Clinical Mimics: An Emergency Medicine–Focused Review of Influenza Mimics

Publication date: Available online 16 February 2017
Source:The Journal of Emergency Medicine
Author(s): Erica Simon, Brit Long, Alex Koyfman
BackgroundInfluenza viruses are a significant cause of morbidity and mortality in the United States. Given the wide range of symptoms, emergency physicians must maintain a broad differential diagnosis in the evaluation and treatment of patients presenting with influenza-like illnesses.ObjectiveThis review addresses objective and subjective symptoms commonly associated with influenza and discusses important mimics of influenza viruses, while offering a practical approach to their clinical evaluation and treatment.DiscussionInfluenza-like symptoms are common in the emergency department (ED), and influenza accounts for > 200,000 hospitalizations annually. The three predominant types are A, B, and C, and these viruses are commonly transmitted through aerosolized viral particles with a wide range of symptoms. The most reliable means of identifying influenza in the ED is rapid antigen detection, although consideration of local prevalence is required. High-risk populations include children younger than 4 years, adults older than 50 years, adults with immunosuppression or chronic comorbidities, pregnancy, obesity, residents of long-term care facilities, and several others. The Centers for Disease Control and Prevention recommends treatment with neuraminidase inhibitors in these populations. However, up to 70% of patients with these symptoms may have a mimic. These mimics include infectious and noninfectious sources. The emergency physician must be aware of life-threatening mimics and assess for these conditions while beginning resuscitation and treatment.ConclusionsThe wide range of symptoms associated with influenza overlap with several life-threatening conditions. Emergency physicians must be able to rapidly identify patients at risk for complications and those who require immediate resuscitation.



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Denosumab versus Zoledronic Acid for Adults with Osteoporosis: A Review of Cost-Effectiveness [Internet].

The purpose of this report is to evaluate the cost-effectiveness of denosumab and zoledronic acid for the treatment of postmenopausal women and men with osteoporosis, including women receiving adjuvant aromatase inhibitor therapy for non-metastatic breast cancer, men receiving androgen deprivation therapy for non-metastatic prostate cancer, and patients with severe renal dysfunction.

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Entyvio (Vedolizumab) [Internet].

The objective of this report is to perform a systematic review of the beneficial and harmful effects of vedolizumab intravenous (IV) infusion in accordance with the Health Canada–approved indication for the treatment of Crohn's disease. Vedolizumab has been previously reviewed through the CADTH Common Drug Review (CDR) for the treatment of ulcerative colitis.

http://ift.tt/2lWmIIL

Home Transcutaneous Electrical Nerve Stimulation for Chronic Pain: A Review of the Clinical Effectiveness [Internet].

This report will review evidence of clinical, cost and comparative effectiveness of home-use of transcutaneous electrical nerve stimulation (TENS) in patients with chronic musculoskeletal pain, osteoarthritis or diabetic neuropathy and existing evidence-based guidelines regarding the use of TENS in home-based settings.

http://ift.tt/2lP5tx7

Printing Processes and Printing Inks, Carbon Black and Some Nitro Compounds.

This volume of the IARC Monographs evaluates the carcinogenic risks to humans posed by exposures in printing processes and to printing inks, to carbon black, and to selected nitro compounds, many of which are used in the production of dye and colourant intermediates. The first monograph evaluate occupational exposures in printing processes and to printing inks. Exposures in the printing industry are assessed according to their occurrence in printing ink manufacture and in printing operations such as letterpress, lithography, flexography, gravure, and screen printing. Although many epidemiological studies have demonstrated some evidence of cancer risk in printing trades and printing industries, the assessment found several important problems in the design of these studies. Occupational exposures in printing processes were classified as possibly carcinogenic to humans. Printing inks could not be classified.

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Nasal Bridle Devices for the Securement of Nasoenteric Feeding Tubes in Adult Patients: Comparative Clinical Effectiveness, Safety, and Cost-Effectiveness [Internet].

The aim of this report is to summarize and compare the current evidence of the clinical effectiveness, safety and cost-effectiveness of nasal bridles and adhesive tapes as nasoenteric tube securement interventions to inform decisions for future research.

http://ift.tt/2lP0Ti8

Dialysis for the Treatment of End Stage Kidney Disease in Indigenous Patients in Canada: A Review of Clinical Effectiveness [Internet].

To supplement a CADTH optimal use project seeking to compare the clinical effectiveness of the various dialysis modalities, this Rapid Response report specifically examines the clinical effectiveness of in-centre and home-based peritoneal dialysis (PD) and hemodialysis (HD) for the treatment of end stage kidney disease (ESKD) in Indigenous Canadians. This report was reviewed by experts in nephrology and dialysis care, one of whom is Indigenous, and another who works with Indigenous populations.

http://ift.tt/2lWpTAc

Electronically Generated Medication Administration and Electronic Medication Administration Records for the Prevention of Medication Transcription Errors: Review of Clinical Effectiveness and Safety [Internet].

In the hospital setting, medication errors represent and significant proportion of all medical errors. These errors can lead to adverse drug events and can increase length of stay in hospitals. Errors can occur at prescription, transcription, dispensation, and administration. Human error is an important factor in all stages of potential medication errors and thus information technology (IT) solutions are often sought in order to mitigate the risk of human error. Transcription errors can occur when patient files and medication orders are being updated from week to week and may be particularly susceptible to error due to healthcare provider fatigue (e.g. files being updated at the end of a shift). Electronic health records, computerized order entry systems, bar-code medication administration (BCMA) systems, and electronic medication administration records (eMARs) are IT solutions that are often considered in order to reduce such error.

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Stability of Sensory Topographies in Adult Cortex

Publication date: Available online 15 February 2017
Source:Trends in Cognitive Sciences
Author(s): Tamar R. Makin, Sliman J. Bensmaia
Textbooks teach us that the removal of sensory input to sensory cortex, for example, following arm amputation, results in massive reorganisation in the adult brain. In this opinion article, we critically examine evidence for functional reorganisation of sensory cortical representations, focusing on the sequelae of arm amputation on somatosensory topographies. Based on literature from human and non-human primates, we conclude that the cortical representation of the limb remains remarkably stable despite the loss of its main peripheral input. Furthermore, the purportedly massive reorganisation results primarily from the formation or potentiation of new pathways in subcortical structures and does not produce novel functional sensory representations. We discuss the implications of the stability of sensory representations on the development of upper-limb neuroprostheses.



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Social Decision-Making and the Brain: A Comparative Perspective

Publication date: Available online 15 February 2017
Source:Trends in Cognitive Sciences
Author(s): Sébastien Tremblay, K.M. Sharika, Michael L. Platt
The capacity and motivation to be social is a key component of the human adaptive behavioral repertoire. Recent research has identified social behaviors remarkably similar to our own in other animals, including empathy, consolation, cooperation, and strategic deception. Moreover, neurobiological studies in humans, nonhuman primates, and rodents have identified shared brain structures (the so-called 'social brain') apparently specialized to mediate such functions. Neuromodulators may regulate social interactions by 'tuning' the social brain, with important implications for treating social impairments. Here, we survey recent findings in social neuroscience from a comparative perspective, and conclude that the very social behaviors that make us human emerge from mechanisms shared widely with other animals, as well as some that appear to be unique to humans and other primates.



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Language Evolution: A Changing Perspective

Publication date: Available online 15 February 2017
Source:Trends in Cognitive Sciences
Author(s): Michael C. Corballis
From ancient times, religion and philosophy have regarded language as a faculty bestowed uniquely and suddenly on our own species, primarily as a mode of thought with communication as a byproduct. This view persists among some scientists and linguists and is counter to the theory of evolution, which implies that the evolution of complex structures is incremental. I argue here that language derives from mental processes with gradual evolutionary trajectories, including the generative capacities to travel mentally in time and space and into the minds of others. What may be distinctive in humans is the means to communicate these mental experiences along with knowledge gained from them.



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Effects of a combination butaphosphan and cyanocobalamin product and insulin on ketosis resolution and milk production

Publication date: Available online 16 February 2017
Source:Journal of Dairy Science
Author(s): J.L. Gordon, T.F. Duffield, T.H. Herdt, D.F. Kelton, L. Neuder, S.J. LeBlanc
The objective of this study was to determine the effects of butaphosphan-cyanocobalamin (B+C), glargine insulin, and propylene glycol on resolution of ketosis and average daily milk yield after treatment. Cows from 16 herds in Ontario, Canada, and 1 herd in Michigan were tested at weekly intervals between 3 and 16 DIM. Ketosis was defined as blood β-hydroxybutyrate (BHB) ≥1.2 mmol/L. All ketotic cows were given a baseline treatment of 3 d of 300 g of propylene glycol orally. Animals were then randomly assigned to treatment with 3 doses of either 25 mL of B+C or 25 mL of saline placebo and 1 dose of either 2 mL (200 IU) of glargine insulin or 2 mL of saline placebo in a 2 × 2 factorial arrangement. Outcomes of interest on all farms were ketosis cure (blood BHB <1.2 mmol/L 1 wk postenrollment), maintenance of ketosis cure (blood BHB <1.2 mmol/L 1 and 2 wk postenrollment), and blood BHB concentrations at 1 and 2 wk postenrollment. Milk weights were collected daily in 1 large freestall herd. Repeated measures ANOVA was used to evaluate blood BHB concentrations 2 wk after treatment and milk production for 30 d after treatment. Poisson regression was used to examine the effect of treatment on cure and maintenance of cure. Due to a regulatory delay causing temporary unavailability of B+C in Canada, data were analyzed in 2 sets of models: one for insulin and the corresponding placebo (n = 620) and one for the full trial (n = 380). Animals with blood glucose concentrations ≤2.2 mmol/L at the time of ketosis diagnosis were 2.1 times more likely (95% CI = 1.2 to 3.7) to be cured if treated with B+C. Animals in lactation 3 or higher that had blood glucose concentrations <2.2 mmol/L at enrollment produced 4.2 kg/d (95% CI = 1.4 to 7.1) more milk if treated with insulin versus placebo and 2.8 kg/d (95% CI = 0.9 to 4.7) more milk if treated with B+C versus placebo. Animals in lactation 3 or higher with blood glucose ≥2.2 mmol/L that were treated with insulin produced 2.3 kg/d (95% CI = 0.3 to 4.4) less milk than untreated controls. No interaction was observed between treatments. This evidence suggests that B+C and insulin may be beneficial for ketosis treatment in animals with blood glucose <2.2 mmol/L at ketosis diagnosis. It also suggests that blood glucose concentration may be an important predictor of success of ketosis treatment.



