed a statistically significantly lower maximum objective pain scale score, lower Pediatric Anesthesia Emergence Delirium score, and lower emergence agitation score compared with group F at arrival at the PACU. There was no statistically significant difference between the two groups as regards preoperative heart rate, but there was significantly lower heart rate in group D than in group F after induction (P<0.05). No side effects were observed during the first 24 h postoperatively in the two groups. Conclusion Dexmedetomidine is a safe and effective analgesic substitute to fentanyl intraoperatively and reduces analgesic requirements postoperatively. It is also effective in reducing the incidence and severity of emergence agitation and delirium in children undergoing adenotonsillectomy.
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Monitored anesthesia care with propofol or dexmedetomidine for patients undergoing upper limb surgeries under brachial plexus blockade: a comparative study
Ain-Shams Journal of Anaesthesiology 2016 9(4):563-568
Background Brachial plexus block is widely used for upper limb surgeries but intraoperatively patients remain aware. The present study aimed to compare the sedative efficacy and safety of propofol infusion versus dexmedetomidine infusion for monitored anesthesia care during upper limb surgeries under ultrasound (US)-guided brachial plexus blockade. Patients and methods Sixty adult consented patients of American Society of Anesthesiologists physical status I–III of both sexes were given 20 ml of 0.75% ropivacaine (150 mg) for brachial plexus blockade under US guidance. The patients were randomized into two groups of 30 patients each, to receive either propofol infusion [group I (P)] or dexmedetomidine infusion [group II (D)] during the intraoperative period. The primary goals were to achieve a sedation score of 2–3 on the Ramsay sedation scale and to compare the duration of postoperative analgesia assessed using the visual analog scale. The hemodynamic stability, respiratory depression, or any complication due to technique or medications was also recorded as secondary outcomes. Results US guidance helped visualization of the nerves, the needle, and the spread of local anesthetic at the brachial plexus block site. Desired sedation score of 2–3 was effectively achieved with intraoperative infusions of dexmedetomidine and propofol. Hypotension occurred in 11 patients of the propofol group, whereas no episode of hypotension was noted in the dexmedetomidine group. Bradycardia was evident in five patients of the dexmedetomidine group. The duration of postoperative analgesia with dexmedetomidine infusion was significantly prolonged when compared with propofol infusion as assessed using visual analog scale. Respiratory depression did not occur in any patient. No adverse events inherent to sedative medication or technique were observed in any patient. Conclusion The clinical efficacy and safety of dexmedetomidine was better than propofol due to prolonged postoperative analgesia and intraoperative hemodynamic stability without respiratory depression.
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Preoperative external nasal compression: does it decrease emergence agitation after nasal surgery?
Ain-Shams Journal of Anaesthesiology 2016 9(4):593-597
Background Emergence agitation after nasal surgeries in adults is common. Acute postoperative nasal obstruction with nasal packing is an important factor in developing agitation after nasal surgeries. Aim The aim of this study was to evaluate the effectiveness of preoperative nasal obstruction by means of external nasal compression on the incidence of emergence agitation after nasal surgeries. Methods Sixty patients of American Society of Anesthesiologists I or II between 20 and 45 years of age who were scheduled for nasal surgery were randomly assigned into three equal groups: the control (C) group, the T10 group, in which nasal compression was carried out for 10 min, and the T30 group, in which nasal compression was carried out for 30 min preoperatively. All patients received the same anesthetic technique. The incidence of agitation, and recovery characteristics were evaluated during emergence. Patient satisfaction was evaluated 24 h after surgery. Results There was a significantly lower incidence of emergence agitation and fentanyl consumption during the emergence period in the T30 group. Moreover, patient satisfaction with recovery was significantly higher in the T30 group. Conclusion Elective preoperative external nasal obstruction may decrease the incidence of emergence agitation and improve patient satisfaction with recovery after nasal surgery.
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Control of autonomic dysreflexia in patients with high level of chronic spinal cord injury during cystoscopy
Ain-Shams Journal of Anaesthesiology 2016 9(4):606-611
Background Autonomic dysreflexia (AD) is a clinical emergency that frequently occurs in patients with spinal cord injury (SCI) during cystoscopy. It should be treated by removing the stimulus and by medications. We aimed in this study to evaluate the effect of adding magnesium sulfate to dexmedetomidine infusion to control AD in high-level chronic SCI patients during cystoscopy. Patients and methods Forty patients with chronic SCI at the level of T6 or above scheduled for cystoscopy were randomly divided into two groups: the dex group, in which the patients received dexmedetomidine infusion 1 µg/kg for 10 min, followed by 0.5 µg/kg/min; and the Mg group, in which patients received a single i.v. dose of magnesium sulfate 50 mg/kg in addition to the same infusion of dexmedetomidine. Blood pressure (BP) and heart rate (HR) were recorded for each patient, and serum magnesium, epinephrine, and norepinephrine levels were estimated preoperatively, intraoperatively, and postoperatively. Results Results showed a significant elevation in intraoperative BP in the Dex group 10 min after cystoscopy and persisted for 20 min compared with the presedation level in the same group and with the same readings in the Mg group. HR dropped down in the Dex group 15 min after cystoscopy and persisted for 15 min compared with the presedation reading in the same group and with the same readings in the Mg group. Serum magnesium was significantly higher intraoperatively and postoperatively in the Mg group, whereas serum epinephrine and serum norepinephrine were significantly higher intraoperatively and postoperatively in the Dex group compared with the presedation level in the same group and with the same readings in the Mg group. Seven patients (35%) in the Dex group experienced a dysreflexic episode [increase in systolic blood pressure (SBP) 30 mmHg or more compared with the presedation reading]; two of them showed elevation of SBP more than 160 mmHg and needed to be treated. On the other hand, only one patient in the Mg group (5%) experienced a dysreflexic episode (SBP 135 mmHg) with no need for medication. Conclusion Addition of a single i.v. dose of magnesium sulfate to dexmedetomidine infusion provides a better control of BP and HR, and reduces the incidence of AD during cystoscopy in patients with high level of chronic SCI.
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Comparison of caudal epidural clonidine with fentanyl as an adjuvant to ropivacaine 0.25% for postoperative analgesia in children undergoing various infraumbilical surgeries: A prospective randomized study
Ain-Shams Journal of Anaesthesiology 2016 9(4):493-500
Background Caudal epidural block is commonly used as a safe, reliable, easy-to-administer technique for abdominal and lower limb surgeries in pediatric patients and allows rapid recovery from anesthesia with effective postoperative analgesia. The aim of our study was to compare the efficacy of clonidine versus fentanyl when used as an additive to ropivacaine during single-shot caudal epidural analgesia in pediatric patients for postoperative pain relief. Patients and methods This randomized prospective double-blind study was conducted on 60 children of American Society of Anesthesiologists grades I and II aged 1–7 years scheduled for various infraumbilical surgical procedures who were randomly allocated into two groups to receive either ropivacaine (0.25%, 1 ml/kg) and clonidine (2 μg/kg) (group RC) or ropivacaine (0.25%, 1 ml/kg) and fentanyl (1 μg/kg) (group RF). Caudal epidural block was performed after induction of general anesthesia. Postoperatively, patients were observed for duration of analgesia, sedation score, recovery time, hemodynamics, and side effects or complications. Results Both groups were similar with respect to patient's demographic profile, baseline hemodynamic parameters, and duration of surgery. The analgesic properties and hemodynamics were also comparable in both groups (P>0.05). The mean recovery time and sedation score were significantly lower in group RC as compared with group RF (P<0.05). Side effects such as nausea, vomiting, and respiratory depression were seen only in group RF. Conclusion From our study we concluded that both clonidine (2 μg/kg) and fentanyl (1 μg/kg) can be used as an adjuvant to single-shot caudal epidural anesthesia using 0.25% ropivacaine for effective postoperative analgesia in children. Because of its more favorable side-effect profile, with less respiratory depression, nausea, vomiting, and more patient comfort, clonidine is a better choice for use as an adjuvant to caudal epidural anesthesia in children.
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Patient-controlled analgesia versus patient-controlled analgesia by proxy for the management of postoperative pain in major pediatric cancer surgery
Ain-Shams Journal of Anaesthesiology 2016 9(4):501-507
Background Children suffer postoperative pain in the same way as adults. Pediatric pain management is a challenge. Patient-controlled analgesia (PCA) is a flexible, reliable, and individualized method in postoperative pain therapy. However, young children are not able to use PCA themselves, and hence they need to receive PCA by proxy (parent or nurse). The guidelines for PCA by proxy in pediatrics are still insufficient. Aim The aim of this study was to determine the safety and efficacy of PCA by proxy after major pediatric cancer surgery. Patients and methods We studied 330 pediatric cancer patients between 1 and 10 years of age scheduled for major surgery. They were divided into three equal groups: group C (child PCA), group P (parent proxy), and group N (nurse proxy). In each group we measured vital signs, pain intensity, total morphine consumption, side effects, and specific PCA monitoring for the first 72 h postoperatively. Results We found that pain scores were higher in the nurse group compared with the other two groups on days 2 and 3 (P < 0.001); morphine consumption was higher in the child group (older age). Vital signs were comparable between groups. There were no significant differences in sedation scale, and there were limited complications with no difference between groups. Conclusion Parent-controlled PCA is a safe and effective method of analgesia for children between 1 and 6 years of age. Nurse-controlled proxy is safe but not effective in controlling child pain. Child-controlled analgesia is safe and effective in children above 6 years of age.
