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Does a meditation protocol supported by a mobile application help people reduce stress? Suggestions from a controlled pragmatic trial.
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The aim of this study was to examine the efficacy of a 3 week mindfulness inspired protocol, delivered by an Android application for smartphones, in reducing stress in the adult population. By using a controlled pragmatic trial, a self-help intervention group of meditators was compared with a typical control group listening to relaxing music and a waiting list group. The final sample included 56 Italian workers as participants, block randomized to the three conditions. The self-reported level of perceived stress was assessed at the beginning and at the end of the protocol. Participants were also instructed to track their heart rate before and after each session. The results did not show any significant differences between groups, but both self-help intervention groups demonstrated an improvement in coping with stress. Nevertheless, meditators and music listeners reported a significant decrease in average heartbeats per minute after each session. Furthermore, both groups perceived a moderate but significant change in stress reduction perceptions, even if with some peculiarities. Limitations and opportunities related to the meditation protocol supported by the mobile application to reduce stress are discussed.
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2,333,501 |
Enhanced QSAR models for drug-triggered inhibition of the main cardiac ion currents.
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The currently changing cardiac safety testing paradigm suggests, among other things, a shift towards using in silico models of cellular electrophysiology and assessment of a concomitant block of multiple ion channels. In this study, a set of four enhanced QSAR models have been developed: for the rapid delayed rectifying potassium current (IKr), slow delayed rectifying potassium current (IKs), peak sodium current (INa) and late calcium current (ICaL), predicting ion currents changes for the specific in vitro experiment from the 2D structure of the compounds. The models are a combination of both in vitro study parameters and physico-chemical descriptors, which is a novel approach in drug-ion channels interactions modeling. Their predictive power assessed in the enhanced, more demanding than standard procedure, 10-fold cross validation was reasonably high. Rough comparison with published pure in silico hERG interaction models shows that the quality of the model predictions does not differ from other models available in the public domain, however, it takes its advantage in accounting for inter-experimental settings variability. Developed models are implemented in the Cardiac Safety Simulator, a commercially available platform enabling the in vitro-in vivo extrapolation of the drugs proarrhythmic effect and ECG simulation. A more comprehensive assessment of the effects of the compounds on ion channels allows for making more informed decisions regarding the risk - and thus avoidance - of exclusion of potentially safe and effective drugs.
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2,333,502 |
Effects of stellate ganglion block on cardiovascular reaction and heart rate variability in elderly patients during anesthesia induction and endotracheal intubation.<Pagination><StartPage>140</StartPage><EndPage>145</EndPage><MedlinePgn>140-5</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.jclinane.2014.06.012</ELocationID><ELocationID EIdType="pii" ValidYN="Y">S0952-8180(14)00331-6</ELocationID><Abstract><AbstractText Label="STUDY OBJECTIVE" NlmCategory="OBJECTIVE">To investigate the effects of stellate ganglion block (SGB) on cardiovascular response and heart rate (HR) variability in elderly patients during anesthesia induction and endotracheal intubation.</AbstractText><AbstractText Label="DESIGN" NlmCategory="METHODS">A randomized, double-blinded, and placebo-controlled study.</AbstractText><AbstractText Label="SETTING" NlmCategory="METHODS">University-affiliated teaching hospital.</AbstractText><AbstractText Label="PARTICIPANTS" NlmCategory="METHODS">Eighty elderly patients (American Society of Anesthesiologists grades I and II) receiving elective surgery during general anesthesia.</AbstractText><AbstractText Label="INTERVENTIONS" NlmCategory="METHODS">Right stellate ganglion injection (SGB) was performed in all patients using 10 mL of 1% lidocaine or normal saline.</AbstractText><AbstractText Label="MEASUREMENTS" NlmCategory="METHODS">Systolic blood pressure (BP), diastolic BP, HR, and calculated rate pressure product. HR variability at the following time points: conscious status before induction (T0); immediately before intubation (T1); immediately after intubation (T2); and 1, 3, and 5 minutes postintubation (T3, T4, and T5).</AbstractText><AbstractText Label="MAIN RESULTS" NlmCategory="RESULTS">No significant differences in BP and HR were observed between the 2 groups. Rate pressure product values significantly increased in the control group compared with baseline and SGB group values. Low-frequency power (LF) and LF/high-frequency power (HF) significantly increased, and HF and normalized units of HF significantly decreased in the control group compared with baseline values. LF, normalized units of LF, and LF/HF in the SGB group significantly decreased compared with those of the control group.</AbstractText><AbstractText Label="CONCLUSION" NlmCategory="CONCLUSIONS">SGB protects the myocardium and effectively suppresses stress responses during anesthesia induction and tracheal intubation in elderly patients.</AbstractText><CopyrightInformation>Copyright © 2014 Elsevier Inc. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Chen</LastName><ForeName>Yong-Quan</ForeName><Initials>YQ</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology, First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui 241001, China. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Jin</LastName><ForeName>Xiao-Ju</ForeName><Initials>XJ</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology, First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui 241001, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Liu</LastName><ForeName>Zhao-Fang</ForeName><Initials>ZF</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology, First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui 241001, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Zhu</LastName><ForeName>Mei-Fang</ForeName><Initials>MF</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology, First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui 241001, China.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016449">Randomized Controlled Trial</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2015</Year><Month>01</Month><Day>03</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>J Clin Anesth</MedlineTA><NlmUniqueID>8812166</NlmUniqueID><ISSNLinking>0952-8180</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000779">Anesthetics, Local</NameOfSubstance></Chemical><Chemical><RegistryNumber>98PI200987</RegistryNumber><NameOfSubstance UI="D008012">Lidocaine</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000768" MajorTopicYN="N">Anesthesia, General</DescriptorName><QualifierName UI="Q000379" MajorTopicYN="Y">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000779" MajorTopicYN="N">Anesthetics, Local</DescriptorName><QualifierName UI="Q000008" MajorTopicYN="N">administration & dosage</QualifierName><QualifierName UI="Q000494" MajorTopicYN="N">pharmacology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D001340" MajorTopicYN="N">Autonomic Nerve Block</DescriptorName><QualifierName UI="Q000379" MajorTopicYN="Y">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D001794" MajorTopicYN="N">Blood Pressure</DescriptorName><QualifierName UI="Q000187" MajorTopicYN="N">drug effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D004311" MajorTopicYN="N">Double-Blind Method</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004562" MajorTopicYN="N">Electrocardiography</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006339" MajorTopicYN="N">Heart Rate</DescriptorName><QualifierName UI="Q000187" MajorTopicYN="N">drug effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007442" MajorTopicYN="N">Intubation, Intratracheal</DescriptorName><QualifierName UI="Q000379" MajorTopicYN="Y">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008012" MajorTopicYN="N">Lidocaine</DescriptorName><QualifierName UI="Q000008" MajorTopicYN="N">administration & dosage</QualifierName><QualifierName UI="Q000494" MajorTopicYN="N">pharmacology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016343" MajorTopicYN="N">Monitoring, Intraoperative</DescriptorName><QualifierName UI="Q000379" MajorTopicYN="N">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D013233" MajorTopicYN="Y">Stellate Ganglion</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Aged</Keyword><Keyword MajorTopicYN="N">Cardiovascular reaction</Keyword><Keyword MajorTopicYN="N">Heart rate variability</Keyword><Keyword MajorTopicYN="N">Intratracheal anesthesia</Keyword><Keyword MajorTopicYN="N">Stellate ganglion block</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2013</Year><Month>11</Month><Day>10</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2014</Year><Month>5</Month><Day>19</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2014</Year><Month>6</Month><Day>9</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2015</Year><Month>1</Month><Day>7</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2015</Year><Month>1</Month><Day>7</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2015</Year><Month>12</Month><Day>15</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">25559299</ArticleId><ArticleId IdType="doi">10.1016/j.jclinane.2014.06.012</ArticleId><ArticleId IdType="pii">S0952-8180(14)00331-6</ArticleId></ArticleIdList></PubmedData></PubmedArticle><PubmedArticle><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">25558682</PMID><DateCompleted><Year>2015</Year><Month>02</Month><Day>10</Day></DateCompleted><DateRevised><Year>2019</Year><Month>11</Month><Day>13</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">0869-6047</ISSN><JournalIssue CitedMedium="Print"><Issue>5-6</Issue><PubDate><Year>2014</Year></PubDate></JournalIssue><Title>Vestnik Rossiiskoi akademii meditsinskikh nauk</Title><ISOAbbreviation>Vestn Ross Akad Med Nauk</ISOAbbreviation></Journal>[The role of alfa-2-beta-adrenoreceptor in development of ventricular conduction disturbance].
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To investigate the effects of stellate ganglion block (SGB) on cardiovascular response and heart rate (HR) variability in elderly patients during anesthesia induction and endotracheal intubation.</AbstractText>A randomized, double-blinded, and placebo-controlled study.</AbstractText>University-affiliated teaching hospital.</AbstractText>Eighty elderly patients (American Society of Anesthesiologists grades I and II) receiving elective surgery during general anesthesia.</AbstractText>Right stellate ganglion injection (SGB) was performed in all patients using 10 mL of 1% lidocaine or normal saline.</AbstractText>Systolic blood pressure (BP), diastolic BP, HR, and calculated rate pressure product. HR variability at the following time points: conscious status before induction (T0); immediately before intubation (T1); immediately after intubation (T2); and 1, 3, and 5 minutes postintubation (T3, T4, and T5).</AbstractText>No significant differences in BP and HR were observed between the 2 groups. Rate pressure product values significantly increased in the control group compared with baseline and SGB group values. Low-frequency power (LF) and LF/high-frequency power (HF) significantly increased, and HF and normalized units of HF significantly decreased in the control group compared with baseline values. LF, normalized units of LF, and LF/HF in the SGB group significantly decreased compared with those of the control group.</AbstractText>SGB protects the myocardium and effectively suppresses stress responses during anesthesia induction and tracheal intubation in elderly patients.</AbstractText>Copyright © 2014 Elsevier Inc. All rights reserved.</CopyrightInformation>
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2,333,503 |
Pregnancy-related issues in women with systemic lupus erythematosus.
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While fertility is preserved in females with systemic lupus erythematosus (SLE), it is well established that pregnancy in these patients is associated with adverse maternal and fetal outcomes, including pregnancy loss, pre-eclampsia, preterm delivery and intrauterine growth retardation, as well as neonatal mortality. Mechanisms underlying these adverse outcomes are poorly understood, and better understanding of these would allow development of targeted and personalized treatment strategies. Established risk factors for adverse pregnancy outcomes include active disease within 6 months prior to conception and during pregnancy, active nephritis, maternal hypertension, antiphospholipid antibodies and hypocomplementemia. While intensive monitoring is recommended, the comparative effectiveness of appropriate management strategies is unclear. While current strategies are able to achieve live births in 85-90% of pregnancies, certain aspects such as prevention of preterm birth, treatment of congenital heart block due to neonatal lupus and recurrent pregnancy loss despite best management, remains challenging. Pregnancy is also associated with an increased risk of flare of lupus, particularly in patients with active disease at time of conception or within 6 months prior to conception. Pregnant patients with SLE should be followed in a high-risk obstetric clinic, and care should be closely coordinated between the obstetrician and rheumatologist.
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2,333,504 |
Optimization of heart block in the left-sided whole breast radiation treatments.
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Blocks have been used to protect heart from potential radiation damage in left-sided breast treatments. Since cardiac motion pattern may not be fully captured on conventional 3DCT or 4DCT simulation scans, this study was intended to investigate the optimization of the heart block design taking the cardiac motion into consideration.</AbstractText>Whole breast treatment plans using two opposed tangential fields were designed based on 4DCT simulation images for 10 left-sided breast cancer patients. Using an OBI system equipped to a Varian Linac, beam-eye viewed fluoroscopy images were acquired for each of the treatment beams after patient treatment setup, and the MLC heart blocks were overlaid onto the fluoroscopy images with an in-house software package. A non-rigid image registration and tracking algorithm was utilized to track the cardiac motion on the fluoroscopy images with minimal manual delineation for initialization, and the tracked cardiac motion information was used to optimize the heart block design to minimize the radiation damage to heart while avoiding the over-shielding that may lead to underdosing certain breast tissues.</AbstractText>Twenty-three sets of fluoroscopy images were acquired on 23 different days of treatment for the 10 patients. As expected, heart moved under the influences of both respiratory and cardiac motion. It was observed that for 16 out of the 23 treatments, heart moved beyond the planed heart block into treatment fields and MLC had to be adjusted to fully block heart. The adjustment was made for all but one patient. The number of the adjusted MLC leaves ranged from 1 to 16 (mean = 10), and the MLC leaf position adjustment ranged from 2 to 10 mm (mean = 6 mm). The added heart block areas ranged from 3 to 1230 mm(2) (mean = 331 mm(2)).</AbstractText>In left-sided whole breast radiation treatments, simulation CT (and 4DCT) based heart block design may not provide adequate heart protection for all the treatments. A fluoroscopy-based method has been developed to adaptively optimize the heart MLC block to achieve optimal heart protection.</AbstractText>
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2,333,505 |
The contribution of illness perception to psychological distress in heart failure patients.
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The influences on the psychological well-being of heart failure (HF) patients have received limited attention. Illness perceptions are a specific set of cognitive representations that have been shown to predict health-related outcomes in other patient groups. This study sought to explore the role of illness perceptions in the psychological well-being of HF patients by creating a profile of illness perceptions in HF and examining their relations with anxiety and depression.</AbstractText>Participants were 95 consecutive outpatients. Indices of psychological well-being were depression and anxiety, measured using the Hospital Anxiety and Depression Scale (HADS). Illness perceptions were measured using the Illness Perception Questionnaire - Revised (IPQ-R). Functional status was also determined using the New York Heart Association (NYHA) classification.</AbstractText>Illness perceptions were associated with indices of psychological well-being. Regression analyses showed that illness perceptions accounted for a significant proportion of the variance in both depression and anxiety. The contribution of illness perceptions was greater than that made by traditional covariates (socio-demographic variables and functional status).</AbstractText>Results highlight dynamic interrelations between perceptions of illness and mental health indices. They also suggest that in considering the role of illness perceptions in psychological well-being, the primary focus should be on the overall dynamic of an individual's illness experience rather than on specific illness dimensions. Findings highlight the potential role of illness perceptions in depression and anxiety in HF. This has implications for interventions to maximise psychological well-being in this patient group.</AbstractText>
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2,333,506 |
Scalp block for brain abscess drainage in a patient with uncorrected tetralogy of Fallot.
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We report a case of an 11-year-old boy with diagnosed but uncorrected tetralogy of Fallot presented to us for brain abscess drainage. The child was managed successfully with scalp block with sedation.
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2,333,507 |
Enhanced efficacy of pluronic copolymer micelle encapsulated SCR7 against cancer cell proliferation.
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5,6-Bis(benzylideneamino)-2-mercaptopyrimidin-4-ol (SCR7) is a new anti cancer molecule having capability to selectively inhibit non-homologous end joining (NHEJ), one of the DNA double strand break (DSB) repair pathways inside the cells. In spite of the promising potential as an anticancer agent, hydrophobicity of SCR7 decreases its bioavailability. Herein the entrapment of SCR7 in Pluronic copolymer is reported. The size of the aggregates was determined by transmission electron microscopy (TEM) and dynamic light scattering (DLS) which yields an average diameter of 23 nm. SCR7 encapsulated micelles (ES) were also characterized by small-angle neutron scattering (SANS). Evaluation of its biological properties by using a variety of techniques, including Trypan blue, MTT and Live-dead cell assays, reveal that encapsulated SCR7 can induce cytotoxicity in cancer cell lines, being more effective in breast cancer cell line. Encapsulated SCR7 treatment resulted in accumulation of DNA breaks within the cells, resulting in cell cycle arrest at G1 phase and activation of apoptosis. More importantly, we found ≈ 5 fold increase in cell death, when encapsulated SCR7 was used in comparison with SCR7 alone.
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2,333,508 |
Recombinant adeno-associated virus-delivered hypoxia-inducible stanniocalcin-1 expression effectively inhibits hypoxia-induced cell apoptosis in cardiomyocytes.
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Ischemia/hypoxia-induced oxidative stress is detrimental for the survival of cardiomyocytes and cardiac function. Stanniocalcin-1 (STC-1), a glycoprotein, has been found to play an inhibitory role in the production of reactive oxygen species (ROS). Here, we speculated that the overexpression of STC-1 might alleviate oxidative damage in cardiomyocytes under conditions of hypoxia. To control the expression of STC-1 in hypoxia, we constructed a recombinant adeno-associated virus (AAV) carrying the hypoxia-responsive element (HRE) to mediate hypoxia induction. Cardiomyocytes were infected with AAV-HRE-STC-1 and cultured in normoxic or hypoxic conditions, and STC-1 overexpression was only detected in hypoxic cultured cardiomyocytes by using quantitative real-time polymerase chain reaction and Western blot analysis. Using the 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, AAV-HRE-STC-1 infection was shown to significantly enhance cell survival under hypoxia. Hypoxia-induced cell apoptosis was inhibited by AAV-HRE-STC-1 infection by using the Annexin V-fluorescein isothiocyanate (FITC)/propidium iodide apoptosis assay. Moreover, the proapoptotic protein Caspase-3 and anti-apoptotic protein Bcl-2, which were dysregulated by hypoxia, were reversed by AAV-HRE-STC-1 infection. AAV-HRE-STC-1-mediated STC-1 overexpression markedly inhibited ROS production in cardiomyocytes cultured under hypoxic conditions. AAV-HRE-STC-1 infection significantly upregulated uncoupled protein 3 (UCP3), whereas silencing of UCP3 blocked the inhibitory effect of AAV-HRE-STC-1 on ROS production. In contrast, AAV-HRE-STC-1 infection had no effect on UCP2, and knockdown of UCP2 did not block the inhibitory effect of AAV-HRE-STC-1 on ROS production in the cardiomyocytes cultured under hypoxic conditions. Taken together, STC1 activates antioxidant pathway in cardiomyocytes through the induction of UCP3, implying that AAV-HRE-STC-1 has potential in the treatment of ischemic-related heart disease.
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2,333,509 |
Central administration of nicotine suppresses tracheobronchial cough in anesthetized cats.
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We tested the hypothesis that nicotine, which acts peripherally to promote coughing, might inhibit reflex cough at a central site. Nicotine was administered via the vertebral artery [intra-arterial (ia)] to the brain stem circulation and by microinjections into a restricted area of the caudal ventral respiratory column in 33 pentobarbital anesthetized, spontaneously breathing cats. The number of coughs induced by mechanical stimulation of the tracheobronchial airways; amplitudes of the diaphragm, abdominal muscle, and laryngeal muscles EMGs; and several temporal characteristics of cough were analyzed after administration of nicotine and compared with those during control and recovery period. (-)Nicotine (ia) reduced cough number, cough expiratory efforts, blood pressure, and heart rate in a dose-dependent manner. (-)Nicotine did not alter temporal characteristics of the cough motor pattern. Pretreatment with mecamylamine prevented the effect of (-)nicotine on blood pressure and heart rate, but did not block the antitussive action of this drug. (+)Nicotine was less potent than (-)nicotine for inhibition of cough. Microinjections of (-)nicotine into the caudal ventral respiratory column produced similar inhibitory effects on cough as administration of this isomer by the ia route. Mecamylamine microinjected in the region just before nicotine did not significantly reduce the cough suppressant effect of nicotine. Nicotinic acetylcholine receptors significantly modulate functions of brain stem and in particular caudal ventral respiratory column neurons involved in expression of the tracheobronchial cough reflex by a mecamylamine-insensitive mechanism.
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2,333,510 |
The impact of galectin-3 inhibition on aldosterone-induced cardiac and renal injuries.
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This study investigated whether galectin (Gal)-3 inhibition could block aldosterone-induced cardiac and renal fibrosis and improve cardiorenal dysfunction.</AbstractText>Aldosterone is involved in cardiac and renal fibrosis that is associated with the development of cardiorenal injury. However, the mechanisms of these interactions remain unclear. Gal-3, a β-galactoside-binding lectin, is increased in heart failure and kidney injury.</AbstractText>Rats were treated with aldosterone-salt combined with spironolactone (a mineralocorticoid receptor antagonist) or modified citrus pectin (a Gal-3 inhibitor), for 3 weeks. Wild-type and Gal-3 knockout mice were treated with aldosterone for 3 weeks. Hemodynamic, cardiac, and renal parameters were analyzed.</AbstractText>Hypertensive aldosterone-salt-treated rats presented cardiac and renal hypertrophy (at morphometric, cellular, and molecular levels) and dysfunction. Cardiac and renal expressions of Gal-3 as well as levels of molecular markers attesting fibrosis were also augmented by aldosterone-salt treatment. Spironolactone or modified citrus pectin treatment reversed all of these effects. In wild-type mice, aldosterone did not alter blood pressure levels but increased cardiac and renal Gal-3 expression, fibrosis, and renal epithelial-mesenchymal transition. Gal-3 knockout mice were resistant to aldosterone effects.</AbstractText>In experimental hyperaldosteronism, the increase in Gal-3 expression was associated with cardiac and renal fibrosis and dysfunction but was prevented by pharmacological inhibition (modified citrus pectin) or genetic disruption of Gal-3. These data suggest a key role for Gal-3 in cardiorenal remodeling and dysfunction induced by aldosterone. Gal-3 could be used as a new biotarget for specific pharmacological interventions.</AbstractText>Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</CopyrightInformation>
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2,333,511 |
Cesarean under general or epidural anesthesia: does it differ in terms of regional cerebral oxygenation?
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It is aimed to evaluate whether there is a difference in regional cerebral saturation of newborns measured by near infrared spectroscopy born either by general anesthesia or combined spinal epidural anesthesia during elective cesarean deliveries.</AbstractText>After approval from the ethics committee of our hospital, and informed consents of the parturients were taken, 68 patients were included in the study. The regional cerebral oxygen saturations (RcSO2) of newborns were measured by near infrared spectroscopy (NIRS) measurements at 1st, 5th min after birth. In group I (n=32), general anesthesia was performed for the cesarean operation and in group II (n=36), combined spinal epidural anesthesia (CSEA) was the anesthetic management. The age of the mother, gestation, the problems related to the pregnancy, heart rate, blood pressure, oxygen saturation (SpO2) of the mother had been recorded. The measurements of the newborn were; SpO2 of right hand, RcSO2 measured by NIRS, the delivery time (from incision to the cessation of circulation in the placental cord), Apgar score. Data were analyzed using GraphPad Prism 5.0 (GraphPad Software, La Jolla, California) and presented as mean +/- SD. Results obtained in different groups were compared using upaired t-test. Differences were statistically significant at p < 0.05.</AbstractText>There were no significant differences between the groups related to the mother's age, gestation week and baseline blood pressure. Both the systolic and diastolic blood pressures measured at 1st and 5th min after induction or start of the spinal block were significantly lower in the mothers who had undergone combined spinal epidural anesthesia. The heart rates of the mothers who had been under CSEA were significantly higher than the general anesthesia group. The Apgar at the 1st min were observed significantly higher in Group II. Oxygen saturation of the newborns were significantly higher in Group II. Regional cerebral oxygenation measured by NIRS were significantly higher in CSEA group.</AbstractText>Combined spinal epidural anesthesia, besides other known advantages, had been shown to be superior to general anesthesia as a means of regional cerebral oxygenation of the newborns.</AbstractText>Copyright © 2014. Published by Elsevier B.V.</CopyrightInformation>
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2,333,512 |
Combined action potential- and dynamic-clamp for accurate computational modelling of the cardiac IKr current.