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Effects of body condition, monensin, and essential oils on ruminal lipopolysaccharide concentration, inflammatory markers, and endoplasmatic reticulum stress of transition dairy cows

Publication date: Available online 16 February 2017
Source:Journal of Dairy Science
Author(s): C. Drong, S. Bühler, J. Frahm, L. Hüther, U. Meyer, D. von Soosten, D.K. Gessner, K. Eder, H. Sauerwein, S. Dänicke
Evidence exists that dairy cows experience inflammatory-like phenomena in the transition period. Rumen health and alterations in metabolic processes and gene networks in the liver as the central metabolic organ might be key factors for cows' health and productivity in early lactation. This study made use of an animal model to generate experimental groups with different manifestations of postpartal fat mobilization and ketogenesis. In total, 60 German Holstein cows were allocated 6 wk antepartum to 3 high-body condition score (BCS) groups (BCS 3.95) and 1 low-BCS group (LC; BCS 2.77). High-BCS cows were fed an antepartal forage-to-concentrate ratio of 40:60 on dry matter basis, in contrast to 80:20 in the LC group, and received a monensin controlled-release capsule (HC/MO), a blend of essential oils (HC/EO), or formed a control group (HC). We evaluated serum haptoglobin, kynurenine, tryptophan, ruminal lipopolysaccharide concentration and mRNA abundance of nuclear factor kappa B (NF-κB), nuclear factor E2-related factor 2 (Nrf2), and endoplasmatic reticulum stress-induced unfolded protein response (UPR) target genes in liver biopsy samples from d −42 until +56 relative to calving. Nearly all parameters were highly dependent on time, with greatest variation near calving. The ruminal lipopolysaccharide concentration and evaluated target genes were not generally influenced by antepartal BCS and feeding management. The kynurenine-to-tryptophan ratio was higher in LC than in HC/MO treatment on d 7. Ruminal lipopolysaccharide concentration was higher in HC/MO than in the HC group, but not increased in HC/EO group. Abundance of UPR target gene X-box binding protein 1 was higher in HC/MO than in HC/EO group on d 7. Hepatic mRNA abundance of Nrf2 target gene glutathione peroxidase 3 was higher, whereas expression of NF-κB target gene haptoglobin tended to be higher in LC than in HC/EO cows. The HC/MO cows showed the most prominent increase in the abundance of glutathione peroxidase 3 and haptoglobin after calving in comparison to antepartal values. Results indicate the presence of inflammatory-like phenomena near calving. Simultaneously, alterations in UPR and Nrf2 target genes with antioxidative properties and haptoglobin occurred, being most prominent in LC and HC/MO group.



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Short communication: Diagnostic performance of on-farm bacteriological culture systems for identification of uterine Escherichia coli in postpartum dairy cows

Publication date: Available online 16 February 2017
Source:Journal of Dairy Science
Author(s): J. Dubuc
The objectives of this study were to validate the performance of on-farm bacteriological culture systems for identification of Escherichia coli in the uterus of early postpartum dairy cows and to determine if an association is present between the results and the subsequent occurrence of puerperal metritis (PM). A prospective cohort study was conducted in one commercial Holstein dairy herd in which 400 cows were sampled between 24 and 48 h after parturition. Three bacteriological samples were obtained from the uterus of each cow and were cultured for identification of E. coli. One sample was cultured in a commercial bacteriology laboratory according to standard procedures for identification of E. coli and was considered as the reference test. The two other samples were cultured on the farm using the Tri-Plate (University of Minnesota, St. Paul, MN) and Petrifilm systems, and plate readings were done after 24 and 48 h of incubation (variables: Tri24h, Tri48h, Petri24h, Petri48h). Participating cows were followed until 21 days in milk to diagnose PM. The prevalence of PM and E. coli (from the reference test) in the cow population was 15.0 and 33.5%, respectively. Both on-farm culture systems were accurate compared with the reference test. The sensitivity and specificity were 97 and 100%, 99 and 100%, 100 and 92%, and 100 and 89% for Tri24h, Tri48h, Petri24h, and Petri48h, respectively. On-farm results for Tri24h, Tri48h, Petri24h, and Petri48h were associated with subsequent occurrence of PM. The results from this study support the use of the Tri-Plate and Petrifilm culture systems on dairy farms to identify the presence of E. coli in the uterus of postpartum cows.



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Changes in rumen microbiota composition and in situ degradation kinetics during the dry period and early lactation as affected by rate of increase of concentrate allowance

Publication date: Available online 16 February 2017
Source:Journal of Dairy Science
Author(s): K. Dieho, B. van den Bogert, G. Henderson, A. Bannink, J. Ramiro-Garcia, H. Smidt, J. Dijkstra
Changes in rumen microbiota and in situ degradation kinetics were studied in 12 rumen-cannulated Holstein Friesian dairy cows during the dry period and early lactation. The effect of a rapid (RAP) or gradual (GRAD) postpartum (pp) rate of increase of concentrate allowance was also investigated. Cows were fed for ad libitum intake and had free access to a mixed ration consisting of chopped wheat straw (dry period only), grass silage, corn silage, and soybean meal. Treatment consisted of either a rapid (1.0 kg of dry matter/d; n = 6) or gradual (0.25 kg of dry matter/d; n = 6) increase of concentrate allowance (up to 10.9 kg of dry matter/d), starting at 4 d pp. In whole rumen contents, bacterial community composition was assessed using samples from 50, 30, and 10 d antepartum (ap), and 3, 9, 16, 30, 44, 60, and 80 d pp, and protozoal and archaeal community composition using samples from 10 d ap, and 16 and 44 d pp. Intake of fermentable organic matter, starch, and sugar was temporarily greater in RAP than GRAD at 16 d pp. Bacterial community richness was higher during the dry period than during the lactation. A rapid increase in concentrate allowance decreased bacterial community richness at 9 and 16 d pp compared with a gradual increase in concentrate allowance, whereas from 30 d pp onward richness of RAP and GRAD was similar. In general, the relative abundances of Bacteroidales and Aeromonadales were greater, and those of Clostridiales, Fibrobacterales, and Spirochaetales were smaller, during the lactation compared with the dry period. An interaction between treatment and sampling day was observed for some bacterial community members, and most of the protozoal and archaeal community members. Transition to lactation increased the relative abundance of Epidinium and Entodinium, but reduced the relative abundance of Ostracodinium. Archaea from genus Methanobrevibacter dominated during both the dry period and lactation. However, during lactation the abundance of the methylotrophic Methanomassiliicoccaceae and Methanosphaera increased. The in situ degradation of organic matter, neutral detergent fiber, starch, and crude protein was neither affected by treatment nor by transition from the dry period to lactation. Results show that the composition of the rumen microbiota can change quickly from the dry period to the lactation period, in particular with a rapid increase in fermentable substrate supply postpartum, but this was not associated with changes in rumen degradation kinetics.



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Economic trade-offs between genetic improvement and longevity in dairy cattle

Publication date: Available online 16 February 2017
Source:Journal of Dairy Science
Author(s): A. De Vries
Genetic improvement in sires used for artificial insemination (AI) is increasing faster compared with a decade ago. The genetic merit of replacement heifers is also increasing faster and the genetic lag with older cows in the herd increases. This may trigger greater cow culling to capture this genetic improvement. On the other hand, lower culling rates are often viewed favorably because the costs and environmental effects of maintaining herd size are generally lower. Thus, there is an economic trade-off between genetic improvement and longevity in dairy cattle. The objective of this study was to investigate the principles, literature, and magnitude of these trade-offs. Data from the Council on Dairy Cattle Breeding show that the estimated breeding value of the trait productive life has increased for 50 yr but the actual time cows spend in the herd has not increased. The average annual herd cull rate remains at approximately 36% and cow longevity is approximately 59 mo. The annual increase in average estimated breeding value of the economic index lifetime net merit of Holstein sires is accelerating from $40/yr when the sire entered AI around 2002 to $171/yr for sires that entered AI around 2012. The expectation is therefore that heifers born in 2015 are approximately $50 more profitable per lactation than heifers born in 2014. Asset replacement theory shows that assets should be replaced sooner when the challenging asset is technically improved. Few studies have investigated the direct effects of genetic improvement on optimal cull rates. A 35-yr-old study found that the economically optimal cull rates were in the range of 25 to 27%, compared with the lowest possible involuntary cull rate of 20%. Only a small effect was observed of using the best surviving dams to generate the replacement heifer calves. Genetic improvement from sires had little effect on the optimal cull rate. Another study that optimized culling decisions for individual cows also showed that the effect of changes in genetic improvement of milk revenue minus feed cost on herd longevity was relatively small. Reduced involuntary cull rates improved profitability, but also increased optimal voluntary culling. Finally, an economically optimal culling model with prices from 2015 confirmed that optimal annual cull rates were insensitive to heifer prices and therefore insensitive to genetic improvement in heifers. In conclusion, genetic improvement is important but does not warrant short cow longevity. Economic cow longevity continues to depends more on cow depreciation than on accelerated genetic improvements in heifers. This is confirmed by old and new studies.



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Short communication: Repeat breeder cows with fluid in the uterine lumen had poorer fertility

Publication date: Available online 16 February 2017
Source:Journal of Dairy Science
Author(s): M. Jaureguiberry, M.J. Giuliodori, A.V. Mang, L.V. Madoz, H. Pothmann, M. Drillich, R.L. de la Sota
The objective of the present study was to test the association between the presence of fluid in uterine lumen and the fertility of repeat breeder cows (RBC). Grazing Holstein cows that were clinically normal and were not pregnant after at least 3 consecutive inseminations were defined as RBC and included in the study (n = 358). A cut-point ≥2 mm of uterine lumen visible by ultrasonography was used as indicative of the presence of fluid in the uterus. The effect of this fluid on the fertility of RBC was assessed by mixed logistic regression. Twenty percent of the RBC had ≥2 mm of fluid in their uterus, and this finding was associated with a marked reduction in the odds of conception (odds ratio = 0.46). Additional intrauterine sampling revealed that 24.0% of RBC showed signs of subclinical endometritis [≥5% neutrophils in endometrial cytology (SCE)]. However, we found no agreement between the finding of uterine fluid and the diagnosis of SCE (Kappa coefficient = 0.03, 95% confidence interval = −0.07 to 0.14). In conclusion, the presence of fluid (≥2 mm) in uterine lumen, detected by ultrasonography, was associated with lower fertility in RBC, but was not related to the diagnosis of SCE. Thus, ultrasonographic evaluation is an important tool to assist in assessment of RBC.



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Changes in milk urea around insemination are negatively associated with conception success in dairy cows

Publication date: Available online 16 February 2017
Source:Journal of Dairy Science
Author(s): A. Albaaj, G. Foucras, D. Raboisson
Dietary protein levels are a risk factor for poor reproductive performance. Conception is particularly impaired in cases of high blood or milk urea. The objective of this study was to investigate the association between conception and low milk urea or changes in milk urea around artificial insemination (AI). Data were obtained from the French Milk Control Program for a 4-yr period (2009–2012). Milk urea values between 250 and 450 mg/kg (4.3 and 7.7 mM) were considered intermediate (I), and values ≤150 mg/kg (2.6 mM) were considered low (L). Milk urea values before and after each AI were allocated into 4 classes representing the dynamics of milk urea (before-after; I-I, I-L, L-I, and L-L). Subclinical ketosis was defined using milk fat and protein contents before AI as proxies. A logistic regression with a Poisson correction and herd as a random variable was then performed on data from Holstein or all breeds of cows. The success of conception was decreased [relative risk (95% confidence interval) = 0.96 (0.94–0.99)] in low-urea cows compared with intermediate-urea cows after AI; no significant association was found for urea levels before AI. When combining data on urea before and after AI, I-L urea cows exhibited a 5 to 9% decrease in conception compared with I-I urea cows, and L-I urea cows showed no difference in conception success compared with I-I urea cows. A decreased conception success for L-L urea cows compared with I-I urea cows was observed for the analysis with cows of all breeds. This work revealed that a decrease in urea from intermediate (before AI) to low (after AI) is a risk factor for conception failure. Surveys of variation in milk urea in dairy cows close to breeding are highly recommended.