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Lidocaine versus dexmedetomidine infusion in diagnostic laparoscopic gynecologic surgery: a comparative study
Ain-Shams Journal of Anaesthesiology 2016 9(4):508-516
Background The aim of this study was to assess the effectiveness of intraoperative lidocaine versus dexmedetomidine infusion on hemodynamic stability during pneumoperitoneum, as well as the recovery profile of diagnostic laparoscopic gynecologic surgeries. Patients and methods A total of 60 female patients of American Society of Anesthesiologist (ASA) physical status I were included in the study and divided into two groups: group L and group D. Group L received lidocaine hydrochloride 2%, and group D received dexmedetomidine hydrochloride. The hemodynamic changes during pneumoperitoneum as well as the recovery profile (postoperative sedation, pain scores, and analgesic requirements) were recorded. Results During pneumoperitoneum, group D patients showed a statistically significant decrease in mean heart rate compared with group L patients. However, the mean systolic blood pressure, diastolic blood pressure, and mean blood pressure in group L patients showed statistically and clinically nonsignificant changes compared with those of group D patients. As regards the recovery profile, group D patients recorded a significantly higher median sedation score compared with group L patients, and the postoperative pain scores were significantly better in group L than in group D patients after 30 min, 1 h from arrival at the postanesthesia care unit, and at 2 h in the ward. However, this resulted in a statistically nonsignificant number of patients requiring pethidine in the postanesthesia care unit, as well as statistically nonsignificant total pethidine requirements of less than 50 mg. Conclusion Lidocaine offers hemodynamic stability during pneumoperitoneum, as well as a decrease in the intensity of postoperative pain with opioid sparing, offering a less sedated patient than dexmedetomidine during day-case diagnostic laparoscopic gynecologic surgery.
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A case report of asystole after a test dose of ceftriaxone in an adult man
Ain-Shams Journal of Anaesthesiology 2016 9(4):617-619
Ceftriaxone is a commonly used antibiotic for various infections such as respiratory tract infection, urinary tract infection, and enteric fever, as well as in surgical prophylaxis. Hypersensitivity reactions after ceftriaxone therapy are uncommon but are potentially life-threatening, and they may lead to cardiac arrest. Here we report a 44-year-old man who presented with bradycardia, bronchospasm, hypotension, and cardiac arrest (asystole) after a single injected dose of ceftriaxone introduced for surgical prophylaxis. Epinephrine was given intravenously, and cardiopulmonary resuscitation was performed successfully. The patient regained his conscious level 2 h later and became hemodynamically stable within 4 h; next, he was extubated and closely observed for 24 h and then discharged. Physicians should be aware of the risk of anaphylaxis and asystole that may occur after the first dose of ceftriaxone and be ready for managing it properly.
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Dexmedetomidine versus granisetron for the management of postspinal shivering
Ain-Shams Journal of Anaesthesiology 2016 9(4):517-523
Background Shivering is one of the most stressful complications for patients and surgeons during spinal anesthesia. In this prospective, randomized, double-blinded study, we compared the efficacy of dexmedetomidine versus granisetron for control of postspinal shivering. Methods This study was conducted on 120 patients, ASA I–III, of either sex, aged 18–60 years, who were scheduled for elective lower limb and lower abdominal surgeries under spinal anesthesia. The response rate, time taken to control shivering, recurrence rate, and adverse effects were recorded. Results Incidence of shivering in 1127 patients was 52.7% (594 patients): we studied 120 patients; 28 patients (2.5%) developed grade 4 and 92 patients (8.2%) developed grade 3 shivering. There were no statistically significant differences regarding the time for onset of shivering, severity, response rate, need for a second dose, or pethidine between the two groups. However, time to control shivering was shorter in the dexmedetomidine group, with a higher recurrence rate. Incidences of hypotension, bradycardia, and sedation were higher in the dexmedetomidine group. However, there was no incidence of severe bradycardia or respiratory depression in our study. Conclusion Both dexmedetomidine and granisetron effectively reduce postspinal shivering without any major adverse effects. However, dexmedetomidine has rapid onset and short duration, whereas granisetron has less hemodynamic alterations.
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Perioperative nutrition to enhance recovery after surgery
Ain-Shams Journal of Anaesthesiology 2016 9(4):469-477
Preoperative malnutrition is a major risk factor for increased postoperative morbidity and mortality. Patients at risk for malnutrition should be identified early. The Nutritional Risk Score is a validated tool to identify patients who should benefit from nutritional support. The adoption of total parenteral nutrition followed by the extraordinary progress in parenteral and enteral feedings, in addition to the increased knowledge of cellular biology and biochemistry, has allowed clinicians to treat malnutrition and improve surgical patient's outcomes. Periods of prolonged fasting should be minimized and nutrition should be commenced as early as possible after surgery, preferably through the enteral route. The surgical patient with established malnutrition should begin aggressive nutrition at least 7–10 days before surgery. Those patients in whom eating is not anticipated beyond the first 5 days following surgery should receive the benefits of early enteral or parenteral feeding depending on whether the gut can be used. Many patients may benefit from newer enteral formulations, such as those designed to enhance immune function (immunonutrition).
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Intravenous low-dose ketamine injection versus dexmedetomidine infusion for prevention of intraoperative shivering during spinal anesthesia
Ain-Shams Journal of Anaesthesiology 2016 9(4):524-530
Background Shivering is considered one of the most common adverse effects that occur during spinal anesthesia. Besides causing patient discomfort, shivering also interferes with patient monitoring and increases tissue oxygen demand. The present study was carried out to compare the effectiveness of intravenous low-dose ketamine (0.25 mg/kg) and dexmedetomidine intravenous infusion in prevention of shivering during spinal anesthesia. Materials and methods Sixty patients of both sexes were included in this prospective randomized-controlled study. Patients were divided randomly into two groups of 30 patients each. Group K (30 patients) received low-dose ketamine (0.25 mg/kg) and group D (30 patients) received dexmedetomidine infusion. The primary outcome measure of this study was intraoperative shivering. The secondary outcome measures were hemodynamic changes, sedation scores, and postoperative side effects. Results Patients in group D had a lower incidence of postspinal anesthesia shivering compared with patients in group K. In all, 13.33% of group K patients had grade 3 shivering in comparison with only 3.33% of patients in group D 10 min after the onset of spinal anesthesia (P=0.031). Deeper sedation was observed in group D patients as 36.67% of group D patients had grade 4 sedation compared with 23.33% of patients in group K after 10 min (P=0.048). Conclusion Dexmedetomidine infusion is more effective as an antishivering and sedating agent than low-dose ketamine injection in patients receiving spinal anesthesia.
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Systemic versus perineural dexamethasone as an adjuvant to bupivacaine in combined femoral and sciatic nerve blocks in lower-limb vascular surgeries: a prospective randomized study
Ain-Shams Journal of Anaesthesiology 2016 9(4):569-575
Background and aim Various peripheral nerve block techniques have been described to deliver anesthesia and analgesia that allow better functional recovery and shortened hospital stay following major lower-limb surgeries. We aimed to compare the possible effect of perineural dexamethasone versus systemic dexamethasone after nerve stimulator-guided combined femoral and sciatic nerve blocks in lower-limb vascular surgeries. Patients and methods After obtaining approval from the ethical committee of Kasr Al-Ainy University Hospital and obtaining written informed consent, 63 patients aged 18–70 years were randomly allocated into three equal groups. Group P received perineural dexamethasone plus bupivacaine 0.5%, group I received intravenous dexamethasone plus perineural bupivacaine 0.5%, and group B received perineural bupivacaine 0.5% alone. We compared the onset and duration of sensory and motor blockade, duration of analgesia, and hemodynamic changes. Results Sensory and motor block onset showed nonsignificant difference between the three groups. Sensory block duration was significantly longer in group P than in groups I and B. Motor block duration was significantly prolonged in groups P and I when compared with group B. Motor block duration was longer in group P than in group I; however, the difference was statistically nonsignificant (p-value 0.34). The duration of analgesia was significantly longer in group P than in the other groups, and significantly longer in group I compared with group B. Conclusion The use of equal doses of perineural or intravenous dexamethasone as an adjuvant in single injection combined femoral and sciatic nerve blocks is associated with extended duration of sensory and motor blocks, extension of postoperative analgesia duration, and reduced postoperative analgesic requirements.
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Intraperitoneal bupivacaine plus fentanyl after laparoscopic pyeloplasty
Ain-Shams Journal of Anaesthesiology 2016 9(4):531-535
Objective Laparoscopic surgery has decreased the severity of postoperative pain. However, patients often experience abdominal and shoulder pain, requiring significant amounts of opioids and potentially prolonging their hospitalization. This study was conducted to assess the effectiveness of intraperitoneal bupivacaine plus fentanyl in reducing postoperative pain without incidence of postoperative complications in patients undergoing laparoscopic pyeloplasty. Patients and methods After hospital ethics committee approval and obtaining written informed consent, 50 consecutive patients undergoing unilateral laparoscopic pyeloplasty were enrolled in this prospective randomized trial. Patients were randomly divided into two groups using the sealed envelope technique: the BF group (25 patients) received induction with 30 ml of bupivacaine (0.25%) plus fentanyl (20 μg) intraperitoneally just before trocar removal, and the saline group (25 patients) received induction with saline (30 ml). Pain scores, time to first analgesic requirement, postoperative opioid requirements, and occurrence of adverse effects were all recorded. Results There was a significant reduction in 24 h of postoperative opioid utilization and visual analog scale scores in the BF group compared with the saline group at all time points. The time to first opioid consumption was significantly longer in the BF group compared with the saline group. The incidence of complications was not significantly different between the study groups. Systolic and diastolic blood pressures were significantly lower in the BF group compared with the saline group. Conclusion The administration of intraperitoneal bupivacaine plus fentanyl just before trocar removal appears to be a simple, effective, and low-cost method to reduce postoperative pain in adults undergoing laparoscopic pyeloplasty.