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In the present work Action-Potential clamp (APC) and Dynamic clamp (DC) were used in combination in order to optimize the Luo-Rudy (LRd) mathematical formulation of the guinea-pig rapid delayed rectifier K(+) current (IKr), and to validate the optimized model. To this end, IKr model parameters were adjusted to fit the experimental E4031-sensitive current (IE4031) recorded under APC in guinea-pig myocytes. Currents generated by LRd model (ILRd) and the optimized one (IOpt) were then compared by testing their suitability to replace IE4031 under DC. Under APC, ILRd was significantly larger than IE4031 (mean current densities 0.51±0.01 vs 0.21±0.05pA/pF; p<0.001), mainly because of different rectification. IOpt mean density (0.17±0.01pA/pF) was similar to the IE4031 one (NS); moreover, IOpt accurately reproduced IE4031 distribution along the different AP phases. Models were then compared under DC by blocking native IKr (5μM E4031) and replacing it with ILRd or IOpt. Whereas injection of ILRd overshortened AP duration (APD90) (by 25% of its pre-block value), IOpt injection restored AP morphology and duration to overlap pre-block values. This study highlights the power of APC and DC for the identification of reliable formulations of ionic current models. An optimized model of IKr has been obtained which fully reversed E4031 effects on the AP. The model strongly diverged from the widely used Luo-Rudy formulation; this can be particularly relevant to the in silico analysis of AP prolongation caused by IKr blocking or alterations.
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2,333,513 |
[Neonatal lupus and maternofetal transmission of anti-SSA/Ro and anti-SSB/La antibodies].
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Neonatal lupus (NL) is a rare syndrome caused by placental transfer of maternal anti-SSA/Ro (60 and 52kDa) or anti-SSB/La antibodies. The aim of this study was to evaluate the clinical and biological profile of NL at the neonatal unit of Sfax, Tunisia, over a 10-year period. Six mother-NB pairs (two sets of twins and two sisters) had positive ANA by transplacental transmission during the study period. The ANA pattern was speckled and the NBs' sera titer was half that of their mothers'. Anti-SSA, anti-Ro52, and anti-SSB were found in 100%, 33%, and 50% of the mothers' sera, respectively. The transmission of anti-SSA was observed in four pregnancies out of six, anti-Ro52 in two pregnancies out of two, and anti-SSB in one pregnancy out of three. The patients' clinical records showed that two NBs had a congenital heart block: one with anti-SSA, whose mother had Sjögren syndrome, and another with anti-SSA, anti-SSB, anti-Ro52, and anti-mitochondrial antibodies (M2 type), whose mother had no diagnosis at the child's birth (cutaneous erythema and positive ANA with the same profile). Cutaneous signs (erythema, petechia) were described in three NBs out of six. The two sets of fraternal twins had cutaneous signs with the same ANA titer and profile (no anti-SSA transmission from their mother with lupus and anti-phospholipid syndrome). The two sisters' (two pregnancies 3 years apart) mother had Sjögren syndrome, one of them had heart block with positive anti-SSA, and the other was asymptomatic with anti-SSA and anti-Ro52. The same mother had a history of three pregnancies with two NBs who died of heart block.
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2,333,514 |
How calorie-focused thinking about obesity and related diseases may mislead and harm public health. An alternative.
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Prevailing thinking about obesity and related diseases holds that quantifying calories should be a principal concern and target for intervention. Part of this thinking is that consumed calories - regardless of their sources - are equivalent; i.e. 'a calorie is a calorie'. The present commentary discusses various problems with the idea that 'a calorie is a calorie' and with a primarily quantitative focus on food calories. Instead, the authors argue for a greater qualitative focus on the sources of calories consumed (i.e. a greater focus on types of foods) and on the metabolic changes that result from consuming foods of different types. In particular, the authors consider how calorie-focused thinking is inherently biased against high-fat foods, many of which may be protective against obesity and related diseases, and supportive of starchy and sugary replacements, which are likely detrimental. Shifting the focus to qualitative food distinctions, a central argument of the paper is that obesity and related diseases are problems due largely to food-induced physiology (e.g. neurohormonal pathways) not addressable through arithmetic dieting (i.e. calorie counting). The paper considers potential harms of public health initiatives framed around calorie balance sheets - targeting 'calories in' and/or 'calories out' - that reinforce messages of overeating and inactivity as underlying causes, rather than intermediate effects, of obesity. Finally, the paper concludes that public health should work primarily to support the consumption of whole foods that help protect against obesity-promoting energy imbalance and metabolic dysfunction and not continue to promote calorie-directed messages that may create and blame victims and possibly exacerbate epidemics of obesity and related diseases.
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2,333,515 |
Sodium zirconium cyclosilicate in hyperkalemia.
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Hyperkalemia (serum potassium level, >5.0 mmol per liter) is associated with increased mortality among patients with heart failure, chronic kidney disease, or diabetes. We investigated whether sodium zirconium cyclosilicate (ZS-9), a novel selective cation exchanger, could lower serum potassium levels in patients with hyperkalemia.</AbstractText>In this multicenter, two-stage, double-blind, phase 3 trial, we randomly assigned 753 patients with hyperkalemia to receive either ZS-9 (at a dose of 1.25 g, 2.5 g, 5 g, or 10 g) or placebo three times daily for 48 hours. Patients with normokalemia (serum potassium level, 3.5 to 4.9 mmol per liter) at 48 hours were randomly assigned to receive either ZS-9 or placebo once daily on days 3 to 14 (maintenance phase). The primary end point was the exponential rate of change in the mean serum potassium level at 48 hours.</AbstractText>At 48 hours, the mean serum potassium level had decreased from 5.3 mmol per liter at baseline to 4.9 mmol per liter in the group of patients who received 2.5 g of ZS-9, 4.8 mmol per liter in the 5-g group, and 4.6 mmol per liter in the 10-g group, for mean reductions of 0.5, 0.5, and 0.7 mmol per liter, respectively (P<0.001 for all comparisons) and to 5.1 mmol per liter in the 1.25-g group and the placebo group (mean reduction, 0.3 mmol per liter). In patients who received 5 g of ZS-9 and those who received 10 g of ZS-9, serum potassium levels were maintained at 4.7 mmol per liter and 4.5 mmol per liter, respectively, during the maintenance phase, as compared with a level of more than 5.0 mmol per liter in the placebo group (P<0.01 for all comparisons). Rates of adverse events were similar in the ZS-9 group and the placebo group (12.9% and 10.8%, respectively, in the initial phase; 25.1% and 24.5%, respectively, in the maintenance phase). Diarrhea was the most common complication in the two study groups.</AbstractText>Patients with hyperkalemia who received ZS-9, as compared with those who received placebo, had a significant reduction in potassium levels at 48 hours, with normokalemia maintained during 12 days of maintenance therapy. (Funded by ZS Pharma; ClinicalTrials.gov number, NCT01737697.).</AbstractText>
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Comparative efficacy of levobupivacaine and ropivacaine for epidural block in outpatients with degenerative spinal disease.
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Levobupivacaine has less toxic potential on both the cardiovascular and central nervous system and has been widely used for postoperative epidural analgesia in surgical patients. However, there are few reports on the efficacy of epidural levobupivacaine in outpatients with lumbosacral radiculopathy. This study was carried out to evaluate the comparative efficacy of levobupivacaine and ropivacaine for epidural block in outpatients with degenerative spinal disease and sciatica.</AbstractText>We studied 32 patients (19 men and 13 women) with degenerative spinal disease and sciatica.</AbstractText>The study was performed in a prospective, randomized, double blind, and crossover fashion.</AbstractText>Treatment room for outpatients.</AbstractText>The epidural block was produced with a caudal approach (0.125% levobupivacaine or 0.2% ropivacaine, 15 mL). The upper level of analgesia, lumbosacral pain, motor blockade, and hemodynamic changes were evaluated by pin prick, visual analogue scale (VAS), Bromage scale, and arterial blood pressure and heart rate at 15, 30, 60, and 90 minutes after epidural block, respectively. The recovery time to mobilization, ambulation, and spontaneous micturition were measured.</AbstractText>There were no significant differences (P < 0.05) in the upper level of analgesia, VAS, and Bromage scale between 0.125% levobupivacaine and 0.2% ropivacaine throughout the time course. There were no significant differences in the recovery times to mobilization, ambulation, and spontaneous micturition between 0.125% levobupivacaine and 0.2% ropivacaine. There were no significant differences in arterial blood pressure and heart rate between the 2 trials throughout the time course.</AbstractText>The results showed that 0.125% levobupivacaine and 0.2% ropivacaine for epidural block by a caudal approach provide similar lumbosacral pain relief, hemodynamic effects, and the degree and the recovery of motor blockade in outpatients with degenerative spinal disease and sciatica.</AbstractText>
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Continuous spinal anaesthesia versus ultrasound-guided combined psoas compartment-sciatic nerve block for hip replacement surgery in elderly high-risk patients: a prospective randomised study.
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Our aim is to compare the hemodynamic effects of combined psoas compartment-sciatic nerve block (PCSNB) with continuous spinal anaesthesia (CSA) in elderly high-risk patients undergoing hip replacement surgery.</AbstractText>Seventy patients over the age of 60 with ASA III or IV physical status were randomly allocated to two groups: In the PCSNB group, ultrasound-guided psoas compartment block was performed with modified Winnie technique using 30 mL of 0.25% bupivacaine with 1:200.000 epinephrine (5 μgr/mL) and iliac crest block was performed using the same local anaesthetic solution (5 mL). All patients in the PCSNB group needed continuing infusion of propofol (2 mg/kg/h) during operation. In the CSA group, CSA was performed in the L3-L4 interspaced with the patient in lateral decubitus position using 2.5 mg of isobaric bupivacaine 0.5%. When sensory block was not reached to the level of T12 within 10 minutes in the CSA group, additional 2.5 mg of isobaric bupivacaine 0.5% was administered through the catheter at 5-min intervals by limiting the total dose of 15 mg until a T12 level of the sensory block was achieved.</AbstractText>The PCSNB group had significantly higher mean arterial blood pressure values at the beginning of surgery and at 5(th), 10(th) and 20(th) minutes of surgery compared to the CSA group (P = 0.038, P = 0.029, P = 0.012, P = 0.009 respectively). There were no significant differences between groups in terms of heart rate and peripheral oxygen saturation values during surgery and the postoperative period (P >0.05). Arterial hypotension required ephedrine was observed in 13 patients in the CSA and 4 patients in the PCSNB group (P =0.012).</AbstractText>CSA and PCSNB produce satisfactory quality of anaesthesia in elderly high-risk patients with fewer hemodynamic changes in PCSNB cases compared with CSA cases.</AbstractText>Australian New Zealand Clinical Trials Registry: ACTRN12614000658617, Registered 24 June 2014.</AbstractText>
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The role of endothelin-1 in pulmonary arterial hypertension.
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Pulmonary arterial hypertension (PAH) is a rare but debilitating disease, which if left untreated rapidly progresses to right ventricular failure and eventually death. In the quest to understand the pathogenesis of this disease differences in the profile, expression and action of vasoactive substances released by the endothelium have been identified in patients with PAH. Of these, endothelin-1 (ET-1) is of particular interest since it is known to be an extremely powerful vasoconstrictor and also involved in vascular remodelling. Identification of ET-1 as a target for pharmacological intervention has lead to the discovery of a number of compounds that can block the receptors via which ET-1 mediates its effects. This review sets out the evidence in support of a role for ET-1 in the onset and progression of the disease and reviews the data from the various clinical trials of ET-1 receptor antagonists for the treatment of PAH.
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Leptin differentially increases sympathetic nerve activity and its baroreflex regulation in female rats: role of oestrogen.
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Obesity and hypertension are commonly associated, and activation of the sympathetic nervous system is considered to be a major contributor, at least in part due to the central actions of leptin. However, while leptin increases sympathetic nerve activity (SNA) in males, whether leptin is equally effective in females is unknown. Here, we show that intracerebroventricular (i.c.v.) leptin increases lumbar (LSNA) and renal (RSNA) SNA and baroreflex control of LSNA and RSNA in α-chloralose anaesthetized female rats, but only during pro-oestrus. In contrast, i.c.v. leptin increased basal and baroreflex control of splanchnic SNA (SSNA) and heart rate (HR) in rats in both the pro-oestrus and dioestrus states. The effects of leptin on basal LSNA, RSNA, SSNA and HR were similar in males and pro-oestrus females; however, i.c.v. leptin increased mean arterial pressure (MAP) only in males. Leptin did not alter LSNA or HR in ovariectomized rats, but its effects were normalized with 4 days of oestrogen treatment. Bilateral nanoinjection of SHU9119 into the paraventricular nucleus of the hypothalamus (PVN), to block α-melanocyte-stimulating hormone (α-MSH) type 3 and 4 receptors, decreased LSNA in leptin-treated pro-oestrus but not dioestrus rats. Unlike leptin, i.c.v. insulin infusion increased basal and baroreflex control of LSNA and HR similarly in pro-oestrus and dioestrus rats; these responses did not differ from those in male rats. We conclude that, in female rats, leptin's stimulatory effects on SNA are differentially enhanced by oestrogen, at least in part via an increase in α-MSH activity in the PVN. These data further suggest that the actions of leptin and insulin to increase the activity of various sympathetic nerves occur via different neuronal pathways or cellular mechanisms. These results may explain the poor correlation in females of SNA with adiposity, or of MAP with leptin.
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Ultrasound-guided continuous thoracic paravertebral block provides comparable analgesia and fewer episodes of hypotension than continuous epidural block after lung surgery.
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Both paravertebral block (PVB) and thoracic epidural block (TEB) are recommended for postoperative pain relief after lung surgery. The addition of fentanyl to the anesthetic solution became popular for TEB because of the stronger effects; however, there have been few comparable trials about the addition of fentanyl to PVB. The purpose of this study was thus to compare postoperative analgesia, side effects, and complications between ultrasound-guided PVB (USG-PVB) and TEB with the addition of fentanyl to ropivacaine after lung surgery.</AbstractText>We examined 90 consecutive patients (age 18-75 years) scheduled for video-assisted thoracic surgery (VATS). In both groups, all blocks (four blocks in USG-PVB and one block in TEB) and one catheter insertion were performed preoperatively. Continuous postoperative infusion (0.1% ropivacaine plus fentanyl at 0.4 mg/day) was undertaken for 36 h in both groups. The recorded data included the verbal rating scale (VRS) for pain, blood pressure, side effects, complications for 2 days, and overall satisfaction score.</AbstractText>There was no difference in the frequency of taking supplemental analgesics (twice or more frequently), or in VRS. Hypotension occurred significantly more frequently in TEB (n = 7/33) than in PVB (n = 1/36) (P = 0.02); on the other hand, the incidences of PONV and pruritus, as well as overall satisfaction score, were similar. There were no complications in both groups; however, the catheters migrated intrathoracically in four patients in PVB.</AbstractText>USG-PVB achieved similar pain relief and lowered the incidence of hypotension compared with TEB. We conclude that both blocks with the same concentration of ropivacaine and fentanyl can provide adequate postoperative analgesia for VATS.</AbstractText>
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Bupivacaine mandibular nerve block affects intraoperative blood pressure and heart rate in a Yucatan miniature swine mandibular condylectomy model: a pilot study.
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<AbstractText Label="PURPOSE/AIM" NlmCategory="OBJECTIVE">The primary objective was to evaluate the effect of a bupivacaine mandibular nerve block on intraoperative blood pressure (BP) and heart rate (HR) in response to surgical stimulation and the need for systemic analgesics postoperatively. We hypothesized that a mandibular nerve block would decrease the need for systemic analgesics both intraoperatively and postoperatively.</AbstractText>Fourteen adult male Yucatan pigs were purchased. Pigs were chemically restrained with ketamine, midazolam, and dexmedetomidine and anesthesia was maintained with isoflurane inhalant anesthesia. Pigs were randomized to receive a mandibular block with either bupivacaine (bupivacaine group) or saline (control group). A nerve stimulator was used for administration of the block with observation of masseter muscle twitch to indicate the injection site. Invasive BP and HR were measured with the aid of an arterial catheter in eight pigs. A rescue analgesic protocol consisting of fentanyl and lidocaine was administered if HR or BP values increased 20% from baseline. Postoperative pain was quantified with a customized ethogram. HR and BP were evaluated at base line, pre-rescue, 10 and 20 min post-rescue.</AbstractText>Pre-rescue mean BP was significantly increased (p = .001) for the bupivacaine group. Mean intraoperative HR was significantly lower (p = .044) in the bupivacaine versus saline group. All other parameters were not significant.</AbstractText>Addition of a mandibular nerve block to the anesthetic regimen in the miniature pig condylectomy model may improve variations in intraoperative BP and HR. This study establishes the foundation for future studies with larger animal numbers to confirm these preliminary findings.</AbstractText>
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Preoperative autonomic nervous system analysis may stratify the risk of hypotension after spinal anesthesia.