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Effect of dietary roughage level on chewing activity, ruminal pH, and saliva secretion in lactating Holstein cows

Publication date: Available online 16 February 2017
Source:Journal of Dairy Science
Author(s): F.G. Jiang, X.Y. Lin, Z.G. Yan, Z.Y. Hu, G.M. Liu, Y.D. Sun, X.W. Liu, Z.H. Wang
Increasing dietary roughage level is a commonly used strategy to prevent subacute ruminal acidosis. We hypothesized that high-roughage diets could promote chewing activity, saliva secretion, and hence more alkaline to buffer rumen pH. To verify the hypothesis, 12 multiparous Holstein cows in mid-lactation were randomly allocated to 4 treatments in a triplicated 4 × 4 Latin square experiment with one cow in each treatment surgically fitted with a ruminal cannula. Treatments were diets containing 40, 50, 60, or 70% of roughage on a DM basis. Increasing dietary roughage level decreased DM, CP, OM, starch, and NEL intake, increased ADF intake, and decreased milk yield linearly. Intake of NDF was quite stable across treatments and ranged from 7.8 to 8.1 kg/d per cow. Daily eating time increased linearly with increased roughage level. The increase in eating time was due to increased eating time per meal but not number of meals per day, which was stable and ranged from 8.3 to 8.5 meals per day across treatments. Increasing dietary roughage level had no effect on ruminating time (min/d), the number of ruminating periods (rumination periods per d), and chewing time per ruminating period (min/ruminating period). Ruminating time per kilogram of NDF intake and total chewing time per kilogram of ADF intake were similar across treatments (57.4 and 183.8 min/kg, respectively). Increasing dietary roughage level linearly increased daily total chewing time; linearly elevated the mean, maximum, and minimum ruminal pH; and linearly decreased total VFA concentration and molar proportion of propionate in ruminal fluid. Saliva secretion during eating was increased, the secretion during rumination was unaffected, but the secretion during resting tended to decrease with increased dietary roughage level. As a result, total saliva secretion was not affected by treatments. In conclusion, the results of the present study did not support the concept that high-roughage diets elevated ruminal pH through increased salivary recycling of buffering substrates.



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Acute and Subacute Presentations of Cerebral Edema following Deep Brain Stimulation Lead Implantation

Background/Aims: Postoperative cerebral edema around a deep brain stimulation (DBS) electrode is an uncommon reported complication. The goal of this study was to identify instances of postoperative edema based on clinical presentation, and to remark on their management. Methods: A retrospective chart review was performed on all patients who underwent DBS electrode implantation over a 3-year period. Routine CT imaging on postoperative day (POD) 1 was negative. Patients were identified based on clinical neurological changes, leading to imaging and subsequent diagnosis. Results: Five of 145 patients (3.4%) presented with new neurological symptoms from POD 1 to 14, which were confirmed by CT imaging to show perilead and/or subcortical edema around 6 of 281 electrodes (2.1%). Four of 5 patients had unilateral edema despite bilateral implantation. Clinical presentations varied widely. Two patients presenting on POD 1 with deteriorating conditions required longer inpatient stays with supportive measures than those presenting later (p = 0.0002). All patients were treated with corticosteroids and returned to baseline by 3 months after surgery. Conclusions: Acute instances of DBS lead edema may occur as early as POD 1 and can rapidly progress into profound deficits. Treatment with supportive care and corticosteroids is otherwise identical to those cases presenting later.
Stereotact Funct Neurosurg 2017;95:86-92

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Carbon dots based FRET for the detection of DNA damage

Publication date: 15 June 2017
Source:Biosensors and Bioelectronics, Volume 92
Author(s): Jiri Kudr, Lukas Richtera, Kledi Xhaxhiu, David Hynek, Zbynek Heger, Ondrej Zitka, Vojtech Adam
Here, we aimed our attention at the synthesis of carbon dots (C-dots) with the ability to interact with DNA to suggest an approach for the detection of DNA damage. Primarily, C-dots modified with amine moieties were synthesized using the one-step microwave pyrolysis of citric acid in the presence of diethylenetriamine. The C-dots showed strong photoluminescence with a quantum yield of 4%. In addition, the C-dots (2.8±0.8nm) possessed a good colloidal stability and exhibited a positive surface charge (ζ=36mV) at a neutral pH. An interaction study of the C-dots and the DNA fragment of λ bacteriophage was performed, and the DNA binding resulted in changes to the photoluminescent and absorption properties of the C-dots. A binding of the C-dots to DNA was also observed as a change to DNA electrophoretic mobility and a decreased ability to intercalate ethidium bromide (EtBr). Moreover, the Förster (or fluorescence) resonance energy transfer (FRET) between the C-dots and EtBr was studied, in which the C-dots serve as an excitation energy donor and the EtBr serves as an acceptor. When DNA was damaged using ultraviolet (UV) radiation (λ=254nm) and hydroxyl radicals, the intensity of the emitted photoluminescence at 612nm significantly decreased. The concept was proved on analysis of the genomic DNA from PC-3 cells and DNA isolated from melanoma tissues.

Graphical abstract

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Amino acid-mediated ‘turn-off/turn-on’ nanozyme activity of gold nanoclusters for sensitive and selective detection of copper ions and histidine

Publication date: 15 June 2017
Source:Biosensors and Bioelectronics, Volume 92
Author(s): Yan Liu, Ding Ding, Yuanlin Zhen, Rong Guo
Herein, we presented a facile strategy for highly sensitive and selective detection of both Cu²⁺ and histidine (His) by combining the peroxidase-like nanozyme activity of gold nanoclusters with amino acid's ambidentate nature. The peroxidase-like catalytic ability of histidine-Au nanoclusters (His-AuNCs) can be inhibited by the addition of Cu²⁺. The sensitivity of this probe to Cu²⁺ is significant with a linear range of 1–100nM, and a low detection limit of 0.1nM. More interestingly, His-AuNC/Cu²⁺ undergoes recovery of the activity upon exposure to free His, because His/Cu²⁺ complex is more stable due to the participation of the imidazole ring of His. The method displays a good selectivity toward histidine over all the other amino acids, with a wide linear relationship in the range of 20nM–2μM, and a low detection limit of 20nM. The feasibility of the probe for the rapid analysis of copper ion and His in human serum has been demonstrated with satisfactory results. With the merits of high sensitivity and selectivity, simplification, low cost, and visual readout with the naked eye, this novel 'turn-off/turn-on' sensing approach based on the amino acid's ambidentate nature is potentially applicable to metal ions, amino acids and peptides in biological and environmental areas.



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Visualizing BPA by molecularly imprinted ratiometric fluorescence sensor based on dual emission nanoparticles

Publication date: 15 June 2017
Source:Biosensors and Bioelectronics, Volume 92
Author(s): Hongzhi Lu, Shoufang Xu
Construction of ratiometric fluorescent probe often involved in tedious multistep preparation or complicated coupling or chemical modification process. The emergence of dual emission fluorescent nanoparticles would simplify the construction process and avoids the tedious chemical coupling. Herein, we reported a facile strategy to prepare ratiometric fluorescence molecularly imprinted sensor based on dual emission nanoparticles (d-NPs) which comprised of carbon dots and gold nanoclusters for detection of Bisphenol A (BPA). D-NPs emission at 460nm and 580nm were first prepared by seed growth co-microwave method using gold nanoparticles as seeds and glucose as precursor for carbon dots. When they were applied to propose ratiometric fluorescence molecularly imprinted sensor, the preparation process was simplified, and the sensitivity of sensor was improved with detection limit of 29nM, and visualizing BPA was feasible based on the distinguish fluorescence color change. The feasibility of the developed method in real samples was successfully evaluated through the analysis of BPA in water samples with satisfactory recoveries of 95.9–98.9% and recoveries ranging from 92.6% to 98.6% in canned food samples. When detection BPA in positive feeding bottles, the results agree well with those obtained by accredited method. The developed method proposed in this work to prepare ratiometric fluorescence molecularly imprinted sensor based on dual emission nanoparticles proved to be a convenient, reliable and practical way to prepared high sensitive and selective fluorescence sensors.



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An integrated dual functional recognition/amplification bio-label for the one-step impedimetric detection of Micro-RNA-21

Publication date: 15 June 2017
Source:Biosensors and Bioelectronics, Volume 92
Author(s): Sawsen Azzouzi, Wing Cheung Mak, Kamalodin Kor, Anthony P.F. Turner, Mounir Ben Ali, Valerio Beni
Alteration in expression of miRNAs has been correlated with different cancer types, tumour stage and response to treatments. In this context, a structurally responsive oligonucleotide-based electrochemical impedimetric biosensor has been developed for the simple and sensitive detection of miRNA-21. A highly specific biotinylated DNA/LNA molecular beacon (MB) probe was conjugated with gold nanoparticles (AuNPs) to create an integrated, dual function bio-label (biotin-MB-AuNPs) for both biorecognition and signal generation. In the presence of target miRNA-21, hybridisation takes place resulting in the "activation" of the biotin-MB; this event makes the biotin group, which was previously "protected" by the steric hindrance of the MB stem-loop structure, accessible. The activated biotin-MB-AuNPs/miRNA complexes become available for capture, via supramolecular interaction, onto a nentravidin-modified electrode for electrochemical transduction. The binding event results in a decrease of the charge transfer resistance at the working electrode/electrolyte interface. The biosensor responded linearly in the range 1–1000 pM of miRNA-21, with a limit of detection of 0.3 pM, good reproducibility (Relative Standard deviation (RSD) =3.3%) and high selectivity over other miRNAs (i.e. miRNA-221 and miRNA-205) sequences. Detection of miRNA-21 in spiked serum samples at clinically relevant levels (low pM range) was also demonstrated, thus illustrating the potential of the biosensor for point-of-care clinical applications. The proposed biosensor design, based on the combination of a neutravidin transducing surface and the dual-function biotin-MB-AuNPs bio-label, provides a simple and robust approach for detection of short-length nucleic acid targets, such as miRNAs.