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A comparative study of propofol and isoflurane for the maintenance of anesthesia in spine surgery using the bispectral index monitor: a randomized control study
Ain-Shams Journal of Anaesthesiology 2016 9(4):584-592
Background Early awakening is required in spine surgery to perform neurological examination in the early postoperative period. Bispectral index (BIS) monitoring allows reduction in the total amount of anesthetic drugs and decreases the time for emergence and recovery. Thus, BIS monitor helps in reducing the incidence of awareness. Kinetics of propofol allows both induction and continuous intravenous maintenance of anesthesia with rapid recovery of consciousness that aids in performing neurological examination in the early postoperative period. This study was conducted to compare propofol and isoflurane in the maintenance of anesthesia during spine surgery using the BIS monitor. Patients and methods A total of 50 patients (American Society of Anesthesiologists grades I and II) scheduled for spine surgeries were divided into two groups (25 each). Group A received an infusion of propofol 5 mg/kg/h and group B received isoflurane 1% vol. for maintenance to keep the BIS value between 40 and 60. The groups were compared as regards pulse rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure, surgeons' satisfaction, time to recovery, extubation time, and side effects. Results Both groups were well matched for their demographic data and preoperative vital data. There was no significant difference in hemodynamic parameter between the two groups. The mean recovery time was significantly different (P<0.001) between groups, with earlier recovery in the propofol group (8.14±0.805 min) compared with the isoflurane group (9.06±0.766 min). Values for BIS were similar between the two groups during surgery (P>0.05). Incidence of postoperative nausea and vomiting was 35% lower in group A compared with group B. The quality of surgical field was acceptable in both groups but slightly better in the propofol group. No other major complications were noted in our study. Conclusion Propofol-based anesthesia provides early and better recovery with clear headedness for early neurological assessment for spine surgery.
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Postoperative analgesia for arthroscopic shoulder surgery: comparison between ultrasound-guided interscalene block and combined suprascapular and axillary nerve blocks
Ain-Shams Journal of Anaesthesiology 2016 9(4):536-541
Background Arthroscopic shoulder surgery is often associated with severe postoperative pain that is often significant enough to interfere with initial recovery and rehabilitation − the pain that can be difficult to manage without large-dose opioids. Opioids can cause nausea, vomiting, sedation, and/or failure to control pain. Supplementing general anesthesia with a regional nerve block might improve the quality of postoperative pain relief. The use of interscalene blockade (ISB) is gaining popularity, but it is associated with infrequent but potentially serious complications. Combined suprascapular nerve block and axillary nerve block (SSNB+ANB) can offer a safe alternative to ISB. Objective This study was designed to compare between ISB and SSNB+ANB in arthroscopic shoulder surgery as regards postoperative analgesia Patients and methods Sixty American Society of Anesthesiologist physical status I and II patients, aged between 18 and 40 years, scheduled for arthroscopic shoulder surgery were randomized to receive ISB or SSNB+ANB. After performing the blocks, general anesthesia was standardized in all groups. All the patients in the two groups were compared as regards postoperative pain assessed by the visual analog scale score at postanesthesia care unit, 4, 6, 12, and 24 h, occurrence of complications, and patient's satisfaction. Results In the postoperative period, there were no statistically significant differences between the two groups as regards visual analog scale and analgesic requirements. Complications such as Horner's syndrome, hoarseness of voice, major weakness of the upper arm, and dyspnea were recorded in the ISB group. Conclusion For certain procedures of shoulder arthroscopic surgery, SSNB+ANB is a safe and effective alternative to ISB as postoperative analgesia.
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The effects of adding lidocaine hydrochloride nasal spray (10%) to xylometazoline nasal drops (0.1%) in functional endoscopic sinus surgery: a comparative study
Ain-Shams Journal of Anaesthesiology 2016 9(4):598-605
Background The aim of this study was to assess the effectiveness of adding lidocaine hydrochloride nasal spray (10%) to xylometazoline nasal drops (0.1%) as an anesthetic approach in patients undergoing functional endoscopic sinus surgery. Patients and methods A total of 52 patients of American Society of Anesthesiologist physical status I were included in the study and divided into two groups: the first group (group X) received xylometazoline hydrochloride nasal drops (0.1%) and lidocaine hydrochloride nasal spray (10%), whereas the second group (group S) received xylometazoline hydrochloride nasal drops (0.1%) only. The total blood loss (TBL) during surgery, the hemodynamic changes up to 30 min following incision of the nasal mucous membrane (m.m.) and in the immediate postoperative period, the need to add propranolol and the dose of propranolol given, as well as the duration of surgery and the quality of the surgical field were recorded. Results TBL and the duration of surgery were statistically significantly lower in group X than in group S. On comparing the grades given by the surgeon for the surgical field assessment, we found the results to be statistically highly significant for each group in favor of a better surgical field in group X than in group S. As for the hemodynamic parameters, the systolic blood pressure, diastolic blood pressure, mean blood pressure, and heart rate in group S were higher than the values at baseline after induction of anesthesia, after incision of the nasal m.m., and during the 30 min after incision of the nasal m.m., and were also higher than those recorded in group X at the same time periods and this was statistically and clinically significant as propranolol was given to patients in group S after induction of anesthesia. Conclusion Better intraoperative hemodynamic control ensuring patient safety with decreased intraoperative TBL and duration of surgery, with better grades for the quality of the surgical field during functional endoscopic sinus surgery, can be achieved with the use of lidocaine hydrochloride nasal spray (10%) with xylometazoline nasal drops (0.1%).
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Ultrasound-guided caudal analgesia using fentanyl versus dexmedetomidine as an adjuvant for levobupivacaine in infraumbilical pediatric surgeries
Ain-Shams Journal of Anaesthesiology 2016 9(4):542-548
Introduction Single-shot caudal analgesia is a useful technique in controlling postoperative pain in infraumbilical pediatric surgeries, although of a limited duration. The aim of this study was to evaluate the analgesic efficacy and rate of success when incorporating dexmedetomidine or fentanyl to levobupivacaine in ultrasound (U/S)-guided caudal block for infraumbilical surgeries. Patients and methods This prospective, randomized, double-blinded study was conducted on 63 pediatric patients undergoing infraumbilical surgeries, allocated into three groups to receive inhalational anesthesia with an appropriately sized laryngeal mask airway, followed by U/S-guided caudal epidural block using either only 0.25% levobupivacaine (L), or incorporating it with 1 μg/kg fentanyl (LF) or 1 μg/kg dexmedetomidine (LD) in a total volume of 0.7 ml/kg. Pain assessment using Children's and Infants' Postoperative Pain Scale (CHIPPS) score, time to first analgesic, and total analgesia required in the three groups and Ramsay sedation score were recorded. Hemodynamics and any adverse effects were also documented. Results None of the patients required intraoperative additional analgesia. A statistically significantly lower postoperative CHIPPS values with prolonged analgesic duration and time to rescue analgesia was observed in the levobupivacaine–fentanyl and levobupivacaine–dexmedetomidine groups (275±20.62 and 304.75±25.2, respectively) as opposed to the levobupivacaine only group (203.1±18), with an evident reduction in the total paracetamol dose required postoperatively (P<0.001). Arousable sedation time was significantly prolonged in the levobupivacaine–fentanyl and levobupivacaine–dexmedetomidine groups. Apart from pruritus and urine retention in the levobupivacaine–fentanyl group, no adverse events were recorded in all groups. Conclusion Caudal levobupivacaine combined with dexmedetomidine 1 μg/kg in pediatric patients undergoing infraumbilical surgeries provides prolonged postoperative analgesia comparable to levobupivacaine–fentanyl and superior to levobupivacaine alone, with reduced postoperative analgesic requirements and extended arousable sedation time. The use of U/S raises the safety and ensures the success of caudal block.
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Single-chromosome Gains Commonly Function as Tumor Suppressors
Publication date: Available online 12 January 2017
Source:Cancer Cell
Author(s): Jason M. Sheltzer, Julie H. Ko, John M. Replogle, Nicole C. Habibe Burgos, Erica S. Chung, Colleen M. Meehl, Nicole M. Sayles, Verena Passerini, Zuzana Storchova, Angelika Amon
Aneuploidy is a hallmark of cancer, although its effects on tumorigenesis are unclear. Here, we investigated the relationship between aneuploidy and cancer development using cells engineered to harbor single extra chromosomes. We found that nearly all trisomic cell lines grew poorly in vitro and as xenografts, relative to genetically matched euploid cells. Moreover, the activation of several oncogenic pathways failed to alleviate the fitness defect induced by aneuploidy. However, following prolonged growth, trisomic cells acquired additional chromosomal alterations that were largely absent from their euploid counterparts and that correlated with improved fitness. Thus, while single-chromosome gains can suppress transformation, the genome-destabilizing effects of aneuploidy confer an evolutionary flexibility that may contribute to the aggressive growth of advanced malignancies with complex karyotypes.
Teaser
By analyzing genetically matched euploid and trisomic cells, Sheltzer et al. find that single-chromosome gains commonly suppress tumorigenicity, and the tumor-suppressive effects of aneuploidy cannot be fully overcome by introducing oncogenic mutations. Following prolonged growth, trisomic cells acquire additional karyotype changes with improved fitness.http://ift.tt/2imFkiU
MYC Drives Progression of Small Cell Lung Cancer to a Variant Neuroendocrine Subtype with Vulnerability to Aurora Kinase Inhibition
Publication date: Available online 12 January 2017
Source:Cancer Cell
Author(s): Gurkan Mollaoglu, Matthew R. Guthrie, Stefanie Böhm, Johannes Brägelmann, Ismail Can, Paul M. Ballieu, Annika Marx, Julie George, Christine Heinen, Milind D. Chalishazar, Haixia Cheng, Abbie S. Ireland, Kendall E. Denning, Anandaroop Mukhopadhyay, Jeffery M. Vahrenkamp, Kristofer C. Berrett, Timothy L. Mosbruger, Jun Wang, Jessica L. Kohan, Mohamed E. Salama, Benjamin L. Witt, Martin Peifer, Roman K. Thomas, Jason Gertz, Jane E. Johnson, Adi F. Gazdar, Robert J. Wechsler-Reya, Martin L. Sos, Trudy G. Oliver
Loss of the tumor suppressors RB1 and TP53 and MYC amplification are frequent oncogenic events in small cell lung cancer (SCLC). We show that Myc expression cooperates with Rb1 and Trp53 loss in the mouse lung to promote aggressive, highly metastatic tumors, that are initially sensitive to chemotherapy followed by relapse, similar to human SCLC. Importantly, MYC drives a neuroendocrine-low "variant" subset of SCLC with high NEUROD1 expression corresponding to transcriptional profiles of human SCLC. Targeted drug screening reveals that SCLC with high MYC expression is vulnerable to Aurora kinase inhibition, which, combined with chemotherapy, strongly suppresses tumor progression and increases survival. These data identify molecular features for patient stratification and uncover a potential targeted treatment approach for MYC-driven SCLC.