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Studies on pregnant women undergoing cesarean delivery or elderly men scheduled for prostate brachytherapy have demonstrated the predictive value of heart rate variability (HRV) analysis for hypotension during spinal anesthesia. We conducted a prospective observational study to investigate if preoperative HRV analysis may have a role in identifying the risk of hypotension following spinal anesthesia in otherwise healthy patients.</AbstractText>The study investigated 47 ASA physical status I-II patients aged between 18-50 years that underwent subarachnoid anesthesia for lower abdominal or orthopedic scheduled surgery. ECG was recorded from all subjects before the subarachnoid block. We analysed the autonomic nervous system modulation, measured by HRV analysis. The variables that were be considered were preoperative HRV total power, low frequency (LF) and high frequency (HF) heart beat oscillations and LF/HF ratio. The LF/HF ratio was dichotomized according to the median for sensitivity analysis. The lowest arterial pressure value between spinal anesthesia and the end of surgery was recorded.</AbstractText>The median LF/HF before anesthesia was 2.3. We considered two groups of 23 (LF/HF<2.3, group LOW) and 24 (LF/HF>2.3, group HIGH) patients respectively. Both groups had similar baseline demographic and hemodynamic variables. A high preoperative sympathetic outflow and loss of vagal modulation, as stated by LF/HF>2.3, was correlated with a relative risk of 7.7 (95%CI 1.04 to 56.6, p=0.023) of post-spinal hypotension.</AbstractText>Preoperative analysis of autonomic nervous system modulation might be useful to stratify the risk of post-spinal hypotension and it might indicate the need for careful monitoring or prophylactic fluids.</AbstractText>
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Transcatheter aortic valve implantation.<Pagination><StartPage>92</StartPage><MedlinePgn>92</MedlinePgn></Pagination><ELocationID EIdType="pii" ValidYN="Y">92</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.12703/P6-92</ELocationID><Abstract><AbstractText>Transcatheter aortic valve implantation was developed to offer a therapeutic solution to patients with severe symptomatic aortic stenosis who are not candidates for conventional aortic valve replacement. The improvement in transcatheter aortic valve implantation outcomes is still of concern in the areas of stroke, vascular injury, heart block, paravalvular regurgitation and valve durability. Concomitantly, the progress, both technical and in terms of material advances of transcatheter valve systems, as well as in patient selection, renders transcatheter aortic valve implantation an increasingly viable treatment for more and more patients with structural heart disease.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Oliemy</LastName><ForeName>Ahmed</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Cardiac Surgery, Golden Jubilee National Hospital Agamemnon Street, Clydebank, G81 4DY, Glasgow UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Al-Attar</LastName><ForeName>Nawwar</ForeName><Initials>N</Initials><AffiliationInfo><Affiliation>Department of Cardiac Surgery, Golden Jubilee National Hospital Agamemnon Street, Clydebank, G81 4DY, Glasgow UK.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016454">Review</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2014</Year><Month>10</Month><Day>01</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>F1000Prime Rep</MedlineTA><NlmUniqueID>101599397</NlmUniqueID><ISSNLinking>2051-7599</ISSNLinking></MedlineJournalInfo></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2014</Year><Month>11</Month><Day>7</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2014</Year><Month>11</Month><Day>7</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2014</Year><Month>11</Month><Day>7</Day><Hour>6</Hour><Minute>1</Minute></PubMedPubDate></History><PublicationStatus>epublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">25374670</ArticleId><ArticleId IdType="pmc">PMC4191242</ArticleId><ArticleId IdType="doi">10.12703/P6-92</ArticleId><ArticleId IdType="pii">92</ArticleId></ArticleIdList><ReferenceList><Reference><Citation>Edwards FH, Peterson ED, Coombs LP, DeLong ER, Jamieson WR, Shroyer ALW, Grover FL. 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EuroIntervention. 2012;8 Suppl Q:Q18–20. doi: 10.4244/EIJV8SQA5.</Citation><ArticleIdList><ArticleId IdType="doi">10.4244/EIJV8SQA5</ArticleId><ArticleId IdType="pubmed">22995107</ArticleId></ArticleIdList></Reference><Reference><Citation>Willson AB, Rodès-Cabau J, Wood DA, Leipsic J, Cheung A, Toggweiler S, Binder RK, Freeman M, DeLarochellière R, Moss R, Nombela-Franco L, Dumont E, Szummer K, Fontana GP, Makkar R, Webb JG. Transcatheter aortic valve replacement with the St. Jude Medical Portico valve: first-in-human experience. J Am Coll Cardiol. 2012;60:581–6. doi: 10.1016/j.jacc.2012.02.045.</Citation><ArticleIdList><ArticleId IdType="doi">10.1016/j.jacc.2012.02.045</ArticleId><ArticleId IdType="pubmed">22657270</ArticleId></ArticleIdList></Reference><Reference><Citation>Sinning J, Werner N, Nickenig G, Grube E. Medtronic CoreValve Evolut valve. EuroIntervention. 2012;8 Suppl Q:Q94–6. doi: 10.4244/EIJV8SQA17.</Citation><ArticleIdList><ArticleId IdType="doi">10.4244/EIJV8SQA17</ArticleId><ArticleId IdType="pubmed">22995121</ArticleId></ArticleIdList></Reference><Reference><Citation>Kempfert J, Treede H, Rastan AJ, Schönburg M, Thielmann M, Sorg S, Mohr F, Walther T. Transapical aortic valve implantation using a new self-expandable bioprosthesis (ACURATE TA™): 6-month outcomes. Eur J Cardiothorac Surg. 2013;43:52–6. doi: 10.1093/ejcts/ezs139.</Citation><ArticleIdList><ArticleId IdType="doi">10.1093/ejcts/ezs139</ArticleId><ArticleId IdType="pubmed">22491663</ArticleId></ArticleIdList></Reference><Reference><Citation>Treede H, Mohr F, Baldus S, Rastan A, Ensminger S, Arnold M, Kempfert J, Figulla H. Transapical transcatheter aortic valve implantation using the JenaValve™ system: acute and 30-day results of the multicentre CE-mark study. 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Up to 2-year follow-up of the direct-flow medical valve: a pilot study. Circ Cardiovasc Interv. 2011;4:595–601. doi: 10.1161/CIRCINTERVENTIONS.111.964072.</Citation><ArticleIdList><ArticleId IdType="doi">10.1161/CIRCINTERVENTIONS.111.964072</ArticleId><ArticleId IdType="pubmed">22128202</ArticleId></ArticleIdList></Reference><Reference><Citation>Meredith IT. Repositionable percutaneous replacement of a stenotic aortic valve through implantation of the Lotus valve system: discharge/7-day outcome in the REPRISE I study. Presented at Proceedings of the Euro; PCR; 15-18 May 2012; Paris, France.</Citation></Reference><Reference><Citation>Seiffert M, Conradi L, Kloth B, Koschyk D, Schirmer J, Schnabel RB, Blankenberg S, Reichenspurner H, Diemert P, Treede H. Single-centre experience with next-generation devices for transapical aortic valve implantation. Eur J Cardiothorac Surg. 2014 doi: 10.1093/ejcts/ezu041. 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N Engl J Med. 2012;366:1705–15. doi: 10.1056/NEJMoa1114705.</Citation><ArticleIdList><ArticleId IdType="doi">10.1056/NEJMoa1114705</ArticleId><ArticleId IdType="pubmed">22551129</ArticleId></ArticleIdList></Reference><Reference><Citation>Généreux P, Head SJ, Hahn R, Daneault B, Kodali S, Williams MR, Van Mieghem Nicolas M, Alu MC, Serruys PW, Kappetein AP, Leon MB. Paravalvular leak after transcatheter aortic valve replacement: the new Achilles’ heel? A comprehensive review of the literature. J Am Coll Cardiol. 2013;61:1125–36. doi: 10.1016/j.jacc.2012.08.1039.</Citation><ArticleIdList><ArticleId IdType="doi">10.1016/j.jacc.2012.08.1039</ArticleId><ArticleId IdType="pubmed">23375925</ArticleId></ArticleIdList></Reference><Reference><Citation>Kodali SK, Williams MR, Smith CR, Svensson LG, Webb JG, Makkar RR, Fontana GP, Dewey TM, Thourani VH, Pichard AD, Fischbein M, Szeto WY, Lim S, Greason KL, Teirstein PS, Malaisrie SC, Douglas PS, Hahn RT, Whisenant B, Zajarias A, Wang D, Akin JJ, Anderson WN, Leon MB. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med. 2012;366:1686–95. doi: 10.1056/NEJMoa1200384.</Citation><ArticleIdList><ArticleId IdType="doi">10.1056/NEJMoa1200384</ArticleId><ArticleId IdType="pubmed">22443479</ArticleId></ArticleIdList></Reference><Reference><Citation>Desai CS, Roselli EE, Svensson LG, Bonow RO. Transcatheter aortic valve replacement: current status and future directions. Semin Thorac Cardiovasc Surg. 2013;25:193–6. doi: 10.1053/j.semtcvs.2013.09.002.</Citation><ArticleIdList><ArticleId IdType="doi">10.1053/j.semtcvs.2013.09.002</ArticleId><ArticleId IdType="pubmed">24331140</ArticleId></ArticleIdList></Reference><Reference><Citation>Athappan G, Patvardhan E, Tuzcu EM, Svensson LG, Lemos PA, Fraccaro C, Tarantini G, Sinning J, Nickenig G, Capodanno D, Tamburino C, Latib A, Colombo A, Kapadia SR. Incidence, predictors, and outcomes of aortic regurgitation after transcatheter aortic valve replacement: meta-analysis and systematic review of literature. J Am Coll Cardiol. 2013;61:1585–95. doi: 10.1016/j.jacc.2013.01.047.</Citation><ArticleIdList><ArticleId IdType="doi">10.1016/j.jacc.2013.01.047</ArticleId><ArticleId IdType="pubmed">23500308</ArticleId></ArticleIdList></Reference><Reference><Citation>Généreux P, Cohen DJ, Williams MR, Mack M, Kodali SK, Svensson LG, Kirtane AJ, Xu K, McAndrew TC, Makkar R, Smith CR, Leon MB. Bleeding complications after surgical aortic valve replacement compared with transcatheter aortic valve replacement: insights from the PARTNER I Trial (Placement of Aortic Transcatheter Valve) J Am Coll Cardiol. 2014;63:1100–9. doi: 10.1016/j.jacc.2013.10.058.</Citation><ArticleIdList><ArticleId IdType="doi">10.1016/j.jacc.2013.10.058</ArticleId><ArticleId IdType="pubmed">24291283</ArticleId></ArticleIdList></Reference><Reference><Citation>Makkar RR, Fontana GP, Jilaihawi H, Kapadia S, Pichard AD, Douglas PS, Thourani VH, Babaliaros VC, Webb JG, Herrmann HC, Bavaria JE, Kodali S, Brown DL, Bowers B, Dewey TM, Svensson LG, Tuzcu M, Moses JW, Williams MR, Siegel RJ, Akin JJ, Anderson WN, Pocock S, Smith CR, Leon MB. Transcatheter aortic-valve replacement for inoperable severe aortic stenosis. N Engl J Med. 2012;366:1696–704. doi: 10.1056/NEJMoa1202277.</Citation><ArticleIdList><ArticleId IdType="doi">10.1056/NEJMoa1202277</ArticleId><ArticleId IdType="pubmed">22443478</ArticleId></ArticleIdList></Reference><Reference><Citation>Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Brown DL, Block PC, Guyton RA, Pichard AD, Bavaria JE, Herrmann HC, Douglas PS, Petersen JL, Akin JJ, Anderson WN, Wang D, Pocock S. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363:1597–607. doi: 10.1056/NEJMoa1008232.</Citation><ArticleIdList><ArticleId IdType="doi">10.1056/NEJMoa1008232</ArticleId><ArticleId IdType="pubmed">20961243</ArticleId></ArticleIdList></Reference><Reference><Citation>Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Williams M, Dewey T, Kapadia S, Babaliaros V, Thourani VH, Corso P, Pichard AD, Bavaria JE, Herrmann HC, Akin JJ, Anderson WN, Wang D, Pocock SJ. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364:2187–98. doi: 10.1056/NEJMoa1103510.</Citation><ArticleIdList><ArticleId IdType="doi">10.1056/NEJMoa1103510</ArticleId><ArticleId IdType="pubmed">21639811</ArticleId></ArticleIdList></Reference><Reference><Citation>Cao C, Ang SC, Indraratna P, Manganas C, Bannon P, Black D, Tian D, Yan TD. Systematic review and meta-analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis. Ann Cardiothorac Surg. 2013;2:10–23.</Citation><ArticleIdList><ArticleId IdType="pmc">PMC3741825</ArticleId><ArticleId IdType="pubmed">23977554</ArticleId></ArticleIdList></Reference><Reference><Citation>Adams DH, Popma JJ, Reardon MJ, Yakubov SJ, Coselli JS, Deeb GM, Gleason TG, Buchbinder M, Hermiller J, Kleiman NS, Chetcuti S, Heiser J, Merhi W, Zorn G, Tadros P, Robinson N, Petrossian G, Hughes GC, Harrison JK, Conte J, Maini B, Mumtaz M, Chenoweth S, Oh JK. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med. 2014;370:1790–8. doi: 10.1056/NEJMoa1400590.</Citation><ArticleIdList><ArticleId IdType="doi">10.1056/NEJMoa1400590</ArticleId><ArticleId IdType="pubmed">24678937</ArticleId></ArticleIdList></Reference><Reference><Citation>Moat NE, Ludman P, de Belder Mark A, Bridgewater B, Cunningham AD, Young CP, Thomas M, Kovac J, Spyt T, MacCarthy PA, Wendler O, Hildick-Smith D, Davies SW, Trivedi U, Blackman DJ, Levy RD, Brecker , Stephen JD, Baumbach A, Daniel T, Gray H, Mullen MJ. Long-term outcomes after transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis: the U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry. J Am Coll Cardiol. 2011;58:2130–8.</Citation><ArticleIdList><ArticleId IdType="pubmed">22019110</ArticleId></ArticleIdList></Reference><Reference><Citation>Chieffo A, Buchanan GL, Van Mieghem Nicolas M, Tchetche D, Dumonteil N, Latib A, van der Boon Robert MA, Vahdat O, Marcheix B, Farah B, Serruys PW, Fajadet J, Carrié D, de Jaegere , Peter PT, Colombo A. Transcatheter aortic valve implantation with the Edwards SAPIEN versus the Medtronic CoreValve Revalving system devices: a multicenter collaborative study: the PRAGMATIC Plus Initiative (Pooled-RotterdAm-Milano-Toulouse In Collaboration) J Am Coll Cardiol. 2013;61:830–6. doi: 10.1016/j.jacc.2012.11.050.</Citation><ArticleIdList><ArticleId IdType="doi">10.1016/j.jacc.2012.11.050</ArticleId><ArticleId IdType="pubmed">23333140</ArticleId></ArticleIdList></Reference><Reference><Citation>van der Boon Robert MA, Marcheix B, Tchetche D, Chieffo A, Van Mieghem Nicolas M, Dumonteil N, Vahdat O, Maisano F, Serruys PW, Kappetein AP, Fajadet J, Colombo A, Carrié D, van Domburg Ron T, de Jaegere , Peter PT. Transapical versus transfemoral aortic valve implantation: a multicenter collaborative study. Ann Thorac Surg. 2014;97:22–8. doi: 10.1016/j.athoracsur.2013.09.088.</Citation><ArticleIdList><ArticleId IdType="doi">10.1016/j.athoracsur.2013.09.088</ArticleId><ArticleId IdType="pubmed">24263012</ArticleId></ArticleIdList></Reference><Reference><Citation>Dewey TM, Bowers B, Thourani VH, Babaliaros V, Smith CR, Leon MB, Svensson LG, Tuzcu EM, Miller DC, Teirstein PS, Tyner J, Brown DL, Fontana GP, Makkar RR, Williams MR, George I, Kirtane AJ, Bavaria JE, Mack MJ. Transapical aortic valve replacement for severe aortic stenosis: results from the nonrandomized continued access cohort of the PARTNER trial. Ann Thorac Surg. 2013;96:2083–9. doi: 10.1016/j.athoracsur.2013.05.093.</Citation><ArticleIdList><ArticleId IdType="doi">10.1016/j.athoracsur.2013.05.093</ArticleId><ArticleId IdType="pubmed">23968764</ArticleId></ArticleIdList></Reference><Reference><Citation>Dvir D, Webb J, Brecker S, Bleiziffer S, Hildick-Smith D, Colombo A, Descoutures F, Hengstenberg C, Moat NE, Bekeredjian R, Napodano M, Testa L, Lefevre T, Guetta V, Nissen H, Hernández J, Roy D, Teles RC, Segev A, Dumonteil N, Fiorina C, Gotzmann M, Tchetche D, Abdel-Wahab M, Marco F de, Baumbach A, Laborde J, Kornowski R. Transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: results from the global valve-in-valve registry. Circulation. 2012;126:2335–44. doi: 10.1161/CIRCULATIONAHA.112.104505.</Citation><ArticleIdList><ArticleId IdType="doi">10.1161/CIRCULATIONAHA.112.104505</ArticleId><ArticleId IdType="pubmed">23052028</ArticleId></ArticleIdList></Reference><Reference><Citation>Piazza N, Bleiziffer S, Brockmann G, Hendrick R, Deutsch M, Opitz A, Mazzitelli D, Tassani-Prell P, Schreiber C, Lange R. Transcatheter aortic valve implantation for failing surgical aortic bioprosthetic valve: from concept to clinical application and evaluation (part 2) JACC Cardiovasc Interv. 2011;4:733–42. doi: 10.1016/j.jcin.2011.05.007.</Citation><ArticleIdList><ArticleId IdType="doi">10.1016/j.jcin.2011.05.007</ArticleId><ArticleId IdType="pubmed">21777880</ArticleId></ArticleIdList></Reference><Reference><Citation>Webb JG, Wood DA, Ye J, Gurvitch R, Masson J, Rodés-Cabau J, Osten M, Horlick E, Wendler O, Dumont E, Carere RG, Wijesinghe N, Nietlispach F, Johnson M, Thompson CR, Moss R, Leipsic J, Munt B, Lichtenstein SV, Cheung A. Transcatheter valve-in-valve implantation for failed bioprosthetic heart valves. Circulation. 2010;121:1848–57. doi: 10.1161/CIRCULATIONAHA.109.924613.</Citation><ArticleIdList><ArticleId IdType="doi">10.1161/CIRCULATIONAHA.109.924613</ArticleId><ArticleId IdType="pubmed">20385927</ArticleId></ArticleIdList></Reference><Reference><Citation>Bourantas CV, Van Mieghem Nicolas M, Farooq V, Soliman OI, Windecker S, Piazza N, Serruys PW. Future perspectives in transcatheter aortic valve implantation. Int J Cardiol. 2013;168:11–8. doi: 10.1016/j.ijcard.2013.03.065.</Citation><ArticleIdList><ArticleId IdType="doi">10.1016/j.ijcard.2013.03.065</ArticleId><ArticleId IdType="pubmed">23597575</ArticleId></ArticleIdList></Reference></ReferenceList></PubmedData></PubmedArticle><PubmedArticle><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">25373270</PMID><DateCompleted><Year>2014</Year><Month>12</Month><Day>09</Day></DateCompleted><DateRevised><Year>2014</Year><Month>11</Month><Day>06</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">1268-6034</ISSN><JournalIssue CitedMedium="Print"><Issue>109</Issue><PubDate><Year>2014</Year><Season>Sep-Oct</Season></PubDate></JournalIssue><Title>Soins. Gerontologie</Title><ISOAbbreviation>Soins Gerontol</ISOAbbreviation></Journal>[An episode of language difficulties].
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Transcatheter aortic valve implantation was developed to offer a therapeutic solution to patients with severe symptomatic aortic stenosis who are not candidates for conventional aortic valve replacement. The improvement in transcatheter aortic valve implantation outcomes is still of concern in the areas of stroke, vascular injury, heart block, paravalvular regurgitation and valve durability. Concomitantly, the progress, both technical and in terms of material advances of transcatheter valve systems, as well as in patient selection, renders transcatheter aortic valve implantation an increasingly viable treatment for more and more patients with structural heart disease.
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The effects of intravenous dexmedetomidine on spinal anesthesia: comparision of different dose of dexmedetomidine.
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In this prospective, randomized, double-blind, placebo-controlled trial, we tried to find out appropriate amounts of single-dose dexmedetomidine to prolong the duration of spinal anesthesia in a clinical setting.</AbstractText>Sixty patients who were scheduled for unilateral lower limb surgery under spinal anesthesia were randomized into three groups receiving normal saline (control group, n = 20) or 0.5 or 1.0 ug/kg dexmedetomidine (D-0.5 group, n = 20; D-1, n = 20) intravenously prior to spinal anesthesia with 12 mg of bupivacaine. The two-dermatome pinprick sensory regression time, duration of the motor block, Ramsay sedation score (RSS), and side effects of dexmedetomidine were assessed.</AbstractText>The two-dermatome pinprick sensory regression time (57.6 ± 23.2 vs 86.5 ± 24.3 vs 92.5 ± 30.7, P = 0.0002) and duration of the motor block (98.8 ± 34.1 vs 132.9 ± 43.4 vs 130.4 ± 50.4, P = 0.0261) were significantly increased in the D-0.5 and D-1 groups than in the control group. The RSS were significantly higher in the D-0.5 and D-1 groups than in the control group. However, there were no patients with oxygen desaturation in dexmedetomidine groups. The incidences of hypotension and bradycardia showed no differences among the three groups.</AbstractText>Both 0.5 and 1.0 ug/kg of dexmedetomidine administered as isolated boluses in the absence of maintenance infusions prolonged the duration of spinal anesthesia.</AbstractText>
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Role of the intercalated disc in cardiac propagation and arrhythmogenesis.
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This review article discusses mechanisms underlying impulse propagation in cardiac muscle with specific emphasis on the role of the cardiac cell-to-cell junction, called the "intercalated disc."The first part of this review deals with the role of gap junction channels, formed by connexin proteins, as a determinant of impulse propagation. It is shown that, depending on the underlying structure of the cellular network, decreasing the conductance of gap junction channels (so-called "electrical uncoupling") may either only slow, or additionally stabilize propagation and reverse unidirectional propagation block to bidirectional propagation. This is because the safety factor for propagation increases with decreasing intercellular electrical conductance. The role of heterogeneous connexin expression, which may be present in disease states, is also discussed. The hypothesis that so-called ephaptic impulse transmission plays a role in heart and can substitute for electrical coupling has been revived recently. Whereas ephaptic transmission can be demonstrated in theoretical simulations, direct experimental evidence has not yet been presented. The second part of this review deals with the interaction of three protein complexes at the intercalated disc: (1) desmosomal and adherens junction proteins, (2) ion channel proteins, and (3) gap junction channels consisting of connexins. Recent work has revealed multiple interactions between these three protein complexes which occur, at least in part, at the level of protein trafficking. Such interactions are likely to play an important role in the pathogenesis of arrhythmogenic cardiomyopathy, and may reveal new therapeutic concepts and targets.
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2,333,526 |
Effect of training-session intensity distribution on session rating of perceived exertion in soccer players.
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To examine the effect of different exercise-intensity distributions within a training session on the session rating of perceived exertion (RPE) and to examine the timing of measure on the rating.</AbstractText>Nineteen junior players (age 16±1 y, height 173±5 cm, body mass 64±6 kg) from a Swiss soccer team were involved in the study. Percentage of heart rate maximum (%HR) and RPE (Borg CR100®) were collected in 4 standardized training sessions (conditions). The Total Quality of Recovery scale (TQR) and a visual analogue scale (VAS) for pain of the lower limbs were used to control for the effect of pretraining fatigue. Every session consisted of three 20-min blocks of different intensities (ie, low-moderate-high) performed in a random order. RPE was collected after every block (RPE5), immediately after the session (RPE-end), and 30 min after the session (RPE30).</AbstractText>RPE5s of each block were different depending on the distribution sequence (P<.0001). RPE-end, TQR, and VAS values were not different between conditions (P=.57, P=.55, and P=.96, respectively). The %HR was significantly different between conditions (P=.008), with condition 3 higher than condition 2 (74.1 vs 70.2%, P=.02). Edwards training loads were not significantly different between conditions (P=.09). RPE30 was not different from RPE-end (P>.05).</AbstractText>The current results show that coaches can design training sessions without concern about the influence of the within-session distribution of exercise intensity on session-RPE and that RPE can be collected at the end of the session or 30 min later.</AbstractText>
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Thoracic epidural infusion with chloroprocaine for postoperative analgesia following epicardial pacemaker placement in an infant.
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In critically ill neonates and infants, major interventions, including thoracotomy, may result in significant postoperative respiratory insufficiency and pain leading to the need for postoperative mechanical ventilation. Although there are many potential options for providing postoperative analgesia, there continues to be expanding use of regional anesthesia in this population. One of the many reported advantages is the provision of postoperative analgesia while avoiding the deleterious effects on respiratory function that may be seen with systemic opioids. We report the use of thoracic epidural anesthesia using a continuous infusion of chloroprocaine to provide analgesia following thoracotomy and epicardial pacemaker placement in an infant. The perioperative plan was complicated by comorbid conditions including congenital complete heart block, recent rhinovirus infection with residual respiratory involvement, and prematurity.
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Cognitive performance after stroke--the Framingham Heart Study.
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Individuals with a high risk of stroke are also more prone to cognitive impairment perhaps because of concomitant vascular risk factors. In addition, clinical stroke increases the risk of subsequent dementia. Nevertheless, the relationship between clinical stroke and subsequent cognitive function in initially nondemented individuals remains less clear as most prior studies examined case series without controls.</AbstractText>To specify among nondemented individuals the cognitive domains affected by clinical stroke, independently of vascular risk factors and prestroke cognition.</AbstractText>One hundred thirty-two Framingham study participants (mean age = 77 ± 9 years, 54% women) with prospectively validated initial strokes, as well as age- and gender-matched controls, underwent identical cognitive evaluations ∼six-months after the stroke. Linear regression models were used to assess the differences in cognitive scores between stroke cases and controls adjusting for prestroke cognitive function as assessed by Mini-Mental State Examination scores, and with and without adjustment for vascular risk factors.</AbstractText>Adjusting for prestroke cognition and vascular risk factors, persons with stroke had poorer cognitive function in the domains of immediate recall of logical and visual memories (β = -1·27 ± 0·60, P = 0·035; β = -1·03 ± 0·47, P = 0·028, respectively), verbal learning (paired associate test; β = -1·31 ± 0·57, P = 0·023), language (Boston naming test; β = -0·27 ± 0·08, P = 0·002), executive function (digit span backward; β = -0·53 ± 0·21, P = 0·015), and visuospatial and motor skills (block design; β = -3·02 ± 1·06, P = 0·005).</AbstractText>Clinical stroke is associated with subsequent poorer performance in multiple cognitive domains. This association cannot be entirely explained by the individual's cognitive function prior to stroke or by concomitant vascular risk factor levels.</AbstractText>© 2014 The Authors. International Journal of Stroke © 2014 World Stroke Organization.</CopyrightInformation>
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Calcium-activated potassium channels in ischemia reperfusion: a brief update.
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Ischemia and reperfusion (IR) injury constitutes one of the major causes of cardiovascular morbidity and mortality. The discovery of new therapies to block/mediate the effects of IR is therefore an important goal in the biomedical sciences. Dysfunction associated with IR involves modification of calcium-activated potassium channels (KCa) through different mechanisms, which are still under study. Respectively, the KCa family, major contributors to plasma membrane calcium influx in cells and essential players in the regulation of the vascular tone are interesting candidates. This family is divided into two groups including the large conductance (BKCa) and the small/intermediate conductance (SKCa/IKCa) K(+) channels. In the heart and brain, these channels have been described to offer protection against IR injury. BKCa and SKCa channels deserve special attention since new data demonstrate that these channels are also expressed in mitochondria. More studies are however needed to fully determine their potential use as therapeutic targets.
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Prophylactic effects of intrathecal Meperidine and intravenous Ondansetron on shivering in patients undergoing lower extremity orthopedic surgery under spinal anesthesia.
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Intraoperative hypothermia is a common problem with anesthesia. Spinal anesthesia, the same as general anesthesia, affects the process of temperature regulation. The aim of this study was to compare the prophylactic effect of intravenous (IV) ondansetron with intrathecal (IT) meperidine on prevention of shivering during spinal anesthesia in patients underwent orthopedic surgery of the lower limb.</AbstractText>In this study, 120 patients with American Society of Anesthesiologists physical status I to II, between the ages 16 and 65 were randomized into three groups. Group O and Group M were given IV ondansetron 8 mg and IT meperidine 0.2 mg/kg, before spinal anesthesia, respectively. Group C received IV saline 0.9%. The core and ambient temperatures, the incidence and intensity of shivering, blood pressure, heart rate, and maximum level of sensory block were recorded.</AbstractText>Shivering was observed in 15%, 2.5%, and 37.5% of patients in Groups O, M, and C, respectively. There was a significant difference between Group O and M compared to Group C (P = 0.023 for Group O vs. Group C, P < 0.001 for Group M vs. Group C, P = 0.049 for Group M vs. Group O). Shivering incidence and intensity in Group M was significantly lower than Group O (P = 0.049 and P = 0.047, respectively). Twenty-two patients required additional IV meperidine among which 15 patients were from Group C (37.5%), six patients from Group O (15%) and one patient from Group M (2.5%).</AbstractText>We concluded that IT meperidine and IV ondansetron comparably can decrease intensity and incidence of shivering compared to control group as well as decreasing the requirement to additional doses of meperidine for shivering the control without any hemodynamic side effect.</AbstractText>
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Induction of alloantigen-specific CD4+ T regulatory Type 1 cells by alloantigen immunization and ultraviolet-B irradiation: a pilot study in murine transplantation models with skin and cardiac allografts.