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Rapid detection and quantification of Enterovirus 71 by a portable surface plasmon resonance biosensor

Publication date: 15 June 2017
Source:Biosensors and Bioelectronics, Volume 92
Author(s): Briliant Adhi Prabowo, Robert Y.L. Wang, Muhammad Khari Secario, Po-Ting Ou, Azharul Alom, Jia-Jung Liu, Kou-Chen Liu
This study presents the first report on a label-free detection and rapid quantification method for human enterovirus 71 (EV71) using a portable surface plasmon resonance (SPR) system. The SPR sensor instrument was configured to run on low power in a miniaturized platform to improve the device portability for a wider application both in laboratories and in the field. A color tunable organic light emitting diode in red spectrum was attached on a trapezoidal prism for the disposable light source module. The SPR signal processing using integration area under the reflectivity curve is applied for optimum signal to noise ratio (SNR) enhancement. The major capsid protein VP1 of EV71 was selected as the biomarker target in the detection study. The experimental time required for the EV71 quantification was reduced from 6 days using the conventional viral plaque assay to several minutes using the proposed method. The study results establish a detection limit of approximately 67 virus particles per milliliter (vp/ml) of EV71 in a Dulbecco's modified Eagle's medium. The VP1 detection in the portable SPR biosensor had a detection limit of approximately 4.8pg/ml in the PBS buffer. Therefore, the proposed direct EV71 viral particle quantification method can be rapidly performed in real time, with high sensitivity and less labor and without assays or fluorescence.



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Editorial Board

Publication date: 15 May 2017
Source:Biosensors and Bioelectronics, Volume 91





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Viremic attack explains the dual-hit theory of Parkinson’s disease

Publication date: Available online 16 February 2017
Source:Medical Hypotheses
Author(s): Isamu Mori
The dual-hit theory of Parkinson's disease proposes that an airborne pathogen attacks both the olfactory and enteric nervous systems to initiate the Lewy pathology, gradually leading to devastating neurodegenerative processes within the brain. Based on published literatures, this article proposes a hypothesis that viruses with viremic potential can simultaneously attack both of these nervous systems via viremia due to the lack of a blood–nerve barrier in these tissues, thereby explaining the dual-hit theory. Understanding the precise mechanisms underlying the neuropathology will facilitate development of better prophylactic and early intervention strategies against Parkinson's disease.



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Dying for Love: Perimenopausal Degeneration of Vaginal Microbiome Drives the Chronic Inflammation-Malignant Transformation of Benign Prostatic Hyperplasia to Prostatic Adenocarcinoma

Publication date: Available online 15 February 2017
Source:Medical Hypotheses
Author(s): Albert Stuart Reece
Prostatic carcinoma is the second commonest cancer in males and is so common as to become almost holoendemic with advancing age. The recent demonstration that far from being benign, "benign" prostatic hypertrophy is a likely a reaction of the prostate to chronic untreated lower genital tract infection, and that this chronic inflammation is likely the usual precursor to the frequent occurrence of prostatic carcinoma has far reaching implications. The obvious source for the chronic inflammatory stimulus in the prostate is the documented dramatically altered lower female genital microbiota associated with the menopause. Hence the major hypothesis is that prostatic cancer may arise due to chronic infection and inflammation in the prostate gland consequent upon the altered microbiome of the menopausal female genital tract. This has implications for testing and diagnosis, treatment, population health and personal hygiene practices. It suggests that male dyspareunia, although almost never encountered in clinical practice may in fact be relatively common in older males, and in particular if diagnosed, represents a critical opportunity for therapeutic intervention to interrupt the chronic inflammation - cancer transformation and progression which has been well documented in other tissues. It implies that the coordinated application of next generation sequencing to the microbiome of the lower genital tracts of male and female couples, including seminal fluid, will have both research applications to further explore this sequence, as well as finding application as a potential population level screening procedure as is presently done for the "Thin Prep" cervical screening for human papillomavirus in females. Moreover this insight opens up new opportunities for chemointervention and chemoprevention for this important clinicopathological progression. These considerations give rise to the exciting possibility that prostatic malignancy may be preventable by various methods of local hygiene in the female partner or some antibacterial method in males. Since the long term application of oral antibiotics is likely to be of limited efficacy this indicates the need for new antimicrobial solutions.



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Quantitation of lead-210 (210Pb) using lead-203 (203Pb) as a “Massless” yield tracer

Publication date: May 2017
Source:Journal of Environmental Radioactivity, Volume 171
Author(s): D. May, A.N. Nelson, M.K. Schultz
Determination of Pb-210 (²¹⁰Pb) in aqueous solution is a common radioanalytical challenge in environmental science. Widely used methods for undertaking these analyses (e.g., ASTM D7535) rely on the use of stable lead (Pb) as a yield tracer that takes into account losses of ²¹⁰Pb that inevitably occur during elemental/radiochemical separations of the procedures. Although effective, these methods introduce technical challenges that can be difficult to track and potentially introduce uncertainty that can be difficult to quantify. Examples of these challenges include interference from endogenous stable Pb in complex sample matrices; contamination of stable Pb carrier with ²¹⁰Pb; and high detection limits due to counting efficiency limitations. We hypothesized that many of these challenges could be avoided by the use of the electron-capture, gamma-emitting isotope, ²⁰³Pb as a chemical yield tracer in the analysis of ²¹⁰Pb.A series of experiments were performed to evaluate the efficacy of ²⁰³Pb as a tracer. Four different matrices were analyzed, including a complex matrix (hydraulic-fracturing produced fluids); and samples comprising less complicated matrices (i.e., river water, deionized water, and tap water). Separation techniques and counting methodologies were also compared and optimized. Due to a relatively short-half life (52 h), ²⁰³Pb tracer is effectively massless for the purposes of chemical separations, allowing for reduced chromatography column resin bed volumes. Because ²⁰³Pb is a gamma emitter (279 keV; 81% intensity), recovery can be determined non-destructively in a variety of matrices, including liquid scintillation cocktail. The use of liquid scintillation as a counting methodology allowed for determination of ²¹⁰Pb activities via ²¹⁰Pb or ²¹⁰Po; and recoveries of greater than 90% are routinely achievable using this approach. The improved method for the analysis of ²¹⁰Pb in aqueous matrices allows for the analysis of complex matrices, at reduced cost, while providing greater counting flexibility in achieving acceptable detections limits.

Graphical abstract

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Lipocalin-2: A Master Mediator of Intestinal and Metabolic Inflammation

Publication date: Available online 15 February 2017
Source:Trends in Endocrinology & Metabolism
Author(s): Alexander R. Moschen, Timon E. Adolph, Romana R. Gerner, Verena Wieser, Herbert Tilg
Lipocalin-2 (LCN2), also known as neutrophil gelatinase-associated lipocalin (NGAL), is released by various cell types and is an attractive biomarker of inflammation, ischemia, infection, and kidney damage. Both intestinal and metabolic inflammation, as observed in obesity and related disorders, are associated with increased LCN2 synthesis. While LCN2 in the intestinal tract regulates the composition of the gut microbiota and shows anti-inflammatory activities, it also exhibits proinflammatory activities in other experimental settings. In animal models of metabolic inflammation, type 2 diabetes mellitus (T2DM), or nonalcoholic steatohepatitis (NASH), increased LCN2 expression favors inflammation via the recruitment of inflammatory cells, such as neutrophils, and the induction of proinflammatory cytokines. A better understanding of this crucial marker of innate immunity might pave the way for targeting this pathway in future therapies.



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Natural extranuclear androgen receptor ligands as endocrine disruptors of cancer cell growth

Publication date: Available online 16 February 2017
Source:Molecular and Cellular Endocrinology
Author(s): Marilena Kampa, George Notas, Elias Castanas
Even though the term endocrine disruption primarily designates environmental chemicals that can interfere with the action of hormones, in recent years it has been extended to include also plant derived compounds that can reach the human body, naturally, or have been identified and studied as alternative pharmaceutical agents. In fact, for a large number of them, their antihormonal action was appreciated by different traditional herbal medicines. In the present review we report the majority of the plant derived compounds that exhibit an antiandrogenic effect and the known mechanisms of action. These include a disruption at testosterone production level and at the classical androgen receptor triggered pathways, including membrane initiated ones. Finally, for the first time we describe the possible involvement of alternative cell membrane androgen receptor systems and the lipid signaling disruption by natural androgen, providing hints about a novel class of therapeutic involvement of androgens.



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Thyroid stimulating hormone increases hepatic gluconeogenesis via CRTC2

Publication date: Available online 15 February 2017
Source:Molecular and Cellular Endocrinology
Author(s): Yujie Li, Laicheng Wang, Lingyan Zhou, Yongfeng Song, Shizhan Ma, Chunxiao Yu, Jiajun Zhao, Chao Xu, Ling Gao
Epidemiological evidence indicates that thyroid stimulating hormone (TSH) is positively correlated with abnormal glucose levels. We previously reported that TSH has direct effects on gluconeogenesis. However, the underlying molecular mechanism remains unclear. In this study, we observed increased fasting blood glucose and glucose production in a mouse model of subclinical hypothyroidism (only elevated TSH levels). TSH acts via the classical cAMP/PKA pathway and CRTC2 regulates glucose homeostasis. Thus, we explore whether CRTC2 is involved in the process of TSH-induced gluconeogenesis. We show that TSH increases CRTC2 expression via the TSHR/cAMP/PKA pathway, which in turn upregulates hepatic gluconeogenic genes. Furthermore, TSH stimulates CRTC2 dephosphorylation and upregulates p-CREB (Ser133) in HepG2 cells. Silencing CRTC2 and CREB decreases the effect of TSH on PEPCK-luciferase, the rate-limiting enzyme of gluconeogenesis. Finally, the deletion of TSHR reduces the levels of the CRTC2:CREB complex in mouse livers. This study demonstrates that TSH activates CRTC2 via the TSHR/cAMP/PKA pathway, leading to the formation of a CRTC2:CREB complex and increases hepatic gluconeogenesis.



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JAK/STAT pathway directed therapy of T-cell leukemia/lymphoma: Inspired by functional and structural genomics

Publication date: Available online 15 February 2017
Source:Molecular and Cellular Endocrinology
Author(s): Thomas A. Waldmann
Abnormal activation of the γc cytokine JAK/STAT signaling pathway assessed by STAT3 or STAT5b phosphorylation was present in a proportion of many T-cell malignancies. Activating mutations of STAT3/STAT5b and JAK1/3 were present in some but not in all cases with constitutive signaling pathway activation. Using shRNA analysis pSTAT malignant T-cell lines were addicted to JAKs/STATs whether they were mutated or not. Activating JAK/STAT mutations were not sufficient to support leukemic cell proliferation but only augmented upstream pathway signals. Functional cytokine receptors were required for pSTAT expression. Combining a JAK1/2 inhibitor with a Bcl-xL inhibitor navitoclax provided additive/synergistic activity with IL-2 dependent ATLL cell lines and in a mouse model of human IL-2 dependent ATLL. The insight that disorders of the γc/JAK/STAT system are pervasive suggests approaches including those that target gamma cytokines, their receptors or that use JAK kinase inhibitors may be of value in multicomponent therapy for T-cell malignancies.