Graphical abstract
Teaser
Mollaoglu et al. generate a mouse model of small cell lung cancer (SCLC) with elevated Myc expression and loss of Rb1 and Trp53. MYC promotes a neuroendocrine-low variant subtype of SCLC, which is paralleled in patients. Mouse and human SCLC with high MYC levels display sensitivity to Aurora kinase inhibition.http://ift.tt/2iqO1Me
Dobutamine aggravates haemodynamic deterioration induced by pleural effusion: A randomised controlled porcine study.
http://ift.tt/2jKOw5M
Microfluidic approaches for isolation, detection, and characterization of extracellular vesicles: Current status and future directions
Source:Biosensors and Bioelectronics, Volume 91
Author(s): Shima Gholizadeh, Mohamed Shehata Draz, Maryam Zarghooni, Amir Sanati-Nezhad, Saeid Ghavami, Hadi Shafiee, Mohsen Akbari
Extracellular vesicles (EVs) are cell-derived vesicles present in body fluids that play an essential role in various cellular processes, such as intercellular communication, inflammation, cellular homeostasis, survival, transport, and regeneration. Their isolation and analysis from body fluids have a great clinical potential to provide information on a variety of disease states such as cancer, cardiovascular complications and inflammatory disorders. Despite increasing scientific and clinical interest in this field, there are still no standardized procedures available for the purification, detection, and characterization of EVs. Advances in microfluidics allow for chemical sampling with increasingly high spatial resolution and under precise manipulation down to single molecule level. In this review, our objective is to give a brief overview on the working principle and examples of the isolation and detection methods with the potential to be used for extracellular vesicles. This review will also highlight the integrated on-chip systems for isolation and characterization of EVs.
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Heparan sulfate storage in the cardiac conduction system triggers atrioventricular block
Source:Brain and Development
Author(s): Rie Kato, Hiroaki Miyahara, Tatsuya Kawano, Atsuko Matsuzuka, Kimiko Noda, Tatsuro Izumi
ObjectiveTo elucidate the novel biological functions of heparan sulfate (HS) by clinic-pathologically studying a patient with paroxysmal atrioventricular (AV) block.PatientA long-surviving male patient with Sanfilippo syndrome type A presented with paroxysmal AV block at age 33years. He then survived another 2.5years after the onset of paroxysmal AV block and pacemaker implantation.Methods and resultsHis cardiac histopathological examination at autopsy showed HS storage in the cardiac conduction system (CCS), especially in the atrioventricular node (AVN)-His bundle branches.ConclusionHS storage in the CCS might trigger AV block, arising from below the AVN-His bundle branches. This is the first description to indicate that HS might be an essential constituent of life-long CCS plasticity and that its storage in the CCS results in AV block.
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Neural activity reveals perceptual grouping in working memory
Source:International Journal of Psychophysiology
Author(s): Laura R. Rabbitt, Daniel M. Roberts, Craig G. McDonald, Matthew S. Peterson
There is extensive evidence that the contralateral delay activity (CDA), a scalp recorded event-related brain potential, provides a reliable index of the number of objects held in visual working memory. Here we present evidence that the CDA not only indexes visual object working memory, but also the number of locations held in spatial working memory. In addition, we demonstrate that the CDA can be predictably modulated by the type of encoding strategy employed. When individual locations were held in working memory, the pattern of CDA modulation mimicked previous findings for visual object working memory. Specifically, CDA amplitude increased monotonically until working memory capacity was reached. However, when participants were instructed to group individual locations to form a constellation, the CDA was prolonged and reached an asymptote at two locations. This result provides neural evidence for the formation of a unitary representation of multiple spatial locations.
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Understanding c-MET signalling in squamous cell carcinoma of the head & neck
Publication date: Available online 12 January 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): P. Szturz, E. Raymond, C. Abitbol, S. Albert, A. de Gramont, S. Faivre
c-MET is a membrane spanning receptor tyrosine kinase for hepatocyte growth factor (HGF) also termed scatter factor. Transmitting signals from mesenchymal to epithelial cells, the HGF/c-MET axis mediates a range of biological processes that stimulate proliferation, motility, invasiveness, morphogenesis, apoptosis, and angiogenesis. Aberrant c-MET signal transduction favours tumorigenesis with the acquisition of invasive and metastatic phenotypes. Biological functions of c-MET may strongly vary according to microenvironmental changes, which occur at different stages of tumorigenesis and include also HGF/c-MET activation in stromal cells. In this review, we focused on abnormalities in non-nasopharyngeal squamous cell carcinoma of the head & neck. While the prevalence of c-MET mutations and amplifications ranges 0–25%, c-MET upregulation can be found in the majority of squamous head & neck carcinomas. Despite marked heterogeneity in published scoring methods, immunohistochemical overexpression of c-MET has been typically linked to advanced stages and associated with impaired survival and/or resistance to radiotherapy, chemoradiotherapy, and cetuximab. Experimental studies in cell lines and patient-derived xenografts using various c-MET antagonists (both as single-agents and in combination with cytotoxic and epidermal growth factor receptor [EGFR]-directed agents) yielded promising results, albeit benefit in clinical trials remains to be demonstrated. Consequently, selecting more active agents and integrating them effectively in studies, which incorporate predictive biomarkers such as c-MET gene mutations, amplifications, and overexpression, remains challenging. Further investigations should increase emphasis on disentangling the role of tumour-stromal interactions and analyse their potential as modifiers of drug response.
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Antimicrobial activity of photodynamic therapy in combination with colistin against a pan-drug resistant Acinetobacter baumannii isolated from burn patient
Source:Photodiagnosis and Photodynamic Therapy
Author(s): Ebrahim Boluki, Hossein Kazemian, Hadi Peeridogaheh, Mohammad Yousef Alikhani, Sima Shahabi, Leili Beytollahi, Roghayeh Ghorbanzadeh
Nosocomially-acquired multi-, extensively-, and pandrug resistant (MDR, XDR, and PDR) strains of microorganisms such as Acinetobacter baumannii remain a serious cause of infection and septic mortality in burn patients. Treatment of patients with nosocomial burn wound infections is often complicated by drug-resistant strains of A. baumannii. Today, many researchers are focusing on the investigation of novel non-antibiotic strategies such as photodynamic therapy (PDT). We report a new PDT strategy that suppresses colistin resistance in PDR A. baumannii by interfering with the expression of a pmrA/pmrB two-component system. In the current study, A. baumannii with a PDR feature isolated from a burn patient was used as a test strain. PDT was carried out using toluidine blue O (TBO) and light-emitting diode (LED) as a photosensitizer and radiation source, respectively. The antimicrobial susceptibility profiles were assessed for cells surviving PDT. The effects of sub-lethal PDT (sPDT) on the expression of the pmrA/pmrB two-component signal transduction system were evaluated by real-time quantitative reverse transcription PCR. Results of drug susceptibly testing (DST) in LED and TBO groups separately showed that the bacteria were resistant to all tested antibiotics, while the DST result of the LED+TBO group showed highly declining bacterial growth when compared with the control group. Reduction in the expression of pmrA and pmrB was observed in the treated strains after sPDT. This represents the first conclusive example of a direct role for the PDT in breaking antibiotic resistance by directly modulating two-component system activity.
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Differences between biological and sociolegal incest offenders: A meta-analysis
Source:Aggression and Violent Behavior
Author(s): Lesleigh E. Pullman, Megan L. Sawatsky, Kelly M. Babchishin, Ian V. McPhail, Michael C. Seto
There is an important theoretical distinction between biological and sociolegal incest offenders, but this is not always recognized in clinical or empirical work. The purpose of the current meta-analysis was to examine the extent to which biological and sociolegal incest offenders differ on a number of theoretically or clinically relevant domains. In this meta-analysis, we compared a total of 4192 biological incest offenders to 2322 sociolegal incest offenders across 27 samples that were disseminated between 1984 and 2012 (Mdn=1993). Sociolegal incest offenders exhibited more antisocial tendencies (general self-regulation problems, impulsivity, drug and alcohol problems) compared to biological incest offenders. Biological incest offenders exhibited more psychopathology (repression, mental health difficulties) compared to sociolegal incest offenders. Differences were generally small to moderate in magnitude. Contrary to expectations, there were no meaningful differences between groups on atypical sexual interests (ds ranged from −0.09 to 0.11), though sociolegal incest offenders were more likely to have sexual self-regulation problems. One meaningful moderator emerged: whether the biological incest offender group was composed only of biological fathers or of both biological fathers and other biological relatives (e.g., uncles and grandfathers). The theoretical implications of these results are discussed, and areas of future research are highlighted.
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Posterior reversible encephalopathy syndrome after high-dose cytarabine in acute myelogenous leukemia
Neurology India 2017 65(1):220-220
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Clinicopathological conference: A strong educational tool
Neurology India 2017 65(1):2-4
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An unusual cause of bilateral tongue wasting and weakness
Neurology India 2017 65(1):188-189
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Two patriarchs of Indian Neurosciences: Professor Baldev Singh and Professor Jacob Chandy
Neurology India 2017 65(1):5-10
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“Hot-cross bun” and “inverse trident sign' in neurosarcoidosis: An important finding
Neurology India 2017 65(1):175-176
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An early description of monomelic amyotrophy: An excerpt from the diaries of Dr. Charles I Smith (1830–1880) in Bangalore, Southern India
Neurology India 2017 65(1):11-13
An early description of paralysis confined to an upper limb can be found in the casebook of Dr. Charles I Smith, who was a doctor in Bangalore in the 19th century. The historical and clinical aspects, as well as the current importance of this entity are described briefly.