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The use of ultraviolet (UV)-B irradiation after alloantigen immunization is unknown because previous studies focused on UV-B irradiation before immunization. Here, we investigated immunosuppressive effects induced by UV-B irradiation after immunization, and examined the phenotype of induced regulatory T cells and the possible mechanism of induction.</AbstractText>B6 mice (H-2(b)) were intravenously immunized by splenocytes from CBF1 mice (H-2(b/d)). One week after alloantigen immunization, B6 mice received high-dose UV-B irradiation (40 kJ/m(2)). Four weeks after UV-B irradiation, proliferation assays (n=4, in each), transplantations with skin or cardiac allografts (n=5, in each), cytokines in mixed lymphocyte culture (n=6, in each), and adoptive transfer of CD4(+) T cells to naïve B6 mice (n=5, in each) were performed. Mice were divided into 4 groups: untreated control, immunized control, UV-irradiated control, and an immunized and UV-irradiated group. B6C3F1 mice (H-2(b/k)) were used as irrelevant alloantigen with immunization controls. Anti-IL-10 monoclonal antibody was used to block IL-10 before and after UV-B irradiation.</AbstractText>Immune responses against the immunizing antigen were markedly suppressed in immunized and UV-irradiated mice in an alloantigen-specific manner. Surprisingly, CD4(+) T cells from immunized and UV-irradiated mice produced significantly larger amounts of IL-10, in an alloantigen-specific manner. Moreover, alloantigen-specific immunosuppression via CD4(+) regulatory T cells was transferable to naïve B6 mice. IL-10 blocking clearly abrogated alloantigen-specific immunosuppression, indicating that UV-B irradiation evoked T regulatory type 1 cells.</AbstractText>This study demonstrates for the first time that immunization and UV irradiation induces alloantigen-specific CD4(+) T regulatory type 1 cells, and that IL-10 plays an important role for this induction.</AbstractText>
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2,333,532 |
Magnesium as an adjuvant for caudal analgesia in children.
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There is a need for an adjuvant agent of caudal block that prolongs its duration and improves the analgesic efficacy to fasten functional recovery. Magnesium is an N-methyl-D-aspartate receptor antagonist that functions as an analgesic. This study was aimed to evaluate whether magnesium as an adjuvant for caudal block in children can improve postoperative analgesia and functional recovery.</AbstractText>Eighty children, 2-6 years of age, undergoing inguinal herniorrhaphy, were included in this prospective, randomized, double-blinded study. For caudal block, Group R received ropivacaine 1.5 mg·ml(-1), 1 ml·kg(-1) and Group RM received the same dose of ropivacaine mixed with 50 mg of magnesium. The Parents' Postoperative Pain Measure (PPPM) score, analgesic consumption, functional recovery, and adverse effects were evaluated at 6, 24, 48, and 72 h after surgery, as well as daily thereafter until the child showed full functional recovery.</AbstractText>The PPPM score after hospital discharge was significantly lower for Group RM than for Group R at all times (P < 0.05). Children in Group RM required less fentanyl for rescue analgesia in the recovery area (16.2% vs 39.5%, P = 0.034) and less oral analgesics after discharge (20.5% vs 52.6%, P = 0.007). The time to return of normal functional activity was shorter in Group RM (P < 0.05). The incidence of adverse effects did not differ between groups.</AbstractText>As an adjuvant for caudal analgesia, 50 mg magnesium provided superior quality of analgesia and faster return of normal functional activity than local anesthetic alone in children.</AbstractText>© 2014 John Wiley & Sons Ltd.</CopyrightInformation>
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2,333,533 |
Long circulating self-assembled nanoparticles from cholesterol-containing brush-like block copolymers for improved drug delivery to tumors.
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Amphiphilic brush-like block copolymers composed of polynorbonene-cholesterol/poly(ethylene glycol) (P(NBCh9-b-NBPEG)) self-assembled to form a long circulating nanostructure capable of encapsulating the anticancer drug doxorubicin (DOX) with high drug loading (22.1% w/w). The release of DOX from the DOX-loaded P(NBCh9-b-NBPEG) nanoparticles (DOX-NPs) was steady at less than 2% per day in PBS. DOX-NPs were effectively internalized by human cervical cancer cells (HeLa) and showed dose-dependent cytotoxicity, whereas blank nanoparticles were noncytotoxic. The DOX-NPs demonstrated a superior in vivo circulation time relative to that of free DOX. Tissue distribution and in vivo imaging studies showed that DOX-NPs preferentially accumulated in tumor tissue with markedly reduced accumulation in the heart and other vital organs. The DOX-NPs greatly improved survival and significantly inhibited tumor growth in tumor-bearing SCID mice compared to that for the untreated and free DOX-treated groups. The results indicated that self-assembled P(NBCh9-b-NBPEG) may be a useful carrier for improving tumor delivery of hydrophobic anticancer drugs.
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2,333,534 |
Evaluation of chromosomal damage, cytostasis, cytotoxicity, oxidative DNA damage and their association with body-mass index in obese subjects.
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Over-weight and obesity are serious problems that increase the risk not only for chronic diseases like diabetes and heart disease but also of various types of cancer. This study was conducted to evaluate cytokinesis-block micronucleus cytome (CBMN-cyt) assay parameters and plasma concentrations of 8-hydroxy-2'-deoxyguanosine (8-OHdG), and their relationship with age, body-mass index (BMI) and waist-to-hip ratio (WHR) in 83 obese, 21 over-weight and 21 normal-weight subjects. Frequencies of micronuclei (MN), nucleoplasmic bridges (NPB), nuclear buds (NBUD), and apoptotic and necrotic cells in lymphocytes of obese subjects were found to be significantly higher than those found in normal-weight and over-weight subjects (p<0.01 and p<0.05), whereas plasma concentrations of 8-OHdG in obese subjects were lower than those observed in normal-weight and over-weight subjects (p<0.05 and p<0.01, respectively). There was a negative correlation between age and frequency of necrotic cells and NDI (p<0.05), whereas there was no correlation between BMI, WHR, CBMN cyt assay parameters and plasma 8-OHdG in normal-weight subjects. In over-weight subjects, a negative correlation was observed between age and NDI (p<0.01) and a positive correlation between age and frequency of NPB (p<0.01) and between BMI and frequency of NBUD (p<0.05). In obese subjects, a negative correlation was observed between age and NDI (p<0.01) and between BMI and NDI (p<0.05), whereas no correlation was observed between WHR and CBMN-cyt assay parameters and plasma 8-OHdG. However, frequencies of MN, NPB, NBUD, apoptotic and necrotic cells in total over-weight/obese (p<0.01/p<0.05) and all subjects (p<0.01) increased with increasing BMI. The increase in genomic damage (MN, NPB and NBUD) in obese subjects and the positive correlation between genomic damage and BMI in total over-weight/obese subjects indicate that obesity increases genomic damage and may be associated with an increased risk of cancer, because an increase in MN frequency is a predictor of cancer risk.
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2,333,535 |
Development and preliminary evaluation of an internet-based healthy eating program: randomized controlled trial.
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The HealthValues Healthy Eating Programme is a standalone Internet-based intervention that employs a novel strategy for promoting behavior change (analyzing one's reasons for endorsing health values) alongside other psychological principles that have been shown to influence behavior. The program consists of phases targeting motivation (dietary feedback and advice, analyzing reasons for health values, thinking about health-related desires, and concerns), volition (implementation intentions with mental contrasting), and maintenance (reviewing tasks, weekly tips).</AbstractText>The aim was to examine the effects of the program on consumption of fruit and vegetables, saturated fat, and added sugar over a 6-month period.</AbstractText>A total of 82 females and 18 males were recruited using both online and print advertisements in the local community. They were allocated to an intervention or control group using a stratified block randomization protocol. The program was designed such that participants logged onto a website every week for 24 weeks and completed health-related measures. Those allocated to the intervention group also completed the intervention tasks at these sessions. Additionally, all participants attended laboratory sessions at baseline, 3 months, and 6 months. During these sessions, participants completed a food frequency questionnaire (FFQ, the Block Fat/Sugar/Fruit/Vegetable Screener, adapted for the UK), and researchers (blind to group allocation) measured their body mass index (BMI), waist-to-hip ratio (WHR), and heart rate variability (HRV).</AbstractText>Data were analyzed using a series of ANOVA models. Per protocol analysis (n=92) showed a significant interaction for fruit and vegetable consumption (P=.048); the intervention group increased their intake between baseline and 6 months (3.7 to 4.1 cups) relative to the control group (3.6 to 3.4 cups). Results also showed overall reductions in saturated fat intake (20.2 to 15.6 g, P<.001) and added sugar intake (44.6 to 33.9 g, P<.001) during this period, but there were no interactions with group. Similarly, there were overall reductions in BMI (27.7 to 27.3 kg/m(2), P=.001) and WHR (0.82 to 0.81, P=.009), but no interactions with group. The intervention did not affect alcohol consumption, physical activity, smoking, or HRV. Data collected during the online sessions suggested that the changes in fruit and vegetable consumption were driven by the motivational and maintenance phases of the program.</AbstractText>Results suggest that the program helped individuals to increase their consumption of fruit and vegetables and to sustain this over a 6-month period. The observed reduction in fat and sugar intake suggests that monitoring behaviors over time is effective, although further research is needed to confirm this conclusion. The Web-based nature of the program makes it a potentially cost-effective way of promoting healthy eating.</AbstractText>
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Comparison of epidural versus intrathecal anaesthesia in dogs undergoing pelvic limb orthopaedic surgery.
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To compare the procedural failure rate (PFR), intraoperative rescue analgesia (iRA) probability and postoperative duration of motor block after epidural and intrathecal anaesthesia in dogs undergoing pelvic limb orthopaedic surgery.</AbstractText>Prospective, randomized clinical trial.</AbstractText>Ninety-two client-owned dogs.</AbstractText>Dogs were assigned randomly to receive either lumbosacral epidural anaesthesia (EA) (bupivacaine 0.5% and morphine 1%) or intrathecal anaesthesia with the same drugs in a hyperbaric solution (HIA). Inaccurate positioning of the needle, assessed by radiographic imaging, and lack of cerebral spinal fluid outflow were considered procedural failures (PFs) of EA and HIA, respectively. Fentanyl (1 μg kg(-1) IV) was provided for intraoperative rescue analgesia, when either the heart rate or the mean arterial pressure increased by 30% above the pre-stimulation value. Its use was recorded as a sign of intraoperative analgesic failure. The motor block resolution was evaluated postoperatively. Variables were compared using Fisher's exact test, the Mann-Whitney U test and the Kaplan-Meier 'survival' analysis as relevant.</AbstractText>The PFRs in the EA and HIA groups were 15/47 (32%) and 3/45 (7%), respectively (p = 0.003). Differences in iRA were analysed in 26 and 30 subjects in the EA and HIA groups respectively, using Kaplan-Meier survival analysis. The iRA probability within the first 80 minutes of needle injection (NI) was higher in the EA group (p = 0.045). The incidence of dogs walking within 3 hours of NI was significantly higher in the HIA group (8/20, 40%) than in the EA group (0/17) (p = 0.004).</AbstractText>HIA was found to have lower PF, lower intraoperative analgesic failure and faster motor block resolution. In this study HIA was shown to provide some advantages over EA in dogs undergoing commonly performed pelvic limb orthopaedic surgery in a day-hospital regime.</AbstractText>© 2014 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.</CopyrightInformation>
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Using an international clinical registry of regional anesthesia to identify targets for quality improvement.
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Despite the widespread use of regional anesthesia, limited information on clinical performance exists. Institutions, therefore, have little knowledge of how they are performing in regard to both safety and effectiveness. In this study, we demonstrate how a medical institution (or physician/physician group) may use data from a multicenter clinical registry of regional anesthesia to inform quality improvement strategies.</AbstractText>We analyzed data from the International Registry of Regional Anesthesia that includes prospective data on peripheral regional anesthesia procedures from 19 centers located around the world. Using data from the clinical registry, we present summary statistics of the overall safety and effectiveness of regional anesthesia. Furthermore, we demonstrate, using a variety of performance measures, how these data can be used by hospitals to identify areas for quality improvement. To do so, we compare the performance of 1 member institution (a US medical center in New Hampshire) to that of the other 18 member institutions of the clinical registry.</AbstractText>The clinical registry contained information on 23,271 blocks that were performed between June 1, 2011, and May 1, 2014, on 16,725 patients. The overall success rate was 96.7%, immediate complication rate was 2.2%, and the all-cause 60-day rate of neurological sequelae was 8.3 (95% confidence interval, 7.2- 9.7) per 10,000. Registry-wide major hospital events included 7 wrong-site blocks, 3 seizures, 1 complete heart block, 1 retroperitoneal hematoma, and 3 pneumothoraces. For our reference medical center, we identified areas meriting quality improvement. Specifically, after accounting for differences in the age, sex, and health status of patient populations, the reference medical center appeared to rely more heavily on opioids for postprocedure management, had higher patient pain scores, and experienced delayed discharge when compared with other member institutions.</AbstractText>To our knowledge, this is the first large-scale effort to use a clinical registry to provide comparative outcome rates representing the safety and effectiveness of regional anesthesia. These results can be used to help inform quality improvement strategies.</AbstractText>
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The carboxyl terminus of VEGF-A is a potential target for anti-angiogenic therapy.
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Anti-VEGF-A therapy has become a mainstay of treatment for ocular neovascularisation and in cancer; however, their effectiveness is not universal, in some cases only benefiting a minority of patients. Anti-VEGF-A therapies bind and block both pro-angiogenic VEGF-Axxx and the partial agonist VEGF-Axxxb isoforms, but their anti-angiogenic benefit only comes about from targeting the pro-angiogenic isoforms. Therefore, antibodies that exclusively target the pro-angiogenic isoforms may be more effective. To determine whether C-terminal-targeted antibodies could inhibit angiogenesis, we generated a polyclonal antibody to the last nine amino acids of VEGF-A165 and tested it in vitro and in vivo. The exon8a polyclonal antibody (Exon8apab) did not bind VEGF-A165b even at greater than 100-fold excess concentration, and dose dependently inhibited VEGF-A165 induced endothelial migration in vitro at concentrations similar to the VEGF-A antibody fragment ranibizumab. Exon8apab can inhibit tumour growth of LS174t cells implanted in vivo and blood vessel growth in the eye in models of age-related macular degeneration, with equal efficacy to non-selective anti-VEGF-A antibodies. It also showed that it was the VEGF-Axxx levels specifically that were upregulated in plasma from patients with proliferative diabetic retinopathy. These results suggest that VEGF-A165-specific antibodies can be therapeutically useful.
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2,333,539 |
Early postoperative bladder training in patients submitted to radical hysterectomy: is it still necessary? A randomized trial.
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To evaluate the role of bladder training during postoperative hospital stay in patients submitted to nerve-sparing radical hysterectomy, and to identify any clinical or surgical factor associated with postoperative bladder dysfunction.</AbstractText><AbstractText Label="DESIGN, SETTING, AND PARTICIPANTS" NlmCategory="METHODS">Parallel group randomized single institution trial, on gynaecologic malignancies patients conducted in Catholic University of Sacred Heart Rome, between April 2009 and November 2011. Randomization was on 1:1, using a block randomized computer-generated list.</AbstractText>Patients underwent Querleu-Morrow type B2 or C1 radical hysterectomy. After 2 days from surgery, patients were randomized to perform or not bladder training (scheduled clamping and unclamping of the trans-urethral catheter every three hours). Main outcome measures Necessity and duration of clean intermittent self catheterization.</AbstractText>Randomized participants were 111 women (bladder training arm n = 55; control arm n = 56). A total of 22 women (19.8%) required clean intermittent self catheterization, equally distributed in the two arms. At univariate analysis, only the type of radical hysterectomy was significantly associated with need of clean intermittent self catheterization (type C1 vs. type B2; p = 0.013). At univariate analysis, duration of clean intermittent self-catheterization was not associated with age, BMI, type of hysterectomy and of neo-adjuvant treatment.</AbstractText>Functional bladder disfunctions are the most common long-term complications following radical hysterectomy. Systematic postoperative bladder training following nerve-sparing radical hysterectomy does not influence the rate of urinary retention or re-admission for bladder catheterization.</AbstractText>
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2,333,540 |
Ethnic differences translate to inadequacy of high-risk screening for gestational diabetes mellitus in an Asian population: a cohort study.
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Universal and high-risk screening for gestational diabetes mellitus (GDM) has been widely studied and debated. Few studies have assessed GDM screening in Asian populations and even fewer have compared Asian ethnic groups in a single multi-ethnic population.</AbstractText>1136 pregnant women (56.7% Chinese, 25.5% Malay and 17.8% Indian) from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort study were screened for GDM by 75-g oral glucose tolerance test (OGTT) at 26-28 weeks of gestation. GDM was defined using the World Health Organization (WHO) criteria. High-risk screening is based on the guidelines of the UK National Institute for Health and Clinical Excellence.</AbstractText>Universal screening detected significantly more cases than high-risk screening [crude OR 2.2 (95% CI 1.7-2.8)], particularly for Chinese women [crude OR = 3.5 (95% CI 2.5-5.0)]. Pre-pregnancy BMI > 30 kg/m2 (adjusted OR = 3.4, 95% CI 1.5-7.9) and previous GDM history (adjusted OR = 6.6, 95% CI 1.2-37.3) were associated with increased risk of GDM in Malay women while GDM history was the only significant risk factor for GDM in Chinese women (adjusted OR = 4.7, 95% CI 2.0-11.0).</AbstractText>Risk factors used in high-risk screening do not sufficiently predict GDM risk and failed to detect half the GDM cases in Asian women. Asian women, particularly Chinese, should be screened to avoid under-diagnosis of GDM and thereby optimize maternal and fetal outcomes.</AbstractText>
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2,333,541 |
Comparison of Spinal Anaesthesia and Paravertebral Block in Unilateral Inguinal Hernia Repair.
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We aimed to compare the efficacy of spinal anaesthesia (SA) and paravertebral block (PVB) in unilateral inguinal hernia repair.</AbstractText>Sixty American Society of Anesthesia physical status (ASA) I-III patients aged between 18-64 years with unilateral inguinal hernia were enrolled in this study. Two patients in Group SA and 4 patients in Group PVB were excluded, and statistical analyses were done on 54 patients. In regard to anaesthetic choice, patients were divided into two groups, with 30 patients in each: Group SA, spinal anaesthesia and Group PVB, paravertebral block. Standard monitoring was done, and mean arterial pressure (MAP) and heart rate (HR) were recorded during the surgical procedure. Demographic variables, surgical data, patient satisfaction, the onset times to reach T10 dermatome and to reach peak sensory level, and onset time to reach modified Bromage 3 motor block were recorded. Postoperative nausea and vomiting and pain at postoperative hours 0-24 with the visual analog scale (VAS) were also measured.</AbstractText>Compared to pre-anaesthesia measurements, the decrease in HR and MAP during the 10(th)-90(th) minute period was significant in Group SA (p<0.01). In Group PVB, sensory block duration time was higher, whereas paralysis rate was higher in Group SA (p<0.01). Bromage scores were significantly different between the groups (p<0.01). In Group SA, VAS score at the 24(th) postoperative hour, nausea, and vomiting were significantly higher compared to Group PVB (p<0.01).</AbstractText>In conclusion, paravertebral block provides acceptable surgical anaesthesia, maintaining good quality and long duration on postoperative analgesia in unilateral hernia repair.</AbstractText>
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2,333,542 |
Expression profile and histological distribution of IFITM1 and IFITM3 during H9N2 avian influenza virus infection in BALB/c mice.
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The H9N2 avian influenza virus is a pandemic threat which has repeatedly caused infection in humans and shows enhanced replication and transmission in mice. Previous reports showed that host factors, the interferon-inducible transmembrane (IFITM) protein, can block the replication of pathogens and affect their pathogenesis. BALB/c mice are routine laboratory animals used in influenza virus research, but the effects of H9N2 influenza virus on tissue distribution and expression pattern of IFITM in these mice are unknown. Here, we investigated the expression patterns and tissue distribution of IFITM1 and IFITM3 in BALB/c mice by infection with H9N2 AIV strains with only a PB2 residue 627 difference. The results showed that the expression patterns of ITITM1 and IFITM3 differ in various tissues of BALB/c mice at different time points after infection. IFITM1 and IFITM3 showed cell- and tissue-specific distribution in the lung, heart, liver, spleen, kidney and brain. Notably, the epithelial and neuronal cells all expressed the proteins of IFITM1 and IFITM3. Our results provide the first look at differences in IFITM1 and IFITM3 expression patterns in BALB/c mice infected by H9N2 influenza viruses. This will enhance research on the interaction between AIV and host and further will elucidate the pathogenesis of influenza virus infection based on the interferon-inducible transmembrane (IFITM) protein.
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2,333,543 |
The influence of piroxicam, a non-selective cyclooxygenase inhibitor, on autonomic nervous system activity in experimental cyclophosphamide-induced hemorrhagic cystitis and bladder outlet obstruction in rats.
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Signs and symptoms of secondary overactive bladder (OAB) are observed both in course of infravesical obstruction of urine outflow in patients with benign prostatic hyperplasia, and as a result of development of hemorrhagic cystitis (HC) following administration of cyclophosphamide (CP). Non-steroidal antiinflammatory drugs (NSAIDs) alleviate symptoms of bladder overactivity reducing local synthesis of prostaglandins (PGs), but precise effects of those agents on functions of the autonomic nervous system (ANS) in course of OAB remain unknown. The purpose of this study was to evaluate the effect of piroxicam-induced prostaglandins (PGs) synthesis block on activity of the ANS in two experimental models of secondary OAB: bladder outlet obstruction (BOO) and cyclophosphamide-induced HC (CP-HC), by heart rate variability analysis (HRV). The experiment was performed on a group of rats with surgically induced 2-week BOO, and on a group of rats that were administered CP five times, with corresponding control groups. Study animals were given piroxicam (PRX) i.p. in two doses: 2 and 10 mg/kg b.w. In the BOO model, PRX in both doses revealed a trend for reduction of value of all non-normalized components of HRV. The lower PRX dose caused an increased nHF value, and PRX administered in the dose of 10 mg/kg b.w. caused an increase of the nLF value. In the CP-HC model, the lower PRX dose caused a trend for an increase of values of all non-normalized components, and the higher dose--for their decrease. Both doses of PRX in that model caused increase of the nLF value. Inhibition of PGs synthesis caused changes of ANS function in both models of OAB. Both in BOO and in CP-HC, PGs seem to be ANS-activating factors, responsible for maintenance of a high parasympathetic activity. In both models, inhibition of PGs synthesis with PRX administered at the dose of 10 mg/kg b.w. lead to functional reconstruction of ANS, with marked sympathetic predominance. That may contribute to reduction of the bladder contractile action and improvement of its compliance in the filling period, which was demonstrated by other authors in urodynamic tests for NSAIDs.
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2,333,544 |
Effect of audiovisual distraction with 3D video glasses on dental anxiety of children experiencing administration of local analgesia: a randomised clinical trial.