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Hyperglycemia is associated with reduced testicular function and activin dysregulation in the Ins2Akita+/- mouse model of type 1 diabetes

Publication date: Available online 16 February 2017
Source:Molecular and Cellular Endocrinology
Author(s): Constanze C. Maresch, Dina C. Stute, Helen Ludlow, Hans-Peter Hammes, David M. de Kretser, Mark P. Hedger, Thomas Linn
Type 1 diabetes (T1D) is associated with subfertility in men. We hypothesised that this results from inhibitory effects of chronic hyperglycemia on testicular function and used the Ins2^{Akita ±} mouse model to investigate this. Diabetic mice exhibited progressive testicular dysfunction, with a 30% reduction in testis weight at 24 weeks of age. Diabetic mice showed significantly reduced seminiferous tubule diameters and increased spermatogenic disruption, although testes morphology appeared grossly normal. Unexpectedly, serum LH and intra-testicular testosterone were similar in all groups. Ins2^Akita+/- mice displayed elevation of the testicular inflammatory cytokines activin A and IL-6. Intratesticular activin B was downregulated, while the activin regulatory proteins, follistatin and inhibin, were unchanged. Activin signalling, measured by pSmad3 and Smad4 production, was enhanced in diabetic mice only. These results suggest that prolonged exposure to hyperglycemia in the Ins2^Akita+/- mice leads to progressive testicular disruption mediated by testicular activin activity, rather than hormonal dysregulation.



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Role of a p53 polymorphism in the development of nonfunctional pituitary adenomas

Publication date: Available online 16 February 2017
Source:Molecular and Cellular Endocrinology
Author(s): Garima Yagnik, Arman Jahangiri, Rebecca Chen, Jeffrey R. Wagner, Manish K. Aghi
Non-functional pituitary adenomas (NFPAs) are among the commonest intracranial neoplasms. While histologically benign, NFPAs sometimes become large enough to limit therapeutic options and reduce quality of life. Investigations of the molecular etiology of NFPAs have failed to identify prevalent genetic changes and, while a role for p53 has been suggested, TP53 gene alterations have yet to be described in NFPAs. We found that the polymorphism rs1042522:C > G in codon 72 of exon 4 of the TP53 gene, whose C variant produces a proline and is more common in most ethnicities, has a G variant producing an arginine in 79.8% of NFPAs (n = 42; p < 1.411 × 10⁻¹⁸ vs. 1000 Genomes database), causing patients to present a decade earlier with symptomatic NFPAs. In cultured NFPA cells, transfection with the rs1042522 G variant versus the C variant reduced expression of cell arrest gene p21 and increased proliferation. These findings suggest that this TP53 polymorphism influences NFPA growth.



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How action selection influences the sense of agency: An ERP study

Publication date: 15 April 2017
Source:NeuroImage, Volume 150
Author(s): Nura Sidarus, Matti Vuorre, Patrick Haggard
Sense of agency (SoA) refers to the feeling that we are in control of our actions and, through them, of events in the outside world. One influential view claims that the SoA depends on retrospectively matching the expected and actual outcomes of action. However, recent studies have revealed an additional, prospective component to SoA, driven by action selection processes. We used event-related potentials (ERPs) to clarify the neural mechanisms underlying prospective agency. Subliminal priming was used to manipulate the fluency of selecting a left or right hand action in response to a supraliminal target. These actions were followed by one of several coloured circles, after a variable delay. Participants then rated their degree of control over this visual outcome. Incompatible priming impaired action selection, and reduced sense of agency over action outcomes, relative to compatible priming. More negative ERPs immediately after the action, linked to post-decisional action monitoring, were associated with reduced agency ratings over action outcomes. Additionally, feedback-related negativity evoked by the outcome was also associated with reduced agency ratings. These ERP components may reflect brain processes underlying prospective and retrospective components of sense of agency respectively.



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A new generation of magnetoencephalography: Room temperature measurements using optically-pumped magnetometers

Publication date: 1 April 2017
Source:NeuroImage, Volume 149
Author(s): Elena Boto, Sofie S. Meyer, Vishal Shah, Orang Alem, Svenja Knappe, Peter Kruger, T. Mark Fromhold, Mark Lim, Paul M. Glover, Peter G. Morris, Richard Bowtell, Gareth R. Barnes, Matthew J. Brookes
Advances in the field of quantum sensing mean that magnetic field sensors, operating at room temperature, are now able to achieve sensitivity similar to that of cryogenically cooled devices (SQUIDs). This means that room temperature magnetoencephalography (MEG), with a greatly increased flexibility of sensor placement can now be considered. Further, these new sensors can be placed directly on the scalp surface giving, theoretically, a large increase in the magnitude of the measured signal. Here, we present recordings made using a single optically-pumped magnetometer (OPM) in combination with a 3D-printed head-cast designed to accurately locate and orient the sensor relative to brain anatomy. Since our OPM is configured as a magnetometer it is highly sensitive to environmental interference. However, we show that this problem can be ameliorated via the use of simultaneous reference sensor recordings. Using median nerve stimulation, we show that the OPM can detect both evoked (phase-locked) and induced (non-phase-locked oscillatory) changes when placed over sensory cortex, with signals ~4 times larger than equivalent SQUID measurements. Using source modelling, we show that our system allows localisation of the evoked response to somatosensory cortex. Further, source-space modelling shows that, with 13 sequential OPM measurements, source-space signal-to-noise ratio (SNR) is comparable to that from a 271-channel SQUID system. Our results highlight the opportunity presented by OPMs to generate uncooled, potentially low-cost, high SNR MEG systems.



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Patients hospitalized abroad as importers of multiresistant bacteria - a cross-sectional study.

Patients hospitalized abroad as importers of multiresistant bacteria - a cross-sectional study.

Clin Microbiol Infect. 2017 Feb 11;:

Authors: Khawaja T, Kirveskari J, Johansson S, Väisänen J, Djupsjöbacka A, Nevalainen A, Kantele A

Abstract
OBJECTIVES: The pandemic spread of multidrug-resistant (MDR) bacteria poses a threat to healthcare worldwide, with highest prevalence in indigent regions of the (sub)tropics. As hospitalization constitutes a major risk factor for colonization, infection control management in low-prevalence countries urgently needs background data on patients hospitalized abroad.
METHODS: We collected data on 1122 patients who, after hospitalization abroad, were treated at the Helsinki University Hospital between 2010 and 2013. They were screened for methicillin resistant Staphylococcus aureus (MRSA), extended-spectrum betalactamase-producing Enterobacteriaceae (ESBL-PE), vancomycin-resistant Enterococci (VRE), carbapenemase-producing Enterobacteriaceae (CPE), multiresistant Pseudomonas aeruginosa (MRPA), and multiresistant Acinetobacter baumannii (MRAB). Risk factors for colonization were explored by multivariate analysis.
RESULTS: MDR colonization rates were higher for those hospitalized in the (sub)tropics (55%; 208/377)) compared to temperate zones (17%; 125/745). For ESBL-PE the percentages were 50 (190/377) versus 12 (92/745), CPE 3.2 (12/377) versus 0.4 (3/745), and MRSA 6.6 (25/377) versus 2.4 (18/745). Colonization rates proved highest in those returning from South Asia (77.6%; 38/49), followed by those having visited Latin America (60%; 9/16), Africa (60%; 15/25) and East and Southeast Asia (52.5%; 94/179). Destination, interhospital transfer, short time interval to hospitalization, young age, surgical intervention, residence abroad, visiting friends and relatives, and antimicrobial use proved independent risk factors for colonization.
CONCLUSIONS: Post-hospitalization colonization rates proved higher in the (sub)tropics than elsewhere; 11% (38/333) of carriers developed an MDR infection. We identified several independent risk factors for contracting MDR bacteria. The data provides a basis for infection control guidelines in low-prevalence countries.

PMID: 28196696 [PubMed - as supplied by publisher]

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Editorial Board

Publication date: March–April 2017
Source:Brain Stimulation, Volume 10, Issue 2





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Table of Contents

Publication date: March–April 2017
Source:Brain Stimulation, Volume 10, Issue 2





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Decision making and emotional processing following Theta Burst Transcranial Magnetic Stimulation on medial prefrontal cortex.

Publication date: March–April 2017
Source:Brain Stimulation, Volume 10, Issue 2
Author(s): K. Konikkou, N. Konstantinou, K. Fanti




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Associations between clinical outcome and navigated TMS characteristics in patients with motor-eloquent brain lesions: a combined nTMS –fiber tracking approach

Publication date: March–April 2017
Source:Brain Stimulation, Volume 10, Issue 2
Author(s): N. Sollmann, N. Wildschutz, T. Boeckh-Behrens, B. Meyer, S.M. Krieg




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Information for Authors

Publication date: March–April 2017
Source:Brain Stimulation, Volume 10, Issue 2





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Gait disturbance is correlated with central cholinergic dysfunction in patients with early Parkinson's disease

Publication date: March–April 2017
Source:Brain Stimulation, Volume 10, Issue 2
Author(s): E.S. Oh, Y.G. Lim, J.Y. Ham, A.Y. Lee




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2nd International Brain Stimulation Conference

Publication date: March–April 2017
Source:Brain Stimulation, Volume 10, Issue 2





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Biomarkers of behavioral and motor control in children: Tourette Syndrome, ADHD, ASD, and neuropharmacology

Publication date: March–April 2017
Source:Brain Stimulation, Volume 10, Issue 2
Author(s): D.L. Gilbert




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Masthead

Publication date: March–April 2017
Source:Brain Stimulation, Volume 10, Issue 2





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Transcranial magnetic stimulation biomarkers in adolescent depression

Publication date: March–April 2017
Source:Brain Stimulation, Volume 10, Issue 2
Author(s): P.E. Croarkin, C. Lewis, J. Vande Voort, J. Kohli, J. Lee, Z.J. Daskalakis




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Frontal and temporal cortical functional recovery after electroconvulsive therapy for depression: A longitudinal functional near-infrared spectroscopy study

Publication date: March–April 2017
Source:Brain Stimulation, Volume 10, Issue 2
Author(s): J. Hirano, A. Takamiya, B. Yamagata, S. Hotta, Y. Miyasaka, S. Pu, A. Iwanami, H. Uchida, M. Mimura




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Non-invasive neuromodulation trials in children: Lessons from perinatal stroke

Publication date: March–April 2017
Source:Brain Stimulation, Volume 10, Issue 2
Author(s): A. Kirton




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Repetitive brain stimulation induces long-term plasticity across patient populations and spatial scales

Publication date: March–April 2017
Source:Brain Stimulation, Volume 10, Issue 2
Author(s): Corey J. Keller, Wei Wu, Rachael Wright, Naho Ichikawa, Julia Huemer, Melinda Wong, Andrew Yee, Lisa McTeague, Maria Fini, Victor Du, Ashesh Mehta, Amit Etkin




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Executive attention enhancement under stress: A TDCS randomized controlled trial

Publication date: March–April 2017
Source:Brain Stimulation, Volume 10, Issue 2
Author(s): Y. Ankri, O. Meiron, Y. Braw