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Extraventricular neurocytoma: An uncommon tumor in a young boy. A review of literature
Neurology India 2017 65(1):202-205
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The death wish and motor neuron disease! The chameleons and new research optimism
Neurology India 2017 65(1):14-15
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Concern and utilization of smart phone based telemedical health-care in allied neurological speciality: Real health–care model of future India
Neurology India 2017 65(1):232-233
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Death wish in patients with amyotrophic lateral sclerosis
Neurology India 2017 65(1):16-17
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Newly described additional sites of extrapontine myelinolysis along with typical pontine and extrapontine myelinolysis
Neurology India 2017 65(1):181-182
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Sonothrombolysis in acute large vessel ischemic stroke
Neurology India 2017 65(1):18-19
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Association between endothelial nitric oxide synthase gene polymorphisms and risk of ischemic stroke: A meta-analysis
Neurology India 2017 65(1):22-34
Previously published studies that have examined whether the three polymorphisms, G894T, T786C, and 4b/a in the endothelial nitric oxide synthase (eNOS) gene, are associated with ischemic stroke (IS) have reported conflicting results. Thus, we performed a meta-analysis to examine the potential association between these three single nucleotide polymorphisms (SNPs) of the eNOS gene and IS risk. A literature search was carried out for eligible candidate gene studies published before August 05, 2015 in the PubMed, Embase, and Google Scholar databases. The following combinations of main keywords were used in our study: ('endothelial nitric oxide synthase') or ('eNOS') and ('G894T, 4b/a, and T786C') and ('polymorphism') or ('polymorphisms') and ('Ischemic Stroke' or 'IS') and ('Cerebral Infarction' or 'CI') and ('genetic polymorphism' or 'single nucleotide polymorphisms' or 'SNP'). Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by using fixed or random effects model. Meta-regression analysis was used to investigate the potential sources of heterogeneity. Begg's funnel plots were used to explore the publication bias, and heterogeneity was assessed by I2 test. Twenty seven case-control studies involving 6733 cases and 7305 controls were analyzed in our meta-analysis. Significant association was observed for G894T (OR = 1.17; 95% CI: 1.08 to 1.28; P< 0.001) and 4b/a (OR = 1.25; 95% CI: 1.13 to 1.39; P < 0.001) whereas a non-significant association was observed for T786C (OR = 1.11; 95% CI: 0.98 to 1.26; P =0.109) eNOS gene polymorphisms and IS. Our meta-analysis establishes that the G894T and 4b/a polymorphisms of eNOS gene are significantly associated with the risk of IS. However, a non-significant association was found between T786C polymorphism of the eNOS gene and IS risk. Further prospective large epidemiological studies need to be done to confirm these findings.
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Treatment challenges in neurogenic stress cardiomyopathy following aneurysmal subarachnoid hemorrhage
Neurology India 2017 65(1):193-195
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Sonothrombolysis: An effective adjunct to intravenous tissue plasminogen activator therapy in acute ischemic stroke
Neurology India 2017 65(1):20-21
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Surgical considerations for intramedullary conus medullaris metastatic tumors with origin from primary lung lesions: A review of the literature
Neurology India 2017 65(1):211-214
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Early-onset pure absence epilepsy with eyebrow myoclonia
Neurology India 2017 65(1):224-225
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A systematic review of pipeline embolization device for giant intracranial aneurysms
Neurology India 2017 65(1):35-38
The experience with respect to the treatment of giant intracranial aneurysms with flow-diversion devices is limited. The aim of the present systematic review was to evaluate the effect of the pipeline embolization device (PED) on giant intracranial aneurysms. Eligible related articles were identified by searching the PubMed, Web of Science, Springer, ScienceDirect, and OVID databases using "giant aneurysm" and "pipeline" as the search items. The date of the last search was November 20, 2015. This systematic review adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In a total of 9 eligible studies with 200 patients and 215 aneurysms, 40 (18.6%) giant (aneurysm diameter >25mm) intracranial aneurysms treated with PED were analyzed. During a 6 to 34 month follow-up, complete occlusion was achieved in 23 (57.5%) cases. Seven patients (17.5%) developed intracranial hemorrhage, 5 developed ischemic attack (12.5%), and 13 (32.5%) developed a mass effect after PED treatment. The complication rate was 77.8% in PED for giant vertebrobasilar artery aneurysms. The cumulative mortality rate for giant paraclinoid carotid artery and middle cerebral artery aneurysms was 13.3% and increased up to 50% for giant vertebrobasilar artery aneurysms. The complete obliteration rate of PED for giant intracranial aneurysms was approximately 60%. Mass effect is the most mechanism of complications. Complication and mortality rates associated with PED for giant vertebrobasilar artery aneurysms are still extremely high.
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Refractory status dystonicus in ataxia telangiectasia
Neurology India 2017 65(1):169-172
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Anti-HMGCR and anti-DFS70 antibodies immunofluorescence patterns
Source:Autoimmunity Reviews
Author(s): Boaz Palterer, Daniele Cammelli, Gianfranco Vitiello, Maria Grazia Giudizi
http://ift.tt/2imlx3b
Icosahedron-forming ability of MgZn alloys studied by molecular dynamics simulations
Publication date: 5 April 2017
Source:Journal of Alloys and Compounds, Volume 700
Author(s): Yong-Chao Liang, Ze-An Tian, Rang-Su Liu, Ting-Hong Gao, Xiao-Tian Guo, Yun-Fei Mo, Quan Xie
A molecular dynamics simulation is performed to investigate the icosahedron in MgxZn(100-x) alloys during solidification at the cooling rate of 1 × 1011 K/s. It is found that with x increase the icosahedron-forming ability (IFA) of MgxZn(100-x) increases first, and then decrease as x > 50; and Mg90Zn10 can crystallize at this cooling rate. Consistent with the geometry, the smaller Zn atoms are usually at the centre of icosahedra, and the maximal fraction of Mg atoms in neighbours of Zn-centred icosahedra is just the critical value with which such icosahedra get the highest packing density. Further analysis reveals that the stronger IFA of Zn-rich alloys is closely related to the forming ability of GE9IS-ICOs (clusters composed of more than 8 icosahedra that are interconnected by IS-linkages) that still grow at low temperatures where all other smaller icosahedral clusters stop grow.
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A DNA probe based on phosphorescent resonance energy transfer for detection of transgenic 35S promoter DNA
Publication date: 15 May 2017
Source:Biosensors and Bioelectronics, Volume 91
Author(s): Jinzhi Lv, Yanming Miao, Jiajia Yang, Jin Qin, Dongxia Li, Guiqin Yan
A QDs-DNA nano-probe was made by combining Mn-doped ZnS room-temperature phosphorescence (RTP) quantum dots (QDs) and DNA. Then an RTP sensor for quantitative detection of genetically-modified mark sequence cauliflower mosaic virus 35S promoter (Ca MV 35S) DNA was built on basis of phosphorescent resonance energy transfer (PRET). The underlying principles were that a QDs-DNA water-soluble nano-probe was built by connecting single-strand DNA to the surfaces of QDs via a ligand exchange method. This probe had good RTP performance and could well identify Ca MV 35S. Thereby, the simple, rapid and efficient detection of genetically-modified organisms was realized. With the increase of target DNA sequence, the phosphorescent intensity of QDs was gradually reduced due to the energy transfer between QDs and the organic quencher BHQ2. This sensor had a detection limit of 4.03nM and a detection range of 12–300nM. Moreover, this sensor had high selectivity. This sensor could effectively detect the target DNA compared with mismatched and random sequences. Thus, this method is very promising for biological analysis.
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Comparison of Pb, Cd, Zn, and Cu chlorination during pyrolysis and incineration
Publication date: 15 April 2017
Source:Fuel, Volume 194
Author(s): Si-Jia Wang, Pin-Jing He, Wen-Tao Lu, Li-Ming Shao, Hua Zhang
The mechanisms of chlorination of PbO, CdO, ZnO, and CuO by poly(vinyl chloride) (PVC) and sodium chloride (NaCl), including their reaction temperatures, pathways, and products, were studied and compared. It was found that PVC can chloridize the four oxides via different mechanisms, producing corresponding chlorides. The heavy metal oxides in PVC–PbO and PVC–CdO were chloridized by gas–solid reaction with HCl, while direct chlorination by PVC occurred at 190°C in PVC–ZnO and PVC–CuO, as their initial temperatures for weight loss were 35–44°C lower than that of PVC decomposition. The relatively facile chlorination of PbO as compared with the other oxides might be a reason why Pb was more volatile than the other metals. NaCl had no chlorination effect on CdO, ZnO, or CuO in the absence of other media. It was found for the first time that NaCl alone could convert PbO to PbCl2 via a liquid–solid reaction when the temperature was higher than the melting point of NaCl (801°C), and oxygen was not involved. The chlorination effect of NaCl was markedly weaker than that of PVC. Since both PVC and NaCl are the most important chlorine sources in solid waste, their chlorination effects on heavy metals cannot be ignored.