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To determine the effect of three-dimensional (3D) audiovisual (AV) distraction in reducing dental anxiety of children.</AbstractText>A randomised clinical trial with a parallel design carried out on 90 children (49 boys and 41 girls) aged between 7 and 10 years (mean age of 8.4 years) to ascertain the comparative efficacy of audio (music) and AV (3D video glasses) distraction in reducing the dental anxiety of children during local analgesia (LA) administration.</AbstractText>Ninety children were randomly divided into three groups; control (basic behaviour guidance techniques without distraction), audio (basic techniques plus music) and AV (basic techniques plus 3D AV) distraction groups. All the children experienced LA administration with/without distraction and the anxiety was assessed using a combination of measures: MCDAS(f) (self-report), pulse rate (physiological), behaviour (using Wright's modification of Frankl behaviour rating scale and Houpt scale) and preferences of children.</AbstractText>All 90 children completed the study. A highly significant reduction in the anxiety of audiovisual group as reported by the MCDAS(f) values (p<0.001) and Houpt scale (p=0.003); whereas pulse rate showed statistically significant increase (p<0.001) in all the three groups irrespective of distraction. The child preferences also affirmed the usage of 3D video glasses.</AbstractText>LA administration with music or 3D video glasses distraction had an added advantage in a majority of children with 3D video glasses being superior to music. High levels of satisfaction from children who experienced treatment with 3D video glasses were also observed.</AbstractText>
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2,333,545 |
Renal biopsy in the management of lupus nephritis during pregnancy.
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The differential diagnosis of proteinuria and hematuria in pregnancy is broad and includes active lupus nephritis. Identification of the correct diagnosis often has a profound therapeutic impact on not only the mother but also the fetus. To date, relatively few reports exist on the role of renal biopsy during pregnancy among women with systemic lupus erythematosus (SLE). We present a case series of 11 pregnant women with SLE who underwent a renal biopsy to evaluate a presumptive flare of lupus nephritis. The electronic medical record was retrospectively analyzed for pre-biopsy serum creatinine, proteinuria, hematuria, antinuclear antibodies (ANA), and antibodies to double-stranded DNA (anti-dsDNA); histologic findings on renal biopsy; and the clinical course of each mother and fetus. From 2001 to 2012, 11 pregnant women with SLE flares during pregnancy underwent a renal biopsy at an academic tertiary medical center. At the time of biopsy, median gestational age was 16 weeks (range 9 to 27), median serum creatinine was 0.6 mg/dl (interquartile range 0.5 to 0.9), six (55%) had hematuria, and all had proteinuria >500 mg/24 hours. Proliferative lupus nephritis was found in 10 (91%) of 11 biopsies (five with ISN/RPS Class III; five with ISN/RPS Class IV). All but one individual underwent a change in management guided by information gleaned from renal biopsy. No apparent biopsy-related complications occurred to mother or fetus. Three women elected to terminate their pregnancy; although many factors were involved, the findings on renal biopsy informed the decision-making process. Among the remaining cases, there were three pre-term deliveries, one fetus with complete heart block, one in utero demise, and one maternal death. Renal biopsy is helpful at informing the management of patients with lupus nephritis during pregnancy.
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2,333,546 |
Effects of dexmedetomidine versus ketorolac as local anesthetic adjuvants on the onset and duration of infraclavicular brachial plexus block.
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Infraclavicular brachial plexus block is an appropriate approach for distal arm and forearm surgeries. Local anesthetic adjuvant agents are used to improve the quality of nerve blocks. Dexmedetomidine and ketorolac are two different types of adjuvants, which have been used in some studies.</AbstractText>The purpose of this study was to examine the effects of dexmedetomidine and ketorolac as local anesthetic adjuvants on the onset and duration of infraclavicular brachial plexus block under ultrasound guide technique.</AbstractText>In a clinical trial study, 111 ASA class I and II patients who were candidates for elective distal arm and forearm surgeries under ultrasound guided infraclavicular brachial plexus block divided into three 37 patient groups. In dexmedetomidine group, 25 mL of lidocaine 1.5% plus 4 ml of normal saline and 100 mcg of dexmedetomidine was injected. Ketorolac group received 25 mL of Lidocaine 1.5% plus 5 mL of ketorolac, and placebo group received 25 mL of lidocaine 1.5% plus 5 mL of normal saline as local anesthetic solution. Sensory and motor onset blocks, duration of sensory and motor blocks and first time to analgesic request and hemodynamic parameters were all recorded.</AbstractText>There were no significant differences in sensory block onset between three groups (P = 0.177). Motor block onset was statistically less in dexmedetomidine compared to ketorolac and placebo groups (both Ps < 0.001). Sensory block duration in dexmedetomidine group was significantly longer than ketorolac and placebo groups (both Ps < 0.001). Motor block duration in dexmedetomidine group was significantly longer than ketorolac and placebo groups (both Ps < 0.001). Time to first analgesic request after the procedures was longer in ketorolac compared to dexmedetomidine and placebo groups (P = 0.016, P < 0.001 respectively), but it was longer in dexmedetomidine compared to placebo group (P = 0.003). The differences of diastolic blood pressure in-between the 5th to 140th minutes after local anesthetic injection among the 3 groups were statistically significant and dexmedetomidine group shows the most reduction in diastolic blood pressure (P < 0.001). Dexmedetomidine showed the lowest mean arterial pressure (P = 0.016) and heart rate in dexmedetomidine group was significantly lower than ketorolac and placebo groups (P = 0.043).</AbstractText>Our study showed that dexmedetomidine had better effects on sensory and motor block duration and motor block onset in comparison with ketorolac, as lidocaine adjuvants in infraclavicular brachial plexus block were present in both protocols. However, the first time to analgesic request by ketorolac was longer than dexmedetomidine.</AbstractText>
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2,333,547 |
Single shot spinal anaesthesia with hypobaric bupivacaine for hip fracture repair surgery in the elderly. Randomized, double blinded comparison of 3.75 mg vs. 7.5 mg.
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Arterial hypotension is the most frequent adverse effect of subarachnoid anaesthesia in the elderly sustaining a femoral proximal fracture. Decreasing the local anaesthetic dose reduces the incidence of hypotension but shortens sensory block duration that could be insufficient in some surgical procedures. Sensory block duration could be prolonged using hypobaric local anaesthetics. We evaluated whether low hypobaric bupivacaine doses were adequate for this type of surgery while maintaining the haemodynamic stability.</AbstractText>A prospective, randomized, double blinded study was designed. Patients over 65 years old, sustaining traumatic hip fracture, were assigned to one of two groups: B0.5 group, hypobaric bupivacaine 7.5mg 5mg/ml (control group), and B0.25 group, hypobaric bupivacaine 3.75 mg 2.5mg/ml (study group). After subarachnoid injection, sensory level and motor blockade degree were registered, as were blood pressure, and heart rate at basal time and at 2, 5, 10, 15, 20 and 30 min after injection. The doses of vasopressor needed were registered as well. Surgical conditions and the duration of the surgical procedure-whether rescue analgesia or anaesthesia was needed-and sensory level regression to T12, were registered as well.</AbstractText>Sixty four patients was the calculated sample size. The study was stopped in an interim analysis because an elevated number of patients in the B0.25 group needed iv rescue anaesthesia. In the analyzed cases, blood pressure was significantly lower in the B0.5 group at the 15 and 30 min measurements. Vasopressor drugs needs were similar between groups [ephedrine accumulated mean (SD) doses 11.4 (5.2) mg vs. 9.1 (2.7) mg, p=0.045)]. Sensory block regression to T12 was faster in the B0.25 group, [(mean (SD) 68.2 (29.0) min vs. 112.8 (17.3) min in the B0.5 group, p<0.05]. Five out of 19 patients in the B0.25 group needed intravenous anaesthesia rescue before surgery started.</AbstractText>Lowering hypobaric bupivacaine dose to 3.75 mg in subarachnoid anaesthesia for hip fracture repair surgery in elderly patients decrease intraoperative blood pressure, but in an important number of patients intravenous anaesthesia rescue was needed and preclude recommendation.</AbstractText>Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.</CopyrightInformation>
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2,333,548 |
Nitrite modulates bacterial antibiotic susceptibility and biofilm formation in association with airway epithelial cells.
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Pseudomonas aeruginosa is the major pathogenic bacteria in cystic fibrosis and other forms of bronchiectasis. Growth in antibiotic-resistant biofilms contributes to the virulence of this organism. Sodium nitrite has antimicrobial properties and has been tolerated as a nebulized compound at high concentrations in human subjects with pulmonary hypertension; however, its effects have not been evaluated on biotic biofilms or in combination with other clinically useful antibiotics. We grew P. aeruginosa on the apical surface of primary human airway epithelial cells to test the efficacy of sodium nitrite against biotic biofilms. Nitrite alone prevented 99% of biofilm growth. We then identified significant cooperative interactions between nitrite and polymyxins. For P. aeruginosa growing on primary CF airway cells, combining nitrite and colistimethate resulted in an additional log of bacterial inhibition compared to treating with either agent alone. Nitrite and colistimethate additively inhibited oxygen consumption by P. aeruginosa. Surprisingly, whereas the antimicrobial effects of nitrite in planktonic, aerated cultures are nitric oxide (NO) dependent, antimicrobial effects under other growth conditions are not. The inhibitory effect of nitrite on bacterial oxygen consumption and biofilm growth did not require NO as an intermediate as chemically scavenging NO did not block growth inhibition. These data suggest an NO-radical independent nitrosative or oxidative inhibition of respiration. The combination of nebulized sodium nitrite and colistimethate may provide a novel therapy for chronic P. aeruginosa airway infections, because sodium nitrite, unlike other antibiotic respiratory chain "poisons," can be safely nebulized at high concentration in humans.
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2,333,549 |
Predictors of Intensive Care Unit Morbidity and Midterm Follow-up after Primary Repair of Tetralogy of Fallot.
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Our objectives were to review our institutional early and midterm experience with primary tetralogy of Fallot (TOF) repair, and identify predictors of intensive care unit (ICU) morbidity.</AbstractText>We analyzed perioperative and midterm follow-up data for all cases of primary TOF repair from 2001 to 2012. The primary endpoint was early mortality and morbidity, and the secondary endpoint was survival and functional status at follow-up.</AbstractText>Ninety-seven patients underwent primary repair. The median age was 4.9 months (range, 1 to 9 months), and the median weight was 5.3 kg (range, 3.1 to 9.8 kg). There was no early surgical mortality. The incidence of junctional ectopic tachycardia and persistent complete heart block was 2% and 1%, respectively. The median length of ICU stay was 6 days (range, 2 to 21 days), and the median duration of mechanical ventilation was 19 hours (range, 0 to 136 hours). By multiple regression analysis, age and weight were independent predictors of the length of ICU stay, while the surgical era was an independent predictor of the duration of mechanical ventilation. At the 8-year follow-up, freedom from death and re-intervention was 97% and 90%, respectively.</AbstractText>Primary TOF repair is a safe procedure with low mortality and morbidity in a medium-sized program with outcomes comparable to national standards. Age and weight at the time of surgery remain significant predictors of morbidity.</AbstractText>
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2,333,550 |
Vegan diet, subnormal vitamin B-12 status and cardiovascular health.
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Vegetarian diets have been associated with atherosclerosis protection, with healthier atherosclerosis risk profiles, as well as lower prevalence of, and mortality from, ischemic heart disease and stroke. However, there are few data concerning the possible cardiovascular effects of a vegan diet (with no meat, dairy or egg products). Vitamin B-12 deficiency is highly prevalent in vegetarians; this can be partially alleviated by taking dairy/egg products in lact-ovo-vegetarians. However, metabolic vitamin B-12 deficiency is highly prevalent in vegetarians in Australia, Germany, Italy and Austria, and in vegans (80%) in Hong Kong and India, where vegans rarely take vitamin B-12 fortified food or vitamin B-12 supplements. Similar deficiencies exist in northern Chinese rural communities consuming inadequate meat, egg or dairy products due to poverty or dietary habits. Vascular studies have demonstrated impaired arterial endothelial function and increased carotid intima-media thickness as atherosclerosis surrogates in such metabolic vitamin B-12 deficient populations, but not in lactovegetarians in China. Vitamin B-12 supplementation has a favourable impact on these vascular surrogates in Hong Kong vegans and in underprivileged communities in northern rural China. Regular monitoring of vitamin B-12 status is thus potentially beneficial for early detection and treatment of metabolic vitamin B-12 deficiency in vegans, and possibly for prevention of atherosclerosis-related diseases.
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2,333,551 |
B cell responses to influenza infection and vaccination.
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Although vaccines against influenza are widely available, control of the disease remains elusive. In part, this is due to the inability of current vaccines to induce durable, broadly protective immune responses. Prevention of influenza depends primarily on effective antibody responses that block virus entry. Following infection, high-affinity IgA antibodies are generated in the respiratory tract that lead to immune exclusion, while IgG prevents systemic spread. These are effective and long-lasting but also exert immune pressure. Mutation of the antigenic determinants of influenza therefore rapidly leads to emergence of novel variants that evade previously generated protective responses. Not only do vaccines suffer from this strain-specific limitation, but also they are suboptimal in their ability to induce durable immunity. However, recent evidence has demonstrated the possibility of inducing broadly cross-reactive antibody responses. Further understanding of the ways in which high-titer, long-lived antibody responses directed against such cross-reactive epitopes can be induced would lead to the development of novel vaccines that may remove the requirement for recurrent vaccination.
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2,333,552 |
Prospective randomized controlled comparison of caudal bupivacaine and ropivacaine in pediatric patients.
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Bupivacaine and ropivacaine are commonly used agents for caudal anesthesia in pediatric patients. Several studies have shown different motor and cardiovascular effects of two drugs.</AbstractText>The primary objective of this study was to evaluate the efficacy of both drugs and secondary objective was to compare motor blockade and hemodynamic effects caused by them.</AbstractText>This was a prospective randomized controlled study including 50 consecutive patients in the age group of 1-10 years, who underwent urogenital surgeries under general anesthesia. Caudal block was given with either bupivacaine (0.25%) 1 ml/kg (Group I) or ropivacaine (0.25%) 1 ml/kg (Group II). Heart rate (HR) and systolic blood pressure (SBP) were recorded as a baseline, before the anesthesia induction and then at 30, 60 and 90 min after incision. Pain scores were assessed post-operatively by a single observer at 30 min and then at 2, 4, 8 and 12 h with a 5-point observer pain score (OPS). Patients and observer were blinded to the medication given. The duration of absolute analgesia was defined as the time from caudal injection until the pain score was >2. Motor block was assessed by modified Bromage scale. Statistical analysis was performed with Chi-square test, Student's t-test and log-rank test. P < 0.05 were considered as significant.</AbstractText>HR and SBP measured at a specific time intervals showed no significant difference. All the patients had adequate intraoperative analgesia. Mean OPS were comparable between two groups. Duration of absolute analgesia was 276.8 (11) min in Group I and 284.8 (12) min for Group II. The only significant difference was the motor-block score at 2, 3 and 4 h after surgery, although the score was same 1 h post-operatively.</AbstractText>The efficacy of both ropivacaine and bupivacaine is almost same in terms of onset and duration of analgesia. Therefore, the motor blockade caused by ropivacaine is less; there is no significant difference in cardiovascular events.</AbstractText>
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2,333,553 |
Obstetrical APS: is there a place for hydroxychloroquine to improve the pregnancy outcome?
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The use of the conventional APS treatment (the combination of low-dose aspirin and LMWH) dramatically improved the obstetrical prognosis in primary obstetrical APS (OAPS). The persistence of adverse pregnancy outcome raises the need to find other drugs to improve obstetrical outcome. Hydroxychloroquine is widely used in patients with various autoimmune diseases, particularly SLE. Antimalarials have many anti-inflammatory, anti-aggregant and immune-regulatory properties: they inhibit phospholipase activity, stabilize lysosomal membranes, block the production of several pro-inflammatory cytokines and, in addition, impair complement-dependent antigen-antibody reactions. There is ample evidence of protective effects of hydroxychloroquine in OAPS similar to the situation in SLE arising from in vitro studies of pathophysiological working mechanism of hydroxychloroquine. However, the clinical data on the use of hydroxychloroquine in primary APS are lacking and prospective studies are necessary.
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2,333,554 |
[Intraoperative esmolol infusion reduces postoperative analgesic consumption and anaesthetic use during septorhinoplasty: a randomized trial].
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Esmolol is known to have no analgesic activity and no anaesthetic properties; however, it could potentiate the reduction in anaesthetic requirements and reduce postoperative analgesic use. The objective of this study is to evaluate the effect of intravenous esmolol infusion on intraoperative and postoperative analgesic consumptions as well as its effect on depth of anaesthesia.</AbstractText>This randomized-controlled double blind study was conducted in a tertiary care hospital between March and June 2010. Sixty patients undergoing septorhinoplasty were randomized into two groups. History of allergy to drugs used in the study, ischaemic heart disease, heart block, bronchial asthma, hepatic or renal dysfunction, obesity and a history of chronic use of analgesic or β-blockers were considered cause for exclusion from the study. Thirty patients received esmolol and remifentanil (esmolol group) and 30 patients received normal saline and remifentanil (control group) as an intravenous infusion during the procedure. Mean arterial pressure, heart rate, and bispectral index values were recorded every 10min. Total remifentanil consumption, visual analogue scale scores, time to first analgesia and total postoperative morphine consumption were recorded.</AbstractText>The total remifentanil consumption, visual analogue scale scores at 0, 20 and 60min, total morphine consumption, time to first analgesia and the number of patients who needed an intravenous morphine were lower in the esmolol group.</AbstractText>Intravenous infusion of esmolol reduced the intraoperative and postoperative analgesic consumption, reduced visual analogue scale scores in the early postoperative period and prolonged the time to first analgesia; however it did not influence the depth of anaesthesia.</AbstractText>Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.</CopyrightInformation>
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2,333,555 |
Randomized clinical trial of continuous femoral nerve block combined with sciatic nerve block versus epidural analgesia for unilateral total knee arthroplasty.
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Pain control following total knee arthroplasty (TKA) is crucial to hasten rehabilitation and decrease morbidity. We evaluated whether there is a difference between epidural infusion and continuous femoral nerve block with respect to postoperative pain control and rehabilitation course. Fifty patients completed the study. There was no statistically significant difference in the pain scores (P=0.33), morphine consumption (P=0.09) mean blood pressure or heart rate (P=0.957, and P=0.716) between groups. The postoperative daily mobilization (P=0.80), knee joint range of motion (P=0.83), and straight leg test (P=0.99) were also similar between both groups. Patients were highly satisfied with their pain management in both groups without statistically significant difference (P=0.98).
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2,333,556 |
Effects of dietary sulfur and distillers dried grains with solubles on carcass characteristics, loin quality, and tissue concentrations of sulfur, selenium, and copper in growing-finishing pigs.
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Inclusion of up to 0.38% S in diets that contain 30% distillers dried grains with solubles (DDGS) has no negative effect on growth performance of growing-finishing pigs, but there is no information about the effects of dietary S on accumulation of S in tissues in pigs. Therefore, the objective of this experiment was to determine if the concentration of S in diets containing DDGS affects carcass characteristics, loin quality, or tissue mineral concentrations in growing-finishing pigs. A total of 120 barrows (34.2 ± 2.3 kg BW) were allotted to 3 dietary treatments with 10 replicate pens and 4 pigs per pen in a randomized complete block design. Pigs were fed grower diets for 42 d and finisher diets for 42 d. At the conclusion of the experiment, the pig in each pen with the BW closest to the pen average was slaughtered. The control diet was based on corn and soybean meal and the finisher diet contained 0.14% S, 0.19 mg/kg Se, and 15.3 mg/kg Cu. The DDGS diet was formulated with corn, soybean meal, and 30% DDGS and the finisher diet with DDGS contained 0.16% S, 0.32 mg/kg Se, and 14.0 mg/kg Cu. The DDGS plus S (DDGS-S) diet was similar to the DDGS diet, except that 1.10% CaSO4 (16.2% S) was included in this diet, and the finisher diet with DDGS-S contained 0.37% S, 0.35 mg/kg Se, and 13.8 mg/kg Cu. Results indicated that organ weights and loin quality, 24-h pH, drip loss, loin subjective color, marbling, and firmness did not differ among treatments, but loin a* was greater (P < 0.05) for pigs fed the control diet than for pigs fed the DDGS-S diet. Concentrations of S in hair, liver, heart, loin, and all other tissues did not differ among treatments, but urinary S concentration was greater (P < 0.05) for pigs fed the DDGS-S diet than for pigs fed the other diets. Pigs fed the DDGS diet or the DDGS-S diet had greater (P < 0.01) concentrations of Se in hair, liver, heart, and loin than pigs fed the control diet, but liver concentrations of Cu did not differ among treatments. In conclusion, inclusion of 30% DDGS in diets fed to growing-finishing pigs did not influence carcass characteristics or tissue S concentrations regardless of S concentration in the diet, and excess dietary S was excreted in the urine. However, because of the greater concentration of Se in DDGS than in corn and soybean meal and, therefore, greater concentrations in DDGS-containing diets, tissue concentrations of Se were increased in pigs fed diets that contained DDGS. In contrast, dietary DDGS did not influence liver concentrations of Cu.
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2,333,557 |
Serial block face scanning electron microscopy for the study of cardiac muscle ultrastructure at nanoscale resolutions.
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Electron microscopy techniques have made a significant contribution towards understanding muscle physiology since the 1950s. Subsequent advances in hardware and software have led to major breakthroughs in terms of image resolution as well as the ability to generate three-dimensional (3D) data essential for linking structure to function and dysfunction. In this methodological review we consider the application of a relatively new technique, serial block face scanning electron microscopy (SBF-SEM), for the study of cardiac muscle morphology. Employing SBF-SEM we have generated 3D data for cardiac myocytes within the myocardium with a voxel size of ~15 nm in the X-Y plane and 50 nm in the Z-direction. We describe how SBF-SEM can be used in conjunction with selective staining techniques to reveal the 3D cellular organisation and the relationship between the t-tubule (t-t) and sarcoplasmic reticulum (SR) networks. These methods describe how SBF-SEM can be used to provide qualitative data to investigate the organisation of the dyad, a specialised calcium microdomain formed between the t-ts and the junctional portion of the SR (jSR). We further describe how image analysis methods may be applied to interrogate the 3D volumes to provide quantitative data such as the volume of the cell occupied by the t-t and SR membranes and the volumes and surface area of jSR patches. We consider the strengths and weaknesses of the SBF-SEM technique, pitfalls in sample preparation together with tips and methods for image analysis. By providing a 'big picture' view at high resolutions, in comparison to conventional confocal microscopy, SBF-SEM represents a paradigm shift for imaging cellular networks in their native environment.
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2,333,558 |
Systemic ropivacaine diminishes pain sensitization processes: a randomized, double-blinded, placebo-controlled, crossover study in healthy volunteers.
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Ropivacaine is a local anesthetic widely used for regional anesthesia. One of its advantages is low toxicity at plasma concentrations reached systemically during continuous peripheral or central nervous block. The objective of this study was to test the effect of systemic ropivacaine on pain, hyperalgesia, dynamic allodynia, and flare response.</AbstractText>This randomized, double-blinded, placebo-controlled, crossover study was carried out in at the Clinical Trials Centre, University of Zurich, Switzerland. Twenty healthy male volunteers were included in the study. Exclusion criteria were contraindications or hypersensitivity to local anesthetics, vulnerable subjects (intellectually or mental impaired), drug, alcohol or nicotine abuse, known peripheral neuropathies, diabetes mellitus and/or congestive heart disease. Ropivacaine and saline were infused intravenously during a subcutaneous electrical stimulation. The stimulation software adjusted the stimulus strength according to the rating on a numeric rating scale (NRS; 0-10) maintaining a NRS of 5. Areas of punctate hyperalgesia, dynamic allodynia, and flare response were measured before and after the infusion.</AbstractText>The area of hyperalgesia increased significantly with saline (303 ± 380%, P < 0.05) and ropivacaine (186 ± 137%, P < 0.05). The area of allodynia (253 ± 299%, P < 0.05) and flare response (112 ± 24%, P < 0.05) increased only during the placebo infusion.</AbstractText>The results of this study imply that systemic ropivacaine may diminish pain sensitization processes.</AbstractText>
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2,333,559 |
Pneumocephalus during cervical transforaminal epidural steroid injections: a case report.