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Diagnostic transcranial magnetic stimulation in children with acute inflammatory demyelinating polyneuropathy

Publication date: March–April 2017
Source:Brain Stimulation, Volume 10, Issue 2
Author(s): V.B. Voitenkov, N.V. Skripchenko, A.V. Klimkin




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Cathodal transcranial direct current stimulation could restore MPTP induced neurotoxicity in mice through autophagy modulation

Publication date: March–April 2017
Source:Brain Stimulation, Volume 10, Issue 2
Author(s): W. Jang




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Non-invasive brain stimulation in children with autism spectrum disorder

Publication date: March–April 2017
Source:Brain Stimulation, Volume 10, Issue 2
Author(s): L. Gómez, B. Vidal, M. Denis, T. Marín, C. Maragoto, H. Vera, M. Serguera, L. Morales, M. Báez, A. Sánchez




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Clinical factors affecting the resting motor threshold in preoperative navigated TMS motor mapping

Publication date: March–April 2017
Source:Brain Stimulation, Volume 10, Issue 2
Author(s): N. Sollmann, N. Tanigawa, L. Bulubas, F. Ringel, B. Meyer, S.M. Krieg




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Effect of deep brain stimulation of the amygdala on post-traumatic stress disorder syndrome-induced by contextual fear conditioning in rat: Role of c-Fos protein and corticosterone hormone

Publication date: March–April 2017
Source:Brain Stimulation, Volume 10, Issue 2
Author(s): M. Mokhtari Hashtjin, G. Pirzad Jahromi, S.S. Sadr, M. Tat, D. Javidnazar, N. Fakhraei, S. Asalgoo




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Therapeutic brain stimulation and biomarker development in adolescent depression

Publication date: March–April 2017
Source:Brain Stimulation, Volume 10, Issue 2
Author(s): P.E. Croarkin




http://ift.tt/2kN2sZZ

Adaptive Independent Vector Analysis for Multi-Subject Complex-Valued fMRI Data

Publication date: Available online 16 February 2017
Source:Journal of Neuroscience Methods
Author(s): Li-Dan Kuang, Qiu-Hua Lin, Xiao-Feng Gong, Fengyu Cong, Vince D. Calhoun
BackgroundComplex-valued fMRI data can provide additional insights beyond magnitude-only data. However, independent vector analysis (IVA), which has exhibited great potential for group analysis of magnitude-only fMRI data, has rarely been applied to complex-valued fMRI data. The main challenges in this application include the extremely noisy nature and large variability of the source component vector (SCV) distribution.New MethodTo address these challenges, we propose an adaptive fixed-point IVA algorithm for analyzing multiple-subject complex-valued fMRI data. We exploited a multivariate generalized Gaussian distribution (MGGD)- based nonlinear function to match varying SCV distributions in which the MGGD shape parameter was estimated using maximum likelihood estimation. To achieve our de-noising goal, we updated the MGGD-based nonlinearity in the dominant SCV subspace, and employed a post-IVA de-noising strategy based on phase information in the IVA estimates. We also incorporated the pseudo-covariance matrix of fMRI data into the algorithm to emphasize the noncircularity of complex-valued fMRI sources.Resultsfrom simulated and experimental fMRI data demonstrated the efficacy of our method.Comparison with Existing Method(s) Our approach exhibited significant improvements over typical complex-valued IVA algorithms, especially during higher noise levels and larger spatial and temporal changes. As expected, the proposed complex-valued IVA algorithm detected more contiguous and reasonable activations than the magnitude-only method for task-related (393%) and default mode (301%) spatial maps.ConclusionsThe proposed approach is suitable for decomposing multi-subject complex-valued fMRI data, and has great potential for capturing additional subject variability.



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Contents

Publication date: April 2017
Source:Magnetic Resonance Imaging, Volume 37





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Comparison of BOLD, diffusion-weighted fMRI and ADC-fMRI for stimulation of the primary visual system with a block paradigm

Publication date: June 2017
Source:Magnetic Resonance Imaging, Volume 39
Author(s): R Nicolas, H Gros-Dagnac, F Aubry, P Celsis
The blood oxygen level-dependent (BOLD) effect is extensively used for functional MRI (fMRI) but presents some limitations. Diffusion-weighted fMRI (DfMRI) has been proposed as a method more tightly linked to neuronal activity. This work proposes a protocol of DfMRI acquired for several b-values and diffusion directions that is compared to gradient-echo BOLD (GE-BOLD) and to repeated spin-echo BOLD (SE-BOLD, acquisitions performed with b=0s/mm²), which was also used to ensure the reproducibility of the response.A block stimulation paradigm of the primary visual system (V1) was performed in 12 healthy subjects with checkerboard alternations (2Hz frequency). DfMRI was performed at 3T with 5 b-values (b=1500, 1000, 500, 250, 0s/mm²) with TR/TE=1004/93ms, Δ/δ=45.4ms/30ms, and 6 spatial directions for diffusion measures. GE-BOLD was performed with a similar block stimulation design timing. Apparent Diffusion Coefficient (ADC)-fMRI was computed with all b-values used. An identical Z-score level was used for all fMRI modalities for the comparison of volumes of activation. ADC-fMRI and SE-BOLD fMRI activation locations were compared in a voxel-based analysis to a cytoarchitectural probability map of V1.SE-BOLD activation volumes represented only 55% of the GE-BOLD activation volumes (P<0.0001). DfMRI activation volumes averaged for all b-values acquired represented only 12% of GE-BOLD (P<0.0001) and only 22% of SE-BOLD activation volumes (P<0.005). Compared to SE-BOLD-fMRI, ADC-fMRI activations showed fewer pixels outside of V1 and a higher average probability of belonging to V1.DfMRI and ADC-fMRI acquisition at 3T could be easily post-processed with common neuro-imaging software. DfMRI and ADC-fMRI activation volumes were significantly smaller than those obtained with SE-BOLD. ADC-fMRI activations were more precisely localized in V1 than those of SE-BOLD-fMRI. This validated the increased capability of ADC-fMRI compared to BOLD to enhance the precision of localizing an fMRI activation in the cyto-architectural zone V1, thereby justifying the use of ADC-fMRI for neuro-scientific studies.



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Editorial Board

Publication date: April 2017
Source:Magnetic Resonance Imaging, Volume 37





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Editorial Board

Publication date: February 2017
Source:Current Opinion in Neurobiology, Volume 42





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Contents page

Publication date: February 2017
Source:Current Opinion in Neurobiology, Volume 42





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Repair of Oxidatively Induced DNA Damage by DNA Glycosylases: Mechanisms of Action, Substrate Specificities and Excision Kinetics

Publication date: Available online 16 February 2017
Source:Mutation Research/Reviews in Mutation Research
Author(s): Miral Dizdaroglu, Erdem Coskun, Pawel Jaruga
Endogenous and exogenous reactive species cause oxidatively induced DNA damage in living organisms by a variety of mechanisms. As a result, a plethora of mutagenic and/or cytotoxic products are formed in cellular DNA. This type of DNA damage is repaired by base excision repair, although nucleotide excision repair also plays a limited role. DNA glycosylases remove modified DNA bases from DNA by hydrolyzing the glycosidic bond leaving behind an apurinic/apyrimidinic (AP) site. Some of them also possess an accompanying AP-lyase activity that cleaves the sugar-phosphate chain of DNA. Since the first discovery of a DNA glycosylase, many studies have elucidated the mechanisms of action, substrate specificities and excision kinetics of these enzymes present in all living organisms. For this purpose, most studies used single- or double-stranded oligodeoxynucleotides with a single DNA lesion embedded at a defined position. High-molecular weight DNA with multiple base lesions has been used in other studies with the advantage of the simultaneous investigation of many DNA base lesions as substrates. Differences between the substrate specificities and excision kinetics of DNA glycosylases have been found when these two different substrates were used. Some DNA glycosylases possess varying substrate specificities for either purine-derived lesions or pyrimidine-derived lesions, whereas others exhibit cross-activity for both types of lesions. Laboratory animals with knockouts of the genes of DNA glycosylases have also been used to provide unequivocal evidence for the substrates, which had previously been found in in vitro studies, to be the actual substrates in vivo as well. On the basis on the knowledge gained from the past studies, efforts are being made to discover small molecule inhibitors of DNA glycosylases that may be used as potential drugs in cancer therapy.



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Intraoperative tranexamic acid use in major spine surgery in adults: a multicentre, randomized, placebo-controlled trial †

<span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>Background.</strong> Perioperative tranexamic acid (TXA) use can reduce bleeding and transfusion requirements in several types of surgery, but level I evidence proving its effectiveness in major spine surgery is lacking. This study was designed to investigate the hypothesis that TXA reduces perioperative blood loss and transfusion requirements in patients undergoing major spine procedures.<strong>Methods.</strong> We conducted a multicentre, prospective, randomized double-blind clinical trial, comparing TXA with placebo in posterior instrumented spine surgery. Efficacy was determined based on the total number of blood units transfused and the perioperative blood loss. Other variables such as the characteristics of surgery, length of hospital stay, and complications were also analysed.<strong>Results.</strong> Ninety-five patients undergoing posterior instrumented spine surgery (fusion of >3 segments) were enrolled and randomized: 44 received TXA (TXA group) and 51 received placebo (controls). The groups were comparable for duration of surgery, number of levels fused, and length of hospitalization. Transfusion was not required in 48% of subjects receiving TXA compared with 33% of controls (<span style="font-style:italic;">P</span> = 0.05). Mean number of blood units transfused was 0.85 in the TXA group and 1.42 with placebo (<span style="font-style:italic;">P</span> = 0.06). TXA resulted in a significant decrease in intraoperative bleeding (<span style="font-style:italic;">P</span> = 0.01) and total bleeding (<span style="font-style:italic;">P</span> = 0.01) relative to placebo. The incidence of adverse events was similar in the two groups.<strong>Conclusions.</strong> TXA did not significantly reduce transfusion requirements, but significantly reduced perioperative blood loss in adults undergoing major spinal surgery.<strong>Clinical trial registration.</strong> NCT01136590.</span>

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Videolaryngoscopy and the search for the Holy Grail

<span class="paragraphSection">Editor—Kleine-Brueggeney and colleagues<a href="#aex022-B1" class="reflinks">¹</a> compared the performance of six videolaryngoscopes (VLs) in 720 patients in a methodologically excellent multicentre study. The context for a difficult airway was simulated by application of a cervical collar, and the results, with all limitations underlined by the authors, raise serious doubts about our (maybe abused) trust in VLs for difficult airways. The most important finding, in our opinion, is that VLs do fail; the success rate was 98% after some data exclusion, while the total success range was 37–98%. Including all VLs, the view was excellent in only 60% of patients, and the time for intubation ranged from 47 to 93 s, including the 'I can see but I can't intubate' scenario. Injury to soft tissue and bleeding occurred in 5–36% of the patients.</span>

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Drugs in Anaesthesia and Intensive Care . E. Scarth and S. Smith (editors). 5th Edn.