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Structural variety of mono- and binuclear transition metal complexes of 3-[(2-hydroxy-benzylidene)-hydrazono]-1-(2-hydroxyphenyl)-butan-1-one: Synthesis, spectral, thermal, molecular modeling, antimicrobial and antitumor studies
Publication date: 15 April 2017
Source:Journal of Molecular Structure, Volume 1134
Author(s): Magdy Shebl, Omima M.I. Adly, Hoda F. El-Shafiy, Saied M.E. Khalil, A. Taha, Mohammed A.N. Mahdi
A new polydentate Schiff base ligand and its metal complexes were synthesized and characterized by elemental analyses, IR, 1H NMR, electronic, ESR and mass spectra, conductivity and magnetic susceptibility measurements as well as thermal analyses. The free ligand was synthesized by condensation of o-acetoacetylphenol with salicylaldehyde hydrazone. The analytical and spectroscopic tools showed that the obtained complexes are mono- and binuclear complexes, which can be generally formulated as: [(L)M2X2(H2O)m]·nZ; M = Cr, Fe, Ni or Cu, X = OAc or NO3, m = 5 or nil and n = 3, 1.5 or 0.5 and Z = EtOH or H2O, [(H2L)2M(X)m].nH2O; M = Mn, Zn, or Cd, X = EtOH, H2O or nil, m = 2 or nil and n = 3.5 or 0, [(HL)2Co2]·0.5H2O and [(H2L)2UO2(H2O)]. The metal complexes displayed octahedral, tetrahedral and square-planar geometrical arrangements, while uranium complex displayed seven-coordinate. Kinetic parameters (Ea, A, ΔH, ΔS and ΔG) of the thermal decomposition stages have been evaluated using Coats–Redfern equations. The molecular structural parameters of the ligand and its metal complexes have been calculated and correlated with the experimental data such as IR. The antimicrobial activity of the ligand and its complexes was screened against some kinds of bacteria and fungi. The antitumor activity of the ligand and its Ni(II) and Cu(II) complexes was investigated against HepG2 cell line.
Graphical abstract
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Structural, electronic, optical and mechanical properties of InP alloyed with Zn, Si, Sn and S under pressure: First-principles calculation
Publication date: 5 April 2017
Source:Journal of Alloys and Compounds, Volume 700
Author(s): Prayoonsak Pluengphon, Thiti Bovornratanaraks, Udomsilp Pinsook
Structural, electronic, optical and mechanical properties of Zn, Si, Sn and S substitutions on InP supercell under pressure in zinc blende (ZB) and rock salt (RS) phases are presented using first-principles method. Cohesive energy and enthalpy difference are observed, and found that the order of possible spontaneous process in experimental growth, which introduced from enthalpy difference, is (In,Zn)P > In(P,S) > In(Si,P) > In(Sn,P). The lower enthalpy difference in RS structure indicates that the spontaneous process of impurity substitution can be occurred in RS more than in ZB. Phase transition from ZB to RS reduces the strain on crystal lattice by the increasing of chemical bond length. The chemical bonding of Zn-P in ZB is the strongest sharing electrons when compared with other compounds, Zn-P>Si-In>S-In>Sn-In. The dielectric performance of InP is reduced by the alloying effect, and it transforms to the conductor performance as high frequencies. Order of photo-absorption coefficient in range of visible light with the impurities is Sn>Si>S>Zn, and it reduces under high-pressure. Mechanical stability of InP alloys was observed, and satisfied the Born stability criteria. The impurities reduce Shear modulus of pure InP. Poisson's ratio of InP alloys in RS exhibit small deformation and high isotropy, corresponding to high-symmetry cubic phase. B/G ratio indicates that ductility of InP alloys is reduced, when it transformed to RS. The ductility of InP is induced by the alloying effect due to the B/G ratio increasing.
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Objective measurements of skin surface roughness after microdermabrasion treatment
Background
The aim of this article is to present a new methodology for assessment of skin topology using a three-dimensional image (3D).
Methods
The measurement of the skin surface roughness is based on 3D scanning of silicone replicas by chromatic aberration length technique in a contactless manner, i.e. by a polychromatic light beam. Analysis of the skin surface reprints was performed using Talymap, Gold version. Results were analysed by fractal geometry, which allows to evaluate changes of the skin surface before and after application of cosmetics and instrumental cosmetological techniques. The methodology was applied for objective assessment of the effects of diamond microdermabrasion on the skin surface roughness. Measurements were performed on 23 volunteers in the age group of 31–67 years.
Results
Based on the results of skin surface scanning after the treatment with diamond microdermabrasion it may be concluded that inequalities of the skin surface are reduced immediately after exfoliation. However, this effect mostly diminishes within 14 days after treatment. The entire study ultimately suggests that the instrumental method used only leads to improvement of the skin surface immediately after its application. Thermo vision images of the skin surface temperature were obtained during the application of the abrasive method. The experimental results showed that the skin is rather cooled than heated by the treatment.
Conclusion
This study is focused on the development of a methodology for objective measurement of changes in treated skin relief using 3D scanning. The results are evaluated using fractal dimension. The output may also include also an enlarged model of the skin surface made by 3D printer, which can serve for illustrative communication with the client.
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Roughness preserving filter design to remove spatial noise from stereoscopic skin images for stable haptic rendering
Background/purpose
A problem in skin rendering with haptic feedback is the reconstruction of accurate 3D skin surfaces from stereo skin images to be used for touch interactions. This problem also encompasses the issue of how to accurately remove haptic spatial noise caused by the construction of disparity maps from stereo skin images, while minimizing the loss of the original skin roughness for cloning real tough textures without errors. Since the haptic device is very sensitive to high frequencies, even small amounts of noise can cause serious system errors including mechanical oscillations and unexpected exerting forces. Therefore, there is a need to develop a noise removal algorithm that preserves haptic roughness.
Methods
A new algorithm for a roughness preserving filter (RPF) that adaptively removes spatial noise, is proposed. The algorithm uses the disparity control parameter (λ) and noise control parameter (k), obtained from singular value decomposition of a disparity map. The parameter k determines the amount of noise to be removed, and the optimum value of k is automatically chosen based on a threshold of gradient angles of roughness (Ra).
Results
The RPF algorithm was implemented and verified with three real skin images. Evaluation criteria include preserved roughness quality and removed noise. Mean squared error (MSE), peak signal to noise ratio (PSNR), and objective roughness measures Ra and Rq were used for evaluation, and the results were compared against a median filter. The results show that the proposed RPF algorithm is a promising technology for removing noise and retaining maximized roughness, which guarantees stable haptic rendering for skin roughness.
Conclusion
The proposed RPF is a promising technology because it allows for any stereo image to be filtered without the risk of losing the original roughness. In addition, the algorithm runs automatically for any given stereo skin image with relation to the disparity parameter λ, and the roughness parameters Ra or Rq are given priority. Although this method has been optimized by graph-cut disparity map building, it can be extended to other disparity map building methods because the parameter k is determined by actual roughness Ra data that can be obtained by simple measurement.
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Development of a hypoxia-triggered and hypoxic radiosensitized liposome as a doxorubicin carrier to promote synergetic chemo-/radio-therapy for glioma
Source:Biomaterials, Volume 121
Author(s): Hongmei Liu, Yandong Xie, Yafei Zhang, Yifan Cai, Baiyang Li, Honglin Mao, Yingguo Liu, Jun Lu, Longzhen Zhang, Rutong Yu
The treatment of malignant primary brain tumors is challenging. Concomitant radiochemotherapy has become the standard clinical treatment for malignant glioma, but there are two critical challenges to overcome in order to increase efficacy. First, glioma is known to have increased resistant to radiation due to its intra-tumoral hypoxia. In addition, the blood-brain barrier (BBB) restricts the distribution of the chemotherapeutic agent to the brain. Therefore, we developed a hypoxic radiosensitizer-prodrug liposome (MLP), in order to deliver DOX to the tumor and to overcome the above challenges, achieving a synergistic chemo-/radiotherapy treatment of malignant glioma. In this study, hypoxic radiosensitizer nitroimidazoles were conjugated with lipid molecules with a hydrolysable ester bond to form MDH. MDH was mixed together with DSPE-PEG2000 and cholesterol to make MLP liposomes, which were found to have strong radiosensitivity and to promote cargo release under hypoxic conditions, due to the properties of nitroimidazoles under hypoxic conditions. MLP/DOX was found to have distinct advantages, including precise and stealthy pharmacokinetics and efficient passive uptake by the tumor. Furthermore, the combination of MLP/DOX and radiotherapy (RT) significantly inhibited glioma growth as assessed by in vivo bioluminescence imaging. These findings suggest that MLP is a promising candidate as a DOX delivery system to enhance the antitumor treatment effects on glioma, owing to synergistic chemo-/radiotherapy.
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In vivo visualization of endogenous miR-21 using hyaluronic acid-coated graphene oxide for targeted cancer therapy
Source:Biomaterials, Volume 121
Author(s): Do Won Hwang, Han Young Kim, Fangyuan Li, Ji Yong Park, Dohyun Kim, Jae Hyung Park, Hwa Seung Han, Jung Woo Byun, Yun-Sang Lee, Jae Min Jeong, Kookheon Char, Dong Soo Lee
Oncogene-targeted nucleic acid therapy has been spotlighted as a new paradigm for cancer therapeutics. However, in vivo delivery issues and uncertainty of therapeutic antisense drug reactions remain critical hurdles for a successful targeted cancer therapy. In this study, we developed a fluorescence-switchable theranostic nanoplatform using hyaluronic acid (HA)-conjugated graphene oxide (GO), which is capable of both sensing oncogenic miR-21 and inhibiting its tumorigenicity simultaneously. Cy3-labeled antisense miR-21 peptide nucleic acid (PNA) probes loaded onto HA-GO (HGP21) specifically targeted CD44-positive MBA-MB231 cells and showed fluorescence recovery by interacting with endogenous miR-21 in the cytoplasm of the MBA-MB231 cells. Knockdown of endogenous miR-21 by HGP21 led to decreased proliferation and reduced migration of cancer cells, as well as the induction of apoptosis, with enhanced PTEN levels. Interestingly, in vivo fluorescence signals markedly recovered 3 h after the intravenous delivery of HGP21 and displayed signals more than 5-fold higher than those observed in the HGPscr-treated group of tumor-bearing mice. These findings demonstrate the possibility of using the HGP nanoplatform as a cancer theranostic tool in miRNA-targeted therapy.