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A cervical transforaminal epidural injection of anesthetic and corticosteroids (CTFESI) is a frequently used procedure for cervical radiculopathy. Most cases of pneumocephalus after an epidural block occur when using an interlaminar approach with the loss-of-resistance technique. The authors present the first case of pneumocephalus after cervical transforaminal epidural injection of anesthetic and corticosteroids. A 64-yr-old woman with left C7 radiculopathy was undergoing C6-7 transforaminal epidural injection of anesthetic and corticosteroids. The epidural spread of contrast was checked by fluoroscope, and 5 mg of dexamethasone in 4 ml of 0.1875% ropivacaine was injected. She lost consciousness 5 mins after the procedure and regained awareness after manual ventilation. She subsequently complained of nausea and headache, and a computed tomography brain scan revealed pneumocephalus. After carefully assessing the fluoroscopic images, the authors believe that the needle may have punctured the dura mater of the nerve root sleeve, allowing air to enter the subdural space. Thus, fluoroscopic images should be carefully examined to reduce dural puncture when performing cervical transforaminal epidural injection of anesthetic and corticosteroids, and air should be completely removed from the needle, extension tube, and syringe.
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2,333,560 |
Comparison of the effects of low volume prilocaine and alkalinized prilocaine for the regional intravenous anesthesia technique in hand and wrist surgery.
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Comparing the effectivity of prilocaine and prilocaine alkalinized with 8.4% NaHCO3 in terms of sensory and motor block onset and termination durations in RIVA technique considering patients' satisfaction and tolerance with application of tourniquet undergoing hand-wrist surgery.</AbstractText>64 patients were randomised into two groups. First group (Group P) was administered prilocaine and second group (Group PN) was administered prilocaine + %8.4 NaHCO3. Sensory and motor block onset and termination times and onset of tourniquet pain were recorded.</AbstractText>No significant difference was found between the two groups in terms of onset and termination of sensory block and the onset of motor block. The duration of the motor block was longer in Group PN than in Group P (P < 0.05). Tourniquet pain was more intense in Group P (P = 0.036). In Group PN, the use of additional drugs was recorded at a lower rate and patients' satisfaction was higher than Group P.</AbstractText>In the present study, it was established that alkalinization of prilocaine had no effect on the duration of sensory block and it prolonged the duration of motor block, increased patients' satisfaction, and decreased tourniquet pain. It is our suggestion that future studies should be carried out on the issue by using different volumes.</AbstractText>
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2,333,561 |
Modified Transtibial Technique for Anterior Cruciate Ligament Reconstruction with Quadriceps Tendon Autograft.
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The modified transtibial technique with quadriceps tendon autograft allows anatomic anterior cruciate ligament (ACL) reconstruction without tunnel widening and results in a stable and functional knee with a satisfactory clinical outcome.</AbstractText><AbstractText Label="STEP 1 PREPARE THE PATIENT" NlmCategory="UNASSIGNED">Prepare the patient under spinal anesthesia with the usual arthroscopic setting.</AbstractText><AbstractText Label="STEP 2 ARTHROSCOPIC EXAMINATION" NlmCategory="UNASSIGNED">Perform arthroscopic examination to confirm the ACL rupture and other intra-articular lesions.</AbstractText><AbstractText Label="STEP 3 HARVEST THE QUADRICEPS TENDON" NlmCategory="UNASSIGNED">Harvest the central one-third of the quadriceps tendon strip with a proximal patellar bone block</i>.</AbstractText><AbstractText Label="STEP 4 PREPARE THE QUADRICEPS TENDON GRAFT" NlmCategory="UNASSIGNED">Prepare the quadriceps tendon graft to pass smoothly through the tunnels.</AbstractText><AbstractText Label="STEP 5 SET THE TIBIAL TUNNEL ENTRY POINT" NlmCategory="UNASSIGNED">Make a 3-cm longitudinal skin incision at the anteromedial aspect of the proximal part of the tibia.</AbstractText><AbstractText Label="STEP 6 CREATE THE TIBIAL TUNNEL" NlmCategory="UNASSIGNED">Drill a 10-mm tibial tunnel.</AbstractText><AbstractText Label="STEP 7 TARGET THE FEMORAL TUNNEL STARTING POINT" NlmCategory="UNASSIGNED">Aim the guide at the lateral bifurcate ridge on the medial wall of the lateral femoral condyle with the modified transtibial technique.</AbstractText><AbstractText Label="STEP 8 CREATE THE FEMORAL TUNNEL" NlmCategory="UNASSIGNED">Drill a 10-mm femoral tunnel.</AbstractText><AbstractText Label="STEP 9 FIX THE GRAFT" NlmCategory="UNASSIGNED">Fix the graft with adequate tension.</AbstractText><AbstractText Label="STEP 10 POSTOPERATIVE REHABILITATION" NlmCategory="UNASSIGNED">Rehabilitate the patient step by step.</AbstractText>In a study that compared fifty-two patients managed with a modified transtibial technique and another fifty-two patients managed with an anteromedial transportal technique, there were no significant differences in the clinical results in terms of manual laxity, arthrometric analysis, and subjective outcome.IndicationsContraindicationsPitfalls & Challenges.</AbstractText>
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2,333,562 |
Turbulent electrical activity at sharp-edged inexcitable obstacles in a model for human cardiac tissue.
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Wave propagation around various geometric expansions, structures, and obstacles in cardiac tissue may result in the formation of unidirectional block of wave propagation and the onset of reentrant arrhythmias in the heart. Therefore, we investigated the conditions under which reentrant spiral waves can be generated by high-frequency stimulation at sharp-edged obstacles in the ten Tusscher-Noble-Noble-Panfilov (TNNP) ionic model for human cardiac tissue. We show that, in a large range of parameters that account for the conductance of major inward and outward ionic currents of the model [fast inward Na(+) current (INa), L-type slow inward Ca(2+) current (ICaL), slow delayed-rectifier current (IKs), rapid delayed-rectifier current (IKr), inward rectifier K(+) current (IK1)], the critical period necessary for spiral formation is close to the period of a spiral wave rotating in the same tissue. We also show that there is a minimal size of the obstacle for which formation of spirals is possible; this size is ∼2.5 cm and decreases with a decrease in the excitability of cardiac tissue. We show that other factors, such as the obstacle thickness and direction of wave propagation in relation to the obstacle, are of secondary importance and affect the conditions for spiral wave initiation only slightly. We also perform studies for obstacle shapes derived from experimental measurements of infarction scars and show that the formation of spiral waves there is facilitated by tissue remodeling around it. Overall, we demonstrate that the formation of reentrant sources around inexcitable obstacles is a potential mechanism for the onset of cardiac arrhythmias in the presence of a fast heart rate.
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2,333,563 |
Comparison of a continuous noninvasive arterial pressure device with invasive measurements in cardiovascular postsurgical intensive care patients: a prospective observational study.
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Arterial pressure monitoring using the a continuous noninvasive arterial pressure (CNAP) device during general anaesthesia is known to be interchangeable with continuous invasive arterial pressure (CIAP) monitoring. Agreement with invasive measurements in cardiovascular postsurgical intensive care patients has not been assessed.</AbstractText>The objective of this study is to assess the agreement and interchangeability of CNAP with CIAP in cardiovascular postsurgical patients and to determine the effects of cardiac arrhythmia, catecholamine dosage, respiratory weaning and calibration intervals on agreement.</AbstractText>A prospective observational study.</AbstractText>German university hospital cardiovascular ICU. Data were collected from April 2010 to December 2011.</AbstractText>From 110 enrolled patients, 104 were included. Inclusion criteria were American Society of Anaesthesiologists (ASA) physical status III or IV patients undergoing controlled ventilation. Exclusion criteria included emergencies, complete heart block and marked arterial pressure differences greater than 10 mmHg in the two arms.</AbstractText>Bland-Altman plots, bias, precision, 95% limits of agreement, percentage error and agreement : tolerability indexes (ATIs) were estimated to determine clinical agreement.</AbstractText>From 11 222 arterial pressure readings, biases (SD) for CIAP-CNAP for systolic arterial pressure (SAP), diastolic arterial pressure (DAP) and mean arterial pressure (MAP) for all patients were 4.3 (11.6), -9.4 (8) and -6 (7.6) mmHg, respectively. Cardiac arrhythmia (4.1 (13.1), -14.4 (8.3), -9.5 (8.9) mmHg) and long interval to last calibration [4.5 (15), -9.8 (9.5), -6.4 (9.1) mmHg] impaired the accuracy of CNAP with failed interchangeability criteria defined by the percentage error. In contrast, use of catecholamines (epinephrine or norepinephrine infusions >0.1 μg kg min), short calibration intervals and weaning conditions did not affect accuracy, interchangeability and agreement, especially of MAP. Agreement was defined as acceptable for MAP for all data and subgroups (ATI 0.8 to 1.0) and at worst, marginal for SAP and DAP (ATI 0.9 to 1.6).</AbstractText>CNAP showed acceptable agreement defined by the ATI with invasive measurements for MAP and partially for DAP, but there was considerable variability for SAP. MAP should be preferred for clinical decision making. Cardiac arrhythmia, in contrast to catecholamine dosage or weaning procedures, impaired the accuracy, agreement and interchangeability of CNAP.</AbstractText>Clinical trials.gov identifier NCT01003665.</AbstractText>
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2,333,564 |
Human rhinovirus 16 causes Golgi apparatus fragmentation without blocking protein secretion.
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The replication of picornaviruses has been described to cause fragmentation of the Golgi apparatus that blocks the secretory pathway. The inhibition of major histocompatibility complex class I upregulation and cytokine, chemokine and interferon secretion may have important implications for host defense. Previous studies have shown that disruption of the secretory pathway can be replicated by expression of individual nonstructural proteins; however the situation with different serotypes of human rhinovirus (HRV) is unclear. The expression of 3A protein from HRV14 or HRV2 did not cause Golgi apparatus disruption or a block in secretion, whereas other studies showed that infection of cells with HRV1A did cause Golgi apparatus disruption which was replicated by the expression of 3A. HRV16 is the serotype most widely used in clinical HRV challenge studies; consequently, to address the issue of Golgi apparatus disruption for HRV16, we have systematically and quantitatively examined the effect of HRV16 on both Golgi apparatus fragmentation and protein secretion in HeLa cells. First, we expressed each individual nonstructural protein and examined their cellular localization and their disruption of endoplasmic reticulum and Golgi apparatus architecture. We quantified their effects on the secretory pathway by measuring secretion of the reporter protein Gaussia luciferase. Finally, we examined the same outcomes following infection of cells with live virus. We demonstrate that expression of HRV16 3A and 3AB and, to a lesser extent, 2B caused dispersal of the Golgi structure, and these three nonstructural proteins also inhibited protein secretion. The infection of cells with HRV16 also caused significant Golgi apparatus dispersal; however, this did not result in the inhibition of protein secretion. Importance: The ability of replicating picornaviruses to influence the function of the secretory pathway has important implications for host defense. However, there appear to be differences between different members of the family and inconsistent results when comparing infection with live virus to expression of individual nonstructural proteins. We demonstrate that individual nonstructural HRV16 proteins, when expressed in HeLa cells, can both fragment the Golgi apparatus and block secretion, whereas viral infection fragments the Golgi apparatus without blocking secretion. This has major implications for how we interpret mechanistic evidence derived from the expression of single viral proteins.
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2,333,565 |
The dose effect of ephedrine on the onset time and intubating conditions after cisatracurium administration.
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The aim of this randomized, double-blind, placebo-controlled study was to evaluate dose effects of ephedrine pretreatment on the onset time and intubating conditions after cisatracurium administration.</AbstractText>A total of 140 adult patients were randomized into 4 groups to receive either 30 µg/kg ephedrine (Group 30, n = 35), 70 µg/kg ephedrine (Group 70, n = 35), 110 µg/kg ephedrine (Group 110, n = 35), 3 ml normal saline (Group C, n = 35) as pretreatment given 30 s before anesthetic induction. Neuromuscular block was achieved with 0.15 mg/kg cisatracurium, evaluated accelomyographically with train-of-four stimulation. An anesthesiologist blinded to patient grouping assessed the intubating conditions 1.5 min after cisatracurium administration.</AbstractText>An onset time of 70 s was obtained in the ephedrine groups (Group 30: 155.4 ± 44.7 s, Group 70: 152.6 ± 40.3 s, Group 110: 151.2 ± 51.6 s) compared to Group C (224.6 ± 56.9 s) after 0.15 mg/kg of cisatracurium (P < 0.001). Ephedrine doses of either 70 or 110 µg/kg for pretreatment significantly improved intubating conditions (P < 0.05). Systolic and diastolic blood pressure and heart rate at 1 min after tracheal intubation were significantly increased than other times in all groups (P < 0.001), with no differences among the groups. However, 5 patients in Group 110 experienced marked hypertension (systolic/diastolic blood pressure: > 200/100 mmHg) 1 min after tracheal intubation with no patients in other groups.</AbstractText>We conclude that pre-treatment with ephedrine 70 µg/kg improved intubating conditions 1.5 min after cisatracurium administration and facilitated the onset of neuromuscular block (70 s) without adverse hemodynamic effects.</AbstractText>
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2,333,566 |
Generation of strip-format fibrin-based engineered heart tissue (EHT).
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This protocol describes a method for casting fibrin-based engineered heart tissue (EHT) in standard 24-well culture dishes. In principle, a hydrogel tissue engineering method requires cardiomyocytes, a liquid matrix that forms a gel, a casting mold, and a device that keeps the developing tissue in place. This protocol refers to neonatal rat heart cells as the cell source; the matrix of choice is fibrin, and the tissues are generated in rectangular agarose-casting molds (12 × 3 × 3 mm) prepared in standard 24-well cell culture dishes, in which a pair of flexible silicone posts is suspended from above. A master mix of freshly isolated cells, medium, fibrinogen, and thrombin is pipetted into the casting mold and, over a period of 2 h, polymerizes and forms a fibrin cell block around two silicone posts. Silicone racks holding four pairs of silicone posts each are used to transfer the fresh fibrin cell blocks into new 24-well dishes with culture medium. Without further handling, the cells start to remodel the fibrin gel, form contacts with each other, elongate, and condense the gel to approximately ¼ of the initial volume. Spontaneous and rhythmic contractions start after 1 week. EHTs are viable and relatively stable for several weeks in this format and can be subjected to repeated measurements of contractile function and final morphological and molecular analyses.
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2,333,567 |
Neuregulin-1/erbB activities with focus on the susceptibility of the heart to anthracyclines.
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Neuregulin-1 (NRG1) signaling through the tyrosine kinase receptors erbB2 and erbB4 is required for cardiac morphogenesis, and it plays an essential role in maintaining the myocardial architecture during adulthood. The tyrosine kinase receptor erbB2 was first linked to the amplification and overexpression of erbb2 gene in a subtype of breast tumor cells, which is indicative of highly proliferative cells and likely a poor prognosis following conventional chemotherapy. The development of targeted therapies to block the survival of erbB2-positive cancer cells revealed that impaired NRG1 signaling through erbB2/erbB4 heterodimers combined with anthracycline chemotherapy may lead to dilated cardiomyopathy in a subpopulation of treated patients. The ventricular-specific deletion of either erbb2 or erbb4 manifested dilated cardiomyopathy, which is aggravated by the administration of doxorubicin. Based on the exacerbated toxicity displayed by the combined treatment, it is expected that the relevant pathways would be affected in a synergistic manner. This review examines the NRG1 activities that were monitored in different model systems, focusing on the emerging pathways and molecular targets, which may aid in understanding the acquired dilated cardiomyopathy that occurs under the conditions of NRG1-deficient signaling.
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2,333,568 |
Effects of different physical forms of wheat grain in corn-based starter on performance of young Holstein dairy calves.
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The objective of the present study was to examine the effects of partially replacing corn with 2 forms of wheat grain on daily intake of starter feed, average daily gain, feed efficiency, rumen pH, fecal score, weaning weight, skeletal growth, and blood metabolites of dairy calves. Thirty-two male and female Holstein dairy calves (n=8 calves per treatment) were used in a completely randomized block design. At d 3 of age, individually housed calves were randomly allocated to different treatments consisting of a starter diet with 60% ground corn (control), a starter diet with 60% whole corn, a starter diet with 30% ground corn plus 30% ground wheat (GCGW), and a starter with 30% ground corn plus 30% whole wheat (GCWW), with all other components in a meal form. All calves had free access to water and feed throughout the study period and received 4 L of milk replacer/d from d 3 to 50 and 2 L/d from d 50 to 52; weaning occurred at the end of d 52. Feed intake was recorded daily and body weight and skeletal growth measures were recorded on d 10 and every 10 d thereafter. Rumen pH was measured on d 30, 45, and 60. Blood sample were collected on d 30 and every 10 d thereafter through d 70. Data were analyzed using MIXED procedures of SAS (SAS Institute Inc., Cary, NC). Over the experimental period (d 1-70), the starter intake for the GCWW group was significantly different from the control group, but not different from the other groups. Calves fed whole wheat had a significantly greater average daily gain compared with other groups over the experimental period (d 1-70). Feed efficiency was only better in calves fed the GCWW diet than the GCGW group for postweaning and overall periods. No differences were observed for preweaning in body length, hip height, or withers height among the treatments; however, differences were significant in heart girth and body barrel. Postweaning, some of the body measurements were greater in calves fed the GCWW and GCGW starter diets. Blood glucose concentration reduced with age; however, blood urea nitrogen, β-hydroxybutyrate, albumin, and total protein increased with age. Treatment × time effects on blood urea nitrogen and total protein concentrations were detected. Blood urea nitrogen concentration (mg/dL) was affected by dietary treatments on d 30, 40, and 70, but no significant difference was detected on d 50 and 60. Serum total protein concentration (g/dL) was also affected by dietary treatments on d 40 and 70, but no significant difference was detected on d 40, 50, and 60. Whereas rumen pH was significantly reduced for the control compared with the GCWW treatment on d 45, comparison of the fecal scores showed no detectable differences among the treatments. Overall, the results of the current study indicate that starter diets containing whole wheat and ground corn can improve performance in young dairy calves compared with diets containing ground corn/ground wheat, whole corn, or ground corn, under our experimental conditions.
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2,333,569 |
Single shot spinal anesthesia with very low hyperbaric bupivacaine dose (3.75 mg) for hip fracture repair surgery in the elderly. A randomized, double blinded study.
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Single shot spinal anesthesia is used worldwide for hip fracture repair surgery in the elderly. Arterial hypotension is a frequent adverse effect. We hypothesized that lowering local anesthetics dose could decrease the incidence of arterial hypotension, while maintaining quality of surgical anesthesia.</AbstractText>In a randomized double blinded study, 66 patients over the age of 65 years, with hip fracture needing surgical repair, were assigned to B0.5 group 7.5mg hyperbaric bupivacaine 5mg/ml (control group), and B0.25 group 3.75mg hyperbaric bupivacaine 2.5mg/ml (study group). Sensory and motor block level, and hemodynamic parameters including blood presure, heart rate and vasopressor dose administration were registered, along with rescue anesthesia needs, the feasibility of surgery, its duration, and regression time of sensory anesthesia to T12.</AbstractText>After exclusions, 61 patients were included in the final analysis. Arterial hypotension incidence was lower in the B0.25 group (at the 5, 10, and 15min determinations), and a lower amount of vasopressor drugs was needed (mean accumulated ephedrine dose 1.6mg vs. 8.7mg in the B0.5 group, p<0.002). Sensory block regression time to T12 was shorter in the B0.25 group, mean 78.6±23.6 (95% CI 51.7-110.2)min vs. 125.5±37.9 (95% CI 101.7-169.4)min in the B0.5 group, p=0.033. All but one patient in the B0.25 group were operated on under the anesthetic procedure first intended. No rescue anesthesia was needed.</AbstractText>Lowering bupivacaine dose for single shot spinal anesthesia for hip fracture repair surgery in elderly patients was effective in decreasing the occurrence of arterial hypotension and vasopressor use, while intraoperative quality remained.</AbstractText>Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.</CopyrightInformation>
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2,333,570 |
Thermal imaging evaluation of paravertebral block for mastectomy in high risk patient: case report.
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Thoracic paravertebral block is the technique of injecting local anesthetic adjacent to the thoracic vertebra close to where the spinal nerves emerge from the intervertebral foramina. It is effective in treating acute and chronic pain of unilateral origin from the chest and abdomen. This technique causes pain relief with pulmonary function preservation and great hemodynamic stability. 66 year old woman (156 cm, 80 kg, BMI 32) with chronic right heart failure, hypertension and obesity, on chronic oxygen therapy was presented for elective mastectomy due to breast cancer. She suffered from severe COPD and also bullous emphysema. FVC 1.59 l; FEV1 0.55 l; FEV1%FVC 34.6. The paravertebral block was performed using the multi-shot percutaneous technique with additional light general anesthesia. For confirmation, of proper analgesia range, control of temperature changes, using FLIR i7 infrared camera, was performed. Control photos were made 20 min after the blockade and then 10 min later. Infrared photo showed rise of temperature reading in every marked region. There were no hemodynamic and pulmonary complications postoperatively. Paravertebral block in combination with sedation creates excellent conditions for breast surgery procedures. Additional temperature changes monitoring performed with infrared camera may confirm proper range of analgesia needed to perform surgery. Great cardiovascular stability and very good pulmonary function preservation make this method excellent for high risk patients. Low complication rate is additional advantage. In our opinion this method is recommendable.
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2,333,571 |
Interhemispheric modulation of dual-mode, noninvasive brain stimulation on motor function.
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To investigate the effects of simultaneous, bihemispheric, dual-mode stimulation using repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) on motor functions and cortical excitability in healthy individuals.</AbstractText>Twenty-five healthy, right-handed volunteers (10 men, 15 women; mean age, 25.5 years) were enrolled. All participants received four randomly arranged, dual-mode, simultaneous stimulations under the following conditions: condition 1, high-frequency rTMS over the right primary motor cortex (M1) and sham tDCS over the left M1; condition 2, high-frequency rTMS over the right M1 and anodal tDCS over the left M1; condition 3, high-frequency rTMS over the right M1 and cathodal tDCS over the left M1; and condition 4, sham rTMS and sham tDCS. The cortical excitability of the right M1 and motor functions of the left hand were assessed before and after each simulation.</AbstractText>Motor evoked potential (MEP) amplitudes after stimulation were significantly higher than before stimulation, under the conditions 1 and 2. The MEP amplitude in condition 2 was higher than both conditions 3 and 4, while the MEP amplitude in condition 1 was higher than condition 4. The results of the Purdue Pegboard test and the box and block test showed significant improvement in conditions 1 and 2 after stimulation.</AbstractText>Simultaneous stimulation by anodal tDCS over the left M1 with high-frequency rTMS over the right M1 could produce interhemispheric modulation and homeostatic plasticity, which resulted in modulation of cortical excitability and motor functions.</AbstractText>
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2,333,572 |
Left main coronary arterial endothelial function and heterogenous segmental epicardial vasomotor reactivity in vivo: novel insights with intravascular ultrasonography.