<span class="paragraphSection"><span style="font-style:italic;">Drugs in Anaesthesia and Intensive Care</span>. ScarthE. and SmithS. (editors). 5th Edn. Published by Oxford University Press. Pp. 427. Price $59.95. ISBN 978-0-19-876881-4</span>

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Front-of-neck access: a practical viewpoint, from experience

<span class="paragraphSection">Editor—The cogent editorial by Timmermann and colleagues<a href="#aex017-B1" class="reflinks">¹</a> deeply resonated with me. As an anaesthetic core trainee, I was called upon to obtain front-of-neck access in an emergency, using a scalpel and Mini-Trach kit (Portex, Smiths Medical, USA). The scenario was a cardiac arrest attributable to anaphylaxis and upper airway obstruction in the Emergency Department of a District General Hospital. Despite receiving excellent airway teaching and previous practice in simulation, I was psychologically unprepared for the practicalities. With no surgical training, it was unlike any task that I had previously performed, and I had no confidence in performing it proficiently. I was surprised by the bleeding, which inevitably occurred, and when the procedure proved to be difficult, I had no real-life experience with which to troubleshoot.</span>

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25 years: looking back to going forward

<span class="paragraphSection">2017 is a momentous year for the Royal College of Anaesthetists (RCoA) as we celebrate the 25^th Anniversary of receiving our Royal Charter. The past quarter of a century has seen anaesthesia make tremendous advances, many of which were first documented in the pages of the British Journal of Anaesthesia (BJA). Interacting with more than two-thirds of hospital in-patients,<a href="#aex027-B1" class="reflinks">¹</a> anaesthesia is now the UK's largest single secondary care speciality supported by a College, that has quadrupled in size with growing political influence to match. Anaesthetists are vital to the delivery of safe, high quality patient care and we know from a recent survey that our efforts are highly valued by patients.<a href="#aex027-B2" class="reflinks">²</a></span>

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Primary blast lung injury - a review

<span class="paragraphSection"><div class="boxTitle">Abstract</div>Bomb or explosion-blast injuries are likely to be increasingly encountered as terrorist activity increases and pre-hospital medical care improves. We therefore reviewed the epidemiology, pathophysiology and treatment of primary blast lung injury.In addition to contemporary military publications and expert recommendation, an EMBASE and MEDLINE search of English speaking journals was undertaken using the medical subject headings (MeSHs) 'blast injury' and 'lung injury'. Review articles, retrospective case series, and controlled animal modelling studies published since 2000 were evaluated.6-11% of military casualties in recent conflicts have suffered primary blast lung injury but the incidence increases to more than 90% in terrorist attacks occurring in enclosed spaces such as trains. The majority of victims require mechanical ventilation and intensive care management. Specific therapies do not exist and treatment is supportive utilizing current best practice.Understanding the consequences and supportive therapies available to treat primary blast lung injury are important for anaesthetists.</span>

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Stranger danger—mortality after transfusions

<span class="paragraphSection">In the 1960s and 1970s hepatitis as a result of blood transfusion was relatively common, but at a recent talk on recent advances in the treatment of hepatitis I was surprised to learn just how high the mortality was after blood transfusion during this time period. In the USA an epidemiological study reported that 6% of nearly 30,000 patients with viral hepatitis had received one or more transfusions of blood or blood product within two weeks to six months before the onset of symptoms and the mortality in these patients was around 10%.<a href="#aew405-B1" class="reflinks">¹</a> In the yrs to come there were also new and emerging viruses and prions to add to the problem. On searching the more recent literature however, there are many reports which still highlight higher mortality in patients who have had blood transfusions. Two immediate questions spring to mind: 1. Are there problems associated with the transfusion itself or 2. Does the original need for a transfusion result in increased mortality?</span>

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SponTaneous Respiration using IntraVEnous anaesthesia and Hi-flow nasal oxygen (STRIVE Hi) maintains oxygenation and airway patency during management of the obstructed airway: an observational study

<span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>Background.</strong> High-flow nasal oxygen (HFNO) has been shown to benefit oxygenation, ventilation and upper airway patency in a range of clinical scenarios, however its use in spontaneously breathing patients during general anaesthesia has not been described. Spontaneous respiration using i.v. anaesthesia is the primary technique used at our institution for tubeless airway surgery. We hypothesized that the addition of HFNO would increase our margin of safety, particularly during management of an obstructed airway.<strong>Methods.</strong> A retrospective observational study was conducted using a SponTaneous Respiration using IntraVEnous anaesthesia and High-flow nasal oxygen (STRIVE Hi) technique to manage 30 adult patients undergoing elective laryngotracheal surgery.<strong>Results.</strong> Twenty-six patients (87%) presented with significant airway and/or respiratory compromise (16 were stridulous, 10 were dyspnoeic). No episodes of apnoea or complete airway obstruction occurred during the induction of anaesthesia using STRIVE Hi. The median [IQR (range)] lowest oxygen saturation during the induction period was 100 [99–100 (97–100)] %. The median [IQR (range)] overall duration of spontaneous ventilation was 44 [40–49.5 (18–100)] min. The median [IQR (range)] end-tidal carbon dioxide (ETCO₂) level at the end of the spontaneous ventilation period was 6.8 [6.4–7.1 (4.8–8.9)] kPa. The mean rate of increase in ETCO₂ was 0.03 kPa min⁻¹.<strong>Conclusions.</strong> STRIVE Hi succeeded in preserving adequate oxygen saturation, end-tidal carbon dioxide and airway patency. We suggest that the upper and lower airway benefits attributed to HFNO, are ideally suited to a spontaneous respiration induction, increasing its margin of safety. STRIVE Hi is a modern alternative to the traditional inhalation induction.</span>

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Facing acute hypoxia: from the mountains to critical care medicine

<span class="paragraphSection">It was not until 1978 that, after many unsuccessful attempts, the summit of Mount Everest (8850 m) was reached by climbers breathing only ambient air. This challenge was first accomplished by Peter Habeler and Reinhold Messner. Their intriguing success renewed interest in high-altitude physiology and medicine, especially because in the preceding 60 yr a number of physiologists and high-altitude climbers had predicted that it would never be possible to conquer this peak without the aid of supplemental oxygen. This view was based on the assumption that the inspired oxygen partial pressure (PO2) of ∼43 mm Hg<a href="#aew407-B1" class="reflinks">¹</a> at the summit of Mount Everest was at, or even below, the limit of human tolerance to hypoxia at rest, leaving no oxygen available for physical work.</span>

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Videolaryngoscopy: the more I practise, the luckier I get

<span class="paragraphSection">Editor—We would like to comment on two recent manuscripts that compared the performance of videolaryngoscopes in manikins and simulated difficult laryngoscopy in patients.<a href="#aex019-B1" class="reflinks">¹</a><a href="#aex019-B2" class="reflinks">²</a> Both manuscripts provided useful steps in our understanding of the variability of intubation performance using videolaryngoscopes. Ultimately, they suggested that differences in performance between devices relate to their design, the nature of the airway difficulty, or indeed, the type of user. Anaesthetists quite rightly consider themselves expert in all matters airway. However, as a result we believe there is an unsupported assumption that somehow expertise in Macintosh laryngoscopy equates to similar levels of performance with novel laryngoscopes. Indeed, Kleine-Brueggeney and colleagues<a href="#aex019-B1" class="reflinks">¹</a> allowed their group of airway experts to self-assess their competence with videolaryngoscopes before study commencement. However, it is known that self-assessment of performance is subject to many confounders and is unreliable.<a href="#aex019-B3" class="reflinks">³</a> Therefore, we believe that a major consideration in device performance is the current expertise of the user and the efficacy of any teaching intervention on skill acquisition. If we consider the two studies in question, the recruits had little opportunity to learn and practise with videolaryngoscopes, which they had seldom if ever used, thus maintaining an expertise gap. It is unsurprising then, that airway experts performed best with non-channelled, Macintosh-like videolaryngoscopes.<a href="#aex019-B1" class="reflinks">¹</a></span>

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Medical research and the ethics of medical treatments: disability-free survival

<span class="paragraphSection">Interest in relevant patient-centred outcomes, instead of surrogate outcomes, continues to increase, and for good reason. An example in the setting of anaesthesia and intensive care is that therapeutic measures that improve oxygenation in the setting of acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) ("blood gas cosmetics"), do not translate into improved survival as might be expected. Other measures (e.g. ICU mortality or even 30-day post-ICU discharge survival) do not really reflect what many medical staff and laypeople believe represents valid outcome parameters. Using surrogate end-points or mortality rates can also lead to spurious results when it comes to clinical research.</span>

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Erector spinae plane block for pain relief in rib fractures

<span class="paragraphSection">Editor—We report a case of successful erector spinae plane (ESP) block using a continuous catheter technique for pain relief in a patient with multiple unilateral rib fractures.</span>

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Remote ischaemic preconditioning: an intervention for anaesthetists?

<span class="paragraphSection">The great tragedy of science<span style="font-style:italic;">—</span>the slaying of a beautiful hypothesis by an ugly fact.Thomas Huxley</span>

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When fasted is not empty: a retrospective cohort study of gastric content in fasted surgical patients †

<span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>Background.</strong> Perioperative aspiration leads to significant morbidity and mortality. Point-of-care gastric ultrasound is an emerging tool to assess gastric content at the bedside.<strong>Methods.</strong> We performed a retrospective cohort study of baseline gastric content on fasted elective surgical patients. The primary outcome was the incidence of full stomach (solid content or >1.5 ml kg⁻¹ of clear fluid). Secondary outcomes included: gastric volume distribution (entire cohort, each antral grade); the association between gastric fullness, fasting intervals, and co-morbidities; anaesthetic management changes and incidence of aspiration.<strong>Results.</strong> We identified 538 patients. Thirty-two patients (6.2%) presented with a full stomach. Nine of these (1.7%) had solid content and 23 (4.5%) had clear fluid >1.5 ml kg⁻¹. An empty stomach was documented in 480 (89.8%) patients. The examination was inconclusive in the remaining 20 patients (5.0%). As expected, increasing antral grade was correlated with larger antral cross-sectional area and higher gastric volume (<span style="font-style:italic;">P</span><0.001). Of the 32 patients with a full stomach, only six had a documented risk factor for prolonged gastric emptying. The anaesthetic management was changed in all nine patients with solid content. No aspiration was reported.<strong>Conclusions.</strong> This retrospective cohort study suggests that a small proportion of elective surgical patients may present with a full stomach despite the recommended duration of fasting. Further research is needed to establish the clinical implications of these findings in the elective setting. At present, the clinical role of gastric ultrasound continues to be for the evaluation of gastric contents to guide management when the risk of aspiration is uncertain or unknown.</span>

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Think drink! Current fasting guidelines are outdated