http://ift.tt/2jGS88S
Personal exposure to PM 2.5 associated with heavy metals in four travel modes of Tianjin during the summer season
Abstract
Personal exposure to PM2.5 associated with heavy metals were investigated at and around the same road by cycling, walking, taxi and bus in Tianjin, China. One trip on each mode was undertaken during 4 h of both morning and evening peak hours. Results of one-way analysis of variance (ANOVA) to compare mean concentrations of PM2.5 and each metal measured by four modes, the enrichment level of heavy metals in four modes and the carcinogenic, non-carcinogenic risk and probabilistic estimation of health risks of metals (Cr, Ni, Cu, Zn and Pb). Arithmetic means of PM2.5 personal exposure were 323.66, 313.37, 214.84 and 160.71 μg/m3 for cycling, walking, bus and taxi, which resulted from the difference of source (vehicle exhaust and road dust) of exposure to PM2.5. Na has the highest concentration, followed by Al, Ca, K, Fe, Mg, Zn, Ni, Pb, Cu and Cr. The higher Na concentrations were observed in Tianjin in light of its major sea salt influence. The concentrations of Ca, Mg, Fe and Zn in four modes followed different orders, while other metals have no significant difference between four modes. Enrichment factors of metals in PM2.5 showed that some metals are enriched, ranging from contaminated to extremely contaminated, for example, Ni, Cu, Zn, Pb, Na and Cr. Others are barely enriched such as Ca, K, Mg and Fe. It illustrated the former is mainly effected by anthropogenic activates and the source of latter comes from crust. From the results of non-carcinogenic and carcinogenic risks of metals, the intake of metals with inhalation for 4 h by four modes did not pose a significant potential chronic-toxic risk and was an acceptable or tolerable risk at present. But uncertainty analysis of health risks showed there were 4.05 and 6.87% probability that make carcinogenic risk values to exceed 10−4 when male choose walking/cycling to work. Commuters' rush hour exposures were significantly influenced by mode of transport. We suggest that future work should focus on further research between heavy metals in PM2.5 exposure and its specific epidemiology effects.
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Relay cropping as a sustainable approach: problems and opportunities for sustainable crop production
Abstract
Climate change, soil degradation, and depletion of natural resources are becoming the most prominent challenges for crop productivity and environmental sustainability in modern agriculture. In the scenario of conventional farming system, limited chances are available to cope with these issues. Relay cropping is a method of multiple cropping where one crop is seeded into standing second crop well before harvesting of second crop. Relay cropping may solve a number of conflicts such as inefficient use of available resources, controversies in sowing time, fertilizer application, and soil degradation. Relay cropping is a complex suite of different resource-efficient technologies, which possesses the capability to improve soil quality, to increase net return, to increase land equivalent ratio, and to control the weeds and pest infestation. The current review emphasized relay cropping as a tool for crop diversification and environmental sustainability with special focus on soil. Briefly, benefits, constraints, and opportunities of relay cropping keeping the goals of higher crop productivity and sustainability have also been discussed in this review. The research and knowledge gap in relay cropping was also highlighted in order to guide the further studies in future.
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Low-cost magnetic herbal biochar: characterization and application for antibiotic removal
Abstract
Magnetic biochar (M-BC) was derived from herbal medicine waste, Astragalus membranaceus residue, and was used as an adsorbent for ciprofloxacin removal from aqueous solutions. The M-BC was characterized by Brunauer–Emmett–Teller surface area analyses, Fourier transform infrared spectrometry, X-ray diffraction analysis, hysteresis loops, scanning electron microscopy energy-dispersive spectrometry, and X-ray photoelectron spectroscopy. The BET surface area increased from 4.40 to 203.70 m2/g after pyrolysis/magnetic modification. Batch experiments were performed at different dosages, initial concentrations, contact times, and solution pHs. Adsorption performances were evaluated using Langmuir and Freundlich isotherm models, and the results indicated that the Langmuir model appropriately described the adsorption process. The kinetic data were better fitted by a pseudo-second-order kinetic model. The maximum ciprofloxacin removal was observed at pH 6 (adsorption capacity of 68.9 ± 3.23 mg/g). Studies demonstrated that magnetically modified biochar might be an attractive, cost-effective, and easily separated adsorbent for contaminated water.
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Large area fabrication of graphene nanoribbons by wetting transparency-assisted block copolymer lithography
Publication date: 10 February 2017
Source:Polymer, Volume 110
Author(s): Reika Katsumata, Maruthi Nagavalli Yogeesh, Helen Wong, Sunshine X. Zhou, Stephen M. Sirard, Tao Huang, Richard D. Piner, Zilong Wu, Wei Li, Alvin L. Lee, Matthew C. Carlson, Michael J. Maher, Deji Akinwande, Christopher J. Ellison
Patterning graphene into nanoribbons (graphene nanoribbons, GNR) allows for tunability in the emerging fields of plasmonic devices in the mid-infrared and terahertz regime. However, the fabrication processes of GNR arrays for plasmonic devices often include a low-throughput electron beam lithography step that cannot be easily scaled to large areas. In this study, we developed a GNR fabrication method using block copolymer (BCP) lithography that takes advantage of the wetting transparency of graphene. One major advantage of this method is that the self-assembled domains of the polystyrene-block-poly(methyl methacrylate) BCP are oriented perpendicularly directly on top of the graphene where they can later serve as an etch mask. Large area (cm2 scale, 3 μm × 3 μm defect-free area) 13–51 nm wide GNR arrays were successfully fabricated using this scalable protocol. This wetting transparency-assisted GNR fabrication method could be useful for high-throughput production of various plasmonic devices, including biosensors, and photodetectors.
Graphical abstract
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The effects of rurality on substance use disorder diagnosis: A multiple-groups latent class analysis
Source:Addictive Behaviors, Volume 68
Author(s): Billy Brooks, Matthew McBee, Robert Pack, Arsham Alamian
BackgroundRates of accidental overdose mortality from substance use disorder (SUD) have risen dramatically in the United States since 1990. Between 1999 and 2004 alone rates increased 62% nationwide, with rural overdose mortality increasing at a rate 3 times that seen in urban populations. Cultural differences between rural and urban populations (e.g., educational attainment, unemployment rates, social characteristics, etc.) affect the nature of SUD, leading to disparate risk of overdose across these communities.MethodsMultiple-groups latent class analysis with covariates was applied to data from the 2011 and 2012 National Survey on Drug Use and Health (n=12.140) to examine potential differences in latent classifications of SUD between rural and urban adult (aged 18years and older) populations. Nine drug categories were used to identify latent classes of SUD defined by probability of diagnosis within these categories. Once the class structures were established for rural and urban samples, posterior membership probabilities were entered into a multinomial regression analysis of socio-demographic predictors' association with the likelihood of SUD latent class membership.ResultsLatent class structures differed across the sub-groups, with the rural sample fitting a 3-class structure (Bootstrap Likelihood Ratio Test P value=0.03) and the urban fitting a 6-class model (Bootstrap Likelihood Ratio Test P value<0.0001). Overall the rural class structure exhibited less diversity in class structure and lower prevalence of SUD in multiple drug categories (e.g. cocaine, hallucinogens, and stimulants).ConclusionsThis result supports the hypothesis that different underlying elements exist in the two populations that affect SUD patterns, and thus can inform the development of surveillance instruments, clinical services, and prevention programming tailored to specific communities.
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Patterns of drug use and HIV infection among adults in a nationally representative sample
Source:Addictive Behaviors, Volume 68
Author(s): Stephanie Shiau, Stephen M. Arpadi, Michael T. Yin, Silvia S. Martins
BackgroundLittle is known about drug use patterns among people living with HIV in comparison to an uninfected group in the general population. The aim of this study was to investigate the association between legal and illegal drug use and HIV infection in a nationally representative sample of adults in the United States.MethodsPublic use data files (2005–2014) from the National Survey on Drug Use and Health (NSDUH) were used. Respondents were asked whether a medical professional had ever told them that they had HIV/AIDS. Ever (lifetime), past-year, and past month use of cigarettes, alcohol, marijuana, cocaine, heroin, hallucinogens, inhalants, and nonmedical use of psychotherapeutics was assessed. Logistic regression was used to estimate adjusted odds ratios (aOR) of the relationship between drug use and HIV infection, adjusting for demographics.ResultsOf 377,787 respondents age 18 and older, 548 (0.19%) were categorized as HIV-infected. Ever use of cigarettes, tobacco, marijuana, cocaine, heroin, hallucinogens, inhalants, and psychotherapeutics was higher in HIV-infected individuals compared to HIV-uninfected individuals after adjustment for sex, age, race/ethnicity, education, total family income, and marital status. Past year and past month use was also higher for HIV-infected individuals for all substances aside from alcohol.ConclusionsIn a nationally representative sample, there are higher levels of drug use and DSM-IV dependence among the HIV-infected population compared to the HIV-uninfected population. This is of concern because drug use and dependence can impede engagement in HIV care and adherence to antiretroviral therapy.
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Socioeconomic differences in adolescent substance abuse treatment participation and long-term outcomes
Source:Addictive Behaviors, Volume 68
Author(s): Camillia K. Lui, Stacy A. Sterling, Felicia W. Chi, Yun Lu, Cynthia I. Campbell
Socioeconomic status (SES) has been consistently linked to poorer access, utilization and outcomes of health care services, but this relationship has been understudied in adolescent substance abuse treatment research. This study examined SES differences in adolescent's treatment participation and long-term outcomes of abstinence and 12-step attendance over five years after treatment. Data are from 358 adolescents (ages 13–18) who were recruited at intake to substance abuse treatment between 2000 and 2002 at four Kaiser Permanente Northern California outpatient treatment programs. Follow-up interviews of adolescents and their parents were conducted at 1, 3, and 5years, with over 80% response rates across time points. Using parent SES as a proxy for adolescent SES, no socioeconomic differences were found in treatment initiation, treatment retention, or long-term abstinence from alcohol or drugs. Parent education, but not parent income, was significantly associated with 12-step attendance post-treatment such that adolescents with higher parent education were more likely to attend than those with lower parent education. Findings suggest a lack of socioeconomic disparities in substance abuse treatment participation in adolescence, but potential disparities in post-treatment 12-step attendance during the transition from adolescence to young adulthood.