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While the relationship between epicardial coronary vasomotor reactivity and cardiovascular events is well established, this observation has yet to be evaluated within the left main coronary artery (LMCA) in humans in vivo. Our aims were to test the endothelium-dependent vasomotor properties of the LMCA, and to compare these responses to downstream epicardial segments.</AbstractText>Thirty patients referred for coronary angiography underwent intracoronary (IC) salbutamol provocation during intravascular ultrasound imaging within a non-critically diseased, left-sided conduit vessel. Macrovascular vasomotor response [change in average lumen area (LA) at baseline and following 5 min of 0.30 µg/min IC salbutamol] and percent atheroma volume (PAV) were evaluated in 30 LMCA, 42 proximal, 109 mid, and 132 distal epicardial coronary segments. In comparison with all other segments, the LMCA had the greatest lumen and vessel areas (P < 0.001), yet the proximal epicardial segments contained the greatest PAV (P < 0.02). The mid and distal epicardial segments displayed significant endothelium-dependent vasodilatation from baseline (P = 0.017 and <0.001, respectively); however, the proximal epicardial and LMCA segments did not (P = 0.45 and 0.16, respectively). Significant segmental vasomotor heterogeneity was noted in all 30 patients, with opposing vasomotor responses between adjacent LMCA and epicardial segments. Across all segments, baseline LA inversely correlated with the % change in LA (r = -0.16, P = 0.0005).</AbstractText>Endothelium-dependent vasomotor reactivity is heterogenous within the conduit coronary system. Vascular dynamic responses were less prominent in the larger calibre LMCA and proximal epicardial segments. This may, in part, relate to higher shear stress in smaller, distal segments and yet also may explain the propensity for culprit plaques to cluster proximally.</AbstractText>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: [email protected].</CopyrightInformation>
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2,333,573 |
[Comparison of tests for SS-A/Ro, Ro52 and Ro60 in predicting congenital heart block].
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Neonatal lupus erythematosus (NLE) is a rare syndrome caused by the transplacental passage of maternal autoantibodies. Anti SS-A antibodies of a mother with Sjögren syndrome are associated with congenital heart block (CHB) in the newborns with NLE. The purpose of this study was to investigate the utility of maternal antibody titers for SS-A, Ro52 and Ro60 in mothers of newborns with CHB. The study involved a total of 304 cases, 25 from mothers of newborns with CHB, 104 from mothers of newborns without and 175 from mothers suspected to have connective tissue diseases. All sera were tested with the EliA SS-A, EliA Ro52, EliA Ro60, MESACUP Ro52 and MESACUP Ro60. The concordance rate of Ro52 assays was 93.4%, whereas Ro60 assays showed a lower concordance rate (74.7%). The areas under the curve (AUC) of the EliA assays were higher than those of the MESACUP assays. The optimal cut-off values for EliA SS-A/Ro and EliA Ro60 as derived from the ROC analysis were 2027 U/mL and 2446 U/mL, respectively. The sensitivity and specificity for EliA SS-A using optimal cut-off values were 96.0% and 92.3%, respectively. A titer of 90% positive predictive value for EliA SS-A was reached at a cut-off of 9897.1 U/mL, corresponding to sensitivity and specificity values of 36.0% and 100%, respectively. In conclusion, the optimal cut-off value for EliA SS-A is likely to be useful for application in clinical practice for the EliA SS-A measurements in mothers to evaluate the risk of NLE for their newborns.
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2,333,574 |
TXNIP mediates NLRP3 inflammasome activation in cardiac microvascular endothelial cells as a novel mechanism in myocardial ischemia/reperfusion injury.
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NLRP3 inflammasome is necessary for initiating acute sterile inflammation. Recent studies have demonstrated that NLRP3 inflammasome is up-regulated and mediates myocardial ischemia/reperfusion (MI/R) injury. However, the signaling pathways that lead to the activation of NLRP3 inflammasome by MI/R injury have not been fully elucidated. C57BL/6J mice were subjected to 30 min ischemia and 3 or 24 h reperfusion. The ischemic heart exhibited enhanced inflammasome activation as evidenced by increased NLRP3 expression and caspase-1 activity and increased IL-1β and IL-18 production. Intramyocardial NLRP3 siRNA injection or an intraperitoneal injection of BAY 11-7028, an inflammasome inhibitor, attenuated macrophage and neutrophil infiltration and decreased MI/R injury, as measured by cardiomyocyte apoptosis and infarct size. The ischemic heart also exhibited enhanced interaction between Txnip and NLRP3, which has been shown to be a mechanism for activating NLRP3. Intramyocardial Txnip siRNA injection also decreased infarct size and NLRP3 activation. In vitro experiments revealed that NLRP3 was expressed in cardiac microvascular endothelial cells (CMECs), but was hardly expressed in cardiomyocytes. Simulated ischemia/reperfusion (SI/R) stimulated NLRP3 inflammasome activation in CMECs, but not in cardiomyocytes. Moreover, CMECs subjected to SI/R injury increased interactions between Txnip and NLRP3. Txnip siRNA diminished NLRP3 inflammasome activation and SI/R-induced injury, as measured by LDH release and caspase-3 activity in CMECs. ROS scavenger dissociated TXNIP from NLRP3 and inhibited the activation of NLRP3 inflammasome in the CMECs. For the first time, we demonstrated that TXNIP-mediated NLRP3 inflammasome activation in CMECs was a novel mechanism of MI/R injury. Interventions that block Txnip/NLRP3 signaling to inhibit the activation of NLRP3 inflammasomes may be novel therapies for mitigating MI/R injury.
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2,333,575 |
Fumaric acid esters can block pro-inflammatory actions of human CRP and ameliorate metabolic disturbances in transgenic spontaneously hypertensive rats.
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Inflammation and oxidative stress have been implicated in the pathogenesis of metabolic disturbances. Esters of fumaric acid, mainly dimethyl fumarate, exhibit immunomodulatory, anti-inflammatory, and anti-oxidative effects. In the current study, we tested the hypothesis that fumaric acid ester (FAE) treatment of an animal model of inflammation and metabolic syndrome, the spontaneously hypertensive rat transgenically expressing human C-reactive protein (SHR-CRP), will ameliorate inflammation, oxidative stress, and metabolic disturbances. We studied the effects of FAE treatment by administering Fumaderm, 10 mg/kg body weight for 4 weeks, to male SHR-CRP. Untreated male SHR-CRP rats were used as controls. All rats were fed a high sucrose diet. Compared to untreated controls, rats treated with FAE showed significantly lower levels of endogenous CRP but not transgenic human CRP, and amelioration of inflammation (reduced levels of serum IL6 and TNFα) and oxidative stress (reduced levels of lipoperoxidation products in liver, heart, kidney, and plasma). FAE treatment was also associated with lower visceral fat weight and less ectopic fat accumulation in liver and muscle, greater levels of lipolysis, and greater incorporation of glucose into adipose tissue lipids. Analysis of gene expression profiles in the liver with Affymetrix arrays revealed that FAE treatment was associated with differential expression of genes in pathways that involve the regulation of inflammation and oxidative stress. These findings suggest potentially important anti-inflammatory, anti-oxidative, and metabolic effects of FAE in a model of inflammation and metabolic disturbances induced by human CRP.
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2,333,576 |
Experiential virtual scenarios with real-time monitoring (interreality) for the management of psychological stress: a block randomized controlled trial.
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The recent convergence between technology and medicine is offering innovative methods and tools for behavioral health care. Among these, an emerging approach is the use of virtual reality (VR) within exposure-based protocols for anxiety disorders, and in particular posttraumatic stress disorder. However, no systematically tested VR protocols are available for the management of psychological stress.</AbstractText>Our goal was to evaluate the efficacy of a new technological paradigm, Interreality, for the management and prevention of psychological stress. The main feature of Interreality is a twofold link between the virtual and the real world achieved through experiential virtual scenarios (fully controlled by the therapist, used to learn coping skills and improve self-efficacy) with real-time monitoring and support (identifying critical situations and assessing clinical change) using advanced technologies (virtual worlds, wearable biosensors, and smartphones).</AbstractText>The study was designed as a block randomized controlled trial involving 121 participants recruited from two different worker populations-teachers and nurses-that are highly exposed to psychological stress. Participants were a sample of teachers recruited in Milan (Block 1: n=61) and a sample of nurses recruited in Messina, Italy (Block 2: n=60). Participants within each block were randomly assigned to the (1) Experimental Group (EG): n=40; B1=20, B2=20, which received a 5-week treatment based on the Interreality paradigm; (2) Control Group (CG): n=42; B1=22, B2=20, which received a 5-week traditional stress management training based on cognitive behavioral therapy (CBT); and (3) the Wait-List group (WL): n=39, B1=19, B2=20, which was reassessed and compared with the two other groups 5 weeks after the initial evaluation.</AbstractText>Although both treatments were able to significantly reduce perceived stress better than WL, only EG participants reported a significant reduction (EG=12% vs. CG=0.5%) in chronic "trait" anxiety. A similar pattern was found for coping skills: both treatments were able to significantly increase most coping skills, but only EG participants reported a significant increase (EG=14% vs CG=0.3%) in the Emotional Support skill.</AbstractText>Our findings provide initial evidence that the Interreality protocol yields better outcomes than the traditionally accepted gold standard for psychological stress treatment: CBT. Consequently, these findings constitute a sound foundation and rationale for the importance of continuing future research in technology-enhanced protocols for psychological stress management.</AbstractText>ClinicalTrials.gov: NCT01683617; http://clinicaltrials.gov/show/NCT01683617 (Archived by WebCite at http://www.webcitation.org/6QnziHv3h).</AbstractText>
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2,333,577 |
Blood pressure response to combined general anaesthesia/interscalene brachial plexus block for outpatient shoulder arthroscopy.
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Shoulder surgery is often performed in the beach-chair position, a position associated with arterial hypotension and subsequent risk of cerebral ischaemia. It can be performed under general anaesthesia or with an interscalene brachial plexus block, each of which has specific advantages but also specific negative effects on blood pressure control. It would be worthwhile to combine the advantages of the two, but the effects of the combination on the circulation are not well investigated. We studied blood pressure, heart rate, and incidence of adverse circulatory events in patients undergoing shoulder surgery in general anaesthesia with or without an interscalene block.</AbstractText>Prospective, randomised, blinded study in outpatients (age 18 to 80 years) undergoing shoulder arthroscopy. General anaesthesia was with propofol/opioid, interscalene block with 40 ml 1% mepivacaine. Hypotension requiring treatment was defined as a mean arterial pressure <60 mmHg or a systolic pressure <80% of baseline; relevant bradycardia was a heart rate <50 bpm with a decrease in blood pressure.</AbstractText>Forty-two patients had general anaesthesia alone, 41 had general anaesthesia plus interscalene block. The average systolic blood pressure under anaesthesia in the beach-chair position was 114 ± 7.3 vs. 116 ± 8.3 mmHg (p = 0.09; all comparisons General vs. General-Regional). The incidence of a mean arterial pressure under 60 mmHg or a decrease in systolic pressure of more than 20% from baseline was 64% vs. 76% (p = 0.45). The number of patients with a heart rate lower than 50 and a concomitant blood pressure decrease was 8 vs. 5 (p = 0.30).</AbstractText>One can safely combine interscalene block with general anaesthesia for surgery in the beach-chair position in ASA I and II patients.</AbstractText>DRKS00005295.</AbstractText>
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2,333,578 |
The assessment of bupivacaine-tramadol and levobupivacaine-tramadol combinations for preemptive caudal anaesthesia in children: a randomized, double-blind, prospective study.
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Caudal block is the regional anesthetic technique that is used most frequently in pediatric surgery and bupivacaine and levobupivacaine are widely utilized in this technique. Opioid drugs have been added to local anesthetic solutions to prolong duration of analgesia but ideal combination were not found. We compared the postoperative analgesic efficacy of equal concentrations of bupivacaine or levobupivacaine plus tramadol in pediatric patients. Sixty eight children aged 2 to 7 years who were undergoing inguinal herniorrhaphies or orchidopexies received bupivacaine 0.25% plus tramadol 2 mg/kg (1 ml/kg) (BT group) or levobupivacaine 0.25% plus tramadol 2 mg/kg (1 ml/kg) (LT group) by the caudal route after laryngeal mask anesthesia. The primary outcome of the study was to compare the duration and quality of postoperative analgesia. The postoperative pain relief was evaluated by the Children and Infants Postoperative Pain Scale (CHIPPS) at 2, 4, 6, 12, and 24 h postoperatively. In addition, the time of first analgesic requirement was noted. The CHIPPS scores were not statistically different between the groups. The duration of analgesia and requirements for rescue analgesia was similar. Urinary retention was observed more often in the BT group. There were no significant differences between groups for arterial pressures and heart rate values after caudal block and during the operation. Caudal bupivacaine plus tramadol and levobupivacaine plus tramadol have similar postoperative analgesic efficacy. But the use of bupivacaine plus tramadol may cause a greater frequency of urinary retention.
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2,333,579 |
Comparing the physiological and perceptual responses of construction workers (bar benders and bar fixers) in a hot environment.
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This study aimed to (1) quantify the respective physical workloads of bar bending and fixing; and (2) compare the physiological and perceptual responses between bar benders and bar fixers. Field studies were conducted during the summer in Hong Kong from July 2011 to August 2011 over six construction sites. Synchronized physiological, perceptual, and environmental parameters were measured from construction rebar workers. The average duration of the 39 field measurements was 151.1 ± 22.4 min under hot environment (WBGT = 31.4 ± 2.2 °C), during which physiological, perceptual and environmental parameters were synchronized. Energy expenditure of overall rebar work, bar bending, and bar fixing were 2.57, 2.26 and 2.67 Kcal/min (179, 158 and 186 W), respectively. Bar fixing induced significantly higher physiological responses in heart rate (113.6 vs. 102.3 beat/min, p < 0.05), oxygen consumption (9.53 vs. 7.14 ml/min/kg, p < 0.05), and energy expenditure (2.67 vs. 2.26 Kcal/min, p < 0.05) (186 vs. 158 W, p < 0.05) as compared to bar bending. Perceptual response was higher in bar fixing but such difference was not statistically significant. Findings of this study enable the calculation of daily energy expenditure of rebar work.
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2,333,580 |
Pregnancy-associated listeriosis: clinical characteristics and geospatial analysis of a 10-year period in Israel.
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Listeria monocytogenes is a foodborne pathogen that causes life-threatening infections in elderly, immunocompromised, and pregnant women. In pregnancy it may cause fetal loss or a preterm delivery, and the neonate is prone to neonatal sepsis and death.</AbstractText>We created a cohort of all L. monocytogenes cases during 10 years (1998-2007) in Israel, by a comprehensive review of cases in hospitals throughout the country and cases reported to the Ministry of Health.</AbstractText>One hundred sixty-six pregnancy-related listeriosis cases were identified, resulting in a yearly incidence of 5-25 cases per 100 000 births. Presentation associated with fetal demise was more common in the second trimester (55.3%), and preterm labor (52.3%) and abnormal fetal heart rate monitoring (22.2%) were more common in the third trimester (P = .001). Fetal viability was low in the second trimester (29.2%) and much higher (95.3%) in the third trimester. Each additional week of pregnancy increased the survival chance by 33% (odds ratio, 1.331 [95% confidence interval, 1.189-1.489]). A single case of maternal mortality was identified. Listeria monocytogenes serotype 4b was more common in pregnancy-related than in non-pregnancy-related cases (79.5% vs 61.3%, P = .011). Pulsed-field gel electrophoresis analysis suggested that 1 pulsotype is responsible for 35.7% of the pregnancy cases between 2001 and 2007. This clone is closely related to the Italian gastroenteritis-associated HPB2262 and the invasive US Scott A L. monocytogenes strains.</AbstractText>Our survey emphasizes the high rate of pregnancy-related listeriosis in Israel and shows that specific clones might account for this.</AbstractText>© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: [email protected].</CopyrightInformation>
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2,333,581 |
Intravenous patient-controlled fentanyl with and without transversus abdominis plane block in cirrhotic patients post liver resection.
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Coagulation changes can complicate liver resection, particularly in patients with cirrhosis. The aim of this prospective hospital-based comparative study was to compare the postoperative analgesic efficacy of intravenous fentanyl patient-controlled analgesia (IVPCA) with and without transversus abdominis plane (TAP) block.</AbstractText>Fifty patients with Child's A cirrhosis undergoing liver resection were randomly divided into two groups for postoperative analgesia, ie, an IVPCA group receiving a 10 μg/mL fentanyl bolus of 15 μg with a 10-minute lockout and a maximum hourly dose of 90 μg, and an IVPCA + TAP group that additionally received TAP block (15 mL of 0.375% bupivacaine) on both sides via a posterior approach with ultrasound guidance before skin incision. Postoperatively, bolus injections of bupivacaine 0.375% were given every 8 hours through a TAP catheter inserted by the surgeon in the open space during closure of the inverted L-shaped right subcostal with midline extension (subcostal approach) guided by the visual analog scale score (<3, 5 mL; 3 to <6, 10 mL; 6-10, 15-20 mL) according to weight (maximum 2 mg/kg). The top-up dosage of local anesthetic could be omitted if the patient was not in pain. Coagulation was monitored using standard coagulation tests.</AbstractText>Age, weight, and sex were comparable between the groups (P>0.05). The visual analog scale score was significantly lower at 12, 18, 24, 48, and 72 hours (P<0.01) in IVPCA + TAP group. The Ramsay sedation score was lower only after 72 hours in the IVPCA + TAP group when compared with the IVPCA group (1.57±0.74 versus 2.2±0.41, respectively, P<0.01). Heart rate, systolic blood pressure, and fentanyl consumption were lower in the IVPCA + TAP group at 24, 48, and 72 hours (P<0.05). Intensive care unit stays were significantly shorter with TAP (2.61±0.74 days versus 4.35±0.79 days, P<0.01). Prothrombin time and International Normalized Ratio indicated temporary hypocoagulability in both groups.</AbstractText>Combining TAP with IVPCA improved postoperative pain management and reduced fentanyl consumption, with a shorter stay in intensive care. TAP block can be included as part of a balanced multimodal postoperative pain regimen.</AbstractText>
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2,333,582 |
Dyspnea and pain frequently co-occur among Medicare managed care recipients.
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Experimental and neuroimaging studies have suggested strong associations between dyspnea and pain. The co-occurrence of these symptoms has not been examined in community samples.</AbstractText>We sought to ascertain the co-occurrence of pain and dyspnea by self-report in a large cohort of Medicare recipients.</AbstractText>We analyzed data from 266,000 Medicare Managed Care recipients surveyed in 2010 and 2012. Dyspnea was defined by aggregating three questions about shortness of breath (at rest, while walking one block, and while climbing stairs). Pain was measured by four questions about pain interference, chest pain, back pain, and arthritis pain. All measures were dichotomized as high or low/none. We calculated the co-occurrence of pain and dyspnea at baseline, and generated logistic regression models to find the adjusted relative risk (RR) of their co-occurrence, adjusting for patient-level factors and three potential medical causes of dyspnea (chronic obstructive pulmonary disease/emphysema/asthma, congestive heart failure, and obesity). We modeled the simultaneous development and the simultaneous resolution of dyspnea and pain between baseline and 2 years.</AbstractText>Participants with dyspnea had considerably higher prevalence of pain than those without (64 vs. 18%). In fully adjusted models, participants with any of the types of pain were substantially more likely to report dyspnea than those without these types of pain (high pain interference: relative risk [RR], 1.99; 95% confidence interval [CI], 1.92-2.07; chest pain: RR, 2.11; 95% CI, 2.04-2.18; back pain: RR, 1.76; 95% CI, 1.71-1.82; and arthritis pain: RR, 1.49; 95% CI, 1.44-1.54). The relative risks of dyspnea developing or resolving at 2 years were greatly increased (RRs of 1.5 - 4) if pain also developed or resolved.</AbstractText>Pain and dyspnea commonly occurred, developed, and resolved together. Most older adults with dyspnea also reported pain. Medical conditions typically assumed to cause dyspnea did not account for this association. The most plausible explanation for the co-occurrence is physical deconditioning.</AbstractText>
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2,333,583 |
Should health insurers target prevention of cardiovascular disease? A cost-effectiveness analysis of an individualised programme in Germany based on routine data.
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Cardiovascular diseases are the main cause of death worldwide, making their prevention a major health care challenge. In 2006, a German statutory health insurance company presented a novel individualised prevention programme (KardioPro), which focused on coronary heart disease (CHD) screening, risk factor assessment, early detection and secondary prevention. This study evaluates KardioPro in CHD risk subgroups, and analyses the cost-effectiveness of different individualised prevention strategies.</AbstractText>The CHD risk subgroups were assembled based on routine data from the statutory health insurance company, making use of a quasi-beta regression model for risk prediction. The control group was selected via propensity score matching based on logistic regression and an approximate nearest neighbour approach. The main outcome was cost-effectiveness. Effectiveness was measured as event-free time, and events were defined as myocardial infarction, stroke and death. Incremental cost-effectiveness ratios comparing participants with non-participants were calculated for each subgroup. To assess the uncertainty of results, a bootstrapping approach was applied.</AbstractText>The cost-effectiveness of KardioPro in the group at high risk of CHD was € 20,901 per event-free year; in the medium-risk group, € 52,323 per event-free year; in the low-risk group, € 186,074 per event-free year; and in the group with known CHD, € 26,456 per event-free year. KardioPro was associated with a significant health gain but also a significant cost increase. However, statistical significance could not be shown for all subgroups.</AbstractText>The cost-effectiveness of KardioPro differs substantially according to the group being targeted. Depending on the willingness-to-pay, it may be reasonable to only offer KardioPro to patients at high risk of further cardiovascular events. This high-risk group could be identified from routine statutory health insurance data. However, the long-term consequences of KardioPro still need to be evaluated.</AbstractText>
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2,333,584 |
Preparation and biological evaluation of photoluminescent carbonaceous nanospheres.
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Carbon nanospheres (CNP) possess several unique properties that render CNP superior to traditional organic dyes and quantum dots in the biological application. However, the interaction of CNP with biological systems was far from well-known. In this study, a simple method using cocoon silk was used to synthesize photoluminescent CNP. The particle size of CNP was 100.6 nm with well dispersity. The excitation/emission wavelength was 340 nm and 442 nm. Cellular uptake demonstrated the uptake of CNP by A549 cells was a time-, concentration- and energy-dependent procedure. Endosome was involved in the uptake rather than mitochondria. Through several uptake inhibitors, it showed the uptake was energy-dependent and mainly mediated by clathrin-mediated endocytosis. In vivo, CNP were mainly distributed in heart and lung, while only a modest amount of CNP was distributed in spleen, liver and kidney. The distribution in tumor was relatively low, which made CNP a candidate for heart cell imaging. At as high as 2mg/mL, CNP showed no obvious toxicity to cells. The hemolysis rate of CNP was also lower than 10%. These results suggested CNP was relatively safe in biological application.
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2,333,585 |
Traffic-related air pollution and the onset of myocardial infarction: disclosing benzene as a trigger? A small-area case-crossover study.