<span class="paragraphSection">Ever since the formative work of Curtis Mendelson<a href="#aew450-B1" class="reflinks">¹</a> in peripartum women, the need for preoperative fasting has been propagated to help to minimize the risk of pulmonary aspiration of gastric content during anaesthesia. That early work described the catastrophic consequences of particulate matter aspiration but also reported all those who aspirated non-particulate matter (40 patients out of 44 016) survived. This is notable considering the lack of sophisticated postoperative monitoring and care more than seven decades ago. Fasting guidelines and recommendations have been produced as a consequence of this early work, with the majority advocating a 6 h fast for solids, 4 h for breast milk, and 2 h for clear fluids for elective surgery in both adults and children,<a href="#aew450-B2" class="reflinks">²</a> <a href="#aew450-B3" class="reflinks">³</a> the so-called 6–4–2 rule. Uncertainty remains for trauma patients, whereas obstetric patients are considered to have a full stomach.</span>

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Ultrasound-guided lumbar plexus block in volunteers; a randomized controlled trial

<span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>Background.</strong> The currently best-established ultrasound-guided lumbar plexus block (LPB) techniques use a paravertebral location of the probe, such as the lumbar ultrasound trident (LUT). However, paravertebral ultrasound scanning can provide inadequate sonographic visibility of the lumbar plexus in some patients. The ultrasound-guided shamrock LPB technique allows real-time sonographic viewing of the lumbar plexus, various anatomical landmarks, advancement of the needle, and spread of local anaesthetic injectate in most patients. We aimed to compare block procedure outcomes, effectiveness, and safety of the shamrock <span style="font-style:italic;">vs</span> LUT.<strong>Methods.</strong> Twenty healthy men underwent ultrasound-guided shamrock and LUT LPBs (2% lidocaine–adrenaline 20 ml, with 1 ml diluted contrast added) in a blinded randomized crossover study. The primary outcome was block procedure time. Secondary outcomes were procedural discomfort, number of needle insertions, injectate spread assessed with magnetic resonance imaging, sensorimotor effects, and lidocaine pharmacokinetics.<strong>Results.</strong> The shamrock LPB procedure was faster than LUT (238 [<span style="text-transform:lowercase;font-variant:small-caps;">sd</span> 74] <span style="font-style:italic;">vs</span> 334 [156] s; <span style="font-style:italic;">P</span>=0.009), more comfortable {numeric rating scale 0–10: 3 [interquartile range (IQR) 2–4] <span style="font-style:italic;">vs</span> 4 [3–6]; <span style="font-style:italic;">P</span>=0.03}, and required fewer needle insertions (2 [IQR 1–3] <span style="font-style:italic;">vs</span> 6 [2–12]; <span style="font-style:italic;">P</span>=0.003). Perineural injectate spread seen with magnetic resonance imaging was similar between the groups and consistent with motor and sensory mapping. Zero/20 (0%) and 1/19 (5%) subjects had epidural spread after shamrock and LUT (<span style="font-style:italic;">P</span>=1.00), respectively. The lidocaine pharmacokinetics were similar between the groups.<strong>Conclusions.</strong> Shamrock was faster, more comfortable, and equally effective compared with LUT.<strong>Clinical trial registration.</strong> NCT02255591.</span>

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Tranexamic acid: still far to go

<span class="paragraphSection">Tranexamic acid (TXA), a synthetic lysine analogue, is a potent antifibrinolytic agent that inhibits both plasminogen and plasmin. Tranexamic acid gained worldwide recognition in the 2010 Clinical Randomization of an Antifibrinolytic in Significant Hemorrhage (CRASH- 2) trial, a multinational randomized placebo-controlled trial of TXA in adult trauma patients with significant bleeding.<a href="#aew470-B1" class="reflinks">¹</a> TXA significantly reduced the risk of death as a result of bleeding by about a sixth and reduced the risk of all cause mortality by about a tenth. In 2011, TXA was recommended by the World Health Organization as an essential medicine for the treatment of acute bleeding in patients with trauma, cardiopulmonary bypass or postpartum haemorrhage.<a href="#aew470-B2" class="reflinks">²</a> The 2013 European guidelines recommended TXA in the prophylactic treatment of bleeding in major surgery to reduce perioperative blood loss and allogeneic blood transfusion.<a href="#aew470-B3" class="reflinks">³</a> The 2015 ASAs practice guidelines for perioperative blood management recommended consideration of TXA in surgical patients with excessive bleeding.<a href="#aew470-B4" class="reflinks">⁴</a> Tranexamic acid has consistently been shown to play an important role in blood conservation and to reduce perioperative blood loss in various settings, from trauma to cardiac, orthopaedic, neurological, craniofacial, obstetrical and gynaecological surgery.<a href="#aew470-B5" class="reflinks">⁵</a></span>

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In the March BJA …

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Meta-analyses of Bland–Altman-style cardiac output validation studies: good, but do they provide answers to all our questions?

<span class="paragraphSection">No one would deny the need for safe, reliable, and non-invasive cardiac output (CO) monitoring in anaesthesia and acute medicine. Measuring CO, or better still stroke volume (SV), adds a further dimension to haemodynamic monitoring as it completes the circulatory equation BP=CO×PR, where BP is blood pressure, PR is peripheral resistance, CO=SV×HR, and HR is heart rate. Clinical use of the pulmonary artery thermodilution catheter has been in decline since the 1990s,<a href="#aew442-B1" class="reflinks">¹</a> and newer, less invasive technologies have been developed that still need clinical evaluation.<a href="#aew442-B2" class="reflinks">²</a> Since its first description in 1986, the Bland–Altman method of determining accuracy and precision against a reference method, such as thermodilution, has become the gold standard in validation statistics.<a href="#aew442-B3" class="reflinks">³</a> In this month's edition of the Journal, one finds a 'state-of-the-art' systematic review and meta-analysis by Joosten and colleagues<a href="#aew442-B4" class="reflinks">⁴</a> that focuses on totally non-invasive and continuous CO monitoring technology and analyses published data extracted from Bland–Altman-style CO validation studies. It is one of a number of recent reviews published by this group that uses 'state-of-the-art' literature searches, paper selection, and statistical analysis technics to determine the overall accuracy and precision of the monitoring methods they review.<a href="#aew442-B5" class="reflinks">^5–7</a></span>

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When are ‘human factors’ not ‘human factors’ in can't intubate can't oxygenate scenarios? When they are ‘human’ factors

<span class="paragraphSection">Editor—Timmermann and colleagues<a href="#aex018-B1" class="reflinks">¹</a> raise valid concerns about the recommendation by the Difficult Airway Society (DAS) to use a scalpel cricothyroidotomy as the sole technique in a can't intubate can't oxygenate (CICO) scenario.<a href="#aex018-B2" class="reflinks">²</a> However, their argument falls short on a number of levels. First, although the Fourth National Audit Project (NAP4) has its drawbacks, it is the best snapshot ever created of current anaesthetic practice with respect to complications of airway management.<a href="#aex018-B3" class="reflinks">³</a> NAP4 tells us what is happening now, in the real world, not in a hypothetical reality where 'dedicated training programme(s)' have been instituted. In the real world, anaesthetists cause morbidity and mortality with a cannula technique. In addition, advocating cannula use because it can be practised on real patients is to obfuscate the issue. Awake fibreoptic intubations, which in some institutions are relatively rare themselves, do not need transtracheal blocks because the airway can be anaesthetized with less invasive means. Nor is the pre-emptive use of cannula cricothyroidotomy likely to catch on. Second, a 'human factors' approach to the CICO problem needs to move beyond the human/anaesthetist viewpoint and look at the wider picture. The authors concentrate on the anaesthetic practitioner in terms of familiarity, training, and pre-emptive use. Human factors is the science of improving human performance and well-being by examining all the effectors of human performance. A 'scalpel only' technique, when viewed using a human factors approach, has a number of benefits, as follows. <ul><li class="roman-lower">Task. Equipment can be minimized and standardized, with no need to decide between 'the Enk Oxygen Flow Modulator (Cook Medical, Bloomington, IN, USA), the Rapid-O2 (Meditech Systems Ltd, Shaftesbury, UK), or the Ventrain (Dolphys Medical BV, Eindhoven, The Netherlands)'.</li><li class="roman-lower">Person. In the crisis, there is no need for the anaesthetist to waste time making a decision between cannula and surgical cricothyroidotomy. Precious training time can be focused on the one technique.</li><li class="roman-lower">Team. In the crisis, the team will know what equipment to get. There is no need to wonder whether the anaesthetist has chosen the correct technique for this patient. Precious team training time can be focused on the one technique</li><li class="roman-lower">Organization. The organization can use implementation of the DAS guidelines as part of its governance procedures. The anaesthetic department can use the DAS guidelines to make a case for equipment and training.</li><li class="roman-lower">Socio-cultural. The adoption of a sole technique means that future reviews of difficult airway management can focus on best practice with the scalpel technique.</li></ul></span>

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Size-resolved characterization of the polysaccharidic and proteinaceous components of sea spray aerosol

Publication date: April 2017
Source:Atmospheric Environment, Volume 154
Author(s): Josephine Y. Aller, JoAnn C. Radway, Wendy P. Kilthau, Dylan W. Bothe, Theodore W. Wilson, Robert D. Vaillancourt, Patricia K. Quinn, Derek J. Coffman, Benjamin J. Murray, Daniel A. Knopf
Dissolved organic polymers released by phytoplankton and bacteria abiologically self-assemble in surface ocean waters into nano-to micro-sized gels containing polysaccharides, proteins, lipids and other components. These gels concentrate in the sea surface microlayer (SML), where they can potentially contribute to sea spray aerosol (SSA). Sea spray is a major source of atmospheric aerosol mass over much of the earth's surface, and knowledge of its properties (including the amount and nature of the organic content), size distributions and fluxes are fundamental for determining its role in atmospheric chemistry and climate. Using a cascade impactor, we collected size-fractionated aerosol particles from ambient air and from freshly generated Sea Sweep SSA in the western North Atlantic Ocean together with biological and chemical characterization of subsurface and SML waters. Spectrophotometric methods were applied to quantify the polysaccharide-containing transparent exopolymer (TEP) and protein-containing Coomassie stainable material (CSM) in these particles and waters. This study demonstrates that both TEP and CSM in surface ocean waters are aerosolized with sea spray with the greatest total TEP associated with particles <180 nm in diameter and >5 000 nm. The higher concentrations of TEP and CSM in particles >5 000 nm most likely reflects collection of microorganism cells and/or fragments. The greater concentration of CSM in larger size particles may also reflect greater stability of proteinaceous gels compared to polysaccharide-rich gels in surface waters and the SML. Both TEP and CSM were measured in the ambient marine air sample with concentrations of 2.1 ± 0.16 μg xanthan gum equivalents (XG eq.) m⁻³ and 14 ± 1.0 μg bovine serum albumin equivalents (BSA eq.) m⁻³. TEP in Sea Sweep SSA averaged 4.7 ± 3.1 μg XG eq. m⁻³ and CSM 8.6 ± 7.3 μg BSA eq. m⁻³. This work shows the transport of marine biogenic material across the air-sea interface through primary particle emission and the first demonstration of particle size discriminated TEP and CSM characterization of SSA and ambient aerosol under field conditions.

Graphical abstract

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