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Self-concept mediate the relationship between childhood maltreatment and abstinence motivation as well as self-efficacy among drug addicts
Source:Addictive Behaviors, Volume 68
Author(s): Feng-Ying Lu, Si Wen, Gang Deng, Yung-Lung Tang
ObjectiveChildhood maltreatment is widely accepted as a risk factor for drug addiction from adolescence to adulthood. However, the influence of childhood maltreatment on drug treatment related variables, such as drug abstinence motivation and self-concept, as well as self-efficacy, remains unclear. This study aims at exploring whether self-concept mediates the relationship between childhood maltreatment and abstinence motivation, as well as self-efficacy, among drug addicts.MethodsThis study involves 816 (550 males, 226 females, mean age=34.59, range=16–58 years) drug addicts from compulsory detoxification units. Participants completed questionnaires, including the childhood trauma questionnaire 28 - item short form (CTQ - SF), Tennessee self-concept scale (TSCS), general self-efficacy scale (GSES), and drug abstinence motivation questionnaire (DAMQ).ResultsThe structural equation model (SEM) analysis, including total and specific forms of maltreatment scores, showed that childhood maltreatment was negatively associated with self-concept, self-efficacy, and abstinence motivation. Self-concept was positively associated with self-efficacy and abstinence motivation. Conversely, significant association between self-efficacy and abstinence motivation did not exist. An indirect analysis showed that self-concept mediated the relationship between childhood maltreatment and self-efficacy. Critically, self-concept arbitrated the relationship between childhood maltreatment and abstinence motivation. The indirect effect of self-concept between childhood maltreatment and abstinence motivation still existed when the total scores of maltreatment were replaced by the scores of specific forms of maltreatment.ConclusionsThese results demonstrated that self-concept is a critical factor in understanding the relationship between childhood maltreatment and abstinence motivation, as well as self-efficacy, among drug addicts. Improving the sense of self-worth may be an effective intervention therapy among drug addicts with childhood maltreatment history.
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Associations between adverse childhood experiences, student-teacher relationships, and non-medical use of prescription medications among adolescents
Source:Addictive Behaviors, Volume 68
Author(s): Myriam Forster, Amy L. Gower, Iris W. Borowsky, Barbara J. McMorris
ObjectiveFew studies have investigated associations between adverse childhood experiences (ACE) and nonmedical use of prescription medication (NMUPM) in population-based samples of adolescents, and even fewer have examined whether promotive factors might buffer these effects. The present study assesses the direct effects of ACE and positive student-teacher relationships on NUMPD and whether positive student-teacher relationships moderate this association.DesignData were from the 2013 Minnesota Student Survey (MSS), an in-school survey administered every three years to students throughout Minnesota. The analytic sample (n=104,332) was comprised of 8th, 9th, and 11th graders.ResultsApproximately 3% of students acknowledged past year NMUPM, the majority of whom reported at least one ACE. The most frequently used prescription drug was Ritalin/ADHD medications (1.71%) followed by opiate-based painkillers (1.67%), tranquilizers (0.92%), and stimulants (0.75%). Students who reported any use tended to use more than one medication. For every additional ACE, there was a 56%, 51%, 47%, and 52% increase in the odds of past year stimulant use, ADHD medication, pain reliever, and tranquilizer use, respectively. The estimated rate of the number of prescription drugs used increased by 62% for every additional ACE. Positive student- teacher relationships buffered the association between ACE and NMUPD, especially at higher levels of ACEs.ConclusionOur findings have important implications for prevention work. Training educators to recognize trauma symptomology and cultivating strong student-teacher relationships are important considerations for future school-based substance use prevention initiatives.
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Prevalence and correlates of fentanyl-contaminated heroin exposure among young adults who use prescription opioids non-medically
Source:Addictive Behaviors, Volume 68
Author(s): Alexandria Macmadu, Jennifer J. Carroll, Scott E. Hadland, Traci C. Green, Brandon D.L. Marshall
BackgroundThe rate of overdose deaths caused by fentanyl-contaminated heroin (FCH) use is increasing rapidly in the United States. We examined risk factors for exposure to FCH and experiences with FCH use among young adult non-medical prescription opioids (NMPO) users.MethodsWe analyzed data from the Rhode Island Young Adult Prescription Drug Study (RAPiDS), which enrolled young adults aged 18 to 29 reporting prior 30day NMPO use between January 2015 and February 2016. Participants completed questionnaires ascertaining drug use patterns and risk behaviors, including FCH exposure. Logistic regression was used to assess factors associated with known or suspected FCH exposure.ResultsOf 199 participants, the median age was 25 (IQR: 22, 27), 130 (65.3%) were male, and 122 (61.3%) were of White, non-Hispanic race/ethnicity. In total, 22 (11%) reported known or suspected FCH exposure in the prior six months. Several drug use patterns and risk behaviors were associated with FCH exposure, including: regular heroin and cocaine use; diverted pharmaceutical fentanyl use in the prior six months; NMPO use to avoid withdrawal symptoms; longer duration of NMPO use; regular injection drug use; and prior overdose (all p<0.001). Among participants who reported FCH exposure, 59% were unaware that their heroin was contaminated with fentanyl prior to last use, 59% reported that FCH provides a better high, and all recognized that fentanyl increases overdose risk.ConclusionsExposure to fentanyl-contaminated heroin is an emerging trend among young adult NMPO users in Rhode Island. Overdose prevention programs addressing FCH use are urgently needed.
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Free breathing whole-heart 3D CINE MRI with self-gated Cartesian trajectory
Publication date: May 2017
Source:Magnetic Resonance Imaging, Volume 38
Author(s): M. Usman, B. Ruijsink, M.S. Nazir, G. Cruz, C. Prieto
PurposeTo present a method that uses a novel free-running self-gated acquisition to achieve isotropic resolution in whole heart 3D Cartesian cardiac CINE MRI.Material and methods3D cardiac CINE MRI using navigator gating results in long acquisition times. Recently, several frameworks based on self-gated non-Cartesian trajectories have been proposed to accelerate this acquisition. However, non-Cartesian reconstructions are computationally expensive due to gridding, particularly in 3D. In this work, we propose a novel highly efficient self-gated Cartesian approach for 3D cardiac CINE MRI. Acquisition is performed using CArtesian trajectory with Spiral PRofile ordering and Tiny golden angle step for eddy current reduction (so called here CASPR-Tiger). Data is acquired continuously under free breathing (retrospective ECG gating, no preparation pulses interruption) for 4–5min and 4D whole-heart volumes (3D+cardiac phases) with isotropic spatial resolution are reconstructed from all available data using a soft gating technique combined with temporal total variation (TV) constrained iterative SENSE reconstruction.ResultsFor data acquired on eight healthy subjects and three patients, the reconstructed images using the proposed method had good contrast and spatio-temporal variations, correctly recovering diastolic and systolic cardiac phases. Non-significant differences (P>0.05) were observed in cardiac functional measurements obtained with proposed 3D approach and gold standard 2D multi-slice breath-hold acquisition.ConclusionThe proposed approach enables isotropic 3D whole heart Cartesian cardiac CINE MRI in 4 to 5min free breathing acquisition.
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Two Indications, One Target: Concomitant Epilepsy and Tourettism Treated with Centromedian/Parafascicular Thalamic Stimulation
Source:Brain Stimulation
Author(s): Marina Picillo, Mohammad Rohani, Andres M. Lozano, Alfonso Fasano
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Synergistic effect of aluminum and ionizing radiation upon ultrastructure, oxidative stress and apoptotic alterations in Paneth cells of rat intestine
Abstract
Environmental and occupational exposure to aluminum along with ionizing radiation results in serious health problems. This study was planned to investigate the impact of oxidative stress provoked by exposure to ionizing radiation with aluminum administration upon cellular ultra structure and apoptotic changes in Paneth cells of rat small intestine . Animals received daily aluminum chloride by gastric gavage at a dose 0.5 mg/Kg BW for 4 weeks. Whole body gamma irradiation was applied at a dose 2 Gy/week up to 8 Gy. Ileum malondialdehyde, advanced oxidation protein products, and protein carbonyl were assessed as biomarkers of lipid peroxidation along with superoxide dismutase, catalase, and glutathione peroxidase activities as enzyme antioxidants. Moreover, analyses of cell cycle division and apoptotic changes were evaluated by flow cytometry. Intestinal cellular ultra structure was investigated using transmission electron microscope. Oxidative stress assessment in the ileum of rats revealed that aluminum and ionizing radiation exposure either alone or in combination exhibits a significant effect upon the increase in biomarkers of lipid peroxidation along with tumor necrosis factor-α with concomitant significant decrease of the antioxidant enzyme activities. Flow cytometric analyses showed significant alterations in the percentage of cells during cell cycle division phases along with significant increase in apoptotic cells. Ultra structurally, intestinal cellular alterations with marked injury in Paneth cells at the sites of bacterial translocation in the crypt of lumens were recorded. The results of this study have clearly suggested that aluminum exposure and ionizing either alone or in combination induced apoptosis and oxidative stress in the Paneth cells of rat intestine, which appeared to play a major role in the pathogenesis of cellular damage. Furthermore, the interaction of these two intestinal toxic routes was found to be synergistic.
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Summary Insulinomas are rare neuroendocrine tumours that classically present with fasting hypoglycaemia. This case report discusses an un...
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