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Exposure to traffic is an established risk factor for the triggering of myocardial infarction (MI). Particulate matter, mainly emitted by diesel vehicles, appears to be the most important stressor. However, the possible influence of benzene from gasoline-fueled cars has not been explored so far.</AbstractText>We conducted a case-crossover study from 2,134 MI cases recorded by the local Coronary Heart Disease Registry (2000-2007) in the Strasbourg Metropolitan Area (France). Available individual data were age, gender, previous history of ischemic heart disease and address of residence at the time of the event. Nitrogen dioxide, particles of median aerodynamic diameter <10 µm (PM10), ozone, carbon monoxide and benzene air concentrations were modeled on an hourly basis at the census block level over the study period using the deterministic ADMS-Urban air dispersion model. Model input data were emissions inventories, background pollution measurements, and meteorological data. We have found a positive, statistically significant association between concentrations of benzene and the onset of MI: per cent increase in risk for a 1 µg/m3 increase in benzene concentration in the previous 0, 0-1 and 1 day was 10.4 (95% confidence interval 3-18.2), 10.7 (2.7-19.2) and 7.2 (0.3-14.5), respectively. The associations between the other pollutants and outcome were much lower and in accordance with the literature.</AbstractText>We have observed that benzene in ambient air is strongly associated with the triggering of MI. This novel finding needs confirmation. If so, this would mean that not only diesel vehicles, the main particulate matter emitters, but also gasoline-fueled cars--main benzene emitters-, should be taken into account for public health action.</AbstractText>
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2,333,586 |
Choosing important health outcomes for comparative effectiveness research: a systematic review.
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A core outcome set (COS) is a standardised set of outcomes which should be measured and reported, as a minimum, in all effectiveness trials for a specific health area. This will allow results of studies to be compared, contrasted and combined as appropriate, as well as ensuring that all trials contribute usable information. The COMET (Core Outcome Measures for Effectiveness Trials) Initiative aims to support the development, reporting and adoption of COS. Central to this is a publically accessible online resource, populated with all available COS. The aim of the review we report here was to identify studies that sought to determine which outcomes or domains to measure in all clinical trials in a specific condition and to describe the methodological techniques used in these studies.</AbstractText>We developed a multi-faceted search strategy for electronic databases (MEDLINE, SCOPUS, and Cochrane Methodology Register). We included studies that sought to determine which outcomes/domains to measure in all clinical trials in a specific condition.</AbstractText>A total of 250 reports relating to 198 studies were judged eligible for inclusion in the review. Studies covered various areas of health, most commonly cancer, rheumatology, neurology, heart and circulation, and dentistry and oral health. A variety of methods have been used to develop COS, including semi-structured discussion, unstructured group discussion, the Delphi Technique, Consensus Development Conference, surveys and Nominal Group Technique. The most common groups involved were clinical experts and non-clinical research experts. Thirty-one (16%) studies reported that the public had been involved in the process. The geographic locations of participants were predominantly North America (n = 164; 83%) and Europe (n = 150; 76%).</AbstractText>This systematic review identified many health areas where a COS has been developed, but also highlights important gaps. It is a further step towards a comprehensive, up-to-date database of COS. In addition, it shows the need for methodological guidance, including how to engage key stakeholder groups, particularly members of the public.</AbstractText>
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2,333,587 |
Pleiotropic effects of the dipeptidylpeptidase-4 inhibitors on the cardiovascular system.
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Dipeptidylpeptidase-4 (DPP-4) is a ubiquitously expressed transmembrane protein that removes NH2-terminal dipeptides from various substrate hormones, chemokines, neuropeptides, and growth factors. Two known substrates of DPP-4 include the incretin hormones glucagon-like peptide-1 (GLP-1) and gastric inhibitory peptide, which are secreted by enteroendocrine cells in response to postprandial hyperglycemia and account for 60–70% of postprandial insulin secretion. DPP-4 inhibitors (DPP-4i) block degradation of GLP-1 and gastric inhibitory peptide, extend their insulinotropic effect, and improve glycemia. Since 2006, several DPP-4i have become available for treatment of type 2 diabetes mellitus. Clinical trials confirm that DPP-4i raises GLP-1 levels in plasma and improves glycemia with very low risk for hypoglycemia and other side effects. Recent studies also suggest that DPP-4i confers cardiovascular and kidney protection, beyond glycemic control, which may reduce the risk for further development of the multiple comorbidities associated with obesity/type 2 diabetes mellitus, including hypertension and cardiovascular disease (CVD) and kidney disease. The notion that DPP-4i may improve CVD outcomes by mechanisms beyond glycemic control is due to both GLP-1-dependent and GLP-1-independent effects. The CVD protective effects by DPP-4i result from multiple factors including insulin resistance, oxidative stress, dyslipidemia, adipose tissue dysfunction, dysfunctional immunity, and antiapoptotic properties of these agents in the heart and vasculature. This review focuses on cellular and molecular mechanisms mediating the CVD protective effects of DPP-4i beyond favorable effects on glycemic control.
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2,333,588 |
An internal focus of attention is not always as bad as its reputation: how specific aspects of internally focused attention do not hinder running efficiency.
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The aim of this study was to examine differentiated effects of internally focused attention in endurance sports. Thirty-two active runners ran 24 min on a treadmill at a fixed speed of moderate intensity. For each 6-min block, participants had to direct their attention on different internal aspects (movement execution, breathing, or feeling of the body) or received no instructions. Oxygen consumption (VO2) was measured continuously to determine running economy. Results revealed that the different internal focus instructions had differentiated effects on VO2: A focus on breathing as well as a focus on the running movement led to higher VO2 than a focus on feeling of the body which showed similar VO2 as the control condition. We conclude that an internal focus of attention is solely detrimental to performance when directed to highly automated processes (e.g., breathing or movement). However, an internal focus on how the body feels during exercise does not disrupt movement efficiency.
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2,333,589 |
Exploring lay views on physical activity and their implications for public health policy. A case study from East Belfast.
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It is now recognised that inactive lifestyles underpin much of the disease burden evident in the richer nations of the world. Indeed, the WHO has identified physical inactivity as a 'global public health problem' and has established minimum physical activity (PA) targets for people at different stages of the life-course. Yet, according to WHO, just under 1/3 of working age adults across the globe meet those targets and it is not at all clear how the disjunction between the recommendations of policy makers and the behaviour of ordinary people might be surmounted. Using an opportunity to examine the impact of an urban regeneration project on community residents in East Belfast (Northern Ireland) this paper examines the views of some 113 people on how to increase rates of PA in an area of multiple deprivation. The results of the analysis suggest that lay people rarely consider PA as a discrete issue, or one that centres on individuals and their motivation, but rather as one component in a complex web of concerns, processes and events that include such things as the actions of neighbours and relatives, material and political environments, vandalism, violence, and the weather. We explore and unravel the nature of those concerns using novel methods of content analysis that generate 'issue webs'. Particular attention is paid to the ways in which lay people conceptualize 'activity' and to the manner in which they point to ways of encouraging activity that are rooted in everyday life rather than in the corpocentric, agent-centred and often sport dominated strategies favoured by local policy makers. Our results support those who argue that interventions to increase rates of PA need to move beyond behavioural approaches that focus on individuals and consider the social, political and material contexts in which 'activity' occurs.
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2,333,590 |
The unique neonatal NK cells: a critical component required for neonatal autoimmune disease induction by maternal autoantibody.
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Human maternal autoantibodies can trigger autoimmune diseases such as congenital heart block (CHB) in the progeny of women with lupus or Sjogren's disease. The pathogenic effect of early autoantibody (autoAb) exposure has been investigated in a murine neonatal autoimmune ovarian disease (nAOD) model triggered by a unique ZP3 antibody. Although immune complexes (IC) are formed in adult and neonatal ovaries, ZP3 antibody triggers severe nAOD only in <7-day-old neonatal mice. Propensity to nAOD is due to the uniquely hyper-responsive neonatal natural killer (NK) cells that lack the inhibitory Ly49C/I receptors. In nAOD, the neonatal NK cells directly mediate ovarian inflammation and oocyte depletion while simultaneously promoting de novo pathogenic ovarian-specific T cell responses. Resistance to nAOD in older mice results from the emergence of the Ly49C/I(+) NK cells that regulate effector NK cells and from CD25(+) regulatory T cell control. In preliminary studies, FcγRIII(+) NK cells as well as the ovarian resident FcγRIII(+) macrophages and/or dendritic cells were found to be as indispensable players. Activated by ovarian IC, they migrate to lymphoid organs where NK cell priming occurs. Remarkably, the findings in nAOD are very similar to those reported for neonatal responses to a retrovirus and its cognate antibody that lead to long-lasting immunity. Studies on nAOD therefore provide insights into maternal autoAb-mediated neonatal autoimmunity, including CHB, while simultaneously uncovering new properties of the neonatal innate and adaptive responses, lethality of premature infant infection, and novel neonatal antiviral vaccine design.
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2,333,591 |
Internal focus of attention in anxiety-sensitive females up-regulates amygdale activity: an fMRI study.
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Cognitive behavioral models of panic disorder (PD) stress the importance of an increased attentional focus towards bodily symptoms in the onset and maintenance of this debilitating anxiety disorder. In this fMRI mental tracking paradigm, we looked at the effects of focusing one's attention internally (interoception) vs. externally (exteroception) in a well-studied group at risk for PD-that is anxiety-sensitive females (AS-high). We hypothesized that AS-high subjects compared to control subjects will present higher arousal and decreased valence scores during interoception and parallel higher activity in brain areas which are associated with fear and interoception. 24 healthy female students with high levels of anxiety sensitivity and 24 healthy female students with normal levels of anxiety sensitivity serving as control group were investigated by 3 T fMRI. Subjects either focused their attention on their heartbeats (internal condition) or on neutral tones (external condition). Task performance was monitored by reporting the number of heartbeats or tones after each block. State of arousal and emotional valence were also assessed. The high anxiety-sensitive group reported higher arousal scores compared to controls during the course of the experiment. Simultaneously, fMRI results indicated higher activation in anxiety-sensitive participants than in controls during interoception in a network of cortical and subcortical brain regions (thalamus, amygdala, parahippocampus) that overlaps with known fear circuitry structures. In particular, the activity of the right amygdala was up-regulated. Future prospective-longitudinal studies are needed to validate the role of the amygdala for transition to disorder. Attention to internal body functions up-regulates the activity of interoceptive and fear-relevant brain regions in anxiety-sensitive females, a high-risk group for the development of anxiety disorders.
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2,333,592 |
Identifying solutions to increase participation in physical activity interventions within a socio-economically disadvantaged community: a qualitative study.
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There is an urgent need to increase population levels of physical activity, particularly amongst those who are socio-economically disadvantaged. Multiple factors influence physical activity behaviour but the generalisability of current evidence to such 'hard-to-reach' population subgroups is limited by difficulties in recruiting them into studies. Also, rigorous qualitative studies of lay perceptions and perceptions of community leaders about public health efforts to increase physical activity are sparse. We sought to explore, within a socio-economically disadvantaged community, residents' and community leaders' perceptions of physical activity (PA) interventions and issues regarding their implementation, in order to improve understanding of needs, expectations, and social/environmental factors relevant to future interventions.</AbstractText>Within an ongoing regeneration project (Connswater Community Greenway), in a socio-economically disadvantaged community in Belfast, we collaborated with a Community Development Agency to purposively sample leaders from public- and voluntary-sector community groups and residents. Individual semi-structured interviews were conducted with 12 leaders. Residents (n = 113), of both genders and a range of ages (14 to 86 years) participated in focus groups (n = 14) in local facilities. Interviews and focus groups were recorded, transcribed verbatim and analysed using a thematic framework.</AbstractText>Three main themes were identified: awareness of PA interventions; factors contributing to intervention effectiveness; and barriers to participation in PA interventions. Participants reported awareness only of interventions in which they were involved directly, highlighting a need for better communications, both inter- and intra-sectoral, and with residents. Meaningful engagement of residents in planning/organisation, tailoring to local context, supporting volunteers, providing relevant resources and an 'exit strategy' were perceived as important factors related to intervention effectiveness. Negative attitudes such as apathy, disappointing experiences, information with no perceived personal relevance and limited access to facilities were barriers to people participating in interventions.</AbstractText>These findings illustrate the complexity of influences on a community's participation in PA interventions and support a social-ecological approach to promoting PA. They highlight the need for cross-sector working, effective information exchange, involving residents in bottom-up planning and providing adequate financial and social support. An in-depth understanding of a target population's perspectives is of key importance in translating PA behaviour change theories into practice.</AbstractText>
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2,333,593 |
Effect of ultrasonographically guided axillary nerve block combined with suprascapular nerve block in arthroscopic rotator cuff repair: a randomized controlled trial.
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The aim of this study was to compare the results of ultrasonographically guided axillary nerve block (ANB) combined with suprascapular nerve block (SSNB) with those of SSNB alone on postoperative pain and satisfaction within the first 48 hours after arthroscopic rotator cuff repair.</AbstractText>Forty-two patients with rotator cuff tears who had undergone arthroscopic rotator cuff repair were enrolled in this study. Among them, 21 patients were randomly allocated to group 1 and received both SSNB and ANB with 10 mL ropivacaine. The other 21 patients were allocated to group 2 and received SSNB with 10 mL 0.75% ropivacaine and ANB with 10 mL saline. Visual analog scale (VAS) pain score, patient satisfaction (SAT), and lateral pain index (LPI) was checked at 1, 3, 6, 12, 18, 24, 36, and 48 hours postoperatively.</AbstractText>Group 1 showed a significantly lower mean VAS score at postoperative 1, 3, 6, 12, 18, and 24 hours compared with group 2 (5.1 < 7.6, 4.4 < 6.3, 3.7 < 5.3, 3.2 < 4.5, 2.7 < 4.0, and 2.7 < 3.4, respectively). A significantly high mean SAT and low mean LPI was observed in group 1 at postoperative 1, 3, 6, 12, 18, 24, and 36 hours (4.9 > 2.4, 5.9 > 3.7, 6.3 > 5.0, 6.8 > 5.7, 7.3 > 6.2, 7.5 > 6.6, and 7.7 > 7.0, respectively), (1.1 < 3.0, 0.8 < 2.5, 0.7 < 2.0, 0.7 < 1.6, 0.6 < 1.3, 0.6 < 1.0, and 0.4 < 0.7, respectively). The frequency of rebound pain decreased in group 1 compared with group 2 (P = .032). In addition, rebound phenomenon showed a correlation with ANB on univariate logistic regression (P = .034; odds ratio, 0.246).</AbstractText>Ultrasonographically guided ANB combined with SSNB in arthroscopic rotator cuff repair showed an improved mean VAS in the first 24 hours after surgery compared with SSNB alone. The mean SAT and LPI of the combined blocks were better than those of the single block within the first 36 hours. Ultrasonographically guided ANB combined with SSNB also decreased the rebound phenomenon.</AbstractText>Level I, randomized controlled trial.</AbstractText>Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.</CopyrightInformation>
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2,333,594 |
Autonomic Reactivity to Infant Crying in Maltreating Mothers.
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We examined autonomic reactivity to infant crying in a sample of 42 maltreating and 38 non-maltreating mothers. Exploratively, we tested if differential reactivity was related to child neglect versus the combination of neglect and abuse, and we tested whether mothers' experiences with maltreatment in their own childhood moderated the association between their current maltreatment status and physiology. During a standardized cry paradigm, mothers listened to cry sounds of various pitches. Heart rate (HR), pre-ejection period (PEP), skin conductance levels (SCLs), and vagal tone (root mean square of successive differences [RMSSD]) were measured as indicators of underlying sympathetic and parasympathetic reactivity. The maltreating mothers showed lower SCL reactivity to the cry sounds than non-maltreating mothers. Furthermore, significant negative correlations between HR and PEP in the non-maltreating group differed from nonsignificant correlations in the maltreating group, which suggests a lack of sympathetic cardiac control in maltreating mothers. We found no differences between neglectful mothers and those who were additionally abusive. Together, our findings support the notion of sympathetic hypoarousal as a risk factor for child maltreatment, which may be indicative of disengagement in a caregiving context. Intervention programs might focus on improving maternal sensitivity to improve responsiveness to child signals.
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2,333,595 |
Neighborhood-level socioeconomic deprivation predicts weight gain in a multi-ethnic population: longitudinal data from the Dallas Heart Study.
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The aim of this study is to examine a relationship between neighborhood-level socioeconomic deprivation and weight change in a multi-ethnic cohort from Dallas County, Texas and whether behavioral/psychosocial factors attenuate the relationship.</AbstractText>Non-movers (those in the same neighborhood throughout the study period) aged 18-65 (N=939) in Dallas Heart Study (DHS) underwent weight measurements between 2000 and 2009 (median 7-year follow-up). Geocoded home addresses defined block groups; a neighborhood deprivation index (NDI) was created (higher NDI=greater deprivation). Multi-level modeling determined weight change relative to NDI. Model fit improvement was examined with adding physical activity and neighborhood environment perceptions (higher score=more unfavorable perceptions) as covariates. A significant interaction between residence length and NDI was found (p-interaction=0.04); results were stratified by median residence length (11 years).</AbstractText>Adjusting for age, sex, race/ethnicity, smoking, and education/income, those who lived in neighborhood >11 years gained 1.0 kg per one-unit increment of NDI (p=0.03), or 6 kg for those in highest NDI tertile compared with those in the lowest tertile. Physical activity improved model fit; NDI remained associated with weight gain after adjustment for physical activity and neighborhood environment perceptions. There was no significant relationship between NDI and weight change for those in their neighborhood ≤11 years.</AbstractText>Living in more socioeconomically deprived neighborhoods over a longer time period was associated with weight gain in DHS.</AbstractText>Published by Elsevier Inc.</CopyrightInformation>
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2,333,596 |
Mono-substituted isopropylated triaryl phosphate, a major component of Firemaster 550, is an AHR agonist that exhibits AHR-independent cardiotoxicity in zebrafish.
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Firemaster 550 (FM550) is an additive flame retardant mixture used within polyurethane foam and is increasingly found in house dust and the environment due to leaching. Despite the widespread use of FM550, very few studies have investigated the potential toxicity of its ingredients during early vertebrate development. In the current study, we sought to specifically investigate mono-substituted isopropylated triaryl phosphate (mITP), a component comprising approximately 32% of FM550, which has been shown to cause cardiotoxicity during zebrafish embryogenesis. Previous research showed that developmental defects are rescued using an aryl hydrocarbon receptor (AHR) antagonist (CH223191), suggesting that mITP-induced toxicity was AHR-dependent. As zebrafish have three known AHR isoforms, we used a functional AHR2 knockout line along with AHR1A- and AHR1B-specific morpholinos to determine which AHR isoform, if any, mediates mITP-induced cardiotoxicity. As in silico structural homology modeling predicted that mITP may bind favorably to both AHR2 and AHR1B isoforms, we evaluated AHR involvement in vivo by measuring CYP1A mRNA and protein expression following exposure to mITP in the presence or absence of CH223191 or AHR-specific morpholinos. Based on these studies, we found that mITP interacts with both AHR2 and AHR1B isoforms to induce CYP1A expression. However, while CH223191 blocked mITP-induced CYP1A induction and cardiotoxicity, knockdown of all three AHR isoforms failed to block mITP-induced cardiotoxicity in the absence of detectable CYP1A induction. Overall, these results suggest that, while mITP is an AHR agonist, mITP causes AHR-independent cardiotoxicity through a pathway that is also antagonized by CH223191.
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2,333,597 |
[MicroRNA--a new diagnostic tool in coronary artery disease and myocardial infarction].
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Coronary artery disease remain one of the leading causes of mortality in the world, indicating the need for innovative therapies and diagnosis for heart disease. MicroRNAs (miRNAs) have recently emerged as one of the central players in regulating gene expression which implicatate in normal cardiac development and many pathological process of the cardiovascular system, including cardiac arrhythmia, heart failure, cardiac fibrosis, coronary artery disease and myocardial infarction. iRNA are small noncoding RNAs 18-23 nucleotides in length that regulate expression of target genes through sequence-specific hybridization to the 3' untranslated region of messenger RNAs and block translation. miRNAs are not only found intracellularly, but also detectable outside cells, including various body fluids (i.e. serum, plasma, saliva, urine). This review will highlight recent findings in the regulation of miRNA biogenesis and secretion, modulation of the cardiovascular pathological process in CAD and AMI and the potential as non-invasive biomarkers for cardiac ischemia.
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2,333,598 |
Comparison of hemodynamics after combined spinal-epidural anesthesia between decubitus and sitting positions in aged patients undergoing total hip replacement.
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To compare the hemodynamics after combined spinal-epidural anesthesia (CSEA) between decubitus and sitting positions in aged patients undergoing total hip replacement.</AbstractText>A total of 80 aged patients who underwent CSEA for elective total hip replacement were randomly divided into a decubitus position group (group D) and a sitting position group (group S; each group with 40 patients). In group D, 10 mg of 0.5% bupivacaine were given into the subarachnoid space in decubitus position. In group S, 10 mg of 0.5% bupivacaine were given into the subarachnoid space in the sitting position, which was maintained for 1 min, after which the patients were in decubitus position. In both groups, the sensory block levels and changes in hemodynamics were assessed.</AbstractText>The mean arterial blood pressure was significantly higher in group S than in group D at each time point within 30 min after anesthesia. There were no significant differences in heart rate between the two groups at each time point. There was also no significant difference in the level of sensory block between the two groups 20 min after the administration of CSEA.</AbstractText>For aged patients undergoing total hip replacement, CSEA is safer and more effective in the sitting position than in decubitus position.</AbstractText>© 2014 S. Karger AG, Basel.</CopyrightInformation>
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2,333,599 |
Intubating conditions and side effects of propofol, remifentanil and sevoflurane compared with propofol, remifentanil and rocuronium: a randomised, prospective, clinical trial.
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Tracheal intubation without muscle relaxants is usually performed with remifentanil and propofol or sevoflurane. Remifentanil 1.0 to 4.0 μg·kg(-1) and propofol 2.0-3.0 mg·kg(-1) or sevoflurane up to 8.0 Vol% provide acceptable, i.e. excellent or good intubating conditions. We hypothesized that sevoflurane 1.0 MAC would provide acceptable intubating conditions when combined with propofol and remifentanil.</AbstractText>Eighty-three patients to be intubated were randomised to two groups. The SEVO group received propofol 1.5 mg kg(-1), remifentanil 0.30 μg kg min(-1) and sevoflurane 1.0 MAC; the MR group received the same doses of propofol and remifentanil plus rocuronium 0.45 mg kg(-1). We evaluated intubation and extubation conditions, mean arterial pressure (MAP), heart rate (HR) and bispectral index (BIS). The vocal cords were examined for injury by videolaryngoscopy before and 24 hours after surgery.</AbstractText>ACCEPTABLE INTUBATING CONDITIONS WERE SEEN MORE FREQUENTLY WITH ROCURONIUM THAN WITH SEVOFLURANE: 97% versus 82%; p = 0.03; the subscore for vocal cords was comparable: 100% versus 98%. MAP before intubation decreased significantly compared with the MAP at baseline to the same extent in both groups; ephedrine IV was given in 15 (SEVO) versus 16 (MR) patients; p = 0.93. BIS at tracheal intubation was 27 (13-65) in the SEVO group, 29 (14-62) in the MR group; p = 0.07. Vocal cord injuries (oedema, haematoma) were similar: 4 patients in each group.</AbstractText>Overall intubating conditions were better when rocuronium was used; the subscore for vocal cords was comparable. The incidence of side effects was the same in the two groups.</AbstractText>ClinicalTrials.Gov: NCT 01591031.</AbstractText>